Congress quietly bans transgender care and abortion from health plans while extending subsidies.

What it does

This bill restructures ACA premium tax credits by routing them into Health Savings Accounts (HSAs) called 'Healthcare Affordability Accounts' starting in 2027, extends enhanced premium subsidies through 2031 with a phasedown, and adds sweeping restrictions: it prohibits coverage of gender transition procedures and abortion in qualified health plans, requires hospitals to publish detailed pricing monthly, and gives states broad new waiver authority to establish high-risk pools and reinsurance programs. The bill also mandates clinical lab price transparency and imposes strict reporting requirements on abortion coverage.

Why we flagged it

While the bill's title and opening sections emphasize cost reduction and transparency (hospital pricing, lab pricing), the substantive bulk of the legislation imposes categorical exclusions on gender transition procedures and abortion coverage in qualified health plans, coupled with structural changes to premium credit delivery. The transparency provisions are real but secondary to the coverage restrictions.

• Sections 104 and 109 impose detailed categorical exclusions on gender transition procedures in HSAs and qualified health plans. These are substantively unrelated to the bill's stated purpose of lowering costs through premium credit restructuring and price transparency.
• Sections 106, 107, and 110 impose detailed restrictions on abortion coverage, including prohibition of federal funds for plans covering abortion (with narrow exceptions), separate premium accounting, and reporting requirements. These are substantively unrelated to cost reduction or price transparency.

What the text implies

• The HSA routing of premium credits (Section 104) may reduce effective subsidies for lower-income enrollees who cannot afford to front-load HSA contributions, effectively shifting cost burden downward over time.
• The phasedown of enhanced premium credits from 2027–2031 (Section 105) will increase out-of-pocket costs for millions of ACA enrollees as subsidies decline by 20–80%, potentially pricing lower-income individuals out of coverage.
• State waiver authority expansion (Section 111) permits states to establish 'invisible high-risk pools' that may segregate high-cost individuals without affecting their premiums on paper, but could reduce plan quality and access for those populations.
• The categorical exclusion of gender transition procedures and abortion coverage may expose insurers and providers to state-level enforcement actions and create compliance complexity, potentially reducing plan participation in certain markets.
• Hospital price transparency requirements (Section 201) impose significant compliance costs and attestation liability on hospitals, with escalating civil penalties ($300–$35 per bed per day, up to $10M for persistent noncompliance), which may be passed to consumers.

Who it affects

The bill contains genuine public benefits (hospital price transparency, lab pricing disclosure, extended premium credits through 2031) that help consumers and market competition. However, these are substantially offset by restrictions that narrow health coverage for vulnerable populations—particularly transgender individuals and those seeking abortion care—and by structural changes (HSA routing, phasedown of subsidies by 2031) that may reduce affordability for lower-income enrollees over time. T

Who stands to gain

• Health insurance issuers (reduced claims for excluded services)
• Hospitals (potential cost savings from reduced gender transition and abortion-related claims)
• HSA administrators and custodians (increased account volume)
• States (federal grants for waiver administration and high-risk pool funding)

Named in the bill

Department of Health and Human Services (HHS), Department of Treasury, Centers for Medicare & Medicaid Services (CMS), Health insurance issuers, Hospitals, Clinical diagnostic laboratories, State insurance commissioners, National Association of Insurance Commissioners (NAIC), Medicaid, Medicare, ACA (Patient Protection and Affordable Care Act), Internal Revenue Code Section 36B — and 1 more

Where it stands

• Dec 9, 2025 — Introduced · Congress.gov: “Introduced in Senate”
• Dec 9, 2025 — Referred to Senate Committee on Finance · Congress.gov: “Read twice and referred to the Committee on Finance”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

4 lobbying clients named this bill on 4 disclosure filings across 2 quarters, Dec 2025 to Jun 2026. Those filings disclosed $3,949,666 in lobbying spend. A filing names 15 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 72% of bills with at least one filing.

Roger Marshall, the sponsor, reported $1,777,391 in PAC receipts in the 2026 cycle.

• Pharmaceutical Care Management Association — $3,189,666 on 1 filing
• Healthequity, Inc. — $660,000 on 1 filing
• Nationwide Children's Hospital Inc — $80,000 on 1 filing
• Chartercare Health of Ri (forrmerly Known As Chartercare Health Partners) — $20,000 on 1 filing

Lobbying Disclosure Act filings through Jul 23, 2026. A filing shows who paid to lobby on a bill it names, not what changed.