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

The bill's core idea is that bigger pools can mean lower premiums. It would expand association health plans by letting eligible employer groups and some self-employed workers band together, as long as the association has existed for at least 2 years, is set up for a real business purpose other than selling insurance, and offers coverage to at least 51 employees. To keep these arrangements from becoming a way to screen out sick people, the bill says associations cannot condition membership on health status-related factors, cannot deny coverage for pre-existing conditions, and cannot vary eligibility or premiums based on health status.

The bill also gives self-employed people a clearer path into these plans. A self-employed individual must have no common law employees, have a real ownership stake in a trade or business, earn wages or self-employment income from it, and work at least 10 hours a week or 40 hours per month providing personal services to that business. A group of at least 20 self-employed individuals can be treated as a single employer member group. If an association is made up only of self-employed people, everyone has to be put in one risk pool and charged the same premium rate, even though the broader premium system may use actuarially sound modified community rating.

Another major piece targets pharmacy benefit managers, or PBMs. For plan years starting on or after 30 months after enactment, PBMs serving large employers and large plans would have to report spending data at least every 6 months, or quarterly if the plan asks. The reports must cover drugs with gross spending above $10,000 in a reporting period, and if fewer than 50 drugs cross that threshold, the PBM still has to report the 50 drugs with the highest spending. The enforcement teeth are strong: failing to provide required information can trigger penalties of $10,000 per day per violation, and false information can bring penalties of up to $100,000 per false item. The Secretary must create a standard reporting format and issue final regulations within 18 months of enactment.

The bill also creates a new Custom Health Option and Individual Care Expense Arrangement, or CHOICE, for plan years beginning after December 31, 2025. Employers would have to give workers written notice at least 60 days before the start of the plan year, and the total permitted benefit would have to appear on the employee's Form W-2. Benefit amounts could vary by age, but the highest amount could not exceed 300% of the lowest maximum dollar amount for a participant. Finally, the bill funds cost-sharing reduction payments again for plan years starting on or after January 1, 2027, but bars those federal funds from being used for qualified health plans that cover abortion except when the pregnancy threatens the life of the mother or results from rape or incest.