Great American Healthcare Plan

This provision significantly increases the maximum annual contribution limits for Health Savings Accounts (HSAs). Instead of the current tiered limits based on individual or family coverage, the new limit is tied to the applicable dollar amount for elective deferrals under section 402(g)(1)(B) of the Internal Revenue Code, which is generally much higher. It also retains an additional catch-up contribution for individuals aged 50 or older.

This section amends the Internal Revenue Code to remove the requirement that an individual must be covered by a high-deductible health plan (HDHP) to be eligible to contribute to a Health Savings Account (HSA). It strikes subsections (c) and (g) of section 223, which previously defined 'eligible individual' and linked HSA eligibility to HDHP coverage. This change broadens HSA eligibility to virtually any individual.

This section expands the definition of 'qualified medical expenses' for HSAs to include amounts paid for health insurance premiums and payments made for direct primary care service arrangements. Previously, HSA funds could only be used for certain health insurance premiums (e.g., COBRA, long-term care, Medicare). This change allows individuals to use their HSA funds to pay for a broader range of health insurance and direct primary care fees.

This provision expands the definition of 'qualified medical expenses' to include 'qualified wellness expenses,' which encompass healthy food, vitamins, dietary supplements, and qualified sports and fitness expenses. There are monthly limits on these expenses, tiered by 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. Specific definitions are provided for 'healthy food' and 'qualified sports and fitness expenses,' including facility memberships, instruction, and equipment.

This section amends ERISA to allow 'health marketplace pools' to be deemed an 'employer' for the purpose of offering group health plans or group health insurance coverage. These pools must meet specific requirements, including being formed in good faith to create a risk pool, not conditioning membership on health status, and offering coverage to all members at established rates. They can offer drug coverage as a standalone benefit and provide administrative services. This effectively creates a new type of entity that can offer group health benefits.

This section significantly strengthens existing hospital price transparency rules. It requires hospitals to publicly disclose all standard charges (gross charge, discounted cash price, payer-specific negotiated charges, de-identified maximum/minimum negotiated charges) for every item and service, in a machine-readable format, and a consumer-friendly format for at least 300 shoppable services (all shoppable services by 2028). It mandates monthly updates, prohibits price estimator tools from being deemed compliant, establishes annual compliance monitoring, requires attestation by senior officials, and imposes substantial civil monetary penalties for non-compliance, tiered by hospital bed count, with no waivers or mitigation.

These sections extend the detailed price transparency requirements, similar to those for hospitals, to clinical diagnostic laboratories, imaging service providers, and ambulatory surgical centers (ASCs). These entities must publicly disclose gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified maximum/minimum negotiated charges for their services in machine-readable and consumer-friendly formats. Labs and imaging centers must update annually, while ASCs must update annually for shoppable services. Enforcement mechanisms, including civil monetary penalties, are also established for non-compliance.

This section amends the Patient Protection and Affordable Care Act to strengthen transparency requirements for health plans and insurers. It mandates a self-service tool providing real-time, accurate information on in-network rates, maximum allowed amounts for out-of-network, patient cost-sharing, accumulated deductibles/out-of-pocket maximums, and prior authorization requirements. It also requires monthly public submission of detailed rate and payment information (in-network rates, historical net drug prices, out-of-network billed/allowed amounts) in machine-readable files. An officer attestation for accuracy is required, and audits by the Secretaries of HHS and Labor are mandated, with civil monetary penalties for non-compliance.

This section amends ERISA to ensure group health plans have full access to claims and encounter information, medical records, and policy documents from their service providers (including health care providers, networks, and third-party administrators). It prohibits contractual provisions that limit or delay this access, restrict audit scope, or limit disclosure of pricing terms for value-based arrangements, overpayments, or administrative fees. It also voids any such restrictive provisions as against public policy and establishes a civil penalty of $10,000 per day for violations. Additionally, it updates attestation requirements for plans to verify compliance with data access and gag clause provisions.

This section further strengthens oversight of health plan service providers (including providers, networks, TPAs, etc.) by requiring them to provide group health plans with quarterly disclosures of detailed information. This includes contractual and subcontractual calculation methodologies, all rebates, fees, and remuneration received or paid, and all payment data related to alternative compensation arrangements (e.g., ACOs, value-based programs). It prohibits agreements that limit or delay this disclosure and voids such provisions as against public policy. Non-compliance incurs a civil penalty of $100,000 per day.

This section mandates that group health plans and health insurance issuers provide an itemized Explanation of Benefits (EOB) to participants within 45 days of receiving a payment request. The EOB must be in clear, understandable language and include whether the provider is in-network, a plain language description of each item/service with billing codes, the amount the plan is responsible for, the patient's cost-sharing, amounts incurred towards deductibles/out-of-pocket maximums, and the site of service. This aims to provide patients with a comprehensive and clear breakdown of costs and coverage post-service.

This section requires healthcare providers and facilities to provide a written, itemized bill to individuals within 30 days of receiving final payment from a third party. The bill must include a plain language description of each item/service, all applicable billing codes, the price and billed amount, any payments already made, language assistance information, contact details for bill discussion, and charity care policies. It prohibits collection actions if the provider fails to comply or if the billed amount exceeds a good faith estimate (unless medically necessary due to unforeseen complications), with the burden of proof on the provider. Penalties of up to $10,000 per instance of non-compliance are established.

This section amends the Social Security Act to modify how Medicare Part B pays for 'selected drugs' subject to maximum fair price (MFP) negotiation. It requires manufacturers of these drugs to pay a rebate to the Federal Supplementary Medical Insurance Trust Fund. The rebate amount is calculated based on the difference between the ASP+6 (Average Sales Price plus 6%) payment amount and the MFP+6 payment amount, taking into account beneficiary coinsurance. This means beneficiaries' coinsurance for selected drugs will be based on the lower MFP+6 amount, and manufacturers will rebate the difference to Medicare. Civil monetary penalties apply for non-compliance.

This section amends the Federal Food, Drug, and Cosmetic Act to establish a new category of 'expanded-access prescription drugs.' The Secretary of HHS is required to create and maintain a list of such drugs, designated based on safety data, low risk, and suitability for assessment in a pharmacy or similar setting (e.g., certain antibiotics, antivirals, hormonal therapies). These drugs may 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. State laws conflicting with this are preempted, though states can explicitly opt-out.