(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.

(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.

(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.

(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

(e) Effective date

The amendments made by this section shall apply to distributions made after December 31, 2025.

(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.

(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.

(a) Increase

(b) Inflation adjustment

Section 223(g), as amended by the preceding provisions of this Act, is amended—

(c) Effective date

(a) In general

Section 223(d)(2) of the Internal Revenue Code of 1986 is amended—

(b) Effective date

The amendment made by this section shall apply to plan years beginning after December 31, 2025.

(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.

(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.

(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.

(a) In general

Section 3(5) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1002(5)) is amended—

(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.

(a) In general

Section 9815(b) is amended—

(b) Inclusion of CHOICE arrangement permitted benefits on W–2

(c) Treatment of current rules relating to certain arrangements

(d) Effective date

The amendments made by this section shall apply to plan years beginning after December 31, 2025.

(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.

(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:

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—

(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.

(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.

(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:

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:

(a) In general

Section 1302(e)(2) of the Patient Protection and Affordable Care Act (42. U.S.C. 18022(e)(2) is amended—

(b) Effective date

The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2026.

(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:

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

(c) Removing age premium variation limitation for certain plans

(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)).

(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:

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.

(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—

(b) Verifying income for individuals enrolled in a qualified health plan through an exchange

(c) Revising rules of allowable variation in actuarial value of health plans

The Secretary of Health and Human Services shall—

(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—

(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—

(h) Prohibiting coverage of gender transition procedures as an essential health benefit under plans offered by exchanges

(i) Ensuring appropriate application of guaranteed issue requirements in case of non-Payment of past premiums

(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.

(a) In general

(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.

(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.

(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:

(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.