S. 3386 · 119th Congress · Senate
Health Care Freedom for Patients Act of 2025
Introduced 2025-12-08 · Sponsored by Sen. Crapo, Mike [R-ID] (R-ID) · Last updated 2026-03-31
Last action (2025-12-11): Cloture on the motion to proceed to the measure not invoked in Senate by Yea-Nay Vote. 51 - 48. Record Vote Number: 643. (CR S8654)
Summary
Takes a different approach than the ACA subsidy extension by letting people with bronze or catastrophic health plans receive federal deposits into health savings accounts during 2026-2027. Also restricts Medicaid and CHIP payments for certain noncitizens and bars coverage of gender-transition procedures under those programs. It is the Republican alternative to extending the ACA’s premium tax credits.
The Good
Expands health savings account eligibility to more plan types
Allows individuals with bronze or catastrophic health plans to receive federal HSA deposits during 2026-2027, giving more people access to tax-advantaged health savings. HSAs let individuals save pre-tax money for medical expenses.
Restricts Medicaid spending on non-citizens
Limits Medicaid and CHIP coverage for certain non-citizens, which supporters argue redirects limited healthcare dollars to eligible citizens and legal residents.
The Bad
HSA expansion primarily benefits higher-income households
HSAs require disposable income to contribute and provide the greatest tax benefit to those in higher brackets. Lower-income individuals on bronze plans often cannot afford to save money in an HSA, making the expansion regressive in practice.
Restricts coverage for gender-transition procedures under Medicaid
The bill prohibits federal Medicaid funding for gender-affirming care for transgender individuals. Medical organizations including the AMA and AAP support access to gender-affirming care as evidence-based treatment, and removing coverage could worsen health outcomes for transgender Medicaid enrollees.
Vote Record
Senate, 2025-12-11
Cloture on Motion to Proceed
Passed Congress.gov — Senate Roll Call #643
Senate vote by state
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