Health Care Freedom for Patients Act of 2025A statutory framework enacted by the U.S. Senate to provide health savings account contributions to certain enrollees, reduce health care costs, and address specified coverage and funding policies in federal health programs.
This non-authoritative StratML Part 1 rendition reflects the structure and intent of draft Senate legislation identified as OTT25772 6N2 S.L.C., commonly cited as the "Health Care Freedom for Patients Act of 2025". It has been structured in accordance with ISO 17469-1 (StratML Part 1: Strategic Plans).
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Submitter's Note: It was compiled from the source by ChatPT.
U.S. Senate10f50517-563b-4a61-9e72-9875f28a06a9
The upper chamber of the United States Congress responsible for considering and enacting federal legislation, including health policy reforms affecting federal health programs and tax law.
Senator Mike Crapo
Chair of the Senate Finance Committee and sponsor of the Health Care Freedom for Patients Act of 2025.
Senator Bill Cassidy
Chair of the Senate health panel and co-sponsor of the Health Care Freedom for Patients Act of 2025.
A health care system that empowers individuals with choice, affordability, and financial control.
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To provide a health savings account contribution to certain enrollees, to reduce health care costs, and for other purposes.
62e2692b-1744-467d-92fe-bb1b831bbc33Choice and Premiums
Increase coverage choice and reduce premiums for individuals in the health insurance Exchanges through the use of Exchange health savings accounts, targeted contributions, and strengthened cost-sharing reduction funding, while broadening access to lower-premium plan options.
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TITLE I — INCREASING CHOICE AND REDUCING PREMIUMS.
Exchange Health Savings Accounts
Establish Exchange plan HSAs within the Internal Revenue Code to govern their designation, rollover treatment, and permissible uses, including restrictions on certain abortion services and sex trait modification procedures as qualified medical expenses.
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Section 101. Exchange plan HSAs. Adds subsection (i) to section 223 of the Internal Revenue Code of 1986 to define "Exchange plan HSA", disallow rollovers except between Exchange HSAs, and provide that amounts spent on specified abortions or sex trait modification procedures (as defined in 45 CFR 156.400) are not treated as paid for medical care.
Exchange HSA Contributions
Provide monthly federal contributions to the Exchange HSAs of eligible enrollees in bronze-level or catastrophic plans to support out-of-pocket health costs and encourage enrollment in lower-premium coverage.
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Section 102. Exchange plan HSA contribution program. Directs the Secretary of Health and Human Services to make payments to the Exchange plan HSA of each eligible enrollee for eligible months in 2026 and 2027, in amounts equal to 1/12 of $1,000 (ages 18–49) or 1/12 of $1,500 (ages 50–64), based on income, age, immigration, and plan enrollment criteria, and excludes such payments from gross income for tax purposes.
Cost-Sharing Reduction Funding
Appropriate funding for cost-sharing reduction payments beginning in 2027 while restricting the use of such funds for plans that cover abortion services except in limited circumstances.
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Section 103. Funding cost-sharing reduction payments. Amends section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) to appropriate such sums as necessary for CSR payments for plan years beginning on or after January 1, 2027, and prohibits their use for plans covering abortion except to save the life of the mother or in cases of rape or incest.
Catastrophic Coverage Option
Expand access to catastrophic plans and integrate their enrollees into individual market risk pools so that all individuals purchasing coverage in the individual market may select lower-premium catastrophic plan options.
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Section 104. Allowing all individuals purchasing health insurance in the individual market the option to purchase a lower premium plan. Amends sections 1302(e) and 1312 of the Patient Protection and Affordable Care Act to broaden eligibility for catastrophic plans, integrate catastrophic enrollees into Exchange risk pools, and eliminate prior enrollment restrictions based on age and hardship exemptions.
American Patients
Prioritize American patients in federal health spending by aligning federal matching payments and financial participation rules with state policies on coverage and by tightening eligibility verification for Medicaid and CHIP benefits.
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TITLE II — PUTTING AMERICAN PATIENTS FIRST.
FMAP Expansion Rules
Modify the enhanced federal medical assistance percentage for Medicaid expansion States that provide comprehensive health coverage or subsidies to certain nonqualified aliens, thereby conditioning enhanced matching funds on state coverage policies.
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Section 201. Expansion FMAP for certain States providing payments for health care furnished to certain individuals. Amends section 1905 of the Social Security Act (42 U.S.C. 1396d) to define "specified State" and adjust the expansion FMAP for States that fund health coverage or financial assistance for certain aliens who are not qualified aliens or otherwise eligible under Medicaid or CHIP provisions.
Eligibility Verification Requirements
Prohibit federal financial participation in Medicaid and CHIP for individuals whose citizenship, nationality, or satisfactory immigration status has not been verified within specified reasonable opportunity periods, while giving States the option to continue coverage during those periods under defined conditions.
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Section 202. Prohibiting Federal financial participation under Medicaid and CHIP for individuals without verified citizenship, nationality, or satisfactory immigration status. Amends sections 1903, 1902, 1905, 1902(ee), 2105, 2107, and 1137 of the Social Security Act to limit FFP for unverified individuals, adjust reasonable opportunity period rules, and create an option for States to continue providing assistance during verification periods with specific conditions, effective October 1, 2026.
Wasteful Spending
Reduce federal health care spending deemed wasteful by prohibiting certain benefits and restrictions on coverage for specified gender transition procedures under Exchange plans, Medicaid, and CHIP.
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TITLE III — PREVENTING WASTEFUL SPENDING.
Exchange Gender Transition Benefits
Bar the inclusion of gender transition procedures as essential health benefits in plans offered through the Exchanges beginning in plan year 2027, while defining the scope and limited exceptions for such procedures.
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Section 301. Prohibiting coverage of gender transition procedures as an essential health benefit under plans offered by Exchanges. Amends section 1302(b)(2) of the Patient Protection and Affordable Care Act to exclude gender transition procedures from essential health benefits for plan years starting on or after January 1, 2027, and adds definitions for "gender transition procedure" and "sex" in section 1304, including enumerated surgeries, medications, and specified medical exceptions.
Medicaid Gender Transition Funding
Prohibit federal Medicaid and CHIP funding for specified gender transition procedures, while defining allowable exceptions and clarifying biological sex terms for the purposes of these funding restrictions.
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Section 302. Prohibiting Federal Medicaid and CHIP funding for certain items and services. Amends sections 1903, 1905, and 2107 of the Social Security Act to deny FFP for specified gender transition procedures furnished to Medicaid enrollees and to extend similar restrictions to CHIP, defining "specified gender transition procedure" and related exceptions, including treatment of disorders of sex development and certain medically necessary interventions.
2025-12-09https://www.finance.senate.gov/imo/media/doc/health_care_freedom_for_patients_act.pdfOwenAmburOwen.Ambur@verizon.net