S. 3264 would allow states to opt out of major Affordable Care Act requirements starting in 2026, including coverage mandates, subsidies, and the individual mandate, as long as they establish high-risk insurance pools to protect insurers. States choosing to participate would redirect federal subsidies that individuals would have received into new "Trump Health Freedom Accounts"—modified health savings accounts for medical expenses—though these accounts could not be used for abortion services or gender transition procedures. The bill also imposes restrictions on healthcare coverage related to gender transition, expands tax credits for small employers in participating states, and requires the Health and Human Services Secretary to strengthen healthcare price transparency requirements within 90 days of enactment, including standardized pricing disclosures and public reporting of provider outcome data. This legislation fundamentally restructures how states can manage health insurance coverage and access to certain healthcare services while emphasizing price transparency and employer incentives.
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