Employers could meet coverage rules through health savings account deposits

Employers could meet federal employer coverage rules by offering $450 monthly health savings account deposits. Health savings accounts hold money for health expenses. Employer deposits of at least $450 per month would be tax-free for an employee only if the employee had health coverage that month. These rules would apply to months in tax years beginning after enactment.

Health marketplace pools could offer group health coverage, including plans covering only drugs. Membership would cover members of entities that establish or join a pool, their employees, employees of businesses they control, and eligible dependents. Pools would have to offer members the same coverage, with exceptions for service areas and coverage limits allowed by the referenced federal rules. Enrollment rules would have to apply consistently and could not depend on health.

Hospitals would publish charges monthly, and providers would send itemized bills when seeking patient payments. Billing rules would cover providers and facilities seeking payment from patients, including for online visits. Providers could not collect debts without the required bill. To collect above disclosed prices or estimates, providers would need to document medically necessary extra care caused by unforeseen complications or a patient-requested change that could not reasonably be anticipated. The hospital price-posting rules would apply beginning January 1, 2027.

Drug makers would pay rebates for selected Medicare Part B drugs with federal negotiated prices in effect. The rules would cover selected drugs whose makers have federal pricing agreements. Rebates would use the specified payment differences multiplied by the number of drug units. For drugs with rebates paid, patients’ shares would use the negotiated-price formula, or the inflation-rebate formula if it gives a lower amount. Rebates would apply to calendar quarters beginning on or after the first day of each drug’s initial negotiated-price period.

Pharmacists and other covered professionals could dispense and give federally listed prescription drugs after assessing patients. Covered professionals would include state-licensed pharmacists and other specified health professionals. Federal officials would select drugs based on safety, low risk, and suitability for assessment in a pharmacy or similar setting. Assessments would follow federal protocols. States could explicitly prohibit or limit this access. Government-sponsored health programs would have to cover listed drugs given by covered professionals, despite state licensing or practice limits.