Great American Healthcare Act

This legislation, known as the "Great American Healthcare Act," aims to reform healthcare through several key provisions, primarily focusing on expanding Health Savings Accounts (HSAs) and enhancing price transparency across the healthcare sector. It seeks to empower consumers with more control over their healthcare spending and provide clearer information on costs. Title I, the "Health Savings Accounts For All Act of 2026," dramatically increases HSA contribution limits, aligning them with 401(k) limits, and adds catch-up contributions for individuals aged 50 and older. Crucially, it removes the requirement for individuals to be enrolled in a high-deductible health plan to contribute to an HSA, making these accounts accessible to a broader population. The bill also expands the definition of qualified medical expenses to include health insurance premiums, direct primary care arrangements, and, with certain limits, healthy food, vitamins, dietary supplements, and sports and fitness expenses. The HSA provisions further allow for rollovers to children, parents, or grandparents, and permit rollovers from health care Flexible Spending Accounts (FSAs) and Health Reimbursement Arrangements (HRAs). It grants HSAs equivalent bankruptcy protections as retirement funds and allows employers to satisfy the employer mandate through HSA contributions. Additionally, the bill introduces "qualified general contributions" from certain entities and charitable contributions to HSAs, and treats payments to health care sharing ministries as qualified medical expenses. It also establishes "Trump account seeding distributions" and rollovers to these accounts upon death. Title II, the "Health Marketplace for All Act," allows the formation of "health marketplace pools" that are deemed employers for the purpose of offering group health plans or group health insurance coverage. These pools can offer comprehensive coverage or even drug-only plans, aiming to increase access to group health benefits for more individuals and small businesses. Title III, the "Patients Deserve Price Tags Act," significantly strengthens price transparency requirements. Hospitals must publicly disclose all standard charges, discounted cash prices, and payer-specific negotiated charges monthly, with escalating civil monetary penalties for non-compliance. Similar transparency mandates are extended to clinical diagnostic laboratories, imaging services, and ambulatory surgical centers, requiring them to publish detailed pricing information. Health plans and insurers are also subject to enhanced transparency, needing to provide real-time, personalized cost-sharing information to enrollees and publicly disclose detailed in-network rates and out-of-network allowed amounts in machine-readable files. The bill mandates that administrative service providers grant group health plans full access to claims and encounter data, prohibiting contractual clauses that limit or delay such access, and imposes substantial penalties for violations. Furthermore, it requires health plans to provide itemized explanations of benefits within 45 days of a payment request and healthcare providers to issue itemized bills within 30 days of final payment, protecting patients from collections if transparency rules are not met. Title IV, the "Protecting Patient Access to Cancer and Complex Therapies Act," modifies Medicare Part B drug payment rules. For selected drugs subject to maximum fair price negotiation, manufacturers will be required to provide a rebate to Medicare equal to the difference between the average sales price plus 6% and the negotiated maximum fair price plus 6%, ensuring beneficiaries' coinsurance is based on the lower negotiated price. Title V introduces "Expanded-Access Prescription Drugs," establishing a list of medications that can be dispensed and administered by certain non-physician healthcare professionals like pharmacists, advanced practice registered nurses, and physician assistants, based on safety and low-risk evidence. States retain the ability to opt-out of this provision, but government-sponsored programs are required to cover these drugs when administered by these covered individuals. Finally, Title VI repeals a provision related to Federal Reserve System earnings on balances, a change unrelated to healthcare but included in the bill.