Fair Care Act of 2026

Full Title:
Fair Care Act of 2026

Summary#

The Fair Care Act of 2026 is a large, multi-part bill that would change many parts of the U.S. health system. It updates rules for health savings accounts (HSAs), lets certain tax credits be deposited into HSAs, and creates grants and outreach for HSA use. It makes many changes to private insurance rules, including guaranteed availability of coverage, rules about premiums and age-rating, new plan types ("copper" plans), shorter-term enrollment options, and repeal of the employer coverage mandate and its reporting. The bill would create a federal reinsurance program (the Invisible Guaranteed Coverage Pool Reinsurance Program) with a large appropriation and a new small tax on Exchange plans. It includes many competition and transparency measures for hospitals, insurers, pharmacies, and pharmacy benefit managers (PBMs), including new reporting, limits on certain contract terms, price transparency, and PBM rules. It contains many prescription drug provisions: faster paths for generic and biosimilar competition, changes to drug exclusivity periods, patent disclosure rules, and new conditional/provisional drug approval pathways at the FDA. The bill also makes wide changes to Medicare and Medicaid payment and program rules, creates new Medicare choice and competition structures, expands telehealth coverage and uses, and includes a long subtitle revising medical malpractice rules (statutes of limitation, caps on noneconomic damages, attorney fee limits, notice and affidavit rules, and volunteer liability protection). The bill contains many other technical, tax, and administrative changes across federal health programs.

What it means for you#

  • If you use or open a health savings account, the bill would change who can contribute and how HSAs can be used. It would allow some unused premium tax credits to go into HSAs and permit rollovers from certain accounts.
  • If you buy individual or small-group insurance, the bill would add new enrollment options, add "copper" plans to Exchanges, change premium rating rules (including a specified adult age ratio), and change rules that affect availability and nondiscrimination.
  • If you get Medicare or Medicaid, the bill would change payment rules, add a new Medicare structure called "unified Medicare" with new enrollment and premium rules, add an out-of-pocket catastrophic limit tied to HSA limits, expand telehealth coverage and where telehealth may be used (including the home and some Native American sites), and offer states new Medicaid payment options.
  • If you take prescription drugs, the bill would speed certain generic and biosimilar pathways, change exclusivity periods for some drugs and biologics, require more patent and pricing disclosure, and create new FDA conditional/provisional approval pathways with registry and reporting requirements.
  • If you are a hospital, insurer, PBM, or pharmacy, the bill would add many reporting, transparency, and contract rules, and would direct agencies to study consolidation, profit-sharing, and PBM practices.
  • If you are involved in health care litigation, the bill would set federal rules for so-called "health care lawsuits," including time limits, caps on noneconomic damages ($250,000), limits on attorney contingent fees, and other pre-trial and procedural rules.

Expenses#

  • The bill expressly appropriates $200,000,000,000 to the Department of Health and Human Services to carry out the Invisible Guaranteed Coverage Pool Reinsurance Program for the first 10 years after program establishment.
  • It authorizes $160,000,000 to the Federal Trade Commission to hire staff to investigate certain health care mergers and practices.
  • It authorizes $1,000,000,000 per year (2026–2035) for a hospital infrastructure improvement grant program.
  • It authorizes up to $5,000,000 annually for HSA assistance and outreach grants.
  • It appropriates $10,000,000 for the Center for Medicare & Medicaid Innovation to fund cross-state enrollment research or pilots.
  • It adds an additional tax of $4 per policy month on health insurance policies sold by insurers offering plans on Exchanges.
  • The bill also creates a new ACA subsection that authorizes “such sums as may be necessary” for cost-sharing payments for plan years 2026–2030 (text provides an appropriation mechanism but does not list a fixed dollar total in the bill language).
  • The bill makes multiple tax and budget-related changes (for example, changes to exclusions for employer health coverage, treatment of certain tax credits, and repeal of some tax provisions). The bill text includes many other financial and budget-related rules but does not present a single overall score or total net cost in the bill text itself.

Proponents' View#

The bill text states its purpose is "To address the high costs of health care services, prescription drugs, and health insurance coverage." Within the bill, many provisions are framed to increase competition, transparency, and choice (for example: price transparency rules, rules to promote generics and biosimilars, expanded HSA options, new reinsurance funding, and telehealth expansions). Provisions also frame payments or program changes as ways to improve affordability or access and to encourage competition among providers and insurers.

Opponents' View#

No publicly available information.