H.R.1776 - New Health Options Act of 2025 (119th Congress)
Summary
H.R.1776, the New Health Options Act of 2025, aims to amend the Patient Protection and Affordable Care Act (ACA) by establishing a reinsurance program and modifying certain regulations related to health insurance coverage. The bill introduces a reinsurance program for off-exchange plans, allowing insurers to opt out of the single risk pool under specific conditions. It also addresses age premium variation limitations and promotes price transparency in healthcare.
Expected Effects
The bill could lead to changes in health insurance premiums, potentially lowering them for some individuals in off-exchange plans due to the reinsurance program. Insurers may have more flexibility in setting premiums based on age for certain plans. Increased transparency in healthcare pricing could empower consumers to make more informed decisions about their healthcare costs.
Potential Benefits
- Potential reduction in premiums for individuals enrolled in covered off-exchange health insurance plans through the reinsurance program.
- Increased flexibility for insurers in setting premiums, potentially leading to more competitive pricing.
- Enhanced price transparency, enabling consumers to compare costs and make informed healthcare decisions.
- The bill promotes high-value care by allowing out-of-pocket costs for out-of-network services to be applied to deductibles and out-of-pocket maximums under certain conditions.
- The bill ensures that individual health coverage reimbursement arrangements are not negatively affected by the opt-out provision.
Most Benefited Areas:
Potential Disadvantages
- The opt-out provision from the single risk pool could potentially destabilize the ACA exchanges and lead to higher premiums for those remaining in the exchanges.
- Allowing greater age premium variation for certain plans could lead to higher premiums for older individuals.
- The effectiveness of the reinsurance program depends on adequate funding, and the appropriation may not be sufficient to cover all eligible claims.
- The complexity of the changes could create confusion for consumers and insurers.
- The benefits may disproportionately favor healthier individuals who opt for off-exchange plans.
Most Disadvantaged Areas:
Constitutional Alignment
The bill's provisions related to healthcare fall under the purview of Congress's power to regulate interstate commerce, as health insurance markets operate across state lines. The establishment of a reinsurance program and modifications to premium regulations are within the scope of congressional authority to enact laws necessary and proper for carrying out its enumerated powers, as outlined in Article I, Section 8 of the Constitution. The bill does not appear to infringe upon any specific constitutional rights or protections.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).