Great American Healthcare Act

This section significantly increases the amount individuals can contribute to Health Savings Accounts (HSAs) annually. It ties the new limit to the applicable dollar amount for 401(k) contributions (currently $23,000 for 2024, much higher than current HSA limits) and retains an additional catch-up contribution for those aged 50 or older. It also removes previous restrictions related to high-deductible health plans.

This section removes the requirement that an individual must be covered by a high-deductible health plan (HDHP) to be eligible for a Health Savings Account (HSA). It strikes subsections (c) and (g) of IRC Section 223, which defined "eligible individual" and included rules for HDHP coverage. This fundamentally changes HSA eligibility.

This section allows Health Savings Account (HSA) funds to be used for health insurance premiums (by striking previous prohibitions) and for payments to direct primary care service arrangements. It also expands the definition of "dependent" for HSA purposes to include children up to age 27, aligning with ACA provisions.

This section allows Health Savings Account (HSA) funds to be used for "qualified wellness expenses," including healthy food, vitamins, dietary supplements, and sports and fitness expenses. There are monthly spending caps tied to the HSA balance: $100/month for balances up to $5,000, $150/month for balances between $5,000 and $10,000, and $200/month for balances over $10,000. It defines "healthy food" and "qualified sports and fitness expenses" with specific criteria.

This section allows employers to satisfy the Affordable Care Act's (ACA) employer mandate by contributing at least $450 per month to an employee's Health Savings Account (HSA). Such an offer would be treated as an offer of minimum essential coverage and affordable coverage. However, the employee must be enrolled in health care coverage for the HSA contribution to be excludable from gross income.

These sections introduce a new type of account called a "Trump account" (defined by reference to IRC Section 530A(b), which refers to Coverdell Education Savings Accounts, but the context here is clearly for a new type of account). Section 115 allows up to $5,000 from an HSA to be transferred directly to a "Trump account" for an eligible individual without penalty. Section 116 allows the entire balance of an HSA to be rolled over to a "Trump account" upon the death of the HSA holder, also without being included in gross income.

This section amends ERISA to allow "health marketplace pools" to be deemed "employers" for the purpose of offering group health plans or group health insurance coverage. These pools must be formed in good faith to create a risk pool, cannot condition membership on health status, and must offer coverage to all members at established rates. They can offer drug coverage as a standalone benefit. The section clarifies that participation in these pools does not create an employer or joint employer relationship for other purposes.

This section significantly strengthens existing hospital price transparency rules. Hospitals must monthly publish all standard charges (gross, discounted cash, payer-specific negotiated, and de-identified max/min negotiated charges) in a machine-readable format. They must also publish consumer-friendly prices for at least 300 shoppable services by 2027, expanding to all shoppable services thereafter. A senior official must attest to accuracy. Penalties for non-compliance are substantially increased, ranging from $300/day for small hospitals to $35/bed/day for large hospitals, with additional penalties for persistent noncompliance (up to $10 million). Price estimator tools do not count as compliance.

This section mandates that clinical diagnostic laboratories publicly disclose prices for specified tests on their websites, starting July 1, 2028. This includes gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified maximum/minimum negotiated charges. The information must be updated monthly and provided in a machine-readable format. Penalties for non-compliance are up to $300 per day.

This section requires providers and suppliers of specified imaging services (e.g., MRI, CT scans) to publicly disclose their prices on an internet website, starting July 1, 2028. Similar to hospitals and labs, this includes gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified maximum/minimum negotiated charges, in a machine-readable format, updated annually. Non-compliance can result in civil monetary penalties of up to $300 per day.

This section significantly strengthens transparency requirements for health plans and insurers. It mandates a self-service tool providing real-time, personalized cost-sharing information for items and services, including deductibles, out-of-pocket maximums, and prior authorization requirements. It also requires monthly public disclosure of in-network rates, historical net prices for drugs, and out-of-network allowed amounts in machine-readable files. An officer must attest to accuracy, and the Secretary will audit compliance. Penalties for non-compliance are up to $300 per member per day or $10 million, whichever is less.

This section amends ERISA to require "Covered Service Providers" (including health care providers, networks, and third-party administrators) to provide group health plans with access to all claims and encounter information, medical records, and documentation supporting payments. It prohibits contract terms that limit or delay this access, restrict audit scope, or limit disclosure of pricing terms for value-based arrangements, overpayments, or administrative fees. Violations can incur a $10,000 per day civil penalty.

This section mandates that group health plans and insurers provide participants with an itemized Explanation of Benefits (EOB) within 45 days of receiving a payment request. The EOB must include whether the provider is in-network, a plain language description of each item/service, all billing codes, the amount the plan is paying, the patient's cost-sharing, and their progress towards deductibles/out-of-pocket maximums.

This section requires healthcare providers and facilities to provide patients with a written, itemized bill for each service within 30 days of receiving final payment from a third party. The bill must include plain language descriptions, billing codes, prices, payments made by or on behalf of the individual, language assistance info, contact for questions, and charity care policies. It prohibits collection actions if the provider fails to comply or if the billed amount exceeds a good faith estimate without documented unforeseen complications or patient-initiated changes. Penalties for non-compliance are up to $10,000 per instance.

This section amends Medicare Part B drug pricing. It removes the previous exemption for "selected drugs" from the ASP+6 payment methodology. Instead, for selected drugs subject to maximum fair price negotiation, manufacturers must pay a rebate to the Federal Supplementary Medical Insurance Trust Fund. The rebate amount is calculated based on the difference between the ASP+6 payment amount (less coinsurance) and the MFP+6 payment amount (less coinsurance), multiplied by the number of units furnished. Beneficiary coinsurance for these drugs will be based on the MFP+6 amount. Civil monetary penalties apply for non-compliance.

This section directs the Secretary of Health and Human Services to establish a list of "expanded-access prescription drugs" (e.g., certain antibiotics, antivirals, hormonal therapies) that can be dispensed and administered by "covered individuals" (pharmacists, advanced practice registered nurses, physician assistants, etc.) after an appropriate patient assessment, consistent with Secretary-issued protocols. It preempts state laws that would prohibit or limit this, unless a state explicitly opts out.

This section repeals the authority of the Federal Reserve to pay interest on reserve balances held by depository institutions. It also makes conforming amendments to the Federal Reserve Act, including establishing an "Earnings Participation Account" for supplemental reserves.