Health care costs

Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act

This bill allows, beginning in 2028, for Medicare coverage and payment for multi-cancer early detection screening tests that are approved by the Food and Drug Administration and that are used to screen for cancer across many cancer types, if the Centers for Medicare & Medicaid Services determines such coverage is appropriate. Coverage is limited to those under a certain age (age 68 in 2028, increased by one year every year thereafter) and to one test every 11 months.

Medicare Patient Access and Practice Stabilization Act of 2025

This bill increases certain payment adjustments under the Medicare physician fee schedule for services furnished between April 1, 2025, and January 1, 2026.

Health Care Affordability Act of 2025

This bill makes permanent temporary changes enacted by the American Rescue Plan Act of 2021 (ARPA) and the Inflation Reduction Act of 2022 (IRA) that generally expand eligibility for and increase the amount of the premium tax credit.

Currently, eligible taxpayers may be able to claim the premium tax credit, which applies toward the cost of obtaining health insurance through health insurance exchanges. To be eligible for the premium tax credit, a taxpayer’s household income must meet or exceed 100% of the federal poverty level (FPL) and, after 2025, may not exceed 400% of the FPL (maximum income limit). For 2021-2025, the ARPA and IRA eliminated the maximum income limit, which generally expands eligibility for the premium tax credit.

Further, under current law, the amount of the premium tax credit is (1) generally the plan premium (conditions apply), minus (2) the taxpayer’s household income multiplied by the applicable percentage. The applicable percentage is a specific percentage that varies depending on which of six income ranges (adjusted for inflation after 2025) the taxpayer’s household income falls within. For 2021-2025, the ARPA and IRA lowered the applicable percentages and eliminated the adjustment of the applicable percentages for inflation, which generally increases the amount of the premium tax credit.

The bill makes permanent the elimination of the 400% maximum income limit, the lower applicable percentages, and the elimination of the inflation adjustment for the applicable percentages.

No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2025

This bill modifies provisions relating to federal funding for, and health insurance coverage of, abortions.

Specifically, the bill prohibits the use of federal funds for abortions or for health coverage that includes abortions. Such restrictions extend to the use of funds in the budget of the District of Columbia. Additionally, abortions may not be provided in a federal health care facility or by a federal employee.

Historically, language has been included in annual appropriations bills for the Department of Health and Human Services (HHS) that prohibits the use of federal funds for abortions—such language is commonly referred to as the Hyde Amendment. Similar language is also frequently included in appropriations bills for other federal agencies and the District of Columbia. The bill makes these restrictions permanent and extends the restrictions to all federal funds (rather than specific agencies).

The bill's restrictions regarding the use of federal funds do not apply in cases of rape, incest, or where a physical disorder, injury, or illness endangers a woman's life unless an abortion is performed. The Hyde Amendment provides the same exceptions.

The bill also prohibits qualified health plans from including coverage for abortions. Currently, qualified health plans may cover abortion, but the portion of the premium attributable to abortion coverage is not eligible for subsidies.

Dentist and Optometric Care Access Act of 2025 or the DOC Access Act of 2025

This bill prohibits private health insurance plans from setting rates for items and services, except for dental cleanings, provided by a doctor of optometry, of dental surgery, or of dental medicine (or an employer of such a doctor) for which the plan does not pay a substantial amount.

Additionally, an agreement between a plan and such a doctor for limited scope dental or vision benefits may last longer than two years only with the prior acceptance of the doctor for each term extension. Plans also may not restrict such a doctor's choice of laboratories or suppliers.

Such doctors may elect to waive the application of the payment amount and choice of laboratories provisions of this bill.

The bill does not supersede state laws regarding health insurers and dental or vision benefit plans.

Alternatives to Prevent Addiction In the Nation Act or the Alternatives to PAIN Act

This bill reduces cost-sharing and prohibits the imposition of certain utilization requirements under the Medicare prescription drug benefit for certain non-opioid pain management drugs.

Specifically, the bill requires such drugs to be covered without a deductible and to be placed on the lowest cost-sharing tier (if any). The bill also prohibits the imposition of prior authorization requirements (i.e., requiring prior approval from a plan) or step therapy requirements (i.e., requiring the use of alternative drugs before a drug is covered under a plan) with respect to such drugs.

Equal Access to Contraception for Veterans Act

This bill prohibits the Department of Veterans Affairs from requiring payment from a veteran for any contraceptive item that is required to be covered by health insurance plans without a cost-sharing requirement.

Support And Value Expectant Moms and Babies Act of 2025 or the SAVE Moms and Babies Act of 2025

This bill prohibits the Food and Drug Administration (FDA) from approving any new drug (either as a brand-name drug or a generic) intended to terminate a pregnancy and imposes additional restrictions on such drugs that are already approved.

Under the bill, an already-approved drug intended to terminate a pregnancy may be dispensed to a patient only with a prescription. Furthermore, the FDA may not approve any labeling change that would authorize (1) using the drug after 70 days of gestation, or (2) dispensing the drug by any means other than in-person administration by the prescribing health care practitioner.

The FDA must also impose additional restrictions on such already-approved drugs, including by (1) requiring the prescribing health care practitioner to receive a special certification, (2) prohibiting the practitioner from also acting as the dispensing pharmacist, and (3) requiring the practitioner to have the ability to provide surgical intervention to the patient.

The bill also rescinds any investigational use exemption already granted to such a drug if the bill would have prohibited the FDA from granting the exemption. (Currently, the FDA may grant an exemption to certain market approval requirements if a drug is intended solely for use in safety and effectiveness investigations.)

This bill lengthens the amount of time for which drug products must have market approval in order for the products to qualify for negotiation under the Medicare Drug Price Negotiation Program.

The Medicare Drug Price Negotiation Program requires the Centers for Medicare & Medicaid Services to negotiate the prices of certain prescription drugs under Medicare beginning in 2026. Among other requirements, drugs must have had market approval for at least 7 years (for drug products) or 11 years (for biologics) to qualify for negotiation.

The bill modifies these provisions so as to require drug products to also have had at least 11 years of market approval in order to qualify for negotiation.

The bill's changes apply retroactively.

Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act

This bill allows, beginning in 2028, for Medicare coverage and payment for multi-cancer early detection screening tests that are approved by the Food and Drug Administration and that are used to screen for cancer across many cancer types, if the Centers for Medicare & Medicaid Services determines such coverage is appropriate. Coverage is limited to those under a certain age (age 68 in 2028, increased by one year every year thereafter) and to one test every 11 months.

Assuring Medicare’s Promise Act of 2025

This bill increases the net investment tax for certain taxpayers and appropriates revenue from the net investment tax to the Federal Hospital Insurance Trust Fund (which finances Medicare Part A). The bill also requires the Internal Revenue Service (IRS) to issue additional guidance on the net investment tax.

The bill requires individuals with a modified adjusted gross income (MAGI) exceeding $400,000 ($500,000 for joint filers and $250,000 for married individuals filing separately), estates, and trusts to pay a tax of 3.8% on the greater of their specified net income or net investment income, subject to limitations. (Under current law, individuals with a MAGI exceeding $200,000 [or $250,000 for joint filers], estates, and trusts pay a 3.8% tax on net investment income.)

The bill defines specified net income by expanding the definition of net investment income to

• include gross income from any trade or business (unless subject to employment taxes), including interest, dividends, annuities, royalties, and rents;

• include net gain from the disposition of business property;

• eliminate the exclusion of income from the investment of working capital; and

• eliminate the exception related to certain active partnership or S corporation interests.

The bill also

• expands the net investment tax definition of a trade or business,

• disallows net operating losses in calculating net investment income,

• includes certain foreign-sourced income in net investment income, and

• requires the IRS to issue guidance on the treatment of certain corporate distributions for purposes of the net investment tax.

Maintaining Investments in New Innovation Act

This bill requires drug products with genetically targeted technology to have had market approval for at least 11 years in order to qualify for the Medicare Drug Price Negotiation Program. (The program requires the Centers for Medicare & Medicaid Services to negotiate the prices of certain prescription drugs under Medicare beginning in 2026. Among other requirements, drugs must have had market approval for at least 7 years (for drug products) or 11 years (for biologics) to qualify for negotiation.)

No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2025

This bill modifies provisions relating to federal funding for, and health insurance coverage of, abortions.

Specifically, the bill prohibits the use of federal funds for abortions or for health coverage that includes abortions. Such restrictions extend to the use of funds in the budget of the District of Columbia. Additionally, abortions may not be provided in a federal health care facility or by a federal employee.

Historically, language has been included in annual appropriations bills for the Department of Health and Human Services (HHS) that prohibits the use of federal funds for abortions—such language is commonly referred to as the Hyde Amendment. Similar language is also frequently included in appropriations bills for other federal agencies and the District of Columbia. The bill makes these restrictions permanent and extends the restrictions to all federal funds (rather than specific agencies).

The bill's restrictions regarding the use of federal funds do not apply in cases of rape, incest, or where a physical disorder, injury, or illness endangers a woman's life unless an abortion is performed. The Hyde Amendment provides the same exceptions.

The bill also prohibits qualified health plans from including coverage for abortions. Currently, qualified health plans may cover abortion, but the portion of the premium attributable to abortion coverage is not eligible for subsidies.

Close the Medigap Act of 2025

This bill (1) expands guaranteed issue rights with respect to Medigap policies (Medicare supplemental health insurance policies), (2) eliminates certain limitations on Medigap policies for newly eligible Medicare beneficiaries, and (3) modifies other provisions related to Medigap policies. (Guaranteed issue rights require that a policy be offered to any eligible applicant without regard to health status.)