Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, 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.
This bill amends the Affordable Care Act to establish a reinsurance program for certain health insurance plans and create new flexibility in how insurance is regulated and priced. The legislation creates a $50-per-member-month reinsurance program (capped at $6 billion annually from 2026–2030) to help lower premiums for individuals enrolled in off-exchange health plans, administered by the Department of Health and Human Services. It also allows insurers to opt out of the ACA's standard single risk pool requirement for certain individual market plans, removes age-based premium limitations for these opt-out plans (allowing higher premiums for older adults), and requires transparency measures such as disclosing whether out-of-network costs can count toward deductibles and out-of-pocket maximums, as well as requiring providers to inform patients when their cost-sharing would exceed what an uninsured person would pay. The bill's provisions take effect for plan years beginning January 1, 2026, and create private enforcement mechanisms allowing individuals to sue providers who fail to disclose pricing information.
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