HR6703-119

What This Bill Does

The Lower Health Care Premiums for All Americans Act is a health-insurance package. Title I expands association health plans by allowing employer groups to maintain ERISA group health plans even when members are not in the same industry, trade, or profession, as long as the association has existed for at least two years, has a formal governing structure, offers coverage to at least 51 employees, makes coverage available to all employees of employer members, and is not owned or controlled by a health insurer. The bill also codifies custom health option and individual care expense arrangements, similar to ICHRAs, as employer-funded arrangements that reimburse individual-market coverage, Medicare Parts A and B, or Medicare Advantage costs subject to class, nondiscrimination, substantiation, and notice rules.

Title II adds pharmacy benefit manager transparency duties. PBMs serving group health plans or health insurance issuers must provide plain-language, machine-readable reports at least every six months, or quarterly on request, with prescription-drug and rebate information needed by the plan. Contracts with applicable entities must allow disclosure to the plan and provide information needed for those reports. Parallel amendments place the PBM rules in the Public Health Service Act, ERISA, and the Internal Revenue Code.

The bill also appropriates such sums as necessary for ACA cost-sharing reduction payments for plan years beginning on or after January 1, 2027. Those funds cannot be used for qualified health plans that cover abortion, except where abortion coverage is limited to saving the life of the mother or pregnancies resulting from rape or incest.

Who Benefits and How

Small employers benefit because broader association health plan rules may let them join larger purchasing pools. Trade associations benefit because qualifying associations can sponsor health coverage across industries. Employees of association members benefit if pooled plans lower premiums or expand plan choice. Employers using ICHRAs benefit because the bill gives a statutory pathway for reimbursing individual-market or Medicare coverage instead of offering a traditional group plan. Individual market insurers benefit from more reimbursed individual coverage. Employer health plans benefit from PBM reports showing drug spending, rebates, fees, and compensation. Low-income ACA marketplace enrollees benefit because cost-sharing reduction payments are funded starting in 2027.

Who Bears the Burden and How

Association health plan administrators must satisfy governance, membership, nondiscrimination, and coverage-availability rules. State insurance regulators may have less leverage if more employer groups use ERISA association plans. PBMs must produce detailed semiannual or quarterly reports and cannot contract around disclosure needed by plans. Applicable PBM vendors must give PBMs the data required for reports. Health insurance issuers offering group coverage must update contracts and reporting workflows. Federal taxpayers bear the cost of open-ended cost-sharing reduction appropriations. Qualified health plans covering abortion outside the listed exceptions lose access to CSR payment funds.

Key Provisions

• Expands ERISA employer definitions to include qualifying association health plans.
• Requires associations to have a formal structure, at least two years of existence, at least 51 covered employees, and coverage for all member-employer employees.
• Codifies custom health option and individual care expense arrangements for individual-market or Medicare-related reimbursements.
• Requires PBMs to provide machine-readable prescription-drug transparency reports at least every six months.
• Requires PBM contracts and applicable entities to allow disclosure needed for plan reporting.
• Applies PBM oversight across Public Health Service Act, ERISA, and Internal Revenue Code provisions.
• Appropriates sums as necessary for ACA cost-sharing reduction payments starting in 2027.
• Bars CSR funds for plans covering abortion except life, rape, or incest exceptions.