Summary#
The Great American Healthcare Plan would make several changes across health tax rules, insurance marketplaces, price transparency, drug payment rules, and patient billing. Major parts include: expanding and changing rules for health savings accounts (HSAs); treating certain "health marketplace pools" as employers so they can offer group plans; requiring hospitals, clinical labs, imaging providers, ambulatory surgical centers, and health plans to publish prices and negotiated rates in standard, machine-readable formats and in consumer-friendly formats; strengthening plan access to claims and payment data and adding oversight and reporting rules for administrative service providers; requiring itemized bills and explanations of benefits within set time frames; setting manufacturer rebate and coinsurance rules for selected drugs subject to a maximum fair price; and creating a list and rules for "expanded-access prescription drugs" that certain licensed providers may dispense.
Key HSA changes in the bill include raising contribution limits by linking them to other Internal Revenue Code indexing rules, allowing rollovers from FSAs and HRAs, permitting rollovers to children or parents of an account holder, allowing certain payments for health insurance and direct primary care, and allowing some wellness expenses (healthy food, vitamins, dietary supplements, and sports and fitness expenses) to be paid from HSAs subject to monthly caps tied to account balance. The bill also provides equivalent bankruptcy protection for HSAs as for individual retirement accounts and treats a $450 per month employer HSA contribution as an offer of minimum essential coverage for employer mandate purposes.
Price transparency requirements direct the Secretary of Health and Human Services to set standard methods and formats (including machine-readable files) and require hospitals and other providers to post gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified max/min negotiated charges. The bill sets timelines for implementation, requires official attestations of accuracy, and establishes civil monetary penalties for noncompliance. It also requires health plans to publish monthly rate and payment files and to provide real-time self-service cost estimators and explanations of benefits.
The drug provisions add a process for quarterly manufacturer rebates for selected drugs subject to maximum fair price negotiation, specify how beneficiary coinsurance will be calculated for those drugs, and direct rebate deposits into the Federal Supplementary Medical Insurance Trust Fund. The bill also directs the Secretary to make a list of expanded-access prescription drugs that certain licensed professionals may dispense under federal protocols and requires government-sponsored programs to cover those drugs.
What it means for you#
- If you use or have an HSA: contribution limits and allowable uses could change. HSAs could pay for some types of health insurance or direct primary care arrangements and certain wellness items. The bill allows limited monthly HSA payments for healthy food, vitamins, supplements, and sports and fitness expenses with caps tied to account balance ($100, $150, or $200 per month depending on the HSA balance).
- If you shop for care: many hospitals, labs, imaging providers, and ambulatory surgical centers would have to publish detailed prices and payer-negotiated rates in machine-readable files and in consumer-friendly formats. Health plans must provide self-service tools and explain expected member cost-sharing.
- If you get a bill: providers must give itemized bills and required information. Providers generally cannot start collection actions until they provide the required itemized bill and certain limits apply to charges that exceed a prior good-faith estimate unless documented as medically necessary due to unforeseen circumstances.
- If you’re covered through a group plan: the bill creates rules letting "health marketplace pools" act like employers to offer group coverage and it requires expanded access to claims and payment data from third-party administrators and other service providers.
- If you rely on certain prescription drugs: the bill creates a rebate process for manufacturers of selected drugs subject to maximum fair pricing and directs coinsurance calculations for those drugs. It also creates a federal list of expanded-access drugs that certain licensed professionals may dispense under federal protocols, and requires government programs to include coverage.
Expenses#
No publicly available information on overall federal cost or savings is included in the bill text. The bill text does include specific monetary provisions and penalties, including:
- Employer HSA contribution treatment: a contribution of $450 per month to an employee HSA is treated as an offer of minimum essential coverage for employer mandate rules.
- HSA wellness caps: monthly caps for qualified wellness expenses of $100, $150, or $200 depending on HSA balance thresholds specified in the bill.
- Hospital civil monetary penalties: tiered per-day penalties by bed count (examples in the bill include $300/day for hospitals with 30 or fewer beds and higher per-bed per-day amounts for larger hospitals, with higher amounts for persistent noncompliance reaching specified multi-million dollar ranges).
- Laboratory and imaging penalties: up to $300 per day for noncompliance (with authority to increase via rulemaking in later years).
- Ambulatory surgical center penalties: up to $300 per day for noncompliance (with authority to increase via rulemaking).
- Health plan penalties for rate/payment file violations: up to $300 per member per day or $10,000,000, whichever is lesser, for failing to comply with certain machine-readable file requirements.
- Itemized bill penalties: up to $10,000 for each instance of failure to comply with itemized bill requirements.
- Oversight penalties for administrative service providers and related enforcement: the bill includes authority for civil penalties of $100,000 per day for certain violations by health plan service providers and for similar penalties under ERISA provisions.
- Drug rebate handling: rebates collected from manufacturers under the selected-drug provisions are to be deposited into the Federal Supplementary Medical Insurance Trust Fund.
These are the monetary provisions and penalties stated in the bill text. The bill text does not provide an overall fiscal estimate or projected federal budget impact.
Proponents' View#
No publicly available information.
Opponents' View#
No publicly available information.