Congress names healthcare accounts after sitting president, bans abortion and gender care.
H.R. 6538 — More Affordable Care Act · Filed by August Pfluger (R-TX) · 5 cosponsors · Introduced Dec 9, 2025 · Referred to committee
Your members of Congress
Enter a ZIP to see where your representative and both senators stood on this bill.
Looked up on this device — your ZIP is never stored on our servers.
What it does
This bill allows states to opt out of major Affordable Care Act requirements (like coverage mandates and subsidies) if they establish a high-risk insurance pool. Instead of traditional subsidies, eligible residents in waiver states receive deposits into new 'Trump Health Freedom Accounts'—special savings accounts that cannot be used for plans covering gender transition procedures or abortion services. The bill also expands tax credits for small employers in waiver states and requires better price transparency in healthcare.
Why we flagged it
The bill's primary function is to permit states to dismantle ACA market regulations and subsidies, replacing them with account-based payments that carry explicit ideological restrictions on reproductive and gender-affirming care. The naming of accounts after the sitting president and the detailed restrictions on covered services signal that the mechanism is designed to embed political values into healthcare access.
- Section 5 (price reporting and outcomes data) is substantively unrelated to the waiver program and account structure; it appears grafted onto an ideological healthcare restructuring bill.
What the text implies
- High-risk pools historically operate at a loss and shift costs to sicker individuals; the bill's requirement that states 'mitigate risk' is vague and may permit inadequate funding, leaving vulnerable populations underinsured.
- Tying federal subsidies to accounts with ideological restrictions on abortion and gender care effectively federalizes state-level abortion and gender-identity policy, overriding state autonomy in some cases while enabling it in others.
The full analysis lists 5 implications of this text.
Who stands to gain
health insurance companies (reduced regulatory burden, ability to offer narrower plans); high-deductible health plan administrators; health savings account custodians