I
119THCONGRESS
1
STSESSION H. R. 1776
To amend the Patient Protection and Affordable Care Act to establish a
reinsurance program, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH3, 2025
Mr. P
ALMERintroduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on
Ways and Means, and Education and Workforce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of
such provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend the Patient Protection and Affordable Care Act
to establish a reinsurance program, and for other purposes.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘New Health Options 4
Act of 2025’’. 5
SEC. 2. CREATION OF A REINSURANCE PROGRAM FOR A 6
NEW HEALTH INSURANCE RISK POOL. 7
(a) I
NGENERAL.—Part V of subtitle B of title I of 8
the Patient Protection and Affordable Care Act (42 9
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U.S.C. 18061 et seq.) is amended by adding at the end 1
the following new section: 2
‘‘SEC. 1344. REINSURANCE PROGRAM FOR CERTAIN OFF-EX-3
CHANGE PLANS. 4
‘‘(a) I
NGENERAL.—There is established a Reinsur-5
ance Program, to be administered by the Secretary of 6
Health and Human Services, to provide payments to 7
health insurance issuers with respect to claims for eligible 8
individuals for the purpose of lowering premiums for such 9
individuals. 10
‘‘(b) F
UNDING.— 11
‘‘(1) A
PPROPRIATION.—For the purpose of pro-12
viding funding for the Reinsurance Program, for 13
each year during the period beginning on January 1, 14
2026, and ending on December 31, 2030, there is 15
appropriated out of any monies in the Treasury not 16
otherwise obligated an amount equal to the product 17
of $50 and the aggregate number of member months 18
for all eligible individuals enrolled in a covered plan 19
during such year. 20
‘‘(2) L
IMITATION ON APPROPRIATION .—In no 21
year shall the appropriation for the Reinsurance 22
Program authorized in paragraph (1) exceed 23
$6,000,000,000. 24
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‘‘(3) USE OF UNEXPENDED FUNDS .—Appro-1
priated amounts remaining unexpended at the end of 2
any year may be used to make payments under the 3
Reinsurance Program in any future year. 4
‘‘(4) L
IMITATION ON USE OF FUNDS .—No 5
funds received under the Reinsurance Program may 6
be used to pay for services described in section 7
1303(b)(1)(B)(i) (as in effect on the date of the en-8
actment of this section). 9
‘‘(c) O
PERATION OFPROGRAM.— 10
‘‘(1) I
N GENERAL.—The Secretary shall estab-11
lish parameters for the operation of the Reinsurance 12
Program consistent with this section. 13
‘‘(2) D
EADLINE FOR INITIAL OPERATION .—Not 14
later than 120 days after the date of the enactment, 15
the Secretary shall establish sufficient parameters to 16
specify how the Program will operate for 2026. 17
‘‘(3) D
EFINITIONS.—In this section: 18
‘‘(A) C
OVERED PLAN.—The term ‘covered 19
plan’ means individual health insurance cov-20
erage (as such term is defined in section 2791 21
of the Public Health Service Act)— 22
‘‘(i) with respect to which the issuer 23
of such coverage has made the election de-24
scribed in section 1312(c)(1)(A); and 25
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‘‘(ii) that does not provide coverage 1
for services described in section 2
1303(b)(1)(B)(i) (as in effect on the date 3
of the enactment of this section). 4
‘‘(B) E
LIGIBLE INDIVIDUAL.—The term 5
‘eligible individual’ means an individual enrolled 6
in a covered plan. 7
‘‘(d) A
TTACHMENTDOLLARAMOUNT ANDPAYMENT 8
P
ROPORTION.— 9
‘‘(1) I
N GENERAL.—The Secretary shall annu-10
ally establish an attachment point, payment propor-11
tion, and reinsurance cap with respect to claims for 12
eligible individuals for payments under the Reinsur-13
ance Program, consistent with the following: 14
‘‘(A) The attachment point for the period 15
beginning January 1, 2026, and ending Decem-16
ber 31, 2026, shall be $110,000. 17
‘‘(B) The payment proportion for the pe-18
riod beginning January 1, 2026, and ending 19
December 31, 2026, shall be 90 percent. 20
‘‘(C) The reinsurance cap for the period 21
beginning January 1, 2026 and ending Decem-22
ber 31, 2026, shall be $300,000. 23
‘‘(2) A
DJUSTMENT AUTHORITY .—The Secretary 24
may adjust any amounts described in paragraph (1) 25
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as necessary to ensure the Reinsurance Program 1
does not make payment for a year in excess of the 2
amount available for such year under subsection 3
(b).’’. 4
(b) E
LECTIONTOOPTOUT OFSINGLERISK 5
P
OOL.— 6
(1) I
N GENERAL.—Section 1312(c)(1) of the 7
Patient Protection and Affordable Care Act (42 8
U.S.C. 18032(c)(1)) is amended— 9
(A) by striking ‘‘A health insurance 10
issuer’’ and inserting the following: 11
‘‘(A) I
N GENERAL.—A health insurance 12
issuer’’; 13
(B) in subparagraph (A), as inserted by 14
paragraph (1), by inserting ‘‘and other than 15
any health plan with respect to which such 16
issuer has elected for this subparagraph not to 17
apply’’ after ‘‘grandfathered health plans’’; and 18
(C) by adding at the end the following new 19
subparagraph: 20
‘‘(B) T
REATMENT OF PLANS OPTING OUT 21
OF SINGLE RISK POOL .—A health insurance 22
issuer shall consider all enrollees in all health 23
plans offered by such issuer in the individual 24
market with respect to which such issuer has 25
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made the election described in subparagraph 1
(A) to be members of a single risk pool.’’. 2
(2) P
ROHIBITING SINGLE RISK POOL OPT OUT 3
FOR QUALIFIED HEALTH PLANS .—Section 4
1301(a)(1)(C) of the Patient Protection and Afford-5
able Care Act (42 U.S.C. 18021(a)(1)) is amend-6
ed— 7
(A) in clause (iii), by striking ‘‘and’’ at the 8
end; 9
(B) in clause (iv), by striking the period 10
and inserting ‘‘; and’’; and 11
(C) by adding at the end the following new 12
clause: 13
‘‘(v) has not made the election de-14
scribed in section 1312(c)(1)(A) with re-15
spect to such plan.’’. 16
(3) E
FFECTIVE DATE.—The amendments made 17
by this subsection shall apply with respect to plan 18
years beginning on or after January 1, 2026. 19
(c) R
EMOVINGAGEPREMIUMVARIATIONLIMITA-20
TION FORCERTAINPLANS.— 21
(1) I
N GENERAL.— 22
(A) R
EMOVAL OF LIMITATION FOR CER -23
TAIN PLANS.—Section 2701(a)(1)(A)(iii) of the 24
Public Health Service Act (42 U.S.C 25
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300gg(a)(1)(A)(iii)) is amended by inserting 1
‘‘or, in the case of such coverage with respect 2
to which the issuer of such coverage has made 3
the election described in section 1312(c)(1)(A) 4
of the Patient Protection and Affordable Care 5
Act, by more than an actuarially justified 6
amount for adults’’ before ‘‘; and’’. 7
(B) E
FFECTIVE DATE.—The amendment 8
made by subparagraph (A) shall apply with re-9
spect to plan years beginning on or after Janu-10
ary 1, 2026. 11
(2) M
AINTAINING AGE PREMIUM VARIATION 12
LIMITATION FOR QUALIFIED HEALTH PLANS .—Sec-13
tion 1301(a)(1) of the Patient Protection and Af-14
fordable Care Act (42 U.S.C. 18021(a)(1)), as 15
amended by subsection (b), is further amended— 16
(A) in subparagraph (B), by striking 17
‘‘and’’ at the end; 18
(B) in subparagraph (C)(v), by striking 19
the period and inserting ‘‘; and’’; and 20
(C) by adding at the end the following new 21
subparagraph: 22
‘‘(D) with respect to the premium rate 23
charged by such plan, if such plan varies such 24
rate by age, does not vary such rate by more 25
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than 3 to 1 for adults (consistent with section 1
2707(c) of the Public Health Service Act).’’. 2
(d) T
REATMENT OF OPTOUTPLANS INRELATION 3
TOINDIVIDUALHEALTHCOVERAGEREIMBURSEMENT 4
A
RRANGEMENTS.—The Secretaries of Health and Human 5
Services, Labor, and the Treasury shall not fail to treat 6
any individual health insurance coverage (as defined in 7
section 2791 of the Public Health Service Act (42 U.S.C. 8
300gg–91)) as eligible for integration with an individual 9
health care reimbursement arrangement on the basis that 10
the health insurance issuer (as so defined) of such cov-11
erage has made the election described in section 12
1312(c)(1)(A) of the Patient Protection and Affordable 13
Care Act (as inserted by subsection (b)). 14
SEC. 3. PROMOTION OF HIGH-VALUE CARE. 15
(a) I
NGENERAL.—Subpart II of part A of title 16
XXVII of the Public Health Service Act (42 U.S.C. 17
300gg–11 et seq.) is amended by adding at the end the 18
following new section: 19
‘‘SEC. 2730. APPLICATION OF CERTAIN OUT-OF-NETWORK 20
COSTS TO DEDUCTIBLES AND OUT-OF-POCK-21
ET MAXIMUMS. 22
‘‘(a) I
NGENERAL.—A group health plan, and a 23
health insurance issuer offering group or individual health 24
insurance coverage, shall, in the case that an individual 25
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enrolled under such plan or coverage is furnished items 1
or services by a health care provider or health care facility 2
that does not have in effect a contractual relationship with 3
such plan or issuer for the furnishing of such items or 4
services and such individual incurs any out-of-pockets 5
costs with respect to such items and services, at the option 6
of such individual, apply such costs to any deductible or 7
out-of-pocket maximum applicable to items and services 8
furnished by health care providers or health care facilities 9
with contracts in effect with such plan or issuer for the 10
furnishing of such items or services, but only if the fol-11
lowing requirements are met: 12
‘‘(1) The item or service furnished by such pro-13
vider or facility without a contract in effect with 14
such plan or issuer is an item or service for which 15
benefits are available under such plan or coverage. 16
‘‘(2) The amount charged by such provider or 17
facility for such item or service is equal to or less 18
than— 19
‘‘(A) the lowest amount recognized by the 20
plan or coverage as payment for such item or 21
service out of all health care providers and 22
health care facilities with a contract in effect 23
with such plan or issuer to furnish such item or 24
service in the same rating area (as defined for 25
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purposes of section 2701) in which the item or 1
service described in paragraph (1) was fur-2
nished; or 3
‘‘(B) the 25th percentile of charges for 4
such item or service furnished in the same 5
State in which the item or service described in 6
paragraph (1) was furnished. 7
‘‘(b) D
ISCLOSURE OF INFORMATION.—A group 8
health plan, and a health insurance issuer offering group 9
or individual health insurance coverage, shall, with respect 10
to each item or service for which benefits are available 11
under such plan or coverage, make available the lowest 12
amount described in subsection (a)(2)(A) and the 25th 13
percentile described in subsection (a)(2)(B) to all individ-14
uals enrolled under such plan or coverage.’’. 15
(b) E
FFECTIVEDATE.—The amendment made by 16
subsection (a) shall apply to plan years beginning on or 17
after January 1, 2026. 18
SEC. 4. DISCLOSURE OF LOWER PRICES. 19
Part E of title XXVII of the Public Health Service 20
Act (42 U.S.C. 300gg–131) is amended by adding at the 21
end the following new section: 22
‘‘SEC. 2799B–10. DISCLOSURE OF LOWER PRICES. 23
‘‘(a) I
NGENERAL.—Beginning January 1, 2026, 24
each health care provider and health care facility shall dis-25
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close to patients and prospective patients enrolled in a 1
group health plan, group or individual health insurance 2
coverage, or a Federal health care program (as defined 3
in section 1128B but including the program established 4
under chapter 89 of title 5, United States Code) being 5
furnished or seeking to be furnished an item or service 6
by such provider or facility for which benefits are available 7
under such plan, coverage, or program, as applicable, 8
whether the amount of cost sharing (including deductibles, 9
copayments, and coinsurance) that would be incurred by 10
such individual for such item or service under such plan, 11
coverage, or program, as applicable, exceeds the charge 12
that would apply for such item or service for an individual 13
without benefits under any such plan, coverage, or pro-14
gram for such item or service. 15
‘‘(b) A
DDITIONALENFORCEMENT.—In addition to 16
any other penalty applicable with respect to a violation of 17
subsection (a), an individual who is harmed by a violation 18
of this section by a health care provider or health care 19
facility may bring an action against such provider or facil-20
ity in an appropriate district court of the United States 21
for— 22
‘‘(1) appropriate injunctive relief; and 23
‘‘(2) damages in an amount that is equal to the 24
amount provided for such harm in a civil action 25
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under the law of the State in which the provider or 1
facility is located.’’. 2
Æ
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