To provide a health savings account contribution to certain enrollees, to reduce health care costs, and for other purposes.
Sponsors
Legislative Progress
IntroducedMr. Crapo (for himself and Mr. Cassidy) introduced the following …
On the Cloture Motion S. 3386
Motion to Invoke Cloture: Motion to Proceed to S. 3386
Summary
What This Bill Does
The Health Care Freedom for Patients Act of 2025 creates a new Health Savings Account program for people enrolled in bronze or catastrophic ACA plans, providing $1,000-$1,500 in annual federal contributions. It also restricts federal healthcare funding in three key ways: penalizing states that provide healthcare to undocumented immigrants, prohibiting coverage of gender transition procedures in ACA and Medicaid plans, and blocking federal funds from covering abortion services.
Who Benefits and How
Individuals aged 18-65 enrolled in bronze or catastrophic ACA Exchange plans receive direct federal contributions to their Health Savings Accounts ($1,000/year for those 18-49, $1,500/year for those 50-64). HSA custodians and financial services companies gain new federally-funded account deposits. Health insurance carriers offering bronze and catastrophic plans may see increased enrollment due to the HSA incentive. States that do not provide healthcare to undocumented immigrants maintain their full 90% federal Medicaid matching rate.
Who Bears the Burden and How
Transgender individuals lose access to insurance coverage for gender-affirming care through both ACA Exchange plans and Medicaid/CHIP. Healthcare providers specializing in gender-affirming care face significant revenue losses. States like California, New York, and Illinois that cover undocumented immigrants face a 10 percentage point reduction in their federal Medicaid matching rate (from 90% to 80%). Abortion providers see reduced revenue as plans drop abortion coverage to receive federal cost-sharing payments. Federal taxpayers fund the $20 billion HSA contribution program over 2026-2027.
Key Provisions
- Appropriates $10 billion per year (2026-2027) for direct HSA contributions to eligible enrollees in bronze/catastrophic ACA plans
- Reduces federal Medicaid matching from 90% to 80% for states providing healthcare to undocumented immigrants
- Prohibits gender transition procedures (surgeries, hormones, puberty blockers) from being covered as essential health benefits under ACA plans
- Bars federal Medicaid/CHIP funding for gender transition procedures
- Prohibits federally-funded HSAs and cost-sharing reduction payments from being used for abortion or gender-affirming care (with limited exceptions for rape, incest, or life-threatening conditions)
- Denies federal Medicaid matching for individuals during citizenship/immigration verification periods unless states opt to cover without federal funds
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Establishes Exchange plan Health Savings Accounts with federal contributions for individuals in bronze/catastrophic ACA plans, restricts federal Medicaid funding for states providing healthcare to non-qualified aliens, and prohibits coverage of gender transition procedures as essential health benefits.
Policy Domains
Legislative Strategy
"Bundle health savings account expansion with restrictions on abortion funding, gender-affirming care, and Medicaid coverage for undocumented immigrants to advance a conservative healthcare reform package."
Likely Beneficiaries
- Individuals aged 18-65 enrolling in bronze or catastrophic ACA plans (receive $1,000-$1,500 annual HSA contributions)
- Health insurance companies offering catastrophic and bronze plans (expanded market due to HSA incentives and loosened catastrophic plan eligibility)
- States with strict immigration enforcement (maintain full FMAP rate while others face reduction)
- HSA custodians and financial institutions (new federally-funded account deposits)
Likely Burden Bearers
- States providing healthcare to undocumented immigrants (face 80% FMAP reduction from 90% to 80%)
- Transgender individuals seeking gender-affirming care (excluded from essential health benefits)
- Healthcare providers offering gender transition services (loss of ACA coverage for services)
- Undocumented immigrants (reduced access to Medicaid/CHIP during verification periods)
- Federal taxpayers ($20 billion appropriation for HSA contributions over 2026-2027)
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
A health savings account which is designated as an Exchange plan HSA upon establishment. Rollovers from non-Exchange plan HSAs are not permitted except between Exchange plan HSAs. Cannot be used for abortion (except rape, incest, or life-threatening conditions) or sex trait modification procedures.
An individual aged 18-65 enrolled in a bronze level qualified health plan or catastrophic plan through an ACA Exchange, who is either a citizen or an eligible alien, with household income not exceeding 700% of the poverty line.
A State that provides financial assistance or comprehensive health benefits coverage to aliens who are not qualified aliens (excluding lawfully residing children or pregnant women).
Any surgery (including castration, hysterectomy, mastectomy, phalloplasty, vaginoplasty, etc.), implant placement, or administration of puberty-blocking drugs or cross-sex hormones when performed to change the body to no longer correspond to biological sex. Excludes treatment for precocious puberty, disorders of sex development, or correction of prior procedures.
Either male or female as biologically determined. Female means an individual with a reproductive system that produces, transports, and utilizes eggs for fertilization. Male means an individual with a reproductive system that produces, transports, and utilizes sperm for fertilization.
A qualified health plan as defined in section 1301(a) of the Patient Protection and Affordable Care Act in the bronze level as defined in section 1302(d)(1)(A).
A plan described in section 1302(e) of the Patient Protection and Affordable Care Act.
Has the meaning given in section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology