H.R. 1776: New Health Options Act of 2025

This bill, titled the New Health Options Act of 2025, aims to amend the existing Patient Protection and Affordable Care Act (ACA) by establishing a new reinsurance program. This program would help lower health insurance premiums for certain individuals and improve their access to healthcare. Below are the key components of the bill:

Establishment of a Reinsurance Program

The bill proposes the creation of a reinsurance program, which is designed to provide financial support to health insurance issuers. This support will apply to claims for eligible individuals, helping to lower premiums for these individuals. The program will be administered by the Secretary of Health and Human Services (HHS).

Funding for the Program

• The bill allocates funding for the reinsurance program, with an appropriation of $50 per member per month for eligible individuals enrolled in covered plans. This funding will be available each year from January 1, 2026, to December 31, 2030.
• The total funding available for the program cannot exceed $6 billion in any given year.
• Unspent funds from previous years can be carried over to future years for payments under the reinsurance program.

Operational Guidelines

• The Secretary of HHS is tasked with setting parameters for how the reinsurance program will function, including determining the attachment point (the threshold for when claims trigger reinsurance payments), payment proportions, and caps on reinsurance payments.
• For the initial year (2026), the attachment point is set at $110,000, with a payment proportion of 90% on claims above this threshold, and a reinsurance cap of $300,000.

Opting Out of the Single Risk Pool

The bill includes provisions that allow health insurance issuers to opt out of single risk pool requirements under certain circumstances. This means that insurers can treat enrollees across multiple plans differently than those in a single risk pool, provided specific conditions are met.

Adjustments to Premium Limitations

• The legislation removes existing limitations on how much health insurance issuers can vary premiums based on age for certain health plans, allowing for more flexibility in charging policyholders.
• However, it maintains the current limits on premium variations for qualified health plans to ensure some level of consistency and fairness.

Out-of-Network Costs and High-Value Care Promotion

The bill includes measures aimed at allowing costs incurred from out-of-network providers to apply towards deductibles and out-of-pocket maximums, provided certain conditions are satisfied. This is intended to promote more high-value care in health insurance plans.

Price Disclosure Requirements

Starting January 1, 2026, health care providers and facilities will be mandated to disclose pricing information to patients, including whether the cost-sharing amount under their insurance exceeds the charge for the service without insurance. This aims to enhance transparency in healthcare pricing.

Legal Recourse for Violations

The bill also establishes mechanisms for individuals who are harmed by violations of the disclosure requirements to seek legal recourse in court, potentially allowing for injunctive relief and damages based on state law.

Implementation Timeline

Most of the provisions in the bill will be effective for plan years beginning on or after January 1, 2026.

Relevant Companies

• AET (Aetna Inc.): As a major health insurance issuer, Aetna may experience changes in its premium pricing models and claims management due to the establishment of the reinsurance program.
• ANTM (Anthem, Inc.): This company could be impacted significantly as it manages several health plans that may become eligible for the reinsurance program.
• CNC (Centene Corp.): As a large healthcare company offering a variety of insurance services, Centene could see changes in how it sets premiums and manages its risk pool.