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LUGPA Policy Update: 2025 Legislative Developments on Healthcare Freedom and Patient Choice 

      AT-A-GLANCE ESSENTIALS
     

What’s Changing
As the December 31, 2025, expiration of enhanced ACA premium tax credits approaches, Congress is weighing competing approaches to healthcare affordability and patient choice. Proposals include extending ACA subsidies, expanding tax-advantaged savings vehicles, increasing employer coverage flexibility, and advancing PBM transparency reforms. On December 11, the Senate rejected both Democratic and Republican subsidy proposals, leaving enhanced subsidies on track to expire and increasing the likelihood of premium increases in 2026.

Why It Matters to Urology
Coverage instability, rising premiums, and greater use of limited-benefit plans may affect patient access, continuity of care, and out-of-pocket costs for urologic services. PBM transparency provisions could influence specialty drug access and formulary design, while expanded savings accounts and employer-driven coverage models may alter patient payment behavior.

Action Points

  • Monitor patient insurance changes tied to subsidy expiration
  • Prepare for wider variation in benefit design and cost-sharing
  • Educate patients on HSAs, proposed Health Freedom Accounts (HFAs), and defined-contribution coverage models
  • Assess exposure to short-term and limited-benefit plans

Key Dates

  • Dec. 31, 2025: Enhanced ACA subsidies expire
  • Jan. 1, 2026: Premium increases take effect absent congressional action

January 2026 

Legislative Context

Throughout 2025, Congress has debated healthcare freedom, affordability, and coverage stability amid uncertainty over the future of enhanced ACA subsidies. Republican-led proposals emphasize tax-advantaged accounts, employer flexibility, and market-based reforms, while Democratic proposals prioritize extending subsidies to preserve coverage gains.

Absent further action, enhanced subsidies will lapse at year’s end, potentially leading to significant premium increases for an estimated 22 million ACA enrollees in 2026. A bipartisan House proposal, H.R. 5145, would provide a one-year extension but faces uncertain prospects in the Senate.

New Legislative Focus: The Lower Health Care Premiums for All Act

H.R. 6703, the Lower Health Care Premiums for All Act, is a House Republican proposal to reduce premiums and expand coverage flexibility for employers and workers, particularly small businesses and the self-employed. The bill combines PBM transparency requirements, targeted market stabilization, and expanded employer coverage options, while directing federal assistance toward lower-income enrollees rather than broadening subsidies.

Key Provisions

Lowering Premiums and Stabilizing Markets

  • PBM Transparency: Requires PBMs to disclose prescription drug spending, rebates, spread pricing, and formulary decisions to employer plans.
  • CSR Funding (Beginning 2027): Appropriates cost-sharing reduction payments to stabilize the individual market and reduce premium pressure for lower-income enrollees.

Expanding Employer Coverage Options

  • Association Health Plans: Expands access to AHPs across industries, including for self-employed individuals.
  • Stop-Loss Insurance Clarification: Confirms stop-loss coverage is not health insurance, supporting employer plan flexibility.
  • CHOICE Arrangements: Codifies defined-contribution coverage models, allows pre-tax premium payments, and expands employer flexibility.

Selected Legislative Proposals

  • Healthcare Freedom Act (H.R. 317): Converts HSAs into universal HFAs and expands eligible services.
  • Healthcare Freedom and Choice Act (H.R. 379): Restores longer-term short-term insurance plans.
  • Health Care Affordability Act (H.R. 247): Permanently extends enhanced ACA subsidies.
  • Bipartisan Premium Tax Credit Extension Act (H.R. 5145): Extends enhanced subsidies through 2026.

Developing House Action on ACA Subsidies

In late 2025, enough House Republicans signed a discharge petition to force a floor vote on a clean, three-year extension of enhanced ACA subsidies, setting up a House vote expected in January, where the bill is widely viewed as having sufficient support to pass.

The measure faces a steep uphill path in the Senate, where prior subsidy extensions failed. As a result, uncertainty persists regarding coverage stability and premium levels heading into 2026.

Implications for LUGPA Members

Opportunities

  • Greater patient payment flexibility through HSAs, HFAs, and defined-contribution models
  • Improved visibility into specialty drug pricing through PBM transparency

Risks

  • Subsidy expiration could drive premium increases, delayed care, and uncompensated services
  • Short-term plans often exclude chronic and preexisting urologic conditions
  • Legislative uncertainty complicates financial and operational planning

LUGPA Position

LUGPA supports policies that expand patient choice and financial flexibility while maintaining access to comprehensive, affordable urologic care. The association encourages bipartisan efforts to minimize coverage disruptions, promote prescription drug transparency, and avoid abrupt policy changes that could negatively affect patients and independent physician practices. LUGPA will continue to monitor developments and provide guidance to members.