Primary and Behavioral Health Care Access Act of 2026
- Sponsor
- Sen. King, Angus S., Jr. [I-ME]
- Committees
- Health, Education, Labor, and Pensions Committee (primary)
- Last action
- Jun 11, 2026
Bottom line
The bill aims to increase access to primary and behavioral health care by eliminating out-of-pocket costs for a limited number of initial visits, potentially shifting costs to premiums.
What it actually does
This bill mandates that most 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 (like deductibles, copayments, or coinsurance). It 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 implement these requirements, ensuring that treatment limitations and reimbursement rates for these visits are consistent with other covered visits. It also includes a critical amendment to the IRC to ensure that high deductible health plans (HDHPs) can cover these visits without jeopardizing their HDHP status.
Proponents argue
Supporters argue that removing cost barriers for initial primary and behavioral health care visits will encourage earlier intervention, improve health outcomes, and reduce the likelihood of more expensive emergency care or advanced disease treatment later on. They contend that this approach makes healthcare more accessible, especially for individuals who might delay seeking care due to financial concerns, and promotes a proactive approach to health management.
Opponents contend
Critics may argue that mandating additional cost-free services will increase healthcare premiums for all insured individuals and employers, potentially making health insurance less affordable overall. They might also raise concerns about potential over-utilization of services if there is no cost-sharing, and question the administrative burden on health plans to implement and track these specific visit types.
The bill is concise and clearly written, making it accessible for an informed reader to understand its core provisions within a short timeframe.
Section 2(a) (ERISA), Section 2(b) (PHSA), Section 2(c) (IRC)
Mandatory Coverage for 3 Primary Care Visits Without Cost-Sharing
This provision requires group health plans and health insurance issuers to cover three primary care visits per plan year without imposing any cost-sharing requirements. A 'primary care visit' is defined as an in-person visit to a designated primary care provider (such as a general practitioner, family physician, or pediatrician) during which primary care services are received. These services are identified by specific HCPCS codes (99201-99215 as of January 1, 2009, and as subsequently modified).
Supporters argue
Supporters contend that eliminating cost-sharing for initial primary care visits removes a significant barrier to accessing essential health services, leading to earlier diagnosis and treatment of conditions, and ultimately better population health outcomes and reduced long-term healthcare expenditures.
Critics contend
Critics might argue that while beneficial for individuals, this mandate will inevitably lead to higher premiums for all policyholders and employers, potentially making health insurance less affordable for some, and could lead to unnecessary utilization of services.
Tradeoffs
The provision balances the goal of improving access to primary care and promoting early intervention against the potential for increased healthcare costs and higher insurance premiums.
Section 2(a) (ERISA), Section 2(b) (PHSA), Section 2(c) (IRC)
Mandatory Coverage for 3 Behavioral Health Care Visits Without Cost-Sharing
This provision similarly requires group health plans and health insurance issuers to cover three behavioral health care visits per plan year without any cost-sharing. A 'behavioral health care visit' is defined as a visit to a qualified provider (including psychiatrists, psychologists, social workers, and advanced practice nurses) for diagnosis, treatment, screening, or prevention of a behavioral health condition. The bill ensures that treatment limitations and reimbursement rates for these visits are no more restrictive than for other covered behavioral health services.
Section 2(a)(1)(B) (ERISA), Section 2(b)(1)(B) (PHSA), Section 2(c)(1)(B) (IRC)
Limitations on Treatment and Reimbursement Rates
This provision clarifies that for the mandated three primary care and three behavioral health care visits, health plans and issuers must ensure that treatment limitations are no more restrictive than those applied to any other primary or behavioral health care visit covered by the plan. Additionally, reimbursement rates for these cost-free visits must be the same as the rates for any other primary or behavioral health care visit covered by the plan or coverage.
The bill amends the Internal Revenue Code to allow high deductible health plans (HDHPs) to cover the mandated primary and behavioral health care visits without cost-sharing, even before the deductible is met. This is crucial for maintaining an individual's eligibility for a Health Savings Account (HSA).
Section 2(c)(2) of the Internal Revenue Code of 1986, amending Section 223(c)(2)(C)
Why it matters:This is standard legislative practice for ensuring new health mandates integrate correctly with existing tax-advantaged health accounts, preventing unintended negative consequences for consumers.
Case for: Supporters argue this amendment is vital to ensure that individuals with HDHPs, who often rely on HSAs for healthcare savings, are not penalized or disqualified from their plans or accounts by utilizing the new cost-free visits. It ensures broad applicability of the bill's benefits.
Case against: Critics might argue that expanding pre-deductible coverage, even for a limited number of visits, slightly erodes the core principle of HDHPs, which is to encourage cost-conscious healthcare consumption through higher deductibles. However, this specific amendment is generally seen as a necessary technical fix.
Estimated impact: Ensures millions of HDHP enrollees can benefit from the cost-free visits without losing HSA eligibility, preserving a popular healthcare savings mechanism.
The amendments made by this Act will 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.
Section 2(d)
Why it matters:This is standard legislative practice to provide health plans, issuers, and employers sufficient time to update their systems, plan designs, and communicate changes to beneficiaries.
Case for: Proponents argue that a two-year delay is reasonable and necessary for smooth implementation, allowing stakeholders to adapt to the new requirements without undue burden or disruption to existing coverage.
Case against: Some advocates might argue for a shorter implementation period to accelerate access to cost-free care, especially given the urgency of behavioral health needs. However, the practicalities of plan year cycles and regulatory changes often necessitate such delays.
Estimated impact: Delays the practical impact of the bill's mandates for two years post-enactment, affecting when beneficiaries can begin utilizing the cost-free visits.