H.R. 6703: Lower Health Care Premiums for All Americans Act

The central bet is that bigger pools mean lower premiums. The bill would let employer groups and some self-employed workers join association health plans, as long as the association has existed for at least 2 years, was formed for a real business purpose other than selling insurance, and offers coverage to at least 51 employees. At least 75% of the group's governing seats would have to be held by employer members.

To stop these plans from quietly screening out sick people, the bill bars them from denying coverage for pre-existing conditions, conditioning membership on health status, or charging higher premiums based on someone's health. An association made up only of self-employed people has to put everyone in one risk pool at the same rate. Solo workers can qualify if they have no employees, own a real stake in a business, earn income from it, and put in at least 10 hours a week, and groups of 20 or more can count as a single employer member.

A separate piece targets pharmacy benefit managers, the middlemen who sit between drugmakers and your plan. Starting 30 months after the bill becomes law, PBMs serving large plans would have to report detailed spending data at least every 6 months, covering any drug with more than $10,000 in spending in a reporting period (or the top 50 if fewer than 50 clear that bar). Miss a required report and the penalty runs $10,000 per day; knowingly file false data and it climbs to as much as $100,000 per item. The Secretary has 18 months to write the reporting rules.

The bill also creates a new employer benefit called a CHOICE arrangement, an account employers fund so workers can buy their own coverage, for plan years after December 31, 2025. Employers would owe workers written notice at least 60 days before the plan year, the benefit amount would show up on the W-2, and the amount can rise with age but not past 300% of the lowest amount offered. Finally, it restarts federal cost-sharing reduction payments for plan years beginning on or after January 1, 2027, while barring those dollars from plans covering abortion except to save the mother's life or in cases of rape or incest.