Primary and Behavioral Health Care Access Act of 2026
- Sponsor
- Rep. Underwood, Lauren [D-IL-14]
- Committees
- Ways and Means Committee (primary)
- Last action
- Jun 11, 2026
Bottom line
The bill aims to enhance access to essential primary and behavioral healthcare by eliminating out-of-pocket costs for a set number of initial visits, potentially increasing utilization and improving public health outcomes.
What it actually does
This bill amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act (PHSA), and the Internal Revenue Code of 1986 (IRC) to mandate that group health plans and health insurance issuers provide coverage for three primary care visits and three behavioral health care visits per plan year without any cost-sharing requirements. It also ensures that these mandated visits are not subject to more restrictive treatment limitations or different reimbursement rates than other covered services.
Proponents argue
Supporters argue that removing financial barriers to primary and behavioral healthcare will encourage individuals to seek preventative care and early intervention for health conditions, leading to improved long-term health outcomes, reduced health disparities, and potentially lowering overall healthcare costs by preventing more serious and expensive conditions.
Opponents contend
Critics might contend that mandating zero cost-sharing for these visits could lead to increased utilization and higher overall healthcare costs, which would then be passed on to employers and individuals through increased insurance premiums, potentially making health coverage less affordable for some.
The bill is concise and clearly outlines its core policy changes, making it accessible for an informed reader to understand its provisions and implications.
Sec. 2(a)(1) (ERISA), Sec. 2(b)(1) (PHSA), Sec. 2(c)(1) (IRC)
Mandatory Coverage of 3 Primary Care Visits with Zero Cost-Sharing
This provision requires all group health plans and health insurance issuers to cover three primary care visits per plan year. Crucially, these visits must be provided without any co-payments, deductibles, or other cost-sharing requirements, making them free at the point of service for the patient. This aims to remove financial barriers to routine health check-ups and early medical consultations.
Supporters argue
Supporters argue this removes a significant financial barrier, encouraging individuals to seek preventative care and address health issues early, leading to better long-term health and potentially reducing more costly treatments down the line.
Critics contend
Critics might argue that eliminating cost-sharing could lead to increased utilization and higher overall healthcare costs, which would then be passed on to consumers through higher premiums or to employers.
Tradeoffs
Balancing improved access and preventative care benefits against potential increases in healthcare costs and insurance premiums.
Sec. 2(a)(2) (ERISA), Sec. 2(b)(2) (PHSA), Sec. 2(c)(1) (IRC)
Mandatory Coverage of 3 Behavioral Health Care Visits with Zero Cost-Sharing
This provision mandates that group health plans and health insurance issuers cover three behavioral health care visits annually without any cost-sharing. This is intended to make mental health and substance use disorder services more accessible by removing initial financial hurdles, encouraging individuals to seek help for behavioral health conditions.
Sec. 727(b) (ERISA), Sec. 2799A-12(b) (PHSA), Sec. 9827(b) (IRC)
Non-Discriminatory Treatment Limitations and Reimbursement Rates
This section ensures that the three mandated primary care and three behavioral health care visits are not subject to more restrictive treatment limitations than any other covered visits. It also requires that reimbursement rates for these specific visits be the same as for any other primary or behavioral health care visit covered by the plan, preventing plans from devaluing these cost-sharing-free visits or imposing hidden restrictions.
Sec. 727(c) (ERISA), Sec. 2799A-12(c) (PHSA), Sec. 9827(c) (IRC)
Definitions of Key Terms
This section provides specific definitions for 'behavioral health care visit,' 'primary care service,' 'primary care visit,' and 'qualified provider.' Notably, 'primary care service' is tied to specific HCPCS codes (99201-99215 as of January 1, 2009), and 'qualified provider' includes a broad range of professionals for both primary and behavioral health care, such as physicians, physician assistants, advanced practice registered nurses, social workers, marriage and family therapists, psychologists, and psychiatrists.
Amends Section 223(c)(2)(C) of the Internal Revenue Code of 1986 to explicitly state that the mandated primary and behavioral health care visits described in section 9827 are exempt from the deductible requirements for High Deductible Health Plans (HDHPs).
Sec. 2(c)(2) (IRC)
Why it matters:This is standard legislative practice for ensuring consistency across different parts of the tax code and health law. It's a necessary technical adjustment to prevent unintended consequences for HSA eligibility rather than an attempt to hide a provision.
Case for: Supporters argue this ensures that individuals with HDHPs, often paired with Health Savings Accounts (HSAs), can also benefit from the cost-sharing-free visits without jeopardizing their HSA eligibility. This promotes preventative care for a significant segment of the insured population.
Case against: Critics might argue that allowing pre-deductible coverage for these visits, even if beneficial, slightly erodes the core principle of HDHPs, which is to encourage cost-conscious healthcare consumption by requiring patients to pay for services up to their deductible.
Estimated impact: Ensures a significant portion of the insured population (those with HDHPs) can access these services without upfront costs, potentially increasing utilization among this group and broadening the bill's reach.
States that the amendments made by this Act shall apply with respect to plan years beginning on or after the date that is 2 years after the date of the enactment of this Act.
Sec. 2(d)
Why it matters:This is standard legislative practice for specifying implementation timelines. It's not evasive but could be missed by a reader focused solely on the policy changes.
Case for: Proponents would argue that a 2-year delay provides ample time for health plans, employers, and healthcare providers to adjust their systems, update policies, and prepare for the new coverage requirements, ensuring a smoother transition and minimizing disruption.
Case against: Advocates for immediate access to care might argue that a 2-year delay postpones critical health benefits for individuals, especially those needing behavioral health support, and that plans should be able to adapt more quickly to urgent public health needs.
Estimated impact: Delays the fiscal and health impacts of the bill for two years, allowing for preparatory measures and system adjustments across the healthcare industry.