S. 3386: Health Care Freedom for Patients Act of 2025

S. 3386 would steer some marketplace shoppers toward lower-premium plans by pairing them with very large federally funded HSA deposits.

Under the bill, eligible adults ages 18 to 49 enrolled in a bronze or catastrophic exchange plan in 2026 or 2027 would get $1,000 a month deposited into a special HSA. Adults ages 50 to 64 would get $1,500 a month. Those payments would be tax-free, and eligibility would extend to people with household income up to 700% of the poverty line.

The bill also opens catastrophic plans to the broader individual market starting in 2027, which means you could buy a lower-premium plan with less generous coverage than many ACA plans offer today. At the same time, it would permanently fund cost-sharing reduction payments to insurers, which backers argue would add stability to the exchange market.

The tradeoff is that lower upfront premiums would come with more room for thinner benefits and new federal limits on what exchange and Medicaid coverage can include.

Beyond the marketplace, S. 3386 would tighten Medicaid and CHIP funding rules for people without verified citizenship, nationality, or satisfactory immigration status. It would also create an 80% Medicaid expansion match for certain states beginning in 2027.

The bill reaches into coverage rules too. Exchange plans could no longer treat gender-transition procedures as an essential health benefit, and federal Medicaid and CHIP funds could not be used for specified gender-transition procedures except in limited cases described by the bill.

This is not just an ACA affordability bill — it is a broader conservative health care package that combines premium relief, Medicaid eligibility restrictions, and coverage limits in one proposal.