H.R. 6512

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6512 Introduced in House (IH)]

<DOC>

119th CONGRESS
1st Session
H. R. 6512

To Empower American Families with Direct Control Over Healthcare 
Dollars, Codify President Trump's Proven Reforms for Flexibility and 
Choice, Prohibit Taxpayer Funding for Abortion and Gender Transition 
Procedures, Eliminate Waste and Fraud in the Affordable Care Act, and 
Reject Extensions of Enhanced Subsidies to Insurance Companies.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

December 9, 2025

Mr. Biggs of Arizona (for himself, Mr. Ogles, and Mr. Clyde) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committees on Ways and Means, 
Education and Workforce, and the Judiciary, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
of such provisions as fall within the jurisdiction of the committee 
concerned

_______________________________________________________________________

A BILL

To Empower American Families with Direct Control Over Healthcare 
Dollars, Codify President Trump's Proven Reforms for Flexibility and 
Choice, Prohibit Taxpayer Funding for Abortion and Gender Transition 
Procedures, Eliminate Waste and Fraud in the Affordable Care Act, and 
Reject Extensions of Enhanced Subsidies to Insurance Companies.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Putting Patients First Healthcare 
Freedom Act''

SEC. 2. TABLE OF CONTENTS.

The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--PUTTING PATIENTS OVER HEALTH INSURANCE COMPANIES

Subtitle A--More Affordable Care Act

Sec. 1001. Short title.
Sec. 1002. Health freedom waiver program.
Sec. 1003. Trump health freedom accounts.
Subtitle B--Improving HSA Access, Utility, and Flexibility

Sec. 1011. Individuals entitled to part A of medicare by reason of age 
allowed to contribute to health savings 
account.
Sec. 1012. Allow both spouses to make catch-up contributions to the 
same health savings account.
Sec. 1013. FSA and HRA terminations or conversions to fund HSAs.
Sec. 1014. Special rule for certain medical expenses incurred before 
establishment of health savings account.
Sec. 1015. Contributions permitted if spouse has health flexible 
spending arrangement.
Sec. 1016. Increase in health savings account contribution limitation 
for certain individuals.
Sec. 1017. Health savings accounts used to purchase insurance.
Subtitle C--Health Care Sharing Ministries

Sec. 1018. Treatment of health care sharing ministries.
Sec. 1019. Health care sharing ministry fees treated as medical care.
Sec. 1020. Health care sharing ministries not treated as health 
insurance.
TITLE II--CODIFYING TRUMP HEALTHCARE FREEDOM AGENDA

Subtitle A--Association Health Plans Act

Sec. 2001. Short title.
Sec. 2002. Treatment of group or association of employers.
Sec. 2003. Rules applicable to employee welfare benefit plans 
established and maintained by a group or 
association of employers.
Sec. 2004. Rule of construction.
Subtitle B--CHOICE Arrangement Act

Sec. 2011. Short title.
Sec. 2012. Treatment of health reimbursement arrangements integrated 
with individual market coverage.
Sec. 2013. Participants in choice arrangement eligible for purchase of 
exchange insurance for purchase of 
cafeteria plan.
Sec. 2014. Employer credit for choice arrangement.
Subtitle C--Self-Insurance Protection Act

Sec. 2021. Short title.
Sec. 2022. Findings.
Sec. 2023. Certain medical stop-loss insurance obtained by certain plan 
sponsors of group health plans not included 
under the definition of health insurance 
coverage.
Sec. 2024. Effect on other laws.
Subtitle D--Small Business Flexibility Act

Sec. 2031. Short title.
Sec. 2032. Notification of flexible health insurance benefits.
Subtitle E--Health Coverage Choice Act

Sec. 2041. Short title.
Sec. 2042. Definition of short-term limited duration insurance.
Subtitle F--IMPACT Act of 2025

Sec. 2051. Short title.
Sec. 2052. Expanding eligibility for catastrophic plans.
Subtitle G--New Health Options Act

Sec. 2061. Short title.
Sec. 2062. Creation of a reinsurance program for a new health insurance 
risk pool.
Sec. 2062. Promotion of high-value care.
Sec. 2064. Disclosure of lower prices.
Subtitle H--Fighting Waste Fraud and Abuse in the Unaffordable Care Act

Sec. 2071. Short title.
Sec. 2072. Addressing waste, fraud, and abuse in the ACA exchanges.
Sec. 2073. Funding cost-sharing reduction payments.
TITLE III--ENDING TAXPAYER FUNDING FOR ABORTION AND GENDER TRANSITION 
PROCEDURES

Subtitle A--No Taxpayer Funding for Abortion and Abortion Insurance 
Full Disclosure Act of 2025

Sec. 3000. Applicability to entire act.
Sec. 3001. Short title.
Sec. 3002. Prohibiting taxpayer funded abortions.
Sec. 3003. Amendment to table of chapters.
Sec. 3004. Clarifying application of prohibition to premium credits and 
cost-sharing reductions under aca.
Sec. 3005. Revision to notice requirements regarding disclosure of 
extent of health plan coverage of abortion 
and abortion premium surcharges.
Subtitle B--Prohibiting Federal Funding for Gender Transition 
Procedures

Sec. 3006. Short title.
Sec. 3007. Prohibiting Federal funding for gender transition 
procedures.

TITLE I--PUTTING PATIENTS OVER HEALTH INSURANCE COMPANIES

Subtitle A--More Affordable Care Act

SEC. 1001. SHORT TITLE.

This Act may be cited as the ``More Affordable Care Act''.

SEC. 1002. HEALTH FREEDOM WAIVER PROGRAM.

Part 4 of subtitle D of title I of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18051 et seq.) is amended by adding the 
following:

``SEC. 1335. HEALTH FREEDOM WAIVER PROGRAM.

``(a) In General.--
``(1) Waiver program.--The Secretary shall waive all or any 
requirements described in paragraph (4), as determined by the 
applicable State, for plan years beginning on or after January 
1, 2026, with respect to health insurance coverage within any 
State that submits a notification under paragraph (2), provided 
that the State maintains an invisible high-risk insurance pool 
or another program designed to mitigate risk to insurance 
premium costs.
``(2) Notification.--A State entity described in paragraph 
(3) desiring a waiver under this section for any plan year 
beginning on or after January 1, 2026, shall notify the 
Secretary of its intent to participate in the waiver program 
with respect to all or any requirements described in paragraph 
(4). Such notification shall be filed at such time, not later 
than 90 days before the State intends to begin participation in 
the waiver program, and in such manner as the Secretary may 
require, and contain such information as the Secretary may 
require, including the requirements under paragraph (4) that 
the State intends to waiver and evidence that the State 
maintains a high-risk insurance pool.
``(3) State submission.--A notification with respect to a 
State may be submitted by--
``(A) the governor of the State; or
``(B) the legislature of the State, upon a majority 
vote by the State legislature.
``(4) Requirements.--The requirements described in this 
paragraph with respect to health insurance coverage within the 
State are as follows:
``(A) Part 1 of subtitle D.
``(B) Part 2 of subtitle D.
``(C) Section 1402.
``(D) Sections 36B and 5000A of the Internal 
Revenue Code of 1986.
``(5) Money follows the person.--
``(A) In general.--With respect to a State waiver 
under paragraph (1), under which, due to the structure 
of the State plan, individuals and small employers in 
the State would not qualify for the premium tax 
credits, cost-sharing reductions, or small business 
credits under sec. 36B of the Internal Revenue Code of 
1986 or under part I of subtitle E for which they would 
otherwise be eligible, the Secretary shall provide for 
an alternative means by which the aggregate amount of 
such credits or reductions that would have been paid on 
behalf of participants in the Exchanges established 
under this title had the State not received such 
waiver, shall be paid into the Trump Health Freedom 
Accounts established under section 223(i) of the 
Internal Revenue Code of 1986 of eligible residents of 
the State.
``(B) Payments to trump health freedom accounts.--
The Secretary shall pay into the Trump Health Freedom 
Accounts of each eligible resident of a State for which 
a waiver is in effect for a play year the amount equal 
to the total amount for which the resident would have 
been eligible in premium tax credit amounts under 
section 36B of the Internal Revenue Code of 1986 and 
cost-sharing reduction amounts under section 1402 for 
the year, had the State not had such waiver in effect. 
In determining the appropriate payment amount under 
this subparagraph, the Secretary shall calculate 
premium tax credit amounts and cost-sharing reduction 
amounts based on the national average annual premium 
amount for a silver tier benchmark plan among States 
that do not have such waivers in effect for the 
applicable year. The Secretary shall make payments into 
the Trump Health Freedom Accounts of eligible residents 
on a monthly basis, quarterly basis, or in one lump sum 
at the beginning of the year, at the option of each 
eligible resident.
``(6) Coordinated waiver process.--The Secretary shall 
develop a process for coordinating and consolidating the State 
waiver processes applicable under the provisions of this 
section, and the existing waiver processes applicable under 
section 1332, and titles XVIII, XIX, and XXI of the Social 
Security Act, and any other Federal law relating to the 
provision of health care items or services. Such processes 
shall permit a State to submit a single application for a 
waiver under any or all of such provisions.
``(7) Exchanges.--
``(A) In general.--In the case of a State in which 
a waiver is in effect under this section for a plan 
year--
``(i) the State may--
``(I) operate an Exchange 
established as described in section 
1311(b); or
``(II) allow one or more private 
entities to run commercial platforms 
that sell health plans approved by the 
State insurance commissioner; or
``(ii) if the State does not operate an 
Exchange as described in clause (i)(I) or allow 
for one or more commercial platforms described 
in clause (i)(II), the Secretary shall operate 
a Federal Exchange, as described in section 
1321(c), provided that any State laws regarding 
the availability of health plans on, and the 
operation of, such Exchange shall apply in lieu 
of any provision under part 1 or part 2 that 
such State has waived.
``(B) Application program interface.--The Secretary 
shall make available to any State that allows for 
commercial platforms described in subparagraph 
(A)(i)(II), the application program interface used for 
operating Federal and State Exchanges, for use by any 
private entity running such a platform under State 
authority.
``(8) Definitions.--In this section:
``(A) Eligible resident.--The term `eligible 
resident' means, with respect to a State for which a 
waiver is in effect under this section, a resident 
who--
``(i) in the absence of such a waiver in 
the State, would be eligible for a premium tax 
credit under section 36B of the Internal 
Revenue Code of 1986 or a cost-sharing 
reduction under section 1402, if the resident 
enrolled in a qualified health plan offered on 
the Exchange of such State; and
``(ii) enrolls in a plan offered on the 
Exchange described in paragraph (7) for the 
applicable plan year.
``(B) Secretary.--The term `Secretary' means--
``(i) the Secretary of Health and Human 
Services with respect to waivers relating to 
the provisions described in subparagraph (A) 
through (C) of paragraph (4); and
``(ii) the Secretary of the Treasury with 
respect to waivers relating to the provisions 
described in paragraph (4)(D).
``(b) Waiver Period.--Each waiver under this section shall be in 
effect beginning on January 1 of the plan year for which a timely 
notice is submitted by the State under subsection (a)(2), and 
continuing until the entity of the State described in subparagraph (A) 
or (B) of subsection (a)(3) that submitted the notification under 
subsection (a)(2) submits to the Secretary a notification of intent to 
discontinue participation in the waiver program under this section.
``(c) Limitation.--The Secretary may not permit a waiver under this 
section of any Federal law or requirement that is not within the 
authority of the Secretary.
``(d) Availability of Plans.--
``(1) In general.--Any health insurance coverage offered in 
a State for which a waiver under this section is in effect, and 
authorized by the insurance commissioner of the State, shall be 
made available on, as applicable, the Federal or State Exchange 
or commercial platforms described in subsection (a)(7), of all 
States for which such a waiver is in effect, subject to the 
laws of each such State.
``(2) Child-only plans.--In any State for which a waiver 
under this section is in effect, a health insurance issuer may 
offer a plan in which the only individuals eligible to enroll 
are individuals who, as of the beginning of a plan year, have 
not attained the age of 21.
``(e) Regulations.--Not later than 1 year after the date of 
enactment of the More Affordable Care Act, the Secretary of Health and 
Human Services, in coordination with the Secretary of the Treasury, 
shall promulgate regulations to carry out this section.
``(f) Rule of Construction Regarding Consumer Protections, 
Including the Pre-Existing Condition Protection.--Nothing in this 
section shall be construed to allow a State to waive the requirements 
of title XXVII of the Public Health Service Act, including sections 
2701, 2702, 2703, 2704, 2705, 2706, 2711, 2712, and 2718 of such 
Act.''.

SEC. 1003. TRUMP HEALTH FREEDOM ACCOUNTS.

(a) In General.--Section 223 of the Internal Revenue Code of 1986 
is amended by adding at the end the following new subsection:
``(i) Trump health freedom accounts.--For 
purposes of this section--
``(1) In general.--In the case of a Trump Health Freedom 
Account, this section shall be applied as provided in 
paragraphs (3) through (8).
``(2) Trump health freedom account.--The term `Trump Health 
Freedom Account' means a health savings account (determined as 
provided in this subsection) established by or on behalf of an 
individual residing in a State for which a waiver under section 
1335 of the Patient Protection and Affordable Care Act is in 
effect which receives deposits of amounts transferred to the 
individual pursuant to section 1335(a)(5) of such Act.
``(3) Eligible individual.--Any individual covered under a 
health plan authorized to be made available on an Exchange by 
section 1335(d) of such Act shall be treated as an eligible 
individual.
``(4) Treatment of transferred contributions.--Amounts 
transferred to a Trump Health Freedom Account pursuant to 
section 1335(a)(5) of such Act shall not be taken into account 
in determining the deduction allowed by subsection (a).
``(5) Account must be only hsa of individual.--
``(A) In general.--An individual who has a Trump 
Health Freedom Account shall not be treated as an 
eligible individual with respect to any health savings 
account other than such Trump Health Freedom Account.
``(B) Rollover of existing account permitted.--An 
individual on whose behalf a Trump Health Freedom 
Account is established may roll over the balance of any 
other health savings account of the individual to such 
Trump Health Freedom Account according to the rule of 
subsection (f)(5).
``(6) No rollovers permitted.--Except as provided in 
paragraph (6)(B), subsection (f)(5) shall not apply and no 
amount shall be contributed from a Trump Health Freedom Account 
to any health saving account other than a Trump Health Freedom 
Account.
``(7) Restriction on use of amounts.--No amounts in a Trump 
Health Freedom Account may be used--
``(A) to pay premiums for a health plan that 
covers--
``(i) gender transition procedures; or
``(ii) abortion; or
``(B) pay for any service described in clause (i) 
or (ii) or subparagraph (A).
``(8) Definitions.--For purposes of paragraph (8)--
``(A) Gender transition procedure.--
``(i) In general.--The term `gender 
transition procedure' means any hormonal or 
surgical intervention for the purpose of gender 
transition, including--
``(I) gonadotropin-releasing 
hormone (GNRH) agonists or other 
puberty-blocking or suppressing drugs 
to stop or delay normal puberty;
``(II) testosterone, estrogen, 
progesterone, or other androgens to an 
individual at doses that are 
superphysiologic to what would normally 
be produced endogenously in a healthy 
individual of the same age and sex;
``(III) castration;
``(IV) orchiectomy;
``(V) scrotoplasty;
``(VI) implantation of erection or 
testicular prostheses;
``(VII) vasectomy;
``(VIII) hysterectomy;
``(IX) oophorectomy;
``(X) ovariectomy;
``(XI) reconstruction of the fixed 
part of the urethra with or without a 
metoidioplasty or a phalloplasty;
``(XII) metoidioplasty;
``(XIII) penectomy;
``(XIV) phalloplasty;
``(XV) vaginoplasty;
``(XVI) clitoroplasty;
``(XVII) vaginectomy;
``(XVIII) vulvoplasty;
``(XIX) reduction 
thyrochondroplasty;
``(XX) chondrolaryngoplasty;
``(XXI) mastectomy;
``(XXII) tubal ligation;
``(XXIII) sterilization;
``(XXIV) any plastic, cosmetic, or 
aesthetic surgery that feminizes or 
masculinizes the facial or other 
physiological features of an 
individual;
``(XXV) any placement of chest 
implants to create feminine breasts;
``(XXVI) any placement of fat or 
artificial implants in the gluteal 
region;
``(XXVII) augmentation mammoplasty;
``(XXVIII) liposuction;
``(XXIX) lipofilling;
``(XXX) voice surgery;
``(XXXI) hair reconstruction;
``(XXXII) pectoral implants; and
``(XXXIII) the removal of any 
otherwise healthy or non-diseased body 
part or tissue.
``(ii) Exclusions.--The term `gender 
transition procedure' does not include the 
following when furnished to an individual by a 
health care provider with the consent of such 
individual or, if applicable, such individual's 
parents or legal guardian:
``(I) Services to individuals born 
with a medically verifiable disorder of 
sex development, including an 
individual with external sex 
characteristics that are irresolvably 
ambiguous such as an individual born 
with 46 XX chromosomes with 
virilization, and individual born with 
46 XY chromosomes with 
undervirilization, or an individual 
born having both ovarian and testicular 
tissue.
``(II) Service provided when a 
physician has otherwise diagnosed a 
disorder of sexual development in which 
the physician has determined through 
genetic or biochemical testing that the 
individual does not have normal sex 
chromosome structure, sex steroid 
hormone production, or sex steroid 
hormone action for a healthy individual 
of the same sex and age.
``(III) The treatment of any 
infection, injury, disease, or disorder 
that has been caused by or exacerbated 
by the performance of gender transition 
procedures, whether or not the gender 
transition procedure was performed in 
accordance with State and Federal law 
or whether or not funding for the 
gender transition procedure is 
permissible under this section.
``(IV) Any procedure undertaken 
because the individual suffers from a 
physical disorder, physical injury, or 
physical illness (but not mental, 
behavioral, or emotional distress or a 
mental, behavioral, or emotional 
disorder) that would, as certified by a 
physician, place the individual in 
imminent danger of death or impairment 
of major bodily function, unless the 
procedure is performed.
``(V) Puberty suppression or 
blocking prescription drugs for the 
purpose of normalizing puberty for a 
minor experiencing precocious puberty.
``(VI) Male circumcision.
``(B) Gender transition.--The term `gender 
transition' means the process in which an individual 
goes from identifying with or presenting as his or her 
sex to identifying with or presenting a self-proclaimed 
identity that does not correspond with or is different 
from his or her sex and may be accompanied with social, 
legal, or physical changes.
``(C) Sex.--The term `sex', when referring to an 
individual's sex, means to refer to either male or 
female, as biologically determined.
``(D) Female.--The term `female', when used to 
refer to a natural person, means an individual who 
naturally has, had, will have, or would have, but for a 
congenital anomaly, historic accident, or intentional 
or unintentional disruption, the reproductive system 
that at some point produces, transports, and utilizes 
eggs for fertilization.
``(E) Male.--The term `male', when used to refer to 
a natural person, means an individual who naturally 
has, had, will have, or would have, but for a 
congenital anomaly, historical accident, or intentional 
or unintentional disruption, the reproductive system 
that at some point produces, transports, and utilizes 
sperm for fertilization.
``(b) Effective Date.--The amendment made by this section shall 
apply to taxable years beginning after December 31, 2025.''.

Subtitle B--Improving HSA Access, Utility, and Flexibility

SEC. 1011. INDIVIDUALS ENTITLED TO PART A OF MEDICARE BY REASON OF AGE 
ALLOWED TO CONTRIBUTE TO HEALTH SAVINGS ACCOUNT.

(a) In General.--Section 223(c)(1)(B) is amended by striking 
``and'' at the end of clause (ii), by striking the period at the end of 
clause (iii) and inserting ``, and'', and by adding at the end the 
following new clause:
``(iv) entitlement to hospital insurance 
benefits under part A of title XVIII of the 
Social Security Act by reason of section 226(a) 
of such Act.''.
(b) Treatment of Health Insurance Purchased From Account.--Section 
223(d)(2)(C)(iv) is amended by inserting ``and who is not an eligible 
individual'' after ``who has attained the age specified in section 1811 
of the Social Security Act''.
(c) Coordination With Penalty on Distributions Not Used for 
Qualified Medical Expenses.--Section 223(f)(4)(C) is amended by 
striking ``Subparagraph (A)'' and inserting ``Except in the case of an 
eligible individual, subparagraph (A)''.
(d) Conforming Amendment.--Section 223(b)(7) is amended by 
inserting ``(other than an entitlement to benefits described in 
subsection (c)(1)(B)(iv))'' after ``Social Security Act''.
(e) Effective Date.--The amendments made by this section shall 
apply to months beginning after December 31, 2025.

SEC. 1012. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CONTRIBUTIONS TO THE 
SAME HEALTH SAVINGS ACCOUNT.

(a) In General.--Section 223(b)(5) is amended to read as follows:
``(5) Special rule for married individuals with family 
coverage.--
``(A) In general.--In the case of individuals who 
are married to each other, if both spouses are eligible 
individuals and either spouse has family coverage under 
a high deductible health plan as of the first day of 
any month--
``(i) the limitation under paragraph (1) 
shall be applied by not taking into account any 
other high deductible health plan coverage of 
either spouse (and if such spouses both have 
family coverage under separate high deductible 
health plans, only one such coverage shall be 
taken into account),
``(ii) such limitation (after application 
of clause (i)) shall be reduced by the 
aggregate amount paid to Archer MSAs of such 
spouses for the taxable year, and
``(iii) such limitation (after application 
of clauses (i) and (ii)) shall be divided 
equally between such spouses unless they agree 
on a different division.
``(B) Treatment of additional contribution 
amounts.--If both spouses referred to in subparagraph 
(A) have attained age 55 before the close of the 
taxable year, the limitation referred to in 
subparagraph (A)(iii) which is subject to division 
between the spouses shall include the additional 
contribution amounts determined under paragraph (3) for 
both spouses. In any other case, any additional 
contribution amount determined under paragraph (3) 
shall not be taken into account under subparagraph 
(A)(iii) and shall not be subject to division between 
the spouses.''.
(b) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2025.

SEC. 1013. FSA AND HRA TERMINATIONS OR CONVERSIONS TO FUND HSAS.

(a) In General.--Section 106(e)(2) is amended to read as follows:
``(2) Qualified hsa distribution.--For purposes of this 
subsection--
``(A) In general.--The term `qualified HSA 
distribution' means, with respect to any employee, a 
distribution from a health flexible spending 
arrangement or health reimbursement arrangement of such 
employee contributed directly to a health savings 
account of such employee if--
``(i) such distribution is made in 
connection with such employee establishing 
coverage under a high deductible health plan 
(as defined in section 223(c)(2)) if during the 
4-year period preceding the date the employee 
so establishes coverage the employee was not 
covered under such a high deductible health 
plan, and
``(ii) such arrangement is described in 
section 223(c)(1)(B)(v) with respect to any 
portion of the plan year remaining after such 
distribution is made, if such employee remains 
enrolled in such arrangement.
``(B) Dollar limitation.--The aggregate amount of 
distributions from health flexible spending 
arrangements and health reimbursement arrangements of 
any employee which may be treated as qualified HSA 
distributions in connection with an establishment of 
coverage described in subparagraph (A)(i) shall not 
exceed the dollar amount in effect under section 
125(i)(1) (twice such amount in the case of coverage 
which is described in section 223(b)(2)(B)).''.
(b) Partial Reduction of Limitation on Deductible HSA 
Contributions.--Section 223(b)(4) is amended by striking ``and'' at the 
end of subparagraph (B), by striking the period at the end of 
subparagraph (C) and inserting ``, and'', and by inserting after 
subparagraph (C) the following new subparagraph:
``(D) so much of any qualified HSA distribution (as 
defined in section 106(e)(2)) made to a health savings 
account of such individual during the taxable year as 
does not exceed the aggregate increases in the balance 
of the arrangement from which such distribution is made 
which occur during the portion of the plan year which 
precedes such distribution (other than any balance 
carried over to such plan year and determined without 
regard to any decrease in such balance during such 
portion of the plan year).''.
(c) Conversion to HSA-Compatible Arrangement for Remainder of Plan 
Year.--Section 223(c)(1)(B), as amended by this preceding provisions of 
this Act, is amended by striking ``and'' at the end of clause (iii), by 
striking the period at the end of clause (iv) and inserting ``, and'', 
and by adding at the end the following new clause:
``(v) coverage under a health flexible spending arrangement or 
health reimbursement arrangement for the portion of the plan year after 
a qualified HSA distribution (as defined in section 106(e)(2) 
determined without regard to subparagraph (A)(ii) thereof) is made, if 
the terms of such arrangement which apply for such portion of the plan 
year are such that, if such terms applied for the entire plan year, 
then such arrangement would not be taken into account under 
subparagraph (A)(ii) of this paragraph for such plan year.''.
(d) Inclusion of Qualified HSA Distributions on W-2.--
(1) In general.--Section 6051(a), as amended by the 
preceding provisions of this Act, is amended by striking 
``and'' at the end of paragraph (19), by striking the period at 
the end of paragraph (20) and inserting ``, and'', and by 
inserting after paragraph (20) the following new paragraph:
``(21) the amount of any qualified HSA distribution (as 
defined in section 106(e)(2)) with respect to such employee.''.
(2) Conforming amendment.--Section 6051(a)(12) is amended 
by inserting ``(other than any qualified HSA distribution, as 
defined in section 106(e)(2))'' before the comma at the end.
(e) Effective Date.--The amendments made by this section shall 
apply to distributions made after December 31, 2025.

SEC. 1014. SPECIAL RULE FOR CERTAIN MEDICAL EXPENSES INCURRED BEFORE 
ESTABLISHMENT OF HEALTH SAVINGS ACCOUNT.

(a) In General.--Section 223(d)(2), as amended by the preceding 
provisions of this Act, is amended by adding at the end the following 
new subparagraph:
``(F) Treatment of certain medical expenses 
incurred before establishment of account.--If a health 
savings account is established during the 60-day period 
beginning on the date that coverage of the account 
beneficiary under a high deductible health plan begins, 
then, solely for purposes of determining whether an 
amount paid is used for a qualified medical expense, 
such account shall be treated as having been 
established on the date that such coverage begins.''.
(b) Effective Date.--The amendment made by this section shall apply 
with respect to coverage beginning after December 31, 2025.

SEC. 1015. CONTRIBUTIONS PERMITTED IF SPOUSE HAS HEALTH FLEXIBLE 
SPENDING ARRANGEMENT.

(a) Contributions Permitted if Spouse Has a Health Flexible 
Spending Arrangement.--Section 223(c)(1)(B), as amended by this 
preceding provisions of this Act, is amended by striking ``and'' at the 
end of clause (iv), by striking the period at the end of clause (v) and 
inserting ``, and'', and by adding at the end the following new clause:
``(vi) coverage under a health flexible 
spending arrangement of the spouse of the 
individual for any plan year of such 
arrangement if the aggregate reimbursements 
under such arrangement for such year do not 
exceed the aggregate expenses which would be 
eligible for reimbursement under such 
arrangement if such expenses were determined 
without regard to any expenses paid or incurred 
with respect to such individual.''.
(b) Effective Date.--The amendment made by this section shall apply 
to plan years beginning after December 31, 2025.

SEC. 1016. INCREASE IN HEALTH SAVINGS ACCOUNT CONTRIBUTION LIMITATION 
FOR CERTAIN INDIVIDUALS.

(a) Increase.--
(1) In general.--Section 223(b) is amended by adding at the 
end the following new paragraph:
``(9) Increase in limitation for certain taxpayers.--
``(A) In general.--The applicable limitation under 
subparagraphs (A) and (B) of paragraph (2) shall be 
increased by $4,300 and $8,550, respectively.
``(B) Limitation based on modified adjusted gross 
income.--The amount of the increase under subparagraph 
(A) (determined without regard to this subparagraph) 
shall be reduced (but not below zero) by the amount 
which bears the same ratio to the amount of such 
increase (as so determined) as--
``(i) the excess (if any) of--
``(I) the taxpayer's adjusted gross 
income for such taxable year, over
``(II) $75,000 ($150,000 in the 
case of a joint return, if the eligible 
individual has family coverage), bears 
to
``(ii) $25,000 ($50,000 in the case of a 
joint return, if the eligible individual has 
family coverage).
For purposes of the preceding sentence, adjusted gross 
income shall be determined in the same manner as under 
section 219(g)(3)(A), except determined without regard 
to any deduction allowed under this section.''.
(2) Only to apply to employee contributions.--Section 
106(d)(1) is amended by inserting ``and section 223(b)(9)'' 
after ``determined without regard to this subsection''.
(b) Inflation Adjustment.--Section 223(g), as amended by the 
preceding provisions of this Act, is amended--
(1) by inserting ``, (b)(9)(A), (b)(9)(B)(i)(II),'' before 
``and (c)(2)(A)'' each place it appears,
(2) by striking ``clauses (ii) and (ii)'' in paragraph 
(1)(B)(i) and inserting ``clauses (ii), (iii), and (iv)'',
(3) by striking ``and'' at the end of paragraph (1)(B)(ii),
(4) by striking the period at the end of paragraph 
(1)(B)(iii) and inserting ``, and'', and
(5) by inserting after paragraph (1)(B)(iii) the following 
new clause:
``(iv) in the case of the dollar amounts in 
subsections (b)(9)(A) and (b)(9)(B)(i)(II), 
calendar year 2025''.
(c) Effective Date.--
(1) Subsection (a).--The amendments made by subsection (a) 
shall apply to taxable years beginning after December 31, 2025.
(2) Subsection (b).--The amendments made by subsection (b) 
shall apply to taxable years beginning after December 31, 2026.

SEC. 1017. HEALTH SAVINGS ACCOUNTS USED TO PURCHASE INSURANCE.

(a) In General.--Section 223(d)(2) of the Internal Revenue Code of 
1986 is amended--
(1) by striking subparagraphs (B) and (C), and
(2) by redesignating subparagraph (D) as subparagraph (C).
(b) Effective Date.--The amendment made by this section shall apply 
to plan years beginning after December 31, 2025.

Subtitle C--Health Care Sharing Ministries

SEC. 1018. TREATMENT OF HEALTH CARE SHARING MINISTRIES.

(a) Inclusion as Medical Expenses.--Paragraph (2) of section 223(c) 
of the Internal Revenue Code of 1986, as redesignated and amended by 
the preceding provisions of this Act, is further amended by adding at 
the end the following new subparagraph:
``(D) Inclusion of health care sharing 
ministries.--The term `qualified medical expenses' 
shall include amounts paid by a member of a health care 
sharing ministry (as defined in section 
5000A(d)(2)(B)(ii) without regard to subclause (IV) 
thereof) for--
``(i) the sharing of medical expenses among 
members, and
``(ii) administrative fees of the 
ministry.''.
(b) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after the date of enactment of this 
Act.

SEC. 1019. HEALTH CARE SHARING MINISTRY FEES TREATED AS MEDICAL CARE.

(a) In General.--Section 213(d) of the Internal Revenue Code of 
1986 is amended by adding at the end the following new paragraph:
``(12) Health care sharing ministries.--For purposes of 
this section, the term `medical care' shall include amounts 
paid by a member of a health care sharing ministry (as defined 
in section 5000A(d)(2)(B)(ii) without regard to subclause (IV) 
thereof) for--
``(A) the sharing of medical expenses among 
members, and
``(B) administrative fees of the ministry.''.
(b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after the date of the enactment of this Act.

SEC. 1020. HEALTH CARE SHARING MINISTRIES NOT TREATED AS HEALTH 
INSURANCE.

(a) In General.--Section 223(c) of the Internal Revenue Code of 
1986, as redesignated and amended by the preceding provisions of this 
Act, is amended by adding at the end the following new paragraph:
``(5) Health care sharing ministries not treated as health 
insurance.--A health care sharing ministry (as defined in 
section 5000A(d)(2)(B)(ii) without regard to subclause (IV) 
thereof) shall not be treated as health plan or insurance for 
purposes of this title.''.
(b) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after the date of enactment of this 
Act.

TITLE II--CODIFYING TRUMP HEALTHCARE FREEDOM AGENDA

Subtitle A--Association Health Plan Act

SEC. 2001. SHORT TITLE.

This Act may be cited the ``Association Health Plan Act''.

SEC. 2002. TREATMENT OF GROUP OR ASSOCIATION OF EMPLOYERS.

(a) In General.--Section 3(5) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1002(5)) is amended--
(1) by striking ``The term'' and inserting ``(A) The 
term''; and
(2) by adding at the end the following:
``(B) For purposes of subparagraph (A), a group or 
association of employers shall be treated as an 
`employer', regardless of whether the employers 
composing such group or association are in the same 
industry, trade, or profession, if such group or 
association--
``(i)(I) has established and maintains an 
employee welfare benefit plan that is a group 
health plan (as defined in section 733(a)(1));
``(II) provides coverage under such 
plan to at least 51 employees after all 
of the employees employed by all of the 
employer members of such group or 
association have been aggregated and 
counted together as described in 
subparagraph (D);
``(III) has been actively in 
existence for at least 2 years;
``(IV) has been formed and 
maintained in good faith for purposes 
other than providing medical care (as 
defined in section 733(a)(2)) through 
the purchase of insurance or otherwise;
``(V) does not condition membership 
in the group or association on any 
health status-related factor (as 
described in section 702(a)(1)) 
relating to any individual;
``(VI) makes coverage under such 
plan available to all employer members 
of such group or association regardless 
of any health status-related factor (as 
described in section 702(a)(1)) 
relating to such employer members;
``(VII) does not provide coverage 
under such plan to any individual other 
than an employee of an employer member 
of such group or association;
``(VIII) has established a 
governing board with by-laws or other 
similar indications of formality to 
manage and operate such plan in both 
form and substance, of which at least 
75 percent of the board members shall 
be made up of employer members of such 
group or association participating in 
the plan that are duly elected by each 
participating employer member casting 1 
vote during a scheduled election;
``(IX) is not a health insurance 
issuer (as defined in section 
733(b)(2)), and is not owned or 
controlled by such a health insurance 
issuer or by a subsidiary or affiliate 
of such a health insurance issuer, 
other than to the extent such a health 
insurance issuer may participate in the 
group or association as a member;
``(ii) is structured in good faith with any 
set of criteria to qualify for such treatment 
in any advisory opinion issued prior to the 
date of enactment of the Association Health 
Plans Act; or
``(iii) meets any other set of criteria to 
qualify for such treatment that the Secretary 
by regulation may provide.
``(C)(i) For purposes of subparagraph (B), a self-
employed individual shall be treated as--
``(I) an employer who may become a 
member of a group or association of 
employers;
``(II) an employee who may 
participate in an employee welfare 
benefit plan established and maintained 
by such group or association; and
``(III) a participant of such plan 
subject to the eligibility 
determination and monitoring 
requirements set forth in clause (iii).
``(ii) For purposes of this subparagraph, 
the term `self-employed individual' means an 
individual who--
``(I) does not have any common law 
employees;
``(II) has a bona fide ownership 
right in a trade or business, 
regardless of whether such trade or 
business is incorporated or 
unincorporated;
``(III) earns wages (as defined in 
section 3121(a) of the Internal Revenue 
Code of 1986) or self-employment income 
(as defined in section 1402(b) of such 
Code) from such trade or business; and
``(IV) works at least 10 hours a 
week or 40 hours per month providing 
personal services to such trade or 
business.
``(iii) The board of a group or association 
of employers shall--
``(I) initially determine whether 
an individual meets the requirements 
under clause (ii) to be considered to a 
self-employed individual for the 
purposes of being treated as an--
``(aa) employer member of 
such group or association (in 
accordance with clause (i)(I)); 
and
``(bb) employee who may 
participate in the employee 
welfare benefit plan 
established and maintained by 
such group or association (in 
accordance with clause 
(i)(II));
``(II) through reasonable 
monitoring procedures, periodically 
determine whether the individual 
continues to meet such requirements; 
and
``(III) if the board determines 
that an individual no longer meets such 
requirements, not make such plan 
coverage available to such individual 
(or dependents thereof) for any plan 
year following the plan year during 
which the board makes such 
determination. If, subsequent to a 
determination that an individual no 
longer meets such requirements, such 
individual furnishes evidence of 
satisfying such requirements, such 
individual (and dependents thereof) 
shall be eligible to receive plan 
coverage.
``(D) For purposes of subparagraph (B), all of the 
employees (including self-employed individuals) 
employed by all of the employer members (including 
self-employed individuals) of a group or association of 
employers shall be--
``(i) treated as participants in a single 
plan multiple employer welfare arrangement; and
``(ii) aggregated and counted together for 
purposes of any regulation of an employee 
welfare benefit plan established and maintained 
by such group or association.''.
(b) Determination of Employer or Joint Employer Status.--The 
provision of employee welfare benefit plan coverage by a group or 
association of employers shall not be construed as evidence for 
establishing an employer or joint employer relationship under any 
Federal or State law.

SEC. 2003. RULES APPLICABLE TO EMPLOYEE WELFARE BENEFIT PLANS 
ESTABLISHED AND MAINTAINED BY A GROUP OR ASSOCIATION OF 
EMPLOYERS.

Part 7 of subtitle B of title I of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1181, et seq.) is amended by adding at 
the end the following:

``SEC. 736. RULES APPLICABLE TO EMPLOYEE WELFARE BENEFIT PLANS 
ESTABLISHED AND MAINTAINED BY A GROUP OR ASSOCIATION OF 
EMPLOYERS.

``(a) Premium Rates for a Group or Association of Employers.--
``(1)(A) In the case of an employee welfare benefit plan 
established and maintained by a group or association of 
employers described in section 3(5)(B), such plan may, to the 
extent not prohibited under State law--
``(i) establish base premium rates formed 
on an actuarially sound, modified community 
rating methodology that considers the pooling 
of all plan participant claims; and
``(ii) utilize the specific risk profile of 
each employer member of such group or 
association to determine contribution rates for 
each such employer member's share of a premium 
by actuarially adjusting above or below the 
established base premium rates.
``(B) For purposes of paragraph (1), the term 
`employer member' means--
``(i) an employer who is a member of such 
group or association of employers and employs 
at least 1 common law employee; or
``(ii) a group made up solely of self-
employed individuals, within which all of the 
self-employed individual members of such group 
or association are aggregated together as a 
single employer member group, provided the 
group includes at least 20 self-employed 
individual members.
``(2) In the event a group or association is made up solely 
of self-employed individuals (and no employers with at least 1 
common law employee are members of such group or association), 
the employee welfare benefit plan established by such group or 
association shall--
``(A) treat all self-employed individuals who are 
members of such group or association as a single risk 
pool;
``(B) pool all plan participant claims; and
``(C) charge each plan participant the same premium 
rate.
``(b) Discrimination and Pre-Existing Condition Protections.--An 
employee welfare benefit plan established and maintained by a group or 
association of employers described in section 3(5)(B) shall be 
prohibited from--
``(1) establishing any rule for eligibility (including 
continued eligibility) of any individual (including an employee 
of an employer member or a self-employed individual, or a 
dependent of such employee or self-employed individual) to 
enroll for benefits under the terms of the plan that 
discriminates based on any health status-related factor that 
relates to such individual (consistent with the rules under 
section 702(a)(1));
``(2) requiring an individual (including an employee of an 
employer member or a self-employed individual, or a dependent 
of such employee or self-employed individual), as a condition 
of enrollment or continued enrollment under the plan, to pay a 
premium or contribution that is greater than the premium or 
contribution for a similarly situated individual enrolled in 
the plan based on any health status-related factor that relates 
to such individual (consistent with the rules under section 
702(b)(1)); and
``(3) denying coverage under such plan on the basis of a 
pre-existing condition (consistent with the rules under section 
2704 of the Public Health Service Act).''.

SEC. 2004. RULE OF CONSTRUCTION.

Nothing in this Act shall be construed to exempt a group health 
plan which is an employee welfare benefit plan offered through a group 
or association of employers from the requirements of part 7 of subtitle 
B of title I of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1181 et. seq.), including the provisions of part A of title 
XXVII of the Public Health Service Act as incorporated by reference 
into this Act through section 715.

Subtitle B--CHOICE Arrangement Act

SEC. 2011. SHORT TITLE.

This Act may be cited as the ``CHOICE Arrangement Act''.

SEC. 2012. TREATMENT OF HEALTH REIMBURSEMENT ARRANGEMENTS INTEGRATED 
WITH INDIVIDUAL MARKET COVERAGE.

(a) In General.--Section 9815(b) is amended--
(1) By striking ``exception Notwithstanding subsection 
(a)'' and inserting the following: ``Exceptions.--
``(1) Self-insured group health plans.--Notwithstanding 
subsection (a)''
(2) by adding at the end the following new paragraph:
``(2) Custom health option and individual care expense 
arrangements.--
``(A) In general.--For purposes of this subchapter, 
a custom health option and individual care expense 
arrangement shall be treated as meeting the 
requirements of section 9802 and sections 2705, 2711, 
2713, and 2715 of title XXVII of the Public Health 
Service Act.
``(B) Custom health option and individual care 
expense arrangements defined.--For purposes of this 
section, the term `custom health option and individual 
care expense arrangement' means a health reimbursement 
arrangement--
``(i) which is an employer-provided group 
health plan funded solely by employer 
contributions to provide payments or 
reimbursements for medical care subject to a 
maximum fixed dollar amount for a period,
``(ii) under which such payments or 
reimbursements may only be made for medical 
care provided during periods during which the 
individual is covered--
``(I) under individual health 
insurance coverage (other than coverage 
that consists solely of excepted 
benefits), or
``(II) under part A and B of title 
XVIII of the Social Security Act or 
part C of such title,
``(iii) which meets the nondiscrimination 
requirements of subparagraph (C),
``(iv) which meets the substantiation 
requirements of subparagraph (D), and
``(v) which meets the notice requirements 
of subparagraph (E).
``(C) Nondiscrimination.--
``(i) In general.--An arrangement meets the 
requirements of this subparagraph if an 
employer offering such arrangement to an 
employee within a specified class of employee--
``(I) offers such arrangement to 
all employees within such specified 
class on the same terms, and
``(II) does not offer any other 
group health plan (other than an 
account-based group health plan or a 
group health plan that consists solely 
of excepted benefits) to any employees 
within such specified class.
In the case of an employer who offers a group 
health plan provided through health insurance 
coverage in the small group market (that is 
subject to section 2701 of the Public Health 
Service Act) to all employees within such 
specified class, subclause (II) shall not apply 
to such group health plan.
``(ii) Specified class of employee.--For 
purposes of this subparagraph, any of the 
following may be designated as a specified 
class of employee:
``(I) Full-time employees.
``(II) Part-time employees.
``(III) Salaried employees.
``(IV) Non-salaried employees.
``(V) Employees whose primary site 
of employment is in the same rating 
area.
``(VI) Employees who are included 
in a unit of employees covered under a 
collective bargaining agreement to 
which the employer is subject 
(determined under rules similar to the 
rules of section 105(h)).
``(VII) Employees who have not met 
a group health plan, or health 
insurance issuer offering group health 
insurance coverage, waiting period 
requirement that satisfies section 2708 
of the Public Health Service Act.
``(VIII) Seasonal employees.
``(IX) Employees who are 
nonresident aliens and who receive no 
earned income (within the meaning of 
section 911(d)(2)) from the employer 
which constitutes income from sources 
within the United States (within the 
meaning of section 861(a)(3)).
``(X) Such other classes of 
employees as the Secretary may 
designate.
An employer may designate (in such manner as is 
prescribed by the Secretary) two or more of the 
classes described in the preceding subclauses 
as the specified class of employees to which 
the arrangement is offered for purposes of 
applying this subparagraph.
``(iii) Special rule for new hires.--An 
employer may designate prospectively so much of 
a specified class of employees as are hired 
after a date set by the employer. Such subclass 
of employees shall be treated as the specified 
class for purposes of applying clause (i).
``(iv) Rules for determining type of 
employee.--For purposes for clause (ii), any 
determination of full-time, part-time, or 
seasonal employment status shall be made under 
rules similar to the rules of section 105(h) or 
4980H, whichever the employer elects for the 
plan year. Such election shall apply with 
respect to all employees of the employer for 
the plan year.
``(v) Permitted variation.--For purposes of 
clause (i)(I), an arrangement shall not fail to 
be treated as provided on the same terms within 
a specified class merely because the maximum 
dollar amount of payments and reimbursements 
which may be made under the terms of the 
arrangement for the year with respect to each 
employee within such class--
``(I) increases as additional 
dependents of the employee are covered 
under the arrangement, and
``(II) increases with respect to a 
participant as the age of the 
participant increases, but not in 
excess of an amount equal to 300 
percent of the lowest maximum dollar 
amount with respect to such a 
participant determined without regard 
to age.
``(D) Substantiation requirements.--An arrangement 
meets the requirements of this subparagraph if the 
arrangement has reasonable procedures to substantiate--
``(i) that the participant and any 
dependents are, or will be, enrolled in 
coverage described in subparagraph (B)(ii) as 
of the beginning of the plan year of the 
arrangement (or as of the beginning of coverage 
under the arrangement in the case of an 
employee who first becomes eligible to 
participate in the arrangement after the date 
notice is given with respect to the plan under 
subparagraph (E) (determined without regard to 
clause (iii) thereof)), and
``(ii) any requests made for payment or 
reimbursement of medical care under the 
arrangement and that the participant and any 
dependents remain so enrolled.
``(E) Notice.--
``(i) In general.--Except as provided in 
clause (iii), an arrangement meets the 
requirements of this subparagraph if, under the 
arrangement, each employee eligible to 
participate is, not later than 60 days before 
the beginning of the plan year, given written 
notice of the employee's rights and obligations 
under the arrangement which--
``(I) is sufficiently accurate and 
comprehensive to apprise the employee 
of such rights and obligations, and
``(II) is written in a manner 
calculated to be understood by the 
average employee eligible to 
participate.
``(ii) Notice requirements.--Such notice 
shall include such information as the Secretary 
may by regulation prescribe.
``(iii) Notice deadline for certain 
employees.--In the case of an employee--
``(I) who first becomes eligible to 
participate in the arrangement after 
the date notice is given with respect 
to the plan under clause (i) 
(determined without regard to this 
clause), or
``(II) whose employer is first 
established fewer than 120 days before 
the beginning of the first plan year of 
the arrangement,
the requirements of this subparagraph shall be 
treated as met if the notice required under 
clause (i) is provided not later than the date 
the arrangement may take effect with respect to 
such employee.''.
(b) Inclusion of CHOICE Arrangement Permitted Benefits on W-2.--
(1) In general.--Section 6051(a), as amended by the 
preceding provisions of this Act, is amended by striking 
``and'' at the end of paragraph (18), by striking the period at 
the end of paragraph (19) and inserting ``, and'', and by 
inserting after paragraph (19) the following new paragraph:
``(20) the total amount of permitted benefits for enrolled 
individuals under a custom health option and individual care 
expense arrangement (as defined in section 9815(b)(2)) with 
respect to such employee.''.
(c) Treatment of Current Rules Relating to Certain Arrangements.--
(1) No inference.--To the extent not inconsistent with the 
amendments made by this section--
(A) no inference shall be made from such amendments 
with respect to the rules prescribed in the Federal 
Register on June 20, 2019 (84 Fed. Reg. 28888), 
relating to health reimbursement arrangements and other 
account-based group health plans, and
(B) any reference to custom health option and 
individual care expense arrangements shall for purposes 
of such rules be treated as including a reference to 
individual coverage health reimbursement arrangements.
(2) Other conforming of rules.--The Secretary of the 
Treasury, the Secretary of Health and Human Services, and the 
Secretary of Labor shall modify such rules as may be necessary 
to conform to the amendments made by this section.
(d) Effective Date.--The amendments made by this section shall 
apply to plan years beginning after December 31, 2025.

SEC. 2013. PARTICIPANTS IN CHOICE ARRANGEMENT ELIGIBLE FOR PURCHASE OF 
EXCHANGE INSURANCE FOR PURCHASE OF CAFETERIA PLAN.

(a) In General.--Section 125(f)(3) is amended by adding at the end 
the following new subparagraph:
``(C) Exception for participants in choice 
arrangement.--Subparagraph (A) shall not apply in the 
case of an employee participating in a custom health 
option and individual care expense arrangement (within 
the meaning of section 9815(b)(2)) offered by the 
employee's employer.''.
(b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after December 31, 2025.

SEC. 2014. EMPLOYER CREDIT FOR CHOICE ARRANGEMENT.

(a) In General.--Subpart D of part IV of subchapter A of chapter 1 
is amended by adding at the end the following new section:

``SEC. 45BB. EMPLOYER CREDIT FOR CHOICE ARRANGEMENT.

``(a) In General.--For purposes of section 38, in the case of an 
eligible employer, the CHOICE arrangement credit determined under this 
section for any taxable year is an amount, with respect to each 
employee enrolled during the credit period in a CHOICE arrangement 
maintained by the employer, equal to--
``(1) $100 multiplied by the number of months for which the 
employee is so enrolled during the first year in the credit 
period, and
``(2) one-half of the dollar amount in effect under 
paragraph (1) for the taxable year, multiplied by the number of 
months for which the employee is so enrolled during the second 
year of the credit period.
``(b) Arrangement Must Constitute Minimum Essential Coverage.--An 
employee shall not be taken into account under subsection (a) unless 
such employee's eligibility for the CHOICE arrangement (determined 
without regard to the employee being enrolled) would cause the employee 
to be treated under section 36B(c)(2) as being eligible for minimum 
essential coverage consisting of an eligible employer-sponsored plan 
(as defined in section 5000A(f)(2)).
``(c) Definitions.--For purposes of this section--
``(1) CHOICE arrangement.--The term `CHOICE arrangement' 
means a custom health option and individual care expense 
arrangement (as defined in section 9815(b)(2)(B)).
``(2) Credit period.--The credit period with respect to an 
eligible employer is the first 2 one-year periods beginning 
with the month during which the employer first establishes a 
CHOICE arrangement on behalf of employees of the employer.
``(3) Eligible employer.--The term `eligible employer' 
means, with respect to any taxable year beginning in a calendar 
year, an employer who is not an applicable large employer for 
the calendar year under section 4980H.
``(d) Inflation Adjustment.--
``(1) In general.--In the case of any taxable year 
beginning in a calendar year after 2026, the dollar amount in 
subsection (a) shall be increased by an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined 
under section 1(f)(3) for the calendar year in which 
such taxable year begins by substituting `calendar year 
2025' for `calendar year 2016' in subparagraph (A)(ii) 
thereof.
``(2) Rounding.--If any amount after adjustment under 
paragraph (1) is not a multiple of $10, such amount shall be 
rounded to the next lower multiple of $10.''.
(b) Credit Made Part of General Business Credit.--Section 38(b) is 
amended by striking ``plus'' at the end of paragraph (40), by striking 
the period at the end of paragraph (41) and inserting ``, plus'', and 
by adding at the end the following new paragraph:
``(42) the CHOICE arrangement credit determined under 
section 45BB(a).''.
(c) Credit Allowed Against Alternative Minimum Tax.--Section 
38(c)(4)(B) is amended--
(1) by redesignating clauses (x), (xi), and (xii) as 
clauses (xi), (xii), and (xiii), respectively, and
(2) by inserting after clause (ix) the following new 
clause:
``(x) the credit determined under section 
45BB,''.
(d) Clerical Amendment.--The table of sections for subpart D of 
part IV of subchapter A of chapter 1 is amended by adding at the end 
the following new item:
(e) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2025.

Subtitle C--Self-Insurance Protection Act

SEC. 2021. SHORT TITLE.

This Act may be cited as the ``Self-Insurance Protection Act''.

SEC. 2022. FINDINGS.

Congress finds the following:
(1) Small and large employers offer health benefit plan 
coverage to employees in self-funded arrangements using company 
assets or a fund, or by paying premiums to purchase fully-
insured coverage from a health insurance company.
(2) Employers that self-fund health benefit plans will 
often purchase stop-loss insurance as a financial risk 
management tool to protect against excess or unexpected 
catastrophic health plan claims losses that arise above 
projected costs paid out of company assets.
(3) Stop-loss coverage insures the employer sponsoring the 
health benefit plan against unforeseen health plan claims, does 
not insure the employee health benefit plan itself, and does 
not pay health care providers for medical services provided to 
the employees.
(4) Employer-sponsored health benefit plans are regulated 
under the Employee Retirement Income Security Act of 1974, 
however, States regulate the availability and the coverage 
terms of stop-loss insurance coverage that employers purchase 
to protect company assets and to protect a fund against excess 
or unexpected claims losses.
(5) Both large and small employers that choose to self-fund 
must also be able to protect company assets or a fund against 
excess or unexpected claims losses and States must reasonably 
regulate stop-loss insurance to assure its availability to both 
large and small employers.

SEC. 2023. CERTAIN MEDICAL STOP-LOSS INSURANCE OBTAINED BY CERTAIN PLAN 
SPONSORS OF GROUP HEALTH PLANS NOT INCLUDED UNDER THE 
DEFINITION OF HEALTH INSURANCE COVERAGE.

Section 733(b)(1) of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1191b(b)(1)) is amended by adding at the end the 
following sentence: ``Such term shall not include a stop-loss policy 
obtained by a self-insured group health plan or a plan sponsor of a 
group health plan that self-insures the health risks of its plan 
participants to reimburse the plan or sponsor for losses that the plan 
or sponsor incurs in providing health or medical benefits to such plan 
participants in excess of a predetermined level set forth in the stop-
loss policy obtained by such plan or sponsor.''.

SEC. 2024. EFFECT ON OTHER LAWS.

Section 514(b) of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1144(b)) is amended by adding at the end the following:
``(10) The provisions of this title (including part 7 
relating to group health plans) shall preempt State laws 
insofar as they may now or hereafter prevent an employee 
benefit plan that is a group health plan from insuring against 
the risk of excess or unexpected health plan claims losses.''.

Subtitle D--Small Business Flexibility Act

SEC. 2031. SHORT TITLE.

This Act may be cited as the ``Small Business Flexibility Act''.

SEC. 2032. NOTIFICATION OF FLEXIBLE HEALTH INSURANCE BENEFITS.

(a) In General.--Subchapter C of chapter 100 of the Internal 
Revenue Code of 1986 is amended by adding at the end the following new 
section:

``SEC. 9835. NOTIFICATION OF FLEXIBLE HEALTH INSURANCE BENEFITS.

``(a) In General.--Not later than 1 year after the date of 
enactment of this section, the Secretary shall notify employers of the 
availability of tax-advantaged flexible health insurance benefits, with 
an initial focus on small businesses, particularly in rural areas (as 
defined in section 1393(a)(2)).
``(b) Definitions.--In this section:
``(1) Employer.--The term `employer' has the meaning given 
such term in section 3(5) of the Employee Retirement Income 
Security Act (29 U.S.C. 1002(5)).
``(2) Flexible health insurance benefits.--The term 
`flexible health insurance benefits' means--
``(A) an individual contribution health 
reimbursement arrangement (as described in the rule 
entitled `Health Reimbursement Arrangements and Other 
Account-Based Group Health Plans' (84 Fed. Reg. 28888 
(June 20, 2019)));
``(B) a qualified small employer health 
reimbursement arrangement (as defined in section 
9831(d)(2)); and
``(C) the small employer health insurance credit 
determined under section 45R.''.
(b) Clerical Amendment.--The table of sections for subchapter C of 
chapter 100 of such Code is amended by adding at the end the following 
new item:

``Sec. 9835. Notification of flexible health insurance benefits''.

Subtitle E--Health Coverage Choice Act

SEC. 2041. SHORT TITLE.

This Act may be cited as the ``Health Coverage Choice Act''.

SEC. 2042. DEFINITION OF SHORT-TERM LIMITED DURATION INSURANCE.

Section 2791(b) of the Public Health Service Act (42 U.S.C. 300gg-
91(b)) is amended by adding at the end the following new paragraph:
``(6) Short-term limited duration insurance.--The term 
`short-term limited duration insurance' means health insurance 
coverage provided under a contract with a health insurance 
issuer that--
``(A) has an expiration date specified in the 
contract that is less than 12 months after the original 
effective date of the contract; and
``(B) has a duration of not more than 10 years 
(taking into account renewals or extensions) after the 
original effective date of the contract.''.

Subtitle F--IMPACT Act of 2025

SEC. 2051. SHORT TITLE.

This Act may be cited as the ``Improved Medical Patients Affordable 
Care Today Act of 2025'' or the ``IMPACT Act of 2025.''

SEC. 2052. EXPANDING ELIGIBILITY FOR CATASTROPHIC PLANS.

(a) In General.--Section 1302(e)(2) of the Patient Protection and 
Affordable Care Act (42. U.S.C. 18022(e)(2) is amended--
(1) in subparagraph (B)(ii), by striking the period at the 
end and inserting ``; or''; and
(2) by adding at the end the following new subparagraph:
``(C) with respect to the plan year involved, is 
determined to be ineligible (or reasonably expects to 
be ineligible) for the premium tax credit under section 
36B of the Internal Revenue Code of 1986 or for reduced 
cost-sharing under section 1402 on the basis of the 
individual's household income for such year.''.
(b) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2026.

Subtitle G--New Health Options Act

SEC. 2061. SHORT TITLE.

This Act may be cited as the ``New Health Options Act''.

SEC. 2062. CREATION OF A REINSURANCE PROGRAM FOR A NEW HEALTH INSURANCE 
RISK POOL.

(a) In General.--Part V of subtitle B of title I of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18061 et seq.) is amended 
by adding at the end the following new section:

``SEC. 1344. REINSURANCE PROGRAM FOR CERTAIN OFF-EXCHANGE PLANS.

``(a) In General.--There is established a Reinsurance Program, to 
be administered by the Secretary of Health and Human Services, to 
provide payments to health insurance issuers with respect to claims for 
eligible individuals for the purpose of lowering premiums for such 
individuals.
``(b) Funding.--
``(1) Appropriation.--For the purpose of providing funding 
for the Reinsurance Program, for each year during the period 
beginning on January 1, 2026, and ending on December 31, 2030, 
there is appropriated out of any monies in the Treasury not 
otherwise obligated an amount equal to the product of $50 and 
the aggregate number of member months for all eligible 
individuals enrolled in a covered plan during such year.
``(2) Limitation on appropriation.--In no year shall the 
appropriation for the Reinsurance Program authorized in 
paragraph (1) exceed $6,000,000,000.
``(3) Use of unexpended funds.--Appropriated amounts 
remaining unexpended at the end of any year may be used to make 
payments under the Reinsurance Program in any future year.
``(4) Limitation on use of funds.--No funds received under 
the Reinsurance Program may be used to pay for services 
described in section 1303(b)(1)(B)(i) (as in effect on the date 
of the enactment of this section).
``(c) Operation of Program.--
``(1) In general.--The Secretary shall establish parameters 
for the operation of the Reinsurance Program consistent with 
this section.
``(2) Deadline for initial operation.--Not later than 120 
days after the date of the enactment, the Secretary shall 
establish sufficient parameters to specify how the Program will 
operate for 2026.
``(3) Definitions.--In this section:
``(A) Covered plan.--The term `covered plan' means 
individual health insurance coverage (as such term is 
defined in section 2791 of the Public Health Service 
Act)--
``(i) with respect to which the issuer of 
such coverage has made the election described 
in section 1312(c)(1)(A); and
``(ii) that does not provide coverage for 
services described in section 1303(b)(1)(B)(i) 
(as in effect on the date of the enactment of 
this section).
``(B) Eligible individual.--The term `eligible 
individual' means an individual enrolled in a covered 
plan.
``(d) Attachment Dollar Amount and Payment Proportion.--
``(1) In general.--The Secretary shall annually establish 
an attachment point, payment proportion, and reinsurance cap 
with respect to claims for eligible individuals for payments 
under the Reinsurance Program, consistent with the following:
``(A) The attachment point for the period beginning 
January 1, 2026, and ending December 31, 2026, shall be 
$110,000.
``(B) The payment proportion for the period 
beginning January 1, 2026, and ending December 31, 
2026, shall be 90 percent.
``(C) The reinsurance cap for the period beginning 
January 1, 2026 and ending December 31, 2026, shall be 
$300,000.
``(2) Adjustment authority.--The Secretary may adjust any 
amounts described in paragraph (1) as necessary to ensure the 
Reinsurance Program does not make payment for a year in excess 
of the amount available for such year under subsection (b).''.
(b) Election To Opt Out of Single Risk Pool.--
(1) In general.--Section 1312(c)(1) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18032(c)(1)) is 
amended--
(A) by striking ``A health insurance issuer'' and 
inserting the following:
``(A) In general.--A health insurance issuer'';
(B) in subparagraph (A), as inserted by paragraph 
(1), by inserting ``and other than any health plan with 
respect to which such issuer has elected for this 
subparagraph not to apply'' after ``grandfathered 
health plans''; and
(C) by adding at the end the following new 
subparagraph:
``(B) Treatment of plans opting out of single risk 
pool.--A health insurance issuer shall consider all 
enrollees in all health plans offered by such issuer in 
the individual market with respect to which such issuer 
has made the election described in subparagraph (A) to 
be members of a single risk pool.''.
(2) Prohibiting single risk pool opt out for qualified 
health plans.--Section 1301(a)(1)(C) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18021(a)(1)) is amended--
(A) in clause (iii), by striking ``and'' at the 
end;
(B) in clause (iv), by striking the period and 
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(v) has not made the election described in section 1312(c)(1)(A) 
with respect to such plan.''.
(3) Effective date.--The amendments made by this subsection 
shall apply with respect to plan years beginning on or after 
January 1, 2026.
(c) Removing Age Premium Variation Limitation for Certain Plans.--
(1) In general.--
(A) Removal of limitation for certain plans.--
Section 2701(a)(1)(A)(iii) of the Public Health Service 
Act (42 U.S.C 300gg(a)(1)(A)(iii)) is amended by 
inserting ``or, in the case of such coverage with 
respect to which the issuer of such coverage has made 
the election described in section 1312(c)(1)(A) of the 
Patient Protection and Affordable Care Act, by more 
than an actuarially justified amount for adults'' 
before ``; and''.
(B) Effective date.--The amendment made by 
subparagraph (A) shall apply with respect to plan years 
beginning on or after January 1, 2026.
(2) Maintaining age premium variation limitation for 
qualified health plans.--Section 1301(a)(1) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18021(a)(1)), as 
amended by subsection (b), is further amended--
(A) in subparagraph (B), by striking ``and'' at the 
end;
(B) in subparagraph (C)(v), by striking the period 
and inserting ``; and''; and
(C) by adding at the end the following new 
subparagraph:
``(D) with respect to the premium rate charged by 
such plan, if such plan varies such rate by age, does 
not vary such rate by more than 3 to 1 for adults 
(consistent with section 2707(c) of the Public Health 
Service Act).''.
(d) Treatment of Opt Out Plans in Relation to Individual Health 
Coverage Reimbursement Arrangements.--The Secretaries of Health and 
Human Services, Labor, and the Treasury shall not fail to treat any 
individual health insurance coverage (as defined in section 2791 of the 
Public Health Service Act (42 U.S.C. 300gg-91)) as eligible for 
integration with an individual health care reimbursement arrangement on 
the basis that the health insurance issuer (as so defined) of such 
coverage has made the election described in section 1312(c)(1)(A) of 
the Patient Protection and Affordable Care Act (as inserted by 
subsection (b)).

SEC. 2062. PROMOTION OF HIGH-VALUE CARE.

(a) In General.--Subpart II of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at 
the end the following new section:

``SEC. 2730. APPLICATION OF CERTAIN OUT-OF-NETWORK COSTS TO DEDUCTIBLES 
AND OUT-OF-POCKET MAXIMUMS.

``(a) In General.--A group health plan, and a health insurance 
issuer offering group or individual health insurance coverage, shall, 
in the case that an individual enrolled under such plan or coverage is 
furnished items or services by a health care provider or health care 
facility that does not have in effect a contractual relationship with 
such plan or issuer for the furnishing of such items or services and 
such individual incurs any out-of-pockets costs with respect to such 
items and services, at the option of such individual, apply such costs 
to any deductible or out-of-pocket maximum applicable to items and 
services furnished by health care providers or health care facilities 
with contracts in effect with such plan or issuer for the furnishing of 
such items or services, but only if the following requirements are met:
``(1) The item or service furnished by such provider or 
facility without a contract in effect with such plan or issuer 
is an item or service for which benefits are available under 
such plan or coverage.
``(2) The amount charged by such provider or facility for 
such item or service is equal to or less than--
``(A) the lowest amount recognized by the plan or 
coverage as payment for such item or service out of all 
health care providers and health care facilities with a 
contract in effect with such plan or issuer to furnish 
such item or service in the same rating area (as 
defined for purposes of section 2701) in which the item 
or service described in paragraph (1) was furnished; or
``(B) the 25th percentile of charges for such item 
or service furnished in the same State in which the 
item or service described in paragraph (1) was 
furnished.
``(b) Disclosure of Information.--A group health plan, and a health 
insurance issuer offering group or individual health insurance 
coverage, shall, with respect to each item or service for which 
benefits are available under such plan or coverage, make available the 
lowest amount described in subsection (a)(2)(A) and the 25th percentile 
described in subsection (a)(2)(B) to all individuals enrolled under 
such plan or coverage.''.
(b) Effective Date.--The amendment made by subsection (a) shall 
apply to plan years beginning on or after January 1, 2026.

SEC. 2064. DISCLOSURE OF LOWER PRICES.

Part E of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg-131) is amended by adding at the end the following new section:

``SEC. 2799B-10. DISCLOSURE OF LOWER PRICES.

``(a) In General.--Beginning January 1, 2026, each health care 
provider and health care facility shall disclose to patients and 
prospective patients enrolled in a group health plan, group or 
individual health insurance coverage, or a Federal health care program 
(as defined in section 1128B but including the program established 
under chapter 89 of title 5, United States Code) being furnished or 
seeking to be furnished an item or service by such provider or facility 
for which benefits are available under such plan, coverage, or program, 
as applicable, whether the amount of cost sharing (including 
deductibles, copayments, and coinsurance) that would be incurred by 
such individual for such item or service under such plan, coverage, or 
program, as applicable, exceeds the charge that would apply for such 
item or service for an individual without benefits under any such plan, 
coverage, or program for such item or service.
``(b) Additional Enforcement.--In addition to any other penalty 
applicable with respect to a violation of subsection (a), an individual 
who is harmed by a violation of this section by a health care provider 
or health care facility may bring an action against such provider or 
facility in an appropriate district court of the United States for--
``(1) appropriate injunctive relief; and
``(2) damages in an amount that is equal to the amount 
provided for such harm in a civil action under the law of the 
State in which the provider or facility is located.''.

Subtitle H--Fighting Waste Fraud and Abuse in the Unaffordable Care Act

SEC. 2071. SHORT TITLE.

This Act may be cited as the ``Fighting Waste Fraud and Abuse in 
the Unaffordable Care Exchanges Act of 2025''.

SEC. 2072. ADDRESSING WASTE, FRAUD, AND ABUSE IN THE ACA EXCHANGES.

(a) Changes to Enrollment Periods for Enrolling in Exchanges.--
Section 1311 of the Patient Protection and Affordable Care Act (42 
U.S.C. 18031) is amended--
(1) in subsection (c)(6)--
(A) by striking subparagraph (A);
(B) by striking ``The Secretary'' and inserting the 
following:
``(A) In general.--The Secretary'';
(C) by redesignating subparagraphs (B) through (D) 
as clauses (i) through (iii) respectively, and 
adjusting the margins accordingly;
(D) in clause (i), as so redesignated, by striking 
``periods, as determined by the Secretary for calendar 
years after the initial enrollment period;'' and 
inserting the following: ``periods for plans offered in 
the individual market--
``(I) for enrollment for plan years 
beginning before January 1, 2027, as 
determined by the Secretary; and
``(II) for enrollment for plan 
years beginning on or after January 1, 
2027, beginning on November 1, and 
ending on December 15 of the preceding 
calendar year;''.
(E) in clause (ii), as so redesignated, by 
inserting ``subject to subparagraph (B),'' before 
``special enrollment period specified''; and
(F) by adding at the end the following new 
subparagraph;
``(B) Prohibited special enrollment period.--With 
respect to plans years beginning on or after January 1, 
2027, the Secretary may not require an Exchange to 
provide for a special enrollment period for an 
individual on the basis of the relationship of the 
income of such individual to the poverty line, other 
than a special enrollment period based on a change in 
circumstances or the occurrence of a specific event.'';
(2) in subsection (d), by adding at the end the following 
new paragraphs:
``(8) Prohibited enrollment periods.--An exchange may not 
provide for, with respect to enrollment for plan years 
beginning on or after January 1, 2027--
``(A) an annual open enrollment period other than 
the period described in subparagraph (A)(i) of 
subsection (c)(6); or
``(B) a special enrollment period described in 
subparagraph (B) of such subsection.
``(9) Verification of eligibility for special enrollment 
periods.--
``(A) In general.--With respect to enrollment for 
plan years beginning on or after January 1, 2027, an 
Exchange shall verify that each individual seeking to 
enroll in a qualified health plan offered by the 
Exchange during a special enrollment period selected 
under paragraph (B) is eligible to enroll during such 
special enrollment period prior to enrolling such 
individual in such plan.
``(B) Selected special enrollment periods.--For 
purposes of subparagraph (A), an Exchange shall select 
one or more special enrollment periods for a plan year 
with respect to which such Exchange shall conduct the 
verification required under subparagraph (A) such that 
the Exchange conducts such verification for not less 
than 75 percent of all individuals enrolling in a 
qualified health plan offered by the Exchange during 
any special enrollment period with respect to such plan 
year.''.
(b) Verifying Income for Individuals Enrolled in a Qualified Health 
Plan Through an Exchange.--
(1) In general.--Section 1411(e)(4) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18081(e)(4)) is 
amended--
(A) by redesignating subparagraph (C) as 
subparagraph (E); and
(B) by inserting after subparagraph (B) the 
following new subparagraphs:
``(C) Requiring verification of income and family 
size when tax data is unavailable.--For plan years 
beginning on or after January 1, 2027, for purposes of 
subparagraph (A), in the case that the Exchange 
requests data from the Secretary of the Treasury 
regarding an individual's household income and the 
Secretary of the Treasury does not return such data, 
such information may not be verified solely on the 
basis of the attestation of such individual with 
respect to such household income, and the Exchange 
shall take the actions described in subparagraph (A).
``(D) Requiring verification of income in the case 
of certain income discrepancies.--
``(i) In general.--Subject to clause (iii), 
for plan years beginning on or after January 1, 
2027, for purposes of subparagraph (A), in the 
case that a specified income discrepancy 
described in clause (ii) of this subparagraph 
exists with respect to the information provided 
by an applicant under subsection (b)(3), the 
household income of such individual shall be 
treated as inconsistent with information in the 
records maintained by persons under subsection 
(c), or as not verified under subsection (d), 
and the Exchange shall take the actions 
described in such subparagraph (A).
``(ii) Specified income discrepancy.--For 
purposes of clause (i), a specified income 
discrepancy exists with respect to the 
information provided by an applicant under 
subsection (b)(3) if--
``(I) the applicant attests to a 
projected annual household income that 
would qualify such applicant to be an 
applicable taxpayer under section 
36B(c)(1)(A) of the Internal Revenue 
Code of 1986 with respect to the 
taxable year involved;
``(II) the Exchange receives data 
from the Secretary of the Treasury or 
other reliable, third party data, that 
indicates that the household income of 
such applicant is less than the 
household income that would qualify 
such applicant to be an applicable 
taxpayer under such section 
36B(c)(1)(A) with respect to the 
taxable year involved;
``(III) such attested projected 
annual household income exceeds the 
income reflected in the data described 
in subclause (II) by a reasonable 
threshold established by the Exchange 
and approved by the Secretary (which 
shall be not less than 10 percent, and 
may also be a dollar amount); and
``(IV) the Exchange has not 
assessed or determined based on the 
data described in subclause (II) that 
the household income of the applicant 
meets the applicable income-based 
eligibility standard for the Medicaid 
program under title XIX of the Social 
Security Act or the State children's 
health insurance program under title 
XXI of such Act.
``(iii) Exclusion of certain individuals 
ineligible for medicaid.--The subparagraph 
shall not apply in the case of an applicant who 
is an alien lawfully present in the United 
States, who is not eligible for the Medicaid 
program under title XIX of the Social Security 
Act by reason of such alien status.''.
(2) Requiring individuals on whose behalf advance payments 
of the premium tax credit are made to file and reconcile on an 
annual basis.--Section 1412(b) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18082(b)) is amended by adding 
at the end the following new paragraph:
``(3) Annual requirement to file and reconcile.--
``(A) In general.--For plan years beginning on or 
after January 1, 2027, in the case of an individual 
with respect to whom any advance payment of the premium 
tax credit allowable under section 36B of the Internal 
Revenue Code of 1986 was made under this section to the 
issuers of a qualified health plan for the relevant 
prior tax year, an advance determination of eligibility 
for such premium tax credit may not be made under this 
subsection with respect to such individual and such 
plan year if the Exchange determines, based on 
information provided by the Secretary of the Treasury, 
that such individual--
``(i) has not filed an income tax return, 
as required under section 6011 and 6012 of such 
code (and implementing regulations), for the 
relevant prior tax year; or
``(ii) as necessarily, has not been 
reconciled (in accordance with subsection (f) 
of such section 36B) the advance payment of the 
premium tax credit made with respect to such 
individual for such relevant prior tax year.
``(B) Relevant prior tax year.--For purposes of 
subparagraph (A), the term `relevant prior tax year' 
means, with respect to the advance determination of 
eligibility made under this subsection with respect to 
an individual, the taxable year for which tax return 
data would be used for purposes of verifying the 
household income and family size of such individual (as 
described in section 1411(b)(3)(A)).
``(C) Preliminary attestation.--If an individual 
subject to subparagraph (A) attests that such 
individual has fulfilled the requirements to file an 
income tax return for the relevant prior tax year and, 
as necessary, to reconcile the advance payment of the 
premium tax credit made with respect to such individual 
for such relevant prior tax year (as described in 
clauses (i) and (ii) of such subparagraph), the 
Secretary may make an initial advance determination of 
eligibility with respect to such individual and may 
delay for a reasonable period (as determined by the 
Secretary) any determination based on information 
provided by the Secretary of the Treasury that such 
individual has not fulfilled such requirements.
``(D) Notice.--If the Secretary determines that an 
individual did not meet the requirements described in 
subparagraph (A) with respect to the relevant prior tax 
year and notifies the Exchange of such determination, 
the Exchange shall comply with the notification 
requirement described in section 155.305(f)(4)(i) of 
title 45, Code of Federal Regulations (as in effect 
with respect to plan year 2025).''.
(3) Removing automatic extension of period to resolve 
income inconsistencies.--The Secretary of Health and Human 
Services shall revise section 155.315(f) of title 45, Code of 
Federal Regulations, to remove paragraph (7) of such section, 
such that, with respect to enrollment for plan years beginning 
on or after January 1, 2027, in the case that an Exchange 
established under subtitle D of title I of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18021 et seq.) 
provides an individual applying for enrollment in a qualified 
health plan with a 90-day period to resolve an inconsistency in 
the application of such individual pursuant to section 
1411(e)(4)(A)(ii)(II) of such Act, the Exchange may not provide 
for an automatic extension to such 90-day period on the basis 
that such individual is required to present satisfactory 
documentary evidence to verify household income.
(c) Revising Rules of Allowable Variation in Actuarial Value of 
Health Plans.--The Secretary of Health and Human Services shall--
(1) revise section 156.140(c) of title 45, Code of Federal 
Regulations, to provide that, for plan years beginning on or 
after January 1, 2027, the allowable variation in the actuarial 
value of a health plan applicable under such section shall be 
the allowable variation for such plan applicable under such 
section for plan year 2022;
(2) revise sections 156.29(b)(3) of title 45, Code of 
Federal Regulations, to provide that, for plan years beginning 
on or after January 1, 2027, the requirement for a qualified 
health plan issuer described in such section is that the issuer 
ensures that each qualified health plan complies with benefit 
design standards, as defined in section 156.20 of such title; 
and
(3) revise section 156.400 of title 45, Code of Federal 
Regulations, to provide that, for plans years beginning on or 
after January 1, 2027, the term ``de minimum variation for a 
silver plan variation'' means a minus 1 percentage point and 
plus 1 percentage point allowable actuarial value variation.
(d) Updating Premium Adjustment Percentage Methodology.--Section 
1302(c)(4) of the Patient Protection and Affordable Care Act (42 U.S.C. 
18022(c)(4)) is amended--
(1) by striking ``For purposes'' and inserting:
``(A) In general.--For purposes''; and
(2) by adding at the end the following new subparagraph:
``(B) Update to methodology.--For calendar years 
beginning with 2027, the premium adjustment percentage 
under this paragraph for such calendar year shall be 
determined consistent with the methodology published in 
the Federal Register on April 25, 2019 (84 Fed. Reg. 
17537 through 17541).''.
(e) Eliminating the Fixed-Dollar and Gross-Percentage Thresholds 
Applicable to Exchange Enrollments.--The Secretary of Health and Human 
Services shall revise section 155.400(g) of title 45, Code of Federal 
Regulations to eliminate, for plan years beginning on or after January 
1, 2027, the gross premium percentage-base premium payment threshold 
policy described in paragraph (2) of such section and the fixed-dollar 
premium payment threshold policy described in paragraph (3) of such 
section.
(f) Prohibiting Automatic Reenrollment From Bronze to Silver Level 
Qualified Health Plans Offered by Exchanges.--The Secretary of Health 
and Human Services shall revise section 155.335(j) of title 45, Code of 
Federal Regulations, to remove paragraph (4) of such section that, with 
respect to reenrollments for plan years beginning on or after January 
1, 2027, an Exchange established under subtitle D of title I of the 
Patient Protection and Affordable Care Act (42 U.S.C. 18021 et seq.) 
may not reenroll an individual who was enrolled in a bronze level 
qualified health plan in a silver level qualified health plan (as such 
terms are defined in section 1301(a) and described in 1302(d) of such 
Act) unless otherwise permitted under section 155.335(j) of title 45, 
Code of Federal Regulations, as in effect on the day before the date of 
the enactment of this section.
(g) Reducing Advance Payments of Premium Tax Credits for Certain 
Individuals Reenrolled in Exchanges.--Section 1412 of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18082) is amended--
(1) in subsection (a)(3), by inserting ``, subject to 
subsection (c)(2)(C),'' after ``qualified health plans''; and
(2) in subsection (c)(2)--
(A) in subparagraph (A), by striking ``The'' and 
inserting ``Subject to subparagraph (C), the''; and
(B) by adding at the end the following 
subparagraph:
``(C) Reduction in advance payment for specified 
reenrolled individuals.--
``(i) In general.--The amount of an advance 
payment made under subparagraph (A) to reduce 
the premium payable for a qualified health plan 
that provides coverage to a specific reenrolled 
individual for an applicable month shall be an 
amount equal to the amount that would otherwise 
be made under such subparagraph reduced by $5 
(or such higher amount as the Secretary 
determines appropriate).
``(ii) Definitions.--In this subparagraph:
``(I) Applicable month.--The term 
`applicable month' means, with respect 
to a specified reenrolled individual, 
any month during a plan year beginning 
on or after January 1, 2027 (or, in the 
case of an individual reenrolled in a 
qualified health plan by an Exchange 
established pursuant to section 
1321(c), January 1, 2027) if, prior to 
the first day of such month, such 
individual has failed to confirm or 
update such information as is necessary 
to redetermine the eligibility of such 
individual for such plan year pursuant 
to section 1411(f).
``(II) Specified reenrolled 
individual.--The term `specified 
reenrolled individual' means an 
individual who is reenrolled in a 
qualified health plan and with respect 
to whom the advance payment made under 
subparagraph (A) would, without 
application of any reduction under this 
subparagraph, reduce the premium 
payable for a qualified health plan 
that provides coverage to such an 
individual to $0.''.
(h) Prohibiting Coverage of Gender Transition Procedures as an 
Essential Health Benefit Under Plans Offered by Exchanges.--
(1) In general.--Section 1302(b)(2) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18022(b)(2)) is 
amended by adding at the end the following new subparagraph:
``(C) Gender transition procedures.--For plan years 
beginning on or after January 1, 2027, the essential 
health benefits defined pursuant to paragraph (1) may 
not include items and services furnished for a gender 
transition procedure.''.
(2) Gender transition procedure defined.--Section 1304 of 
the Patient Protection and Affordable Care Act (42 U.S.C. 
18024) is amended by adding at the end the following new 
subsection:
``(f) Gender Transition Procedure.--
``(1) In general.--In this title, except as provided in 
paragraph (2), the term `gender transition procedure' means, 
with respect to an individual, any of the following when 
performed for this purpose of intentionally changing the body 
of such individual (including by disrupting the body's 
development, inhibiting its natural functions, or modifying its 
appearance) to no longer correspond to the individuals sex:
``(A) Performing any surgery, including--
``(i) castration;
``(ii) sterilization;
``(iii) orchiectomy;
``(iv) scrotoplasty;
``(v) vasectomy;
``(vi) tubal ligation;
``(vii) hysterectomy;
``(viii) oophorectomy;
``(ix) ovariectomy;
``(x) metoidioplasty;
``(xi) clitoroplasty;
``(xii) reconstruction of the fixed part of 
the urethra with or without a metoidioplasty or 
a phalloplasty;
``(xiii) penectomy;
``(xiv) phalloplasty;
``(xv) vaginoplasty;
``(xvi) vaginectomy;
``(xvii) vulvoplasty;
``(xviii) reduction thyrochondroplasty;
``(xix) chrondrolaryngoplasty;
``(xx) mastectomy; and
``(xxi) any plastic, cosmetic, or aesthetic 
surgery that feminizes or masculinizes the 
facial or other body features of an individual.
``(B) Any placement of chest implants to create 
feminine breasts or any placement of erection or 
testicular prostheses.
``(C) Any placement of fat or artificial implants 
in the gluteal region.
``(D) Administering, prescribing, or dispensing to 
an individual medications, including--
``(i) gonadotropin-releasing hormone (GnRH) 
analogues or other puberty-blocking drugs to 
stop or delay normal puberty; and
``(ii) testosterone, estrogen, or other 
androgens to an individual at doses that are 
superphysiologic than would normally be 
produced endogenously in a health individual of 
the same age and sex.
``(2) Exception.--Paragraph (1) shall not apply to the 
following:
``(A) Puberty suppression or blocking prescription 
drugs for the purpose of normalizing puberty for an 
individual experiencing precocious puberty.
``(B) Medically necessary procedures or treatments 
to correct for--
``(i) a medically verifiable disorder of 
sex development, including--
``(I) 46, XX chromosomes with 
virilization;
``(II) 46, XY chromosomes with 
undervirilization; and
``(III) both ovarian and testicular 
tissue;
``(ii) sex chromosome structure, sex 
steroid hormone production, or sex hormone 
action, if determined to be abnormal by a 
physician through genetic or biochemical 
testing;
``(iii) infection, disease, injury, or 
disorder caused or exacerbated by a previous 
procedure described in paragraph (1), or a 
physical disorder, physical injury, or physical 
illness that would, as certified by a 
physician, place the individual in imminent 
danger of death or impairment of a major bodily 
function unless the procedure is performed, not 
including procedures performed for the 
alleviation of mental distress; or
``(iv) procedures to restore or reconstruct 
the body of the individual in order to 
correspond to the individual's sex after one or 
more previous procedures described in paragraph 
(1), which may include the removal of a pseudo 
phallus or breast augmentation.
``(3) Sex.--For purposes of this subsection, the term `sex' 
means either male or female, as biologically determined and 
defined by subparagraph (A) and subparagraph (B).
``(A) Female.--The term `female' means an 
individual who naturally has, had, will have, or would 
have, but for a developmental or genetic anomaly or 
historical accident, the reproductive systems that at 
some point produces, transports, and utilizes eggs for 
fertilization.
``(B) Male.--The term `male' means an individual 
who naturally has, had, will have, or would have, but 
for a developmental or genetic anomaly or historical 
accident, the reproductive system that at some point 
produces, transports, and utilizes sperm for 
fertilization.''.
(i) Ensuring Appropriate Application of Guaranteed Issue 
Requirements in Case of Non-Payment of Past Premiums.--
(1) In general.--Section 2702 of the Public Health Service 
Act (42 U.S.C. 300gg-1) is amended by adding at the end the 
following new subsection:
``(e) Nonpayment of Past Premiums.--
``(1) In general.--A health insurance issuer offering 
individual health coverage may, to the extent allowed under 
State law, deny such coverage in the case of an individual who 
owes any amount for premiums for individual health insurance 
coverage offered by such issuer (or by a health insurance 
issuer in the same controlled group (as defined in paragraph 
(3)) as such issuer) in which such individual was previously 
enrolled.
``(2) Attribution of initial premium payment owed amount.--
A health insurance issued offering individual health insurance 
coverage may, in the case of an individual described in 
paragraph (1) and to the extent allowed under State law, 
attribute the initial premium payment for such coverage 
applicable to such individual to the amount owed by such 
individual for premiums for individual health insurance 
coverage offered by such issuer (or by a health insurance 
issuer in the same controlled group as the issuer) in which 
such individual was previously enrolled.
``(3) Controlled group defined.--For purposes of this 
subsection, the term `controlled group' means a group of two or 
more persons that is treated as a single employed under section 
52(a), 52(b), 414(m), or 414(o) of the Internal Revenue Code of 
1986.''.
(2) Effective date.--The amendment made by paragraph (1) 
shall apply with respect to plan years beginning on or after 
January 1, 2027.

SEC. 2073. FUNDING COST-SHARING REDUCTION PAYMENTS.

Section 1402 of the Patient Protection and Affordable Care Act (42 
U.S.C. 18071) is amended by adding at the end the following new 
subsection:
``(h) Funding.--
``(1) In general.--There are appropriated out of any monies 
in the Treasury not otherwise appropriated such sums as may be 
necessary for purposes of making payments under this section 
for plan years beginning on or after January 1, 2027.
``(2) Limitation.--
``(A) In general.--The amounts appropriated under 
paragraph (1) may not be used for purposes of making 
payments under this section for a qualified health plan 
that provides health benefit coverage that includes 
coverage of abortion.
``(B) Exception.--Subparagraph (A) shall not apply 
to payments for a qualified health plan that provides 
coverage of abortion only if necessary to save the life 
of the mother or if the pregnancy is a result of an act 
of rape or incest.''.

TITLE III--ENDING TAXPAYER FUNDING FOR ABORTION AND GENDER TRANSITION 
PROCEDURES

Subtitle A--No Taxpayer Funding for Abortion and Abortion Insurance 
Full Disclosure Act of 2025

SEC. 3000. APPLICABILITY TO ENTIRE ACT.

(a) Notwithstanding any other provision of law, the prohibitions 
and limitations set forth in this title, including the amendments made 
by this title, shall apply to all funds authorized or appropriated 
under this Act, including under title I, title II, and every subtitle 
thereof, and to any trust fund to which such funds are contributed.
(b) Effective Date.--This section shall take effect on the date of 
the enactment of this Act.

SEC. 3001. SHORT TITLE.

This Act may be cited as the ``No Taxpayer Funding for Abortion and 
Abortion Insurance Full Disclosure Act of 2025''.

SEC. 3002. PROHIBITING TAXPAYER FUNDED ABORTIONS.

Title 1, United States Code, is amended by adding at the end the 
following new chapter:

``CHAPTER 4--PROHIBITING TAXPAYER FUNDED ABORTIONS

``Sec. 301. Prohibition on funding for abortions
``No funds authorized or appropriated by Federal law, and none of 
the funds in any trust fund to which funds are authorized or 
appropriated by Federal law, shall be expended for any abortion.
``Sec. 302. Prohibition on funding for health benefits plans that cover 
abortion
``None of the funds authorized or appropriated by Federal law, and 
none of the funds in any trust fund to which funds are authorized or 
appropriated by Federal law, shall be expended for health benefits 
coverage that includes coverage of abortion.
``Sec. 303. Limitation on federal facilities and employees
``No health care service furnished--
``(1) by or in a health care facility owned or operated by 
the Federal Government; or
``(2) by any physician or other individual employed by the 
Federal Government to provide health care services within the 
scope of the physician's or individual's employment, may 
include abortion.
``Sec. 304. Construction relating to separate coverage
``Nothing in this chapter shall be construed as prohibiting any 
individual, entity, or State or locality from purchasing separate 
abortion coverage or health benefits coverage that includes abortion so 
long as such coverage is paid for entirely using only funds not 
authorized or appropriated by Federal law and such coverage shall not 
be purchased using matching funds required for a federally subsidized 
program, including a State's or locality's contribution of Medicaid 
matching funds.
``Sec. 305. Construction relating to the use of non-federal funds for 
health coverage
``Nothing in this chapter shall be construed as restricting the 
ability of any non-Federal health benefits coverage provider from 
offering abortion coverage, or the ability of a State or locality to 
contract separately with such a provider for such coverage, so long as 
only funds not authorized or appropriated by Federal law are used and 
such coverage shall not be purchased using matching funds required for 
a federally subsidized program, including a State's or locality's 
contribution of Medicaid matching funds.
``Sec. 306. Non-preemption of other federal laws
``Nothing in this chapter shall repeal, amend, or have any effect 
on any other Federal law to the extent such law imposes any limitation 
on the use of funds for abortion or for health benefits coverage that 
includes coverage of abortion, beyond the limitations set forth in this 
chapter.
``Sec. 307. Construction relating to complications arising from 
abortion
``Nothing in this chapter shall be construed to apply to the 
treatment of any infection, injury, disease, or disorder that has been 
caused by or exacerbated by the performance of an abortion. This rule 
of construction shall be applicable without regard to whether the 
abortion was performed in accord with Federal or State law, and without 
regard to whether funding for the abortion is permissible under section 
308.
``Sec. 308. Treatment of abortions related to rape, incest, or 
preserving the life of the mother
``The limitations established in sections 301, 302, and 303 shall 
not apply to an abortion--
``(1) if the pregnancy is the result of an act of rape or 
incest; or
``(2) in the case where a woman suffers from a physical 
disorder, physical injury, or physical illness that would, as 
certified by a physician, place the woman in danger of death 
unless an abortion is performed, including a life-endangering 
physical condition caused by or arising from the pregnancy 
itself.
``Sec. 309. Application to district of columbia
``In this chapter:
``(1) Any reference to funds appropriated by Federal law 
shall be treated as including any amounts within the budget of 
the District of Columbia that have been approved by an Act of 
Congress pursuant to section 446 of the District of Columbia 
Home Rule Act (or any applicable successor Federal law).
``(2) The term `Federal Government' includes the Government 
of the District of Columbia.''.

SEC. 3003. AMENDMENT TO TABLE OF CHAPTERS.

The table of chapters for title 1, United States Code, is amended 
by adding at the end the following new item:

``4 Prohibiting taxpayer funded abortions................... 301''.

SEC. 3004. CLARIFYING APPLICATION OF PROHIBITION TO PREMIUM CREDITS AND 
COST-SHARING REDUCTIONS UNDER ACA.

(a) In General.--
(1) Disallowance of refundable credit and cost-sharing 
reductions for coverage under qualified health plan which 
provides coverage for abortion.--
(A) In general.--Subparagraph (A) of section 
36B(c)(3) of the Internal Revenue Code of 1986 is 
amended by inserting before the period at the end the 
following: ``or any health plan that includes coverage 
for abortions (other than any abortion or treatment 
described in section 307 or 308 of title 1, United 
States Code)''.
(B) Option to purchase or offer separate coverage 
or plan.--Paragraph (3) of section 36B(c) of such Code 
is amended by adding at the end the following new 
subparagraph:
``(C) Separate abortion coverage or plan allowed.--
``(i) Option to purchase separate coverage 
or plan.--Nothing in subparagraph (A) shall be 
construed as prohibiting any individual from 
purchasing separate coverage for abortions 
described in such subparagraph, or a health 
plan that includes such abortions, so long as 
no credit is allowed under this section with 
respect to the premiums for such coverage or 
plan.
``(ii) Option to offer coverage or plan.--
Nothing in subparagraph (A) shall restrict any 
non-Federal health insurance issuer offering a 
health plan from offering separate coverage for 
abortions described in such subparagraph, or a 
plan that includes such abortions, so long as 
premiums for such separate coverage or plan are 
not paid for with any amount attributable to 
the credit allowed under this section (or the 
amount of any advance payment of the credit 
under section 1412 of the Patient Protection 
and Affordable Care Act).''.
(2) Disallowance of small employer health insurance expense 
credit for plan which includes coverage for abortion.--
Subsection (h) of section 45R of the Internal Revenue Code of 
1986 is amended--
(A) by striking ``Any term'' and inserting the 
following:
``(1) In general.--Any term''; and
(B) by adding at the end the following new 
paragraph:
``(2) Exclusion of health plans including coverage for 
abortion.--
``(A) In general.--The term `qualified health plan' 
does not include any health plan that includes coverage 
for abortions (other than any abortion or treatment 
described in section 307 or 308 of title 1, United 
States Code).
``(B) Separate abortion coverage or plan allowed.--
``(i) Option to purchase separate coverage 
or plan.--Nothing in subparagraph (A) shall be 
construed as prohibiting any employer from 
purchasing for its employees separate coverage 
for abortions described in such subparagraph, 
or a health plan that includes such abortions, 
so long as no credit is allowed under this 
section with respect to the employer 
contributions for such coverage or plan.
``(ii) Option to offer coverage or plan.--
Nothing in subparagraph (A) shall restrict any 
non-Federal health insurance issuer offering a 
health plan from offering separate coverage for 
abortions described in such subparagraph, or a 
plan that includes such abortions, so long as 
such separate coverage or plan is not paid for 
with any employer contribution eligible for the 
credit allowed under this section.''.
(3) Conforming aca amendments.--Section 1303(b) of Public 
Law 111-148 (42 U.S.C. 18023(b)) is amended--
(A) by striking paragraph (2);
(B) by striking paragraph (3), as amended by 
section 202(a); and
(C) by redesignating paragraph (4) as paragraph 
(2).
(b) Application to Multi-State Plans.--Paragraph (6) of section 
1334(a) of Public Law 111-148 (42 U.S.C. 18054(a)) is amended to read 
as follows:
``(6) Coverage consistent with federal abortion policy.--In 
entering into contracts under this subsection, the Director 
shall ensure that no multi-State qualified health plan offered 
in an Exchange provides health benefits coverage for which the 
expenditure of Federal funds is prohibited under chapter 4 of 
title 1, United States Code.''.
(c) Effective Date.--The amendments made by subsection (a) shall 
apply to taxable years ending after December 31, 2025, but only with 
respect to plan years beginning after such date, and the amendment made 
by subsection (b) shall apply to plan years beginning after such date.

SEC. 3005. REVISION TO NOTICE REQUIREMENTS REGARDING DISCLOSURE OF 
EXTENT OF HEALTH PLAN COVERAGE OF ABORTION AND ABORTION 
PREMIUM SURCHARGES.

(a) In General.--Paragraph (3) of section 1303(b) of Public Law 
111-148 (42 U.S.C. 18023(b)) is amended to read as follows:
``(3) Rules relating to notice.--
``(A) In general.--The extent of coverage (if any) 
of services described in paragraph (1)(B)(i) or 
(1)(B)(ii) by a qualified health plan shall be 
disclosed to enrollees at the time of enrollment in the 
plan and shall be prominently displayed in any 
marketing or advertising materials, comparison tools, 
or summary of benefits and coverage explanation made 
available with respect to such plan by the issuer of 
the plan, by an Exchange, or by the Secretary, 
including information made available through an 
internet portal or Exchange under sections 1311(c)(5) 
and 1311(d)(4)(C).
``(B) Separate disclosure of abortion surcharges.--
In the case of a qualified health plan that includes 
the services described in paragraph (1)(B)(i) and where 
the premium for the plan is disclosed, including in any 
marketing or advertising materials or any other 
information referred to in subparagraph (A), the 
surcharge described in paragraph (2)(B)(i)(II) that is 
attributable to such services shall also be disclosed 
and identified separately.''.
(b) Effective Date.--The amendment made by subsection (a) shall 
apply to materials, tools, or other information made available more 
than 30 days after the date of the enactment of this Act.

Subtitle B--Prohibiting Federal Funding for Gender Transition 
Procedures

SEC. 3006. SHORT TITLE.

This Act may be cited as the ``End Taxpayer Funding of Gender 
Experimentation Act of 2025''

SEC. 3007. PROHIBITING FEDERAL FUNDING FOR GENDER TRANSITION 
PROCEDURES.

(a) Definition.--In this section, the term ``Specified sex-trait 
modification procedure'' means any pharmaceutical or surgical 
intervention that is provided for the purpose of attempting to align an 
individual's physical appearance or body with an asserted identity that 
differs from the individual's sex either by:
(1) Intentionally disrupting or suppressing the normal 
development of natural biological functions, including primary 
or secondary sex-based traits; or
(2) Intentionally altering an individual's physical 
appearance or body, including amputating, minimizing or 
destroying primary or secondary sex-based traits such as the 
sexual and reproductive organs.
(3) This term does not include procedures undertaken:
(A) To treat a person with a medically verifiable 
disorder of sexual development; or
(B) For purposes other than attempting to align an 
individual's physical appearance or body with an 
asserted identity that differs from the individual's 
sex.
(b) General Prohibition.--Notwithstanding any other provision of 
law, no Federal funds (including funds provided through grants, 
contracts, insurance, or any other means) may be used to pay for, 
reimburse, or otherwise support any specified sex-trait modification 
procedure.
(c) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act and shall apply to 
payments, reimbursements, and services provided on or after such date.
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