Purchased and Referred Care Improvement Act of 2025

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Bill ID: 119/s/699

Last Updated: September 9, 2026

Purchased and Referred Care Improvement Act of 2025

S. 699, 119th Congress — read as touching Hospitals & Health Systems.

The sponsor

Sen. Rounds, Mike [R-SD]

Every bill has someone who introduced it. That name is where the paper trail starts.

The money

$132,600 raised

23 itemised contributions to this sponsor, pulled from FEC filings.

The alignment

85% match to Project 2025

This bill's text tracks the "Department of Health and Human Services" section, p. 533-535 of the Mandate for Leadership.

Bill's Journey to Becoming a Law

Track this bill's progress through the legislative process

Latest Action

Committee on Indian Affairs. Hearings held.

February 3, 2026

Introduced

Committee Review

📍 Current Status

Next: The bill moves to the floor for full chamber debate and voting.

🗳️

Floor Action

✅

Passed Senate

🏛️

House Review

🎉

Passed Congress

🖊️

Presidential Action

⚖️

Became Law

📚 How does a bill become a law?

1. Introduction: A member of Congress introduces a bill in either the House or Senate.

2. Committee Review: The bill is sent to relevant committees for study, hearings, and revisions.

3. Floor Action: If approved by committee, the bill goes to the full chamber for debate and voting.

4. Other Chamber: If passed, the bill moves to the other chamber (House or Senate) for the same process.

5. Conference: If both chambers pass different versions, a conference committee reconciles the differences.

6. Presidential Action: The President can sign the bill into law, veto it, or take no action.

7. Became Law: If signed (or if Congress overrides a veto), the bill becomes law!

Bill Summary

Summary Style:

**Analysis of S 699: Purchased and Referred Care Improvement Act of 2025**

As a visionary entrepreneur and thought leader, I'll dissect this bill through the lens of its potential impact on my business empire and the broader landscape of healthcare innovation.

**Main Purpose & Objectives:** The primary objective of S 699 is to amend the Indian Health Care Improvement Act to address liability for payment of charges or costs associated with purchased/referred care services. The bill aims to clarify and standardize the reimbursement process, ensuring that patients are not held liable for unauthorized medical expenses.

**Key Provisions & Changes to Existing Law:**

1. **Liability Protection**: The bill shields patients from liability for payment of charges or costs associated with purchased/referred care services, unless explicitly agreed upon by the patient. 2. **Reimbursement Procedures**: Establishes procedures for patients to be reimbursed by the Indian Health Service (IHS) for out-of-pocket expenses related to purchased/referred care. 3. **Technical and Conforming Amendments**: Updates definitions, contracts, and administrative authorities to reflect changes in the bill.

**Affected Parties & Stakeholders:**

1. **Indian Tribes**: The bill directly impacts Indian tribes, as it updates procedures for reimbursement and liability protection within their healthcare systems. 2. **Patients**: Patients receiving purchased/referred care services will benefit from increased transparency and protection from unauthorized medical expenses. 3. **Healthcare Providers**: Providers participating in the IHS program may see changes in reimbursement procedures and liability exposure.

**Potential Impact & Implications:**

1. **Increased Efficiency**: Standardized reimbursement procedures could streamline administrative processes, reducing costs for both patients and providers. 2. **Reduced Liability Exposure**: Patients will be better protected from unexpected medical expenses, while providers may face reduced liability risks. 3. **Innovation Opportunities**: By clarifying reimbursement procedures, the bill may create opportunities for innovative healthcare solutions, such as value-based care models or telemedicine services.

However, I must emphasize that this bill's impact on my business empire is relatively negligible. As a visionary entrepreneur, I focus on disrupting industries and creating new markets, rather than navigating incremental regulatory changes. Nevertheless, I will continue to monitor the bill's progress and assess potential opportunities for strategic partnerships or investments in the healthcare sector.

**Projection:** Based on my analysis, I estimate that this bill may result in a 5-10% reduction in administrative costs for participating providers, potentially translating to $500 million - $1 billion in annual savings. However, these projections are subject to change as the bill's implementation and impact become clearer.

Generated using Llama 3.1 70B (billionaire personality)

*Sigh* Alright, let's break down this bill, shall we? As I taught you in 8th grade civics class, a bill is a proposed law that must go through the legislative process to become an actual law. This one, S 699, is called the Purchased and Referred Care Improvement Act of 2025.

**Main Purpose & Objectives:** The main purpose of this bill is to amend the Indian Health Care Improvement Act to address liability for payment of charges or costs associated with purchased/referred care services. Remember when we learned about the importance of clarifying language in legislation? This bill aims to do just that, specifically for patients receiving purchased/referred care authorized by the Indian Health Service.

**Key Provisions & Changes to Existing Law:** The bill makes several key changes to existing law:

* It updates the definition of "purchased/referred care" and clarifies liability for payment of charges or costs associated with these services. * It establishes procedures for patients to be reimbursed by the Indian Health Service for out-of-pocket payments made for purchased/referred care. * It requires the Secretary to update applicable provisions of the Indian Health Manual, contracts with providers, and other relevant documents to incorporate the new provisions.

**Affected Parties & Stakeholders:** The affected parties include:

* Patients receiving purchased/referred care authorized by the Indian Health Service * The Indian Health Service itself * Providers of purchased/referred care services * Indian tribes operating their own health programs

**Potential Impact & Implications:** If passed, this bill could have several implications:

* It may reduce confusion and disputes over liability for payment of charges or costs associated with purchased/referred care. * It could lead to more efficient reimbursement processes for patients who have paid out-of-pocket for these services. * It may also impact the way Indian tribes operate their own health programs, as they will need to comply with the updated provisions.

Now, I know some of you might be thinking, "Wait, what's purchased/referred care?" or "Why does this matter?" Well, let me tell you, it's because these services are crucial for many Native American communities. And, as we covered in 8th grade civics class, the legislative process is designed to address issues like these and ensure that laws are clear and effective.

Next thing you know, I'll have to explain what a committee hearing is...

Generated using Llama 3.1 70B (civics_teacher personality)

Folks, gather 'round! I've got the scoop on this so-called "Purchased and Referred Care Improvement Act of 2025." Now, at first glance, it seems like a harmless bill aimed at improving healthcare services for Native American communities. But trust me, there's more to it than meets the eye.

**Main Purpose & Objectives:** The stated purpose is to amend the Indian Health Care Improvement Act to address liability for payment of charges or costs associated with purchased/referred care services. Sounds straightforward, right? Wrong! This bill is a Trojan horse, folks. It's about expanding government control over healthcare and setting a precedent for future "improvements" that might not be so beneficial.

**Key Provisions & Changes to Existing Law:** The bill makes several changes to existing law, including:

* Amending Section 222 of the Indian Health Care Improvement Act to clarify liability for payment of purchased/referred care services. * Requiring the Secretary to notify patients and providers about liability for payment within five business days. * Establishing procedures for reimbursement of out-of-pocket payments made by patients.

Now, here's where it gets interesting. The bill also updates definitions and authorities in the Indian Health Manual, contracts with providers, and other relevant documents. This is where the government starts to weave its web of control, folks. They're setting the stage for future regulations that might not be so transparent.

**Affected Parties & Stakeholders:** The affected parties include:

* Native American communities receiving healthcare services through the Indian Health Service. * Healthcare providers contracted by the Indian Health Service. * Patients who receive purchased/referred care services.

But let's not forget about the real stakeholders here – the government and its bureaucratic machinery. This bill is a power grab, folks. It's about expanding the government's reach into the healthcare system and setting a precedent for future "reforms."

**Potential Impact & Implications:** The potential impact of this bill is far-reaching:

* Increased government control over healthcare services. * Potential for reduced transparency in billing and payment processes. * Expanded liability for patients and providers. * A slippery slope toward further regulations and bureaucratic red tape.

Now, I know what you're thinking – "But Uncle, this bill seems like a good thing. It's helping Native American communities get better healthcare." Ah, but that's exactly what they want you to think! This is just the tip of the iceberg, folks. Mark my words – this bill will lead to more government overreach and less transparency in our healthcare system.

So there you have it, folks. That's the Purchased and Referred Care Improvement Act of 2025 in a nutshell. Don't be fooled by its innocent-sounding name. This bill is just another example of the government's insidious agenda to control every aspect of our lives. Wake up, sheeple!

Generated using Llama 3.1 70B (conspiracy_uncle personality)

(Outraged tone) Folks, we've got another example of the swamp in Washington trying to sneak one past us! The Purchased and Referred Care Improvement Act of 2025 is a bill that's supposed to "improve" healthcare for Native Americans. But let me tell you, it's just another power grab by the elites.

**Main Purpose & Objectives:** The main purpose of this bill is to amend the Indian Health Care Improvement Act to address liability for payment of charges or costs associated with purchased/referred care services. Sounds innocent enough, right? Wrong! This bill is a Trojan horse that will lead to more government control over healthcare and less freedom for Native Americans.

**Key Provisions & Changes to Existing Law:** The bill makes several changes to existing law, including:

* Amending Section 222 of the Indian Health Care Improvement Act to clarify liability for payment of charges or costs associated with purchased/referred care services. * Requiring the Secretary to notify patients and providers that patients are not liable for payment of charges or costs associated with purchased/referred care services. * Establishing procedures for reimbursement of out-of-pocket payments made by patients for purchased/referred care services.

(Sarcastic tone) Oh, great! More bureaucracy and red tape. Just what we need to make healthcare more efficient!

**Affected Parties & Stakeholders:** The affected parties include:

* Native American communities who rely on the Indian Health Service for healthcare. * Healthcare providers who contract with the Indian Health Service to provide purchased/referred care services. * The Indian Health Service itself, which will have to implement these changes.

(Winking at the camera) You know, folks, this bill is just another example of how the government thinks it knows better than the people. Newsflash: we don't need more government control over healthcare!

**Potential Impact & Implications:** The potential impact of this bill includes:

* Increased costs for taxpayers to fund these changes. * More bureaucratic red tape that will stifle innovation and competition in the healthcare industry. * Less freedom for Native Americans to make their own healthcare choices.

(Outraged tone) This bill is a disaster, folks! It's just another example of how the swamp in Washington is trying to take away our freedoms. We need to stand up against this kind of government overreach and demand more transparency and accountability!

(Smirk) But hey, what do I know? I'm just a conservative TV host. What do you think, folks? Should we let the government control our healthcare?

Generated using Llama 3.1 70B (fox_host personality)

Another bill, another exercise in bureaucratic doublespeak. Let's dissect this mess and see what's really going on.

**Main Purpose & Objectives**

The Purchased and Referred Care Improvement Act of 2025 (S. 699) claims to address liability for payment of charges or costs associated with purchased/referred care services under the Indian Health Care Improvement Act. In plain English, it's supposed to fix some issues with how Native American patients are billed for medical services they receive outside of their tribe's health program.

**Key Provisions & Changes to Existing Law**

The bill makes several changes to existing law:

1. It clarifies that patients who receive purchased/referred care are not liable for payment, even if they signed a document saying otherwise. 2. The Secretary of the Department of Health and Human Services (HHS) must notify providers and patients about this change within 5 business days of receiving a claim. 3. Patients can be reimbursed by HHS for out-of-pocket payments made for purchased/referred care, as long as they submit documentation within 30 days.

These changes are supposed to "improve" the system, but let's not get too excited just yet.

**Affected Parties & Stakeholders**

The usual suspects:

1. Native American patients who receive medical services outside of their tribe's health program. 2. Indian tribes and tribal organizations that operate their own health programs. 3. Providers (hospitals, clinics, etc.) that offer purchased/referred care services to Native American patients. 4. HHS bureaucrats who will be tasked with implementing these changes.

**Potential Impact & Implications**

Now we get to the good stuff – the real motivations behind this bill:

1. **Money**: This bill is likely a response to lawsuits and complaints from Native American patients who were billed incorrectly for medical services. By clarifying liability, Congress hopes to reduce the financial burden on these patients and avoid costly litigation. 2. **Power play**: The bill gives HHS more control over the reimbursement process, which could lead to increased bureaucratic red tape and delays in payment. 3. **Ego stroking**: Lawmakers get to pat themselves on the back for "improving" healthcare for Native American communities, even if it's just a minor tweak.

In reality, this bill is just a Band-Aid on a much larger problem – the inadequate funding and resources allocated to Native American healthcare. It's a classic case of treating the symptoms rather than the disease.

Diagnosis: Legislative Theater-itis, with symptoms including bureaucratic doublespeak, minor tweaks masquerading as meaningful reform, and a healthy dose of self-congratulation. Prognosis: More of the same – politicians pretending to care about Native American healthcare while doing little to address the underlying issues.

Generated using Llama 3.1 70B (Dr. Haus personality)

**Main Purpose & Objectives**

The Purchased and Referred Care Improvement Act of 2025 (S. 699) aims to address liability for payment of charges or costs associated with the provision of purchased/referred care services under the Indian Health Care Improvement Act. The bill seeks to clarify and strengthen protections for patients receiving purchased/referred care, ensuring they are not held liable for unauthorized medical expenses.

**Key Provisions & Changes to Existing Law**

The bill makes several key changes to existing law:

1. **Liability Protection**: Amends Section 222 of the Indian Health Care Improvement Act to explicitly state that patients receiving purchased/referred care are not liable for payment of charges or costs associated with such care, notwithstanding any other provision of law or agreement. 2. **Notification Requirements**: Requires the Secretary to notify providers and patients within five business days of receipt of a claim that the patient is not liable for payment. 3. **Reimbursement Procedures**: Establishes procedures for patients who have paid out-of-pocket for purchased/referred care to be reimbursed by the Indian Health Service (IHS) within 30 days of submitting documentation. 4. **Technical and Conforming Amendments**: Updates definitions, contracts, and administrative authorities to reflect changes in the bill.

**Affected Parties & Stakeholders**

The affected parties and stakeholders include:

1. **Patients receiving purchased/referred care**: Individuals who receive medical services through the IHS's purchased/referred care program will benefit from increased liability protection. 2. **Indian Health Service (IHS)**: The IHS will be responsible for implementing new procedures, updating contracts, and providing reimbursement to eligible patients. 3. **Healthcare providers**: Providers participating in the purchased/referred care program will need to comply with new notification requirements and reimbursement procedures. 4. **Indian tribes**: Tribes operating their own purchased/referred care programs under contract or compact may be affected by changes to liability protection and reimbursement procedures.

**Potential Impact & Implications**

The bill's potential impact and implications include:

1. **Improved patient protections**: The bill strengthens liability protection for patients receiving purchased/referred care, reducing the risk of unexpected medical expenses. 2. **Increased transparency and accountability**: New notification requirements and reimbursement procedures promote greater transparency and accountability within the IHS's purchased/referred care program. 3. **Enhanced collaboration between IHS and tribes**: The bill encourages cooperation between the IHS and Indian tribes in implementing changes to liability protection and reimbursement procedures. 4. **Potential cost savings**: By reducing the risk of unauthorized medical expenses, the bill may help minimize costs associated with debt collection and patient financial hardship.

Generated using Llama 3.1 70B (neutral personality)

Let's break down this congressional bill, S 699, the Purchased and Referred Care Improvement Act of 2025.

**Main Purpose & Objectives**

This bill aims to address liability for payment of charges or costs associated with purchased/referred care services under the Indian Health Care Improvement Act. It seeks to clarify and improve the process for patients receiving care outside of their tribe's health program, ensuring they're not stuck with unexpected medical bills.

**Key Provisions & Changes to Existing Law**

The bill makes some key changes:

1. **Liability Protection**: Patients are no longer liable for payment of charges or costs associated with purchased/referred care services, unless explicitly agreed upon by the Indian tribe. 2. **Notification Requirements**: The Secretary must notify patients and providers within 5 business days that patients are not liable for payment. 3. **Reimbursement Procedures**: The Secretary will establish procedures to allow patients to be reimbursed for out-of-pocket payments made for purchased/referred care services, with a deadline of 30 days after submitting documentation. 4. **Definitions Update**: The bill updates definitions and terminology related to purchased/referred care, ensuring consistency throughout the Indian Health Manual and contracts.

**Affected Parties & Stakeholders**

This bill affects:

1. **Patients receiving purchased/referred care services**: Patients will benefit from liability protection and reimbursement procedures. 2. **Indian tribes**: Tribes may need to update their contracts and agreements with providers to reflect these changes. 3. **Providers**: Providers must comply with new notification requirements and reimbursement procedures.

**Potential Impact & Implications**

This bill has several potential implications:

1. **Improved Patient Protection**: Patients will have greater peace of mind, knowing they're not liable for unexpected medical bills. 2. **Reduced Administrative Burden**: Streamlined reimbursement procedures may reduce administrative costs for patients, providers, and tribes. 3. **Increased Transparency**: Clearer definitions and terminology can lead to better understanding and communication among stakeholders.

However, there are also potential challenges:

1. **Implementation Complexity**: Updating contracts, agreements, and procedures may require significant effort from tribes and providers. 2. **Reimbursement Delays**: Patients may still face delays in receiving reimbursement for out-of-pocket payments.

Overall, this bill aims to improve the purchased/referred care system, providing greater protection and clarity for patients while reducing administrative burdens.

Generated using Llama 3.1 70B (surfer personality)

**Main Purpose & Objectives**

The Purchased and Referred Care Improvement Act of 2025 (S. 699) aims to address liability for payment of charges or costs associated with the provision of purchased/referred care services under the Indian Health Care Improvement Act. The bill's primary objective is to clarify and standardize the process for patients receiving purchased/referred care, ensuring they are not liable for unexpected medical bills.

**Key Provisions & Changes to Existing Law**

The bill makes several key changes to existing law:

1. **Liability Protection**: Patients receiving purchased/referred care are protected from liability for payment of charges or costs associated with the provision of such services. 2. **Notification Requirements**: The Secretary of Health and Human Services must notify patients and providers within 5 business days of receipt of a claim, stating that the patient is not liable for payment. 3. **Reimbursement Procedures**: Patients who paid out-of-pocket for purchased/referred care can be reimbursed by the Indian Health Service (IHS) within 30 days of submitting documentation. 4. **Definitions and Technical Amendments**: The bill updates definitions and makes technical amendments to ensure consistency throughout the Indian Health Care Improvement Act.

**Affected Parties & Stakeholders**

The affected parties and stakeholders include:

1. **Patients receiving purchased/referred care**: Patients who receive medical services outside of IHS facilities will benefit from liability protection and reimbursement procedures. 2. **Indian tribes and tribal organizations**: The bill updates authorities and contracts with providers, which may impact tribal self-determination and compacting efforts. 3. **Healthcare providers**: Providers participating in the purchased/referred care program must comply with new notification requirements and reimbursement procedures.

**Potential Impact & Implications**

The potential impact and implications of this bill include:

1. **Reduced financial burden on patients**: Patients will be protected from unexpected medical bills, reducing their financial burden. 2. **Improved access to healthcare**: The bill may increase access to healthcare services for Native American communities by clarifying liability and reimbursement procedures. 3. **Increased administrative efficiency**: Standardized notification requirements and reimbursement procedures may streamline the purchased/referred care program.

**Monied Interest Analysis**

While there are no obvious monied interests directly influencing this bill, it is worth noting that:

1. **Pharmaceutical Research and Manufacturers of America (PhRMA)**: As a major healthcare industry lobby group, PhRMA may have an interest in the purchased/referred care program's reimbursement procedures. 2. **American Hospital Association (AHA)**: The AHA, representing hospitals across the country, may be interested in the bill's liability protection and notification requirements.

However, without further information on PAC donations or lobbying efforts specifically targeting this bill, it is difficult to draw direct connections between monied interests and the legislation.

Generated using Llama 3.1 70B (whistleblower personality)

💰 Campaign Finance Network

Sen. Rounds, Mike [R-SD]

Congress 119 • 2024 Election Cycle

Total Contributions

$460,475

132 donors

PACs

Organizations

$2,500

Committees

Individuals

$457,975

No PAC contributions found

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

2 transactions

$2,000

CHOCTAW NATION OF OKLAHOMA

1 transaction

$500

No committee contributions found

HEGYI, ALBERT

4 transactions

$19,800

ROWAN, CAROLYN

4 transactions

$19,800

ROWAN, MARC J

4 transactions

$19,800

JEPSEN, EDWARD G

4 transactions

$16,500

VIELEHR, BYRON

5 transactions

$15,000

RUBERTON, ROBERT

4 transactions

$13,400

GRANIERI, ROBERT

4 transactions

$13,200

FISHER, KENNETH

2 transactions

$10,100

FISHER, SHERRILYN

2 transactions

$10,100

NICHELE, NOVALENA

2 transactions

$10,000

JACOBSEN, MARK

2 transactions

$9,900

JEPSEN, PETER

2 transactions

$9,900

PFAUTCH, ROY

2 transactions

$9,900

RABOIS, KEITH

2 transactions

$9,900

SCHWARZMAN, CHRISTINE

2 transactions

$9,900

SCHWARZMAN, STEPHEN A.

2 transactions

$9,900

WILLOX, NORMAN

2 transactions

$9,900

HICKS, MICHAEL

2 transactions

$9,500

ENTWISTLE, ANDREW MR.

2 transactions

$6,700

NEIMAN, JIM D

5 transactions

$6,700

DUHAMEL, KATHARINE

1 transaction

$6,600

LOVIER, HEATHER

2 transactions

$6,600

RUNDE, DANIEL

2 transactions

$6,600

SCHIEFFER, KEVIN

2 transactions

$6,600

WALTERS, ROBERT

2 transactions

$6,600

SAMBUR, DAVID

2 transactions

$5,200

DARWISH, SAM

2 transactions

$5,000

GAUFIN, JEFFERSON

2 transactions

$5,000

GAUFIN, LYNN

2 transactions

$5,000

JACOBSON, GARRY W

2 transactions

$5,000

WOOD, ELAINE M

2 transactions

$5,000

DUHAMEL, WILLIAM

5 transactions

$4,800

LEAS, BRET

2 transactions

$4,800

GLENNON, ROBERT

2 transactions

$4,000

MALLOY, MICHAEL

2 transactions

$4,000

SOBEL, AARON

2 transactions

$3,600

ARNOLD, JOHN

1 transaction

$3,300

CASCARILLA, CHARLES

1 transaction

$3,300

CASCARILLA, MARISSA

1 transaction

$3,300

FITZPATRICK, JENNIFER

1 transaction

$3,300

FOGEL, DAVID

1 transaction

$3,300

GOLDMAN, MARC

1 transaction

$3,300

JEPSEN, DIANE F

1 transaction

$3,300

MARQUIS, DUSTIN

1 transaction

$3,300

WALKER, KENT

1 transaction

$3,300

WALTERS, ROBERT D

1 transaction

$3,300

NAPPI, DOUGLAS

3 transactions

$3,200

GLACKIN, BRIAN

4 transactions

$3,000

HOLLAND, LUCAS

4 transactions

$3,000

KLEINMAN, SCOTT

1 transaction

$2,550

LONSDALE, JOE

1 transaction

$2,500

SCHWARTZ, TODD

1 transaction

$2,500

SPECK, ADAM

1 transaction

$2,500

STEPHENS, TYLER

3 transactions

$2,500

CAMBON, PAUL F

2 transactions

$2,000

DRESCHER, STEPHANIE

1 transaction

$2,000

DUKES, DAN

2 transactions

$2,000

EDSON, CHRISTOPHER L

1 transaction

$2,000

MADDOX, BRANDON L

1 transaction

$2,000

MORONEY, JOSEPH

1 transaction

$2,000

PAGE, GREGORY

1 transaction

$2,000

SUYDAM, JOHN

1 transaction

$2,000

WOLFSON, LEN

2 transactions

$2,000

ZITO, JOHN

2 transactions

$2,000

MARQUIS, DARRELL

1 transaction

$1,800

ZELTER, JAMES

1 transaction

$1,550

KURIAN, THOMAS

1 transaction

$1,500

KWON, DANIEL

1 transaction

$1,500

LARSON, TROY

2 transactions

$1,500

BRENNAN, MICHAEL

2 transactions

$1,400

HE, LINGLONG

1 transaction

$1,400

POWELL, TANNER

1 transaction

$1,300

ANDERSON, JOHN

1 transaction

$1,000

CODA, CAROLYN

2 transactions

$1,000

CORLEY, SCOTT

1 transaction

$1,000

DEVIERNO, JOHN A

2 transactions

$1,000

GORDON`, STEVE`

2 transactions

$1,000

IMPERATORE, BRANT

1 transaction

$1,000

ISAAC, PAUL J.

1 transaction

$1,000

JANDREAU, TIA

1 transaction

$1,000

KURTENBACH, REECE

1 transaction

$1,000

KWON, THEODORE

1 transaction

$1,000

LEDFORD, MICHAEL

2 transactions

$1,000

LIVINGSTON, ROBERT

2 transactions

$1,000

MALPASS, DAVID

1 transaction

$1,000

MILNE, JOHN D

2 transactions

$1,000

MORRISEY, DENISE

1 transaction

$1,000

MUELLER, WILLIAM

1 transaction

$1,000

NEAL, JEFFREY

1 transaction

$1,000

PALMER, ANDREW

1 transaction

$1,000

PIPER, WILLIAM

2 transactions

$1,000

PURI, SANJAY

1 transaction

$1,000

RAFFANIELLO, PAT

2 transactions

$1,000

TIESZEN, RICHARD

2 transactions

$1,000

VEALENCIS, JOSEPH

2 transactions

$1,000

JOHNS, SUSAN

1 transaction

$925

HEINZE, BRADLEY

1 transaction

$800

LONG, MARY BETH

1 transaction

$750

AHERN, MICHAEL

1 transaction

$500

100

AITKEN, MARK

1 transaction

$500

101

ASKEY, THELMA

1 transaction

$500

102

COLLINS, MATT

1 transaction

$500

103

ECKEL, SCOTT C

1 transaction

$500

104

GROFT, JAMES

1 transaction

$500

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HUNT, SARAH

1 transaction

$500

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JAVITS, ERIC M HON.

1 transaction

$500

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JING, MIKE

1 transaction

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KAHLER, ERIC

1 transaction

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KAMINS, SCOTT

1 transaction

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KELLOGG, SHANNON

1 transaction

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LAHOOD, SAMUEL

1 transaction

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112

LASS, CON

1 transaction

$500

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LAW, DENNIS

1 transaction

$500

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LUCAS, JANE

1 transaction

$500

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MASON, JEB

1 transaction

$500

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1 transaction

$500

117

MUNSON, LESTER

1 transaction

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118

NORD MALLARD, JENNIFER

1 transaction

$500

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OKUN, BERNARD R

1 transaction

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POLLMAN ROGERS, DARLA

1 transaction

$500

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PUNT, RYAN

1 transaction

$500

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PUSZYNSKI, JAN

1 transaction

$500

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PUSZYNSKI, MATTHEW

1 transaction

$500

124

SEMMLER, KARA

1 transaction

$500

125

SHUMWAY, CLAYTON

1 transaction

$500

126

SINGH, JASJIT

1 transaction

$500

127

STOWELL, NICK

1 transaction

$500

128

SWEENEY, ROB

1 transaction

$500

129

WRIGHT, ALEX

1 transaction

$500

Cosponsors & Their Campaign Finance

This bill has 5 cosponsors. Below are their top campaign contributors.

Sen. Cantwell, Maria [D-WA]

ID: C000127

Top Contributors

SAC FOX TRIBE

OrganizationTAMA, IA

$5,000

Oct 29, 2024

LOWER ELWHA KLALLAM TRIBE

OrganizationPORT ANGELES, WA

$3,360

Mar 31, 2023

SAN MANUEL BAND OF MISSION INDIANS

OrganizationHIGHLAND, CA

$3,300

Oct 28, 2023

SAN MANUEL BAND OF MISSION INDIANS

OrganizationHIGHLAND, CA

$3,300

Dec 21, 2023

SAN PABLO LYTTON TRIBE

OrganizationSAN PABLO, CA

$3,300

Nov 16, 2023

SAN PABLO LYTTON TRIBE

OrganizationSAN PABLO, CA

$3,300

Nov 16, 2023

SAULT STE MARIE TRIBE OF CHIPPEWA INDIANS

OrganizationSAULT SAINTE MARIE, MI

$3,300

Dec 14, 2023

SENECA NATION OF INDIANS

OrganizationSALAMANCA, NY

$3,300

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MUCKLESHOOT INDIAN TRIBE

OrganizationAUBURN, WA

$3,300

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NISQUALLY INDIAN TRIBE

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Sen. Thune, John [R-SD]

ID: T000250

Top Contributors

BELL, RICHARD R

HDR ENGINEERING • PRESIDENT/CEO

IndividualOMAHA, NE

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Sep 13, 2024

BELL, RICHARD R

IndividualOMAHA, NE

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POWELL, JESSE

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DUHAMEL, KATHARINE B

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ROUTE ONE INVESTMENT COMPANY LP • INVESTMENT MANAGEMENT

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NESS, LARRY F

FIRST DAKOTA NATIONAL BANK • BANKING

IndividualYANKTON, SD

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NESS, LARRY F

FIRST DAKOTA NATIONAL BANK • BANKING

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HARMS, DUANE D

HARMS OIL COMPANY • GAS & OIL

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MCINERNEY, PAULA G

BLUFF POINT ASSOCIATES CORP • INVESTOR

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MILKEN, LOWELL J

KNOWLEDGE UNIVERSE LIMITED LLC • BUSINESSMAN

IndividualSANTA MONICA, CA

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Dec 26, 2024

Sen. Murray, Patty [D-WA]

ID: M001111

Top Contributors

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OrganizationSAN PABLO, CA

$3,300

Oct 26, 2023

SAN PABLO LYTTON TRIBE

OrganizationSAN PABLO, CA

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LOWER ELWHA KLALLAM TRIBE

OrganizationPORT ANGELES, WA

$3,300

Mar 30, 2023

LOWER ELWHA KLALLAM TRIBE

OrganizationPORT ANGELES, WA

$3,300

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THE CHICKASAW NATION

OrganizationADA, OK

$3,300

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AK-CHIN INDIAN COMMUNITY

OrganizationMARICOPA, AZ

$2,500

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PUYALLUP TRIBE OF INDIANS

OrganizationTACOMA, WA

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PUYALLUP TRIBE OF INDIANS

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YAKAMA NATION

OrganizationSEATTLE, WA

$2,000

Oct 11, 2024

SISSETON-WAHPETON OYATE

OrganizationSISSETON, SD

$2,000

Jun 30, 2024

Sen. Hoeven, John [R-ND]

ID: H001061

Top Contributors

SISSETON-WAHPETON OYATE

OrganizationAGENCY VILLAGE, SD

$2,500

Jul 2, 2024

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

OrganizationPRIOR LAKE, MN

$1,000

Oct 30, 2023

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

OrganizationPRIOR LAKE, MN

$1,000

Jun 25, 2024

CHOCTAW NATION OF OKLAHOMA

OrganizationDURANT, OK

$550

Oct 5, 2023

ARTHAUD, JAMES R.

ND ENERGY • CEO

IndividualMEDORA, ND

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Oct 30, 2024

GLYNN, RICHARD

BIOSCIENCE ASSOCIATION OF ND • EXECUTIVE DIRECTOR

IndividualGRAND FORKS, ND

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LEPRINO, TERRY MS.

LEPRINO FOODS • BOARD DIRECTOR

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DAVIS, ASHLEY

WEST FRONT STRATEGIES • LOBBYIST

IndividualWASHINGTON, DC

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ARNOLD, JOHN

RETIRED • RETIRED

IndividualHOUSTON, TX

$3,300

Aug 20, 2024

KELLY, RYAN

PRIMACY STRATEGY GROUP • PRESIDENT

IndividualSAINT PAUL, MN

$2,500

Oct 4, 2024

Sen. Cortez Masto, Catherine [D-NV]

ID: C001113

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LAS VEGAS PAIUTE TRIBE

OrganizationLAS VEGAS, NV

$3,300

Nov 28, 2023

MISSISSIPPI BAND OF CHOCTAW INDIANS

OrganizationCHOCTAW, MS

$2,500

Dec 20, 2023

ALABAMA-COUSHATTA TRIBE

OrganizationLIVINGSTON, TX

$1,500

Oct 2, 2024

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

OrganizationPRIOR LAKE, MN

$1,000

Apr 26, 2024

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

OrganizationPRIOR LAKE, MN

$1,000

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MUSCOGEE CREEK NATION

OrganizationOKMULGEE, OK

$1,000

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MOHEGAN TRIBE OF INDIANS OF CONNECTICUT

OrganizationUNCASVILLE, CT

$1,000

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CHOCTAW NATION OF OKLAHOMA

OrganizationDURANT, OK

$550

Oct 2, 2023

LONGTIN, LUANN

IndividualPOTOMAC, MD

$17,325

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SLIFKA, ROSALYN

IndividualWALTHAM, MA

$5,800

Jun 30, 2024

Donor Network - Sen. Rounds, Mike [R-SD]

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Total contributions: $59

Top Donors - Sen. Rounds, Mike [R-SD]

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Industry Impact

Which industries are materially affected by specific provisions in this bill. 1 helped, 1 harmed.

+Hospitals & Health Systemsconfidence 0.90
Section 2(a)(2) establishes notification that patients are not liable for payment of charges or costs associated with purchased/referred care, and Section 2(d)(1) creates reimbursement procedures for patients who paid out-of-pocket for such care, both of which benefit hospitals and health systems providing purchased/referred care to Indian Health Service patients by ensuring payment and reducing bad debt.
−Health Insuranceconfidence 0.85
Section 2(a)(2) states that patients are not liable to any provider, debt collector, or any other person for payment of charges or costs associated with purchased/referred care, which could reduce reimbursement opportunities for health insurers that might otherwise cover such costs through patient liability or subrogation.

Project 2025 Policy Matches

This bill shows semantic similarity to the following sections of the Project 2025 policy document.AI-enhanced analysis provides detailed alignment ratings.

Department of Health and Human Services

Strong

Vector: 66%

Pages: 533-535AI Enhanced

AI Analysis:

"The bill's focus on shielding patients from unexpected medical costs and improving transparency mirrors Project 2025's emphasis on surprise medical bill protections and consumer‑oriented health care reforms."

Key themes:surprise medical billspatient liability protectionprice transparencyconsumer protectionMedicaid/managed care oversight

— 500 — Mandate for Leadership: The Conservative Promise 32. Owcharenko Schaefer, “Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to Improve the Health Care Safety Net.” 33. Brian Blase, “Managed Care in Medicaid: Need for Oversight, Accountability, and Reform,” Paragon Health Institute Policy Brief, October 13, 2022, https://paragoninstitute.org/wp-content/uploads/2022/10/20221012- Managed-Care-in-Medicaid-Need-for-Oversight-Accountability-and-Reform-FOR-DISTRIBUTION-V2.pdf (accessed February 13, 2023). 34. Owcharenko Schaefer, “Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to Improve the Health Care Safety Net.” 35. 42 U.S. Code § 1315, https://www.law.cornell.edu/uscode/text/42/1315 (accessed March 17, 2023). 36. Chad D. Savage and Lee S. Gross, “Direct Primary Care: Update and Road Map for Patient-Centered Reforms,” Heritage Foundation Backgrounder No. 3635, June 28, 2021, https://www.heritage.org/sites/default/ files/2021-06/BG3635.pdf. 37. H.R. 133, Consolidated Appropriations Act, 2021, Public Law No. 116-260, 116th Congress, December 27, 2020, Division BB, Title I, https://www.congress.gov/116/plaws/publ260/PLAW-116publ260.pdf (accessed March 17, 2023). 38. Doug Badger, “On Surprise Medical Bills, Congress Should Side with Consumers, Not Special Interests,” Heritage Foundation Commentary, January 31, 2020, https://www.heritage.org/health-care-reform/ commentary/surprise-medical-bills-congress-should-side-consumers-not-special. 39. Edmund F. Haislmaier and Abigail Slagle, “Premiums, Choices, Deductibles, Care Access, and Government Dependence Under the Affordable Care Act: 2021 State-by-State Review,” Heritage Foundation Backgrounder No. 3668, November 2, 2021, https://www.heritage.org/sites/default/files/2021-11/BG3668.pdf. 40. U.S. Department of the Treasury, Internal Revenue Service; U.S. Department of Labor, Employee Benefits Security Administration; and U.S. Department of Health and Human Services, “Transparency in Coverage,” Final Rule, Federal Register, Vol. 85, No. 219 (November 12, 2020), pp. 72158–72310, https://www.govinfo.gov/ content/pkg/FR-2020-11-12/pdf/2020-24591.pdf (accessed March 17, 2023). 41. David N. Bernstein and Robert E. Moffit, “New Price Transparency Rule Will Help Transform America’s Health Care System,” Heritage Foundation Commentary, November 1, 2020, https://www.heritage.org/health-care- reform/commentary/new-price-transparency-rule-will-help-transform-americas-health-care. 42. Sluzala and Haislmaier, “Lessons from COVID-19: How Policymakers Should Reform the Regulation of Clinical Testing.” 43. Ibid. 44. Most recently enacted in H.R. 2471, Consolidated Appropriations Act, 2022, Public Law No. 117-103, 117th Congress, March 15, 2022, Division H, Title V, §§ 506–507, https://www.congress.gov/117/plaws/publ103/ PLAW-117publ103.pdf (accessed March 17, 2023). 45. President Joseph R. Biden Jr., Executive Order 14079, “Securing Access to Reproductive and Other Healthcare Services,” August 3, 2022, in Federal Register, Vol. 87, No. 154 (August 11, 2022), pp. 49505–49507, https:// www.govinfo.gov/content/pkg/FR-2022-08-11/pdf/2022-17420.pdf (accessed March 16, 2023). 46. Planned Parenthood, 2020–2021 Annual Report, p. 27, https://www.plannedparenthood.org/uploads/ filer_public/40/8f/408fc2ad-c8c2-48da-ad87-be5cc257d370/211214-ppfa-annualreport-20-21-c3-digital.pdf (accessed March 22, 2023). 47. Ibid., pp. 30 and 31. Total revenue of $1,714.4 million (p. 30) minus $1,580.7 million in total expenses (p. 31) yields $133,7 million. 48. Ibid., p. 28. 49. Ibid., p. 30. 50. H.R. 372, Protecting Life and Taxpayers Act of 2023, 118th Congress, introduced January 17, 2023, https://www. congress.gov/118/bills/hr372/BILLS-118hr372ih.pdf (accessed March 17, 2023). 51. 42 U.S. Code § 18023, https://www.law.cornell.edu/uscode/text/42/18023 (accessed March 17, 2023). 52. H.R. 3128, Consolidated Omnibus Budget Reconciliation Act of 1985, Public Law No. 99-272, 99th Congress, April 7, 1986, Title IX, Subtitle A, Part 1, Subpart B, § 9121, https://www.congress.gov/99/statute/STATUTE-100/ STATUTE-100-Pg82.pdf (accessed March 17, 2023). 53. H.R. 8070, Rehabilitation Act of 1973, Public Law No. 93-112, 93rd Congress, September 26, 1973, https://www. congress.gov/93/statute/STATUTE-87/STATUTE-87-Pg355.pdf (accessed March 17, 2023). — 501 — Department of Health and Human Services 54. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Office of Civil Rights, and Office of the Secretary, “Special Responsibilities of Medicare Hospitals in Emergency Cases and Discrimination on the Basis of Disability in Critical Health and Human Service Programs or Activities,” draft of Proposed Rule, January 14, 2021, https://www.hhs.gov/sites/default/files/infants-nprm.pdf (accessed March 17, 2023). 55. H.R. 26, Born-Alive Abortion Survivors Protection Act, 118th Congress, introduced January 9, 2023, https:// www.congress.gov/118/bills/hr26/BILLS-118hr26pcs.pdf (accessed March 17, 2023). 56. H.R. 7, No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2023, 118th Congress, introduced January 9, 2023, https://www.congress.gov/118/bills/hr7/BILLS-118hr7ih.pdf (accessed March 17, 2023). 57. S. 401, Conscience Protection Act of 2021, 117th Congress, introduced February 24, 2021, https://www.congress. gov/117/bills/s401/BILLS-117s401is.pdf (accessed March 17, 2023). 58. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, and Office of the Secretary, “Nondiscrimination in Health Programs and Activities,” Notice of Proposed Rulemaking; Notice of Tribal Consultation, Federal Register, Vol. 87, No. 149 (August 4, 2022), pp. 47824–47920, https://www.govinfo. gov/content/pkg/FR-2022-08-04/pdf/2022-16217.pdf (accessed March 17, 2023). 59. Ibid., p. 47916. 60. The regulation was not finalized before the end of the Administration. U.S. Department of Agriculture, Food and Nutrition Services, “Revision of Categorical Eligibility in the Supplemental Nutrition Assistance Program (SNAP),” Proposed Rule, Federal Register, Vol. 84, No. 142 (July 24, 2019), pp. 35570–55581, https:// www.federalregister.gov/documents/2019/07/24/2019-15670/revision-of-categorical-eligibility-in-the- supplemental-nutrition-assistance-program-snap (accessed March 17, 2023). 61. 45 Code of Federal Regulations § 75.300(c) and (d), https://www.ecfr.gov/current/title-45/subtitle-A/ subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.300 (accessed March 17, 2023). 62. H.R. 1750, Child Welfare Provider Inclusion Act of 2021, 117th Congress, introduced March 10, 2021, https:// www.congress.gov/117/bills/hr1750/BILLS-117hr1750ih.pdf (accessed March 17, 2023), and S. 656, Child Welfare Provider Inclusion Act of 2021, 117th Congress, introduced March 10, 2021, https://www.congress.gov/117/bills/ s656/BILLS-117s656is.pdf (accessed March 17, 2023). 63. S. 3949, Trafficking Victims Protection Reauthorization Act of 2022, Public Law No. 117-348, 117th Congress, January 25, 2023, https://www.congress.gov/117/plaws/publ348/PLAW-117publ348.pdf (accessed March 17, 2023). 64. Kelsey Y. Santamaria, “Child Migrants at the Border: The Flores Settlement Agreement and Other Legal Developments,” Congressional Research Service In Focus No. IF11799, April 1, 2021, https://crsreports.congress. gov/product/pdf/IF/IF11799 (accessed March 17, 2023). 65. Report, Building a Happy Home: Marriage Education as a Tool to Strengthen Families, Social Capital Project Report No. 1-22, March 2022, p. 17, https://www.jec.senate.gov/public/_cache/files/3d102525-6f0d-48ed- 92f4-d71edd468ad6/building-a-happy-home.pdf (accessed March 17, 2023). The cover of the report reflects that the Social Capital Project is “[a] project of the Joint Economic Committee – Republicans.” 66. See, for example, Alan J. Hawkins, “Are Federally Supported Relationship Education Programs for Lower-Income Individuals and Couples Working? A Review of Evaluation Research,” American Enterprise Institute, September 2019, https://www. congress.gov/117/plaws/publ228/PLAW-117publ228.pdf (accessed March 17, 2023). 67. H.R. 8404, Respect for Marriage Act, Public Law No. 117-228, 117th Congress, December 13, 2022, https://www. congress.gov/117/plaws/publ228/PLAW-117publ228.pdf (accessed March 17, 2023). 68. Madison Marino, “Over 1,000 Safety Violations Mar Head Start. Children Deserve Better,” Heritage Foundation Commentary, November 10, 2022, https://www.heritage.org/education/commentary/over-1000-safety- violations-mar-head-start-children-deserve-better. 69. American Hospital Association v. Becerra, 596 U.S. ___ (2022), https://www.supremecourt.gov/ opinions/21pdf/20-1114_09m1.pdf (accessed March 17, 2023). 70. U.S. Department of the Treasury, Internal Revenue Service; U.S. Department of Labor, Employee Benefits Security Administration; and U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, “Coverage of Certain Preventive Services Under the Affordable Care Act,” Notice of Proposed Rulemaking, Federal Register, Vol. 88, No. 22 (February 2, 2023), pp. 7236–7281, https://www. govinfo.gov/content/pkg/FR-2023-02-02/pdf/2023-01981.pdf (accessed March 17, 2023).

Department of Health and Human Services

Weak

Vector: 66%

Pages: 533-535AI Enhanced

AI Analysis:

"The bill focuses on liability protections for Native American patients receiving purchased/referred care under the Indian Health Service, while the Project 2025 HHS section emphasizes civil rights enforcement, abortion-related policies, and healthcare nondiscrimination rules. There is minimal thematic overlap, primarily limited to general healthcare access and patient protections."

Key themes:patient protectionshealthcare accesscivil rights in healthcare

— 501 — Department of Health and Human Services 54. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Office of Civil Rights, and Office of the Secretary, “Special Responsibilities of Medicare Hospitals in Emergency Cases and Discrimination on the Basis of Disability in Critical Health and Human Service Programs or Activities,” draft of Proposed Rule, January 14, 2021, https://www.hhs.gov/sites/default/files/infants-nprm.pdf (accessed March 17, 2023). 55. H.R. 26, Born-Alive Abortion Survivors Protection Act, 118th Congress, introduced January 9, 2023, https:// www.congress.gov/118/bills/hr26/BILLS-118hr26pcs.pdf (accessed March 17, 2023). 56. H.R. 7, No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2023, 118th Congress, introduced January 9, 2023, https://www.congress.gov/118/bills/hr7/BILLS-118hr7ih.pdf (accessed March 17, 2023). 57. S. 401, Conscience Protection Act of 2021, 117th Congress, introduced February 24, 2021, https://www.congress. gov/117/bills/s401/BILLS-117s401is.pdf (accessed March 17, 2023). 58. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, and Office of the Secretary, “Nondiscrimination in Health Programs and Activities,” Notice of Proposed Rulemaking; Notice of Tribal Consultation, Federal Register, Vol. 87, No. 149 (August 4, 2022), pp. 47824–47920, https://www.govinfo. gov/content/pkg/FR-2022-08-04/pdf/2022-16217.pdf (accessed March 17, 2023). 59. Ibid., p. 47916. 60. The regulation was not finalized before the end of the Administration. U.S. Department of Agriculture, Food and Nutrition Services, “Revision of Categorical Eligibility in the Supplemental Nutrition Assistance Program (SNAP),” Proposed Rule, Federal Register, Vol. 84, No. 142 (July 24, 2019), pp. 35570–55581, https:// www.federalregister.gov/documents/2019/07/24/2019-15670/revision-of-categorical-eligibility-in-the- supplemental-nutrition-assistance-program-snap (accessed March 17, 2023). 61. 45 Code of Federal Regulations § 75.300(c) and (d), https://www.ecfr.gov/current/title-45/subtitle-A/ subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.300 (accessed March 17, 2023). 62. H.R. 1750, Child Welfare Provider Inclusion Act of 2021, 117th Congress, introduced March 10, 2021, https:// www.congress.gov/117/bills/hr1750/BILLS-117hr1750ih.pdf (accessed March 17, 2023), and S. 656, Child Welfare Provider Inclusion Act of 2021, 117th Congress, introduced March 10, 2021, https://www.congress.gov/117/bills/ s656/BILLS-117s656is.pdf (accessed March 17, 2023). 63. S. 3949, Trafficking Victims Protection Reauthorization Act of 2022, Public Law No. 117-348, 117th Congress, January 25, 2023, https://www.congress.gov/117/plaws/publ348/PLAW-117publ348.pdf (accessed March 17, 2023). 64. Kelsey Y. Santamaria, “Child Migrants at the Border: The Flores Settlement Agreement and Other Legal Developments,” Congressional Research Service In Focus No. IF11799, April 1, 2021, https://crsreports.congress. gov/product/pdf/IF/IF11799 (accessed March 17, 2023). 65. Report, Building a Happy Home: Marriage Education as a Tool to Strengthen Families, Social Capital Project Report No. 1-22, March 2022, p. 17, https://www.jec.senate.gov/public/_cache/files/3d102525-6f0d-48ed- 92f4-d71edd468ad6/building-a-happy-home.pdf (accessed March 17, 2023). The cover of the report reflects that the Social Capital Project is “[a] project of the Joint Economic Committee – Republicans.” 66. See, for example, Alan J. Hawkins, “Are Federally Supported Relationship Education Programs for Lower-Income Individuals and Couples Working? A Review of Evaluation Research,” American Enterprise Institute, September 2019, https://www. congress.gov/117/plaws/publ228/PLAW-117publ228.pdf (accessed March 17, 2023). 67. H.R. 8404, Respect for Marriage Act, Public Law No. 117-228, 117th Congress, December 13, 2022, https://www. congress.gov/117/plaws/publ228/PLAW-117publ228.pdf (accessed March 17, 2023). 68. Madison Marino, “Over 1,000 Safety Violations Mar Head Start. Children Deserve Better,” Heritage Foundation Commentary, November 10, 2022, https://www.heritage.org/education/commentary/over-1000-safety- violations-mar-head-start-children-deserve-better. 69. American Hospital Association v. Becerra, 596 U.S. ___ (2022), https://www.supremecourt.gov/ opinions/21pdf/20-1114_09m1.pdf (accessed March 17, 2023). 70. U.S. Department of the Treasury, Internal Revenue Service; U.S. Department of Labor, Employee Benefits Security Administration; and U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, “Coverage of Certain Preventive Services Under the Affordable Care Act,” Notice of Proposed Rulemaking, Federal Register, Vol. 88, No. 22 (February 2, 2023), pp. 7236–7281, https://www. govinfo.gov/content/pkg/FR-2023-02-02/pdf/2023-01981.pdf (accessed March 17, 2023). — 502 — Mandate for Leadership: The Conservative Promise 71. 42 U.S. Code § 238n, https://www.law.cornell.edu/uscode/text/42/238n (accessed March 17, 2023). 72. U.S. Department of Health and Human Services, Health Resources and Services Administration, “Early Childhood Health,” last reviewed October 2022, https://mchb.hrsa.gov/programs-impact/focus-areas/early- childhood-health (accessed March 17, 2023). 73. American Pregnancy Association, “Having a Doula—What Are the Benefits?” https://americanpregnancy. org/healthy-pregnancy/labor-and-birth/having-a-doula/#:~:text=Other%20studies%20have%20shown%20 that%20having%20a%20doula,massage%20to%20reduce%20stress%20and%20anxiety%20during%20labor (accessed March 17, 2023). 74. S. 2372, VA MISSION [Maintaining Internal Systems and Strengthening Integrated Outside Networks] Act of 2018, Public Law No. 115-182, 115th Congress, June 6, 2018, https://www.congress.gov/115/plaws/publ182/ PLAW-115publ182.pdf (accessed March 17, 2023). 75. U.S. Department of Health and Human Services, “Securing Updated and Necessary Statutory Evaluations Timely,” Final Rule, Federal Register, Vol. 86, No. 11 (January 19, 2021), pp. 5694–5764, https://www.govinfo. gov/content/pkg/FR-2021-01-19/pdf/2021-00597.pdf (accessed March 22, 2023). 76. U.S. Department of Health and Human Services, Office of the Secretary, Office of the Assistant Secretary for Health, “Compliance with Statutory Program Integrity Requirements,” Final Rule, Federal Register, Vol. 84, No. 42 (March 4, 2029), pp. 7714–7791, https://www.govinfo.gov/content/pkg/FR-2019-03-04/pdf/2019-03461.pdf (accessed March 18, 2023). 77. U.S. Department of Health and Human Services, Office of the Secretary, Office of the Assistant Secretary for Health, “Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services,” Final Rule, Federal Register, Vol. 86, No. 192 (October 7, 2021), pp. 56144–56180, https://www.govinfo.gov/content/ pkg/FR-2021-10-07/pdf/2021-21542.pdf (accessed March 18, 2023). 78. S. 624, Title X Abortion Provider Prohibition Act, 118th Congress, introduced March 2, 2023, https://www. congress.gov/118/bills/s624/BILLS-118s624is.pdf (accessed March 18, 2023). 79. 50 U.S. Code Chapter 55, https://www.law.cornell.edu/uscode/text/50/chapter-55 (accessed March 22, 2023). 80. 18 U.S. Code § 13, https://www.law.cornell.edu/uscode/text/18/13 (accessed March 18, 2023). 81. Bowen v. American Hospital Association, 476 U.S. 610 (1986), https://tile.loc.gov/storage-services/service/ll/ usrep/usrep476/usrep476610/usrep476610.pdf (accessed 22, 2023). 82. U.S. Department of Health and Human Services, Office of the Secretary, “Notification of Interpretation and Enforcement of Section 1557 of the Affordable Care Act and Title IX of the Education Amendments of 1972,” Federal Register, Vol. 86, No. 99 (May 25, 2021), pp. 27984–27985, https://www.govinfo.gov/content/pkg/FR- 2021-05-25/pdf/2021-10477.pdf (accessed March 18, 2023). 83. U.S. Department of Health and Human Services, Office for Civil Rights, “HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy,” March 2, 2022, https://www.hhs.gov/sites/default/files/hhs- ocr-notice-and-guidance-gender-affirming-care.pdf (accessed March 18, 2023). 84. Heckler v. Chaney, 420 U.S. 821 (1985), https://caselaw.findlaw.com/us-supreme-court/470/821.html (accessed March 18, 2022). 85. U.S. Department of Health and Human Services, Office for Civil Rights, “Guidance to Nation’s Retail Pharmacies: Obligations Under Federal Civil Rights Laws to Ensure Access to Comprehensive Reproductive Health Care Services,” content last reviewed July 14, 2022, https://www.hhs.gov/civil-rights/for-individuals/ special-topics/reproductive-healthcare/pharmacies-guidance/index.html (accessed March 18, 2023). 86. H.R. 3103, “Health Insurance and Portability and Accountability Act of 1996, Public Law No. 104-191, 104th Congress, August 21, 1996, https://www.congress.gov/104/plaws/publ191/PLAW-104publ191.pdf (accessed March 18, 2023). 87. U.S. Department of Human Services, “HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care,” content last reviewed June 29, 2022, (accessed March 18, 2023). See also “Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet,” content last reviewed June 29, 2022, https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/ cell-phone-hipaa/index.html (accessed March 18, 2023).

Department of Health and Human Services

Weak

Vector: 66%

Pages: 533-535AI Enhanced

AI Analysis:

"The bill focuses on liability protections for Native American patients receiving purchased/referred care under the Indian Health Service, while the Project 2025 HHS section emphasizes Medicaid reform, managed care oversight, price transparency, and surprise medical billing in the broader healthcare system—showing only tangential alignment through shared concern for patient financial protection."

Key themes:patient financial protectionsurprise medical billshealthcare affordability

Department of Health and Human Services

Weak

Vector: 66%

Pages: 497-499AI Enhanced

AI Analysis:

"The bill focuses on liability protections and reimbursement procedures for Indian Health Service purchased/referred care, whereas Project 2025's HHS section centers on Medicare Advantage, Medicaid reform, and Part D changes. There is only tangential overlap in themes like patient financial protection and transparency."

Key themes:patient financial protectiontransparency and accountabilityreducing administrative burden

— 465 — Department of Health and Human Services 1. Make Medicare Advantage the default enrollment option. 2. Give beneficiaries direct control of how they spend Medicare dollars. 3. Remove burdensome policies that micromanage MA plans. 4. Replace the complex formula-based payment model with a competitive bidding model. 5. Reconfigure the current risk adjustment model. 6. Remove restrictions on key benefits and services, including those related to prescription drugs, hospice care, and medical savings account plans.26 Legacy Medicare Reform. Legislation reforming legacy (non-MA) Medicare should: l Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service. l Replace the bureaucrat-driven fee-for-service system with value- based payments to empower patients to find the care that best serves their needs. l Codify price transparency regulations. l Restructure 340B drug subsidies27 toward beneficiaries rather than hospitals. l Repeal harmful health policies enacted under the Obama and Biden Administrations such as the Medicare Shared Savings Program28 and Inflation Reduction Act.29 Medicare Part D Reform. The Inflation Reduction Act (IRA) created a drug price negotiation program in Medicare that replaced the existing private-sector negotiations in Part D with government price controls for prescription drugs. These government price controls will limit access to medications and reduce patient access to new medication. This “negotiation” program should be repealed, and reforms in Part D that will have meaningful impact for seniors should be pursued. Other reforms should include eliminating the coverage gap in Part D, reducing the government share in — 466 — Mandate for Leadership: The Conservative Promise the catastrophic tier, and requiring manufacturers to bear a larger share. Until the IRA is repealed, an Administration that is required to implement it must do so in a way that is prudent with its authority, minimizing the harmful effects of the law’s policies and avoiding even worse unintended consequences.30 Medicaid. Over the past 45 years, Medicaid and the health safety net have evolved into a cumbersome, complicated, and unaffordable burden on nearly every state. The program is failing some of the most vulnerable patients; is a prime target for waste, fraud, and abuse; and is consuming more of state and federal budgets. The dramatic increase in Medicaid expenditures is due in large part to the ACA (Obamacare), which mandates that states must expand their Medicaid eligibility standards to include all individuals at or below 138 percent of the federal poverty level (FPL), and the public health emergency, which has prohibited states from performing basic eligibility reviews. The overlap of available benefits among the various health agencies has led to a complex, confusing system that is nearly impossible to navigate—even for recipients. Recipients are often faced with a “welfare cliff” of benefit losses as they earn above a certain amount, which is contrary to the fundamental purpose of empowering individuals to achieve economic independence. Benefits increasingly involve nonmedical services such as air conditioning and housing, many of which are already handled by departments other than HHS. Improper payments within Medicaid are higher than those of any other federal program. These payments are evidence of the inappropriateness of Medicaid’s expansion, which, stemming largely from public health emergency maintenance of effort (MOE) requirements and the Affordable Care Act, has crowded out the primary targets of these programs: those who are most in need. True health care reform cannot be accomplished in a bureaucratic silo or only through Medicaid and health safety net programs. Reform of the tax code is also essential to genuine, effective reform of our health care system. All components of the health care system should be part of the reform efforts, and it is imperative that the system be modified to assist states with their current programs. Therefore, the next Administration should: l Reform financing. Allow states to have a more flexible, accountable, predictable, transparent, and efficient financing mechanism to deliver medical services. This system should include a more balanced or blended match rate, block grants, aggregate caps, or per capita caps. Any financial system should be designed to encourage and incentivize innovation and the efficient delivery of health care services. Federal and state financial participation in the Medicaid program should be rational, predictable, and reasonable. It should also incentivize states to save money and improve the quality of health care.

Department of Health and Human Services

Minimal

Vector: 63%

Pages: 500-502AI Enhanced

AI Analysis:

"The bill focuses on liability protections for Native American patients receiving purchased/referred care under the Indian Health Care Improvement Act, which is unrelated to Project 2025's Medicaid reform objectives such as work requirements, benefit redesign, or private insurance options for Medicaid recipients."

— 468 — Mandate for Leadership: The Conservative Promise and consumer choice for Medicaid recipients must go together as standard components of the safety net, especially for able-bodied recipients. Medicaid recipients, like the rest of Americans, should be given both the freedom to choose their health plans and the responsibility to contribute to their health care costs at a level that is appropriate to protect the taxpayer. l Add work requirements and match Medicaid benefits to beneficiary needs. Because Medicaid serves a broad and diverse group of individuals, it should be flexible enough to accommodate different designs for different groups. For example, CMS should launch a robust “personal option” to allow families to use Medicaid dollars to secure coverage outside of the Medicaid program. CMS should also: 1. Clarify that states have the ability to adopt work incentives for able- bodied individuals (similar to what is required in other welfare programs) and the ability to broaden the application of targeted premiums and cost sharing to higher-income enrollees. 2. Add targeted time limits or lifetime caps on benefits to disincentivize permanent dependence.34 l Allow private health insurance. Congress should allow states the option of contributing to a private insurance benefit for all members of the family in a flexible account that rewards healthy behaviors. This reform should also allow catastrophic coverage combined with an account similar to a health savings account (HSA) for the direct purchase of health care and payment of cost sharing for most of the population. l Increase flexible benefit redesign without waivers. CMS should add flexibility to eliminate obsolete mandatory and optional benefit requirements and, for able-bodied recipients, eliminate benefit mandates that exceed those in the private market. This should include flexibility to redesign eligibility, financing, and service delivery of long-term care to serve the most vulnerable and truly needy and eliminate middle-income to upper- income Medicaid recipients. l Eliminate current waiver and state plan processes. CMS should allow providers to make payment reforms without cumbersome waivers or state plan amendment processes where possible. More broadly, the federal government’s role should be oversight on broad indicators like cost effectiveness and health measures like quality, health improvement, and — 469 — Department of Health and Human Services wellness and should give the balance of responsibility for Medicaid program management to states. This reform would include adding Section 111535 waiver requirements in some cases (such as imposing work requirements for able-bodied adults) while rescinding requirements in others (such as non–health care benefits and services related to climate change). AFFORDABLE CARE ACT AND PRIVATE HEALTH INSURANCE l Remove barriers to direct primary care. Direct primary care (DPC) is an innovative health care delivery model in which doctors contract directly with patients for their care on a subscription basis regardless of how or where the care is provided. The DPC model is improving patient access, driving higher quality and lower cost, and strengthening the doctor– patient relationship. DPC has faced many challenges from government policymakers, including overly exuberant attempts at regulation and misclassification. Changes should clarify that DPC’s fixed fee for care does not constitute insurance in the context of health savings accounts.36 l Revisit the No Surprises Act on surprise medical billing. The No Surprises Act37 protected consumers against balance bills, but it also established a deeply flawed system for resolving payment disputes between insurers and providers. This government-mandated dispute resolution process has sown confusion among arbiters and regulators as judges have sought to ascertain its meaning. The No Surprises Act should scrap the dispute resolution process in favor of a truth-in-advertising approach that will protect consumers and free doctors, insurers, and arbiters from confused and conflicting standards for resolving disputes that the disputing parties can best resolve themselves.38 l Facilitate the development of shared savings and reference pricing plan options. Under traditional insurance, patients who choose lower- cost care do not benefit financially from that choice. Barriers to rewarding patients for cost-saving decisions should be removed. CMS should ensure that shared savings and reference pricing models that reward consumers are permitted. l Separate the subsidized ACA exchange market from the non- subsidized insurance market. The Affordable Care Act has made insurance more expensive and less competitive, and the ACA subsidy scheme simply masks these impacts. To make health insurance coverage more affordable for those who are without government subsidies, CMS should develop a plan to separate the non-subsidized insurance market

Showing 3 of 5 policy matches

About These Correlations

Policy matches are calculated using a hybrid approach: initial candidates are found using semantic similarity between bill summaries and Project 2025 policy text, then an AI model (Llama 3.1 70B) provides detailed alignment ratings and analysis. Ratings range from 1 (minimal alignment) to 5 (very strong alignment). This analysis does not imply direct causation or intent.

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