HELP Copays Act

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Bill ID: 119/s/864
Last Updated: May 12, 2026

Sponsored by

Sen. Marshall, Roger [R-KS]

ID: M001198

Follow the money

The bill

HELP Copays Act

S. 864, 119th Congress — read as touching Pharmaceuticals.

The sponsor

Sen. Marshall, Roger [R-KS]

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

The money

$154,700 raised

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

The alignment

62% match to Project 2025

This bill's text tracks the "Introduction" section, p. 497-499 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 Health, Education, Labor, and Pensions. Hearings held.

March 18, 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

Another masterpiece of legislative theater, brought to you by the esteemed members of Congress. The HELP Copays Act - because what's a more pressing issue than helping patients with copays while ignoring the actual disease that is our healthcare system?

Let's dissect this bill like the festering wound it is.

**New regulations being created or modified:** This bill amends various sections of the Public Health Service Act and the Patient Protection and Affordable Care Act to include financial assistance from non-profit organizations and prescription drug manufacturers in calculating deductibles, coinsurance, copayments, and out-of-pocket limits. Because, you know, it's not like these organizations have any vested interests in "helping" patients.

**Affected industries and sectors:** The pharmaceutical industry is the clear winner here. By allowing financial assistance to be counted towards cost-sharing requirements, manufacturers can continue to charge exorbitant prices for their products while pretending to be benevolent. Meanwhile, insurers will get to reap the benefits of reduced costs without actually having to do anything meaningful.

**Compliance requirements and timelines:** The bill applies to group health plans and health insurance issuers for plan years beginning on or after January 1, 2026. Because who needs a smooth transition period when you can just dump new regulations on an already-overwhelmed system?

**Enforcement mechanisms and penalties:** Ah, the usual suspects: "conforming amendments" and "safe harbors." Translation: we'll make sure to create enough loopholes for our friends in the pharmaceutical industry to exploit while pretending to hold them accountable.

**Economic and operational impacts:** This bill is a Band-Aid on a bullet wound. It does nothing to address the underlying issues driving healthcare costs, instead opting for a cosmetic fix that benefits only those with the deepest pockets. Patients will still be stuck with unaffordable copays, deductibles, and premiums, while insurers and manufacturers reap the rewards.

Diagnosis: Legislative myopia, symptoms include:

* Shortsightedness (focusing on short-term gains rather than meaningful reform) * Industry-induced astigmatism (seeing only what benefits special interests) * Chronic cowardice (avoiding actual solutions in favor of feel-good legislation)

Treatment: A healthy dose of skepticism and a strong stomach. Because when it comes to Congress, you can't trust anything that sounds too good (or bad) to be true.

Related Topics

Healthcare & Insurance ReformPublic Health & Pandemic Response
Generated using Llama 3.1 70B (Dr. Haus personality)

💰 Campaign Finance Network

Sen. Marshall, Roger [R-KS]

Congress 119 • 2024 Election Cycle

Total Contributions
$154,700
19 donors
PACs
$9,500
Organizations
$0
Committees
$0
Individuals
$145,200
1
THE KROGER CO. POLITICAL ACTION COMMITTEE
2 transactions
$5,500
2
INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS
1 transaction
$2,500
3
THE POLITICAL ACTION COMMITTEE OF THE FERTILIZER INSTITUTE
1 transaction
$1,500

No organization contributions found

No committee contributions found

1
BRACH, JEREMIAH
4 transactions
$26,400
2
ILLIG, MICHAEL
1 transaction
$13,200
3
MADAY, GREG
1 transaction
$13,200
4
DOWNING, BARRY L.
2 transactions
$13,200
5
ILLIG, BONNE
1 transaction
$6,600
6
ILLIG, AMY
1 transaction
$6,600
7
MADAY, LIZ
1 transaction
$6,600
8
MAXWELL, KORB II
1 transaction
$6,600
9
ILLIG, CLIFFORD
1 transaction
$6,600
10
PRENGER, JEANETTE
1 transaction
$6,600
11
O'BRATE, CECIL L.
1 transaction
$6,600
12
SPARKS, LANCE
1 transaction
$6,600
13
LINDSEY, RYAN
1 transaction
$6,600
14
LEFKOWITZ, JOEL
1 transaction
$6,600
15
SMILOWITZ, DOV
1 transaction
$6,600
16
MCKEE, JACK C.
1 transaction
$6,600

Cosponsors & Their Campaign Finance

This bill has 10 cosponsors. Below are their top campaign contributors.

Sen. Kaine, Tim [D-VA]

ID: K000384

Top Contributors

10

1
THE CHICKASAW NATION
OrganizationADA, OK
$2,300
Jun 18, 2024
2
THE CHICKASAW NATION
OrganizationADA, OK
$1,000
Jun 26, 2023
3
SAN MANUEL BAND OF MISSION INDIANS
OrganizationLOS ANGELES, CA
$1,000
Jun 18, 2024
4
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jun 25, 2024
5
THE CHICKASAW NATION
OrganizationADA, OK
$1,000
Jun 18, 2024
6
CHOCTAW NATION OF OKLAHOMA
OrganizationDURANT, OK
$1,000
Oct 15, 2024
7
CHEROKEE NATION
OrganizationTAHLEQUAH, OK
$1,000
Dec 29, 2023
8
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$600
Oct 25, 2023
9
STONEHALL FARM
OrganizationTHE PLAINS, VA
$500
Jun 30, 2024
10
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$400
Oct 25, 2023

Sen. Tillis, Thomas [R-NC]

ID: T000476

Top Contributors

10

1
SASTRY, ASHWANI
SUNRISE VASCULARPHYSICIAN
IndividualORLANDO, FL
$3,400
Dec 12, 2024
2
AGARWAL, SAJJAN K
GREENHAWK CORPORATIONCEO
IndividualCARY, NC
$3,300
Dec 11, 2024
3
ALLYN, JILL
BRIGHTHOUSE FINANCIALINVESTMENTS
IndividualESTERO, FL
$3,300
Oct 17, 2024
4
BARATTA, JOSEPH PATRICK
BLACKSTONEFINANCE EXECUTIVE
IndividualNEW YORK, NY
$3,300
Dec 18, 2024
5
BARATTA, JOSEPH PATRICK
BLACKSTONEFINANCE EXECUTIVE
IndividualNEW YORK, NY
$3,300
Dec 18, 2024
6
BIELEN, RICHARD J
PROTECTIVE LIFE CORPORATIONPRESIDENT & CEO
IndividualMOUNTAIN BRK, AL
$3,300
Oct 29, 2024
7
BLITZER, DAVID S
BLACKSTONECHAIRMAN
IndividualNEW YORK, NY
$3,300
Dec 12, 2024
8
BLITZER, DAVID S
BLACKSTONECHAIRMAN
IndividualNEW YORK, NY
$3,300
Dec 12, 2024
9
BRAND, MARTIN
BLACKSTONEFINANCE
IndividualNEW YORK, NY
$3,300
Dec 20, 2024
10
CAMERON, WILLIAM H
CAMERON MANAGMENTPRESIDENT
IndividualWILMINGTON, NC
$3,300
Oct 28, 2024

Sen. Markey, Edward J. [D-MA]

ID: M000133

Top Contributors

10

1
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jun 28, 2024
2
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jul 26, 2023
3
DONOHUE, JOHN
ARBELLAINSURANCE
IndividualBELMONT, MA
$6,600
May 20, 2024
4
MARCHAND, PAUL
CHARTER COMMUNICATIONSEVP HR
IndividualMONTCLAIR, NJ
$4,200
Mar 11, 2024
5
MOUTOUDIS, ELEFTHERIA
ELEFTHERIA MOUTOUDISSELF EMPLOYEED
IndividualSOUTHBOROUGH, MA
$3,300
Nov 1, 2024
6
MOUTOUDIS, EVANGELOS
DEKK GROUOBUSINESS OWNER
IndividualSOUTHBOROUGH, MA
$3,300
Nov 1, 2024
7
SCHMIDT, WENDY
NONEINVESTMENTS AND PHILANTHROPY
IndividualPALO ALTO, CA
$3,300
Oct 2, 2024
8
SWIG, MARY
NOT EMPLOYEDNOT EMPLOYED
IndividualSAN FRANCISCO, CA
$3,300
Aug 31, 2024
9
ABRAMS, JEFFREY J.
BAD ROBOTFOUNDER
IndividualENCINO, CA
$3,300
Oct 10, 2023
10
ABRAMS, JEFFREY J.
BAD ROBOTFOUNDER
IndividualENCINO, CA
$3,300
Oct 10, 2023

Sen. Murkowski, Lisa [R-AK]

ID: M001153

Top Contributors

10

1
MUCKLESHOOT INDIAN TRIBE
OrganizationAUBURN, WA
$3,300
May 15, 2023
2
THE CHICKASAW NATION
OrganizationADA, OK
$2,500
Dec 20, 2023
3
MUCKLESHOOT INDIAN TRIBE
OrganizationAUBURN, WA
$1,000
Nov 20, 2024
4
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Oct 26, 2023
5
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jun 3, 2024
6
PUYALLUP TRIBE OF INDIANS
OrganizationTACOMA, WA
$1,000
Sep 30, 2024
7
SUQUAMISH INDIAN TRIBE
OrganizationSUQUAMISH, WA
$1,000
Sep 30, 2024
8
TOHONO O'ODHAM NATION
OrganizationSELLS, AZ
$1,000
Aug 9, 2024
9
CHOCTAW NATION OF OKLAHOMA
OrganizationDURANT, OK
$550
Oct 26, 2023
10
SEGAL, PAUL
LS POWER DEVELOPMENT, LLCCHIEF EXECUTIVE OFFICER
IndividualNEW YORK, NY
$3,300
Dec 16, 2023

Sen. Merkley, Jeff [D-OR]

ID: M001176

Top Contributors

10

1
AK-CHIN INDIAN COMMUNITY
OrganizationMARICOPA, AZ
$2,500
Oct 17, 2024
2
CHEROKEE NATION
OrganizationTAHLEQUAH, OK
$2,500
Dec 30, 2023
3
SISSETON-WAHPETON OYATE
OrganizationAGENCY VILLAGE, SD
$2,000
Jun 21, 2024
4
CONFEDERATED TRIBES AND BANDS OF THE YAKAMA NATION
OrganizationTOPPENISH, WA
$1,000
Oct 7, 2024
5
CHOCTAW NATION OF OKLAHOMA
OrganizationDURANT, OK
$1,000
Nov 9, 2023
6
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
May 2, 2024
7
MISSISSIPPI BAND OF CHOCTAW INDIANS
OrganizationCHOCTAW, MS
$1,000
Aug 2, 2024
8
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$400
Jul 17, 2023
9
STUBBS, MARILYN L.
NOT EMPLOYEDRETIRED
IndividualPORTLAND, OR
$5,000
Jul 17, 2023
10
BARNHART, PHILIP N.
NOT EMPLOYEDRETIRED
IndividualEUGENE, OR
$5,000
Jun 21, 2024

Sen. Capito, Shelley Moore [R-WV]

ID: C001047

Top Contributors

10

1
CHEROKEE NATION
OrganizationTAHLEQUAH, OK
$2,800
Dec 31, 2024
2
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Nov 8, 2023
3
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jul 22, 2024
4
ARNOLD, JOHN MR.
RETIREDRETIRED
IndividualHOUSTON, TX
$6,600
Dec 27, 2023
5
MANOCHERIAN, JENNIFER MS.
RETIREDRETIRED
IndividualSCARSDALE, NY
$6,600
Feb 17, 2023
6
MANOCHERIAN, JED MR.
SELFREAL ESTATE
IndividualNEW YORK, NY
$6,600
Feb 23, 2023
7
MANOCHERIAN, GREG MR.
SELF EMPLOYEDREAL ESTATE
IndividualPOUND RIDGE, NY
$6,600
Mar 1, 2023
8
MANOCHERIAN, KIM
PANAM EQUITIESEXECUTIVE
IndividualNEW YORK, NY
$6,600
Mar 27, 2023
9
KAY, ALISON MS.
KIDS CAPITALHEDGE FUND MANAGER
IndividualBEVERLY HILLS, CA
$6,600
Jun 20, 2023
10
MANDELBLATT, DANIELLE
DMM PROPRIETA MANAGEMENTMANAGER
IndividualASPEN, CO
$6,600
Sep 26, 2024

Sen. Coons, Christopher A. [D-DE]

ID: C001088

Top Contributors

10

1
CHEROKEE NATION
OrganizationTAHLEQUAH, OK
$3,300
Dec 27, 2023
2
CHEROKEE NATION
OrganizationTAHLEQUAH, OK
$1,700
Dec 27, 2023
3
CHEN, YU
NOT EMPLOYEDNOT EMPLOYED
IndividualMIAMI, FL
$3,300
Dec 17, 2024
4
MIRZAIE, REZA
RUSS AUGUST & KABAT LLPATTORNEY
IndividualPACIFIC PALISADES, CA
$3,300
Oct 7, 2024
5
CHEN, YU
NOT EMPLOYEDNOT EMPLOYED
IndividualMIAMI, FL
$3,300
Dec 17, 2024
6
WASSERMAN, CASEY
WASSERMANCEO
IndividualLOS ANGELES, CA
$3,300
Nov 5, 2024
7
ZHAO, PENG
CITADEL SECURITIESCEO
IndividualMIAMI, FL
$3,300
Dec 17, 2024
8
WASSERMAN, CASEY
WASSERMANCEO
IndividualLOS ANGELES, CA
$3,300
Nov 5, 2024
9
ZHAO, PENG
CITADEL SECURITIESCEO
IndividualMIAMI, FL
$3,300
Dec 17, 2024
10
MIRZAIE, REZA
RUSS AUGUST & KABAT LLPATTORNEY
IndividualPACIFIC PALISADES, CA
$3,300
Oct 7, 2024

Sen. Budd, Ted [R-NC]

ID: B001305

Top Contributors

10

1
MACFARLANE, RON
IndividualBUFFALO GROVE, IL
$13,068
Apr 10, 2024
2
HEGYI, ALBERT P MR.
IndividualNEW YORK, NY
$6,600
Dec 31, 2024
3
NAZIROV, ATABEK
UZDIFCEO
IndividualCHARLOTTE, NC
$6,600
Sep 14, 2023
4
NAZIROV, ATABEK
IndividualCHARLOTTE, NC
$6,600
Sep 26, 2023
5
FROST, BRANT IV
SELF-EMPLOYEDFINANCIAL SERVICES
IndividualNEWNAN, GA
$3,300
Dec 31, 2024
6
FROST, KRISTA
HOMEMAKERHOMEMAKER
IndividualNEWNAN, GA
$3,300
Dec 31, 2024
7
TAYLOR, WILLIAM MR.
VETERANS GUARDIAN VA CLAIM CONSULTINGBUSINESS OWNER
IndividualPINEHURST, NC
$3,300
Dec 7, 2023
8
TAYLOR, WILLIAM MR.
VETERANS GUARDIAN VA CLAIM CONSULTINGBUSINESS OWNER
IndividualPINEHURST, NC
$3,300
Dec 7, 2023
9
GREENBLATT, SCOTT MR.
VETERANS GUARDIANCEO
IndividualPINEHURST, NC
$3,300
Dec 8, 2023
10
GREENBLATT, SCOTT MR.
VETERANS GUARDIANCEO
IndividualPINEHURST, NC
$3,300
Dec 8, 2023

Sen. Murray, Patty [D-WA]

ID: M001111

Top Contributors

10

1
SAN PABLO LYTTON TRIBE
OrganizationSAN PABLO, CA
$3,300
Oct 26, 2023
2
SAN PABLO LYTTON TRIBE
OrganizationSAN PABLO, CA
$3,300
Oct 26, 2023
3
LOWER ELWHA KLALLAM TRIBE
OrganizationPORT ANGELES, WA
$3,300
Mar 30, 2023
4
LOWER ELWHA KLALLAM TRIBE
OrganizationPORT ANGELES, WA
$3,300
Mar 30, 2023
5
THE CHICKASAW NATION
OrganizationADA, OK
$3,300
Sep 22, 2023
6
AK-CHIN INDIAN COMMUNITY
OrganizationMARICOPA, AZ
$2,500
Nov 13, 2024
7
PUYALLUP TRIBE OF INDIANS
OrganizationTACOMA, WA
$2,500
Feb 22, 2024
8
PUYALLUP TRIBE OF INDIANS
OrganizationTACOMA, WA
$2,500
Sep 30, 2024
9
YAKAMA NATION
OrganizationSEATTLE, WA
$2,000
Oct 11, 2024
10
SISSETON-WAHPETON OYATE
OrganizationSISSETON, SD
$2,000
Jun 30, 2024

Sen. Boozman, John [R-AR]

ID: B001236

Top Contributors

10

1
CHEROKEE NATION
OrganizationTAHLEQUAH, OK
$3,300
Oct 3, 2024
2
SHAKOPEE MDEKEWAKANTON COMMUNITY
OrganizationPRIOR LAKE, MN
$3,300
Nov 7, 2023
3
SHAKOPEE MDEKEWAKANTON COMMUNITY
OrganizationPRIOR LAKE, MN
$3,300
Jun 27, 2024
4
BJERKE, TYLER
HERITAGE INSURANCE SERVICESSALES
IndividualFARGO, ND
$5,000
Mar 22, 2023
5
LEPRINO, TERRY
LEPRINO FARMSBOARD DIRECTOR
IndividualDENVER, CO
$3,300
Dec 6, 2024
6
POWELL, JESSE
PAYWARD INC.CEO
IndividualSAN FRANCISCO, CA
$3,300
Nov 5, 2024
7
POWELL, JESSE
PAYWARD INC.CEO
IndividualSAN FRANCISCO, CA
$3,300
Nov 5, 2024
8
STEPHENS, WARREN MR.
STEPHENS INCPRESIDENT
IndividualLITTLE ROCK, AR
$3,300
Jul 7, 2023
9
STEPHENS, WARREN MR.
STEPHENS INCPRESIDENT
IndividualLITTLE ROCK, AR
$3,300
Jul 7, 2023
10
WALTON, ALICE L.. MS.
SELF-EMPLOYEDPHILANTHROPIST
IndividualBENTONVILLE, AR
$3,300
Aug 11, 2023

Donor Network - Sen. Marshall, Roger [R-KS]

PACs
Organizations
Individuals
Politicians

Hub layout: Politicians in center, donors arranged by type in rings around them.

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Showing 48 nodes and 39 connections (38 secondary connections hidden)

Total contributions: $191,400

Top Donors - Sen. Marshall, Roger [R-KS]

Showing top 19 donors by contribution amount

3 PACs16 Individuals

Industry Impact

Which industries are materially affected by specific provisions in this bill. 3 helped, 1 harmed.

  • +Pharmaceuticalsconfidence 0.95

    Section 2(a) amends PHSA to include financial assistance from prescription drug manufacturers toward cost-sharing requirements, effectively allowing such assistance to count toward deductibles, coinsurance, copayments, and out-of-pocket limits, which benefits pharmaceutical manufacturers by increasing affordability and uptake of their drugs.

  • +Biotech & Researchconfidence 0.90

    Biotech firms often manufacture specialty drugs; Section 2(c)(1) specifies the amendments apply to standards for specialty drugs, meaning financial assistance for high-cost biologics and gene therapies will count toward out-of-pocket limits, improving patient access and supporting biotech sales.

  • By allowing financial assistance (including from non-profits and drug manufacturers) to count toward cost-sharing, the bill reduces patient financial barriers to care, likely increasing utilization of hospital and health system services, particularly for specialty drugs subject to utilization management (per Section 2(c)(1)-(2)).

  • Health Insuranceconfidence 0.80

    The bill imposes new requirements on health insurance issuers and group health plans to count third-party financial assistance toward cost-sharing, which may increase administrative burden and reduce the effectiveness of cost-sharing designs intended to limit utilization, potentially increasing plan costs.

Project 2025 Policy Matches

This bill shows semantic similarity to the following sections of the Project 2025 policy document.

Introduction

Moderate62.2%
Pages: 497-499

— 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.

Introduction

Moderate61.8%
Pages: 497-499

— 464 — Mandate for Leadership: The Conservative Promise l The Risk Adjustment Data Validation (RADV) rule; l The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration; and l The Global and Professional Direct Contracting (GPDC, rebranded as the Accountable Care Organization Realizing Equity, Access, and Community Health or ACO REACH) model. Additionally, regulations should advance site neutrality by eliminating the inpa- tient-only list and expanding the ambulatory surgical center covered procedures list. Medicare generally pays more for inpatient hospital procedures and less for the same procedures performed in an outpatient setting. Whether a medical ser- vice is delivered in a physician’s office, a clinic, or a hospital setting, the Medicare payment for that service should be the same. CMS should expand the application of site-neutral payment options to more settings. Such a policy would level the playing field among providers and remove the financial disabilities for medical professionals who would compete with hospital systems.23 Finally, HHS needs to restore and enhance conscience protection regulations that allow medical practitioners to participate in federal health care programs without being compelled to provide sex changes or similar services. LEGISLATIVE PROPOSALS l Remove restrictions on physician-owned hospitals. The Affordable Care Act (ACA)24 imposed restrictions prohibiting Medicare from reimbursing physician-owned and specialty hospitals. The current restrictions do little more than serve the special interests of large hospital systems and undercut consumer choice of high-quality, specialty care. These restrictions should be removed so that physician-owned hospitals can compete with other hospitals in serving Medicare patients.25 l Encourage more direct competition between Medicare Advantage and private plans. Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future. Specifically:

Introduction

Moderate61.8%
Pages: 497-499

— 464 — Mandate for Leadership: The Conservative Promise l The Risk Adjustment Data Validation (RADV) rule; l The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration; and l The Global and Professional Direct Contracting (GPDC, rebranded as the Accountable Care Organization Realizing Equity, Access, and Community Health or ACO REACH) model. Additionally, regulations should advance site neutrality by eliminating the inpa- tient-only list and expanding the ambulatory surgical center covered procedures list. Medicare generally pays more for inpatient hospital procedures and less for the same procedures performed in an outpatient setting. Whether a medical ser- vice is delivered in a physician’s office, a clinic, or a hospital setting, the Medicare payment for that service should be the same. CMS should expand the application of site-neutral payment options to more settings. Such a policy would level the playing field among providers and remove the financial disabilities for medical professionals who would compete with hospital systems.23 Finally, HHS needs to restore and enhance conscience protection regulations that allow medical practitioners to participate in federal health care programs without being compelled to provide sex changes or similar services. LEGISLATIVE PROPOSALS l Remove restrictions on physician-owned hospitals. The Affordable Care Act (ACA)24 imposed restrictions prohibiting Medicare from reimbursing physician-owned and specialty hospitals. The current restrictions do little more than serve the special interests of large hospital systems and undercut consumer choice of high-quality, specialty care. These restrictions should be removed so that physician-owned hospitals can compete with other hospitals in serving Medicare patients.25 l Encourage more direct competition between Medicare Advantage and private plans. Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future. Specifically: — 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

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Policy matches are calculated using semantic similarity between bill summaries and Project 2025 policy text. A score of 60% or higher indicates meaningful thematic overlap. This does not imply direct causation or intent, but highlights areas where legislation aligns with Project 2025 policy objectives.

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