Health CARE Act of 2026

(a) Short title. This Act may be cited as the Health for the Commonwealth through Affordability, Reform, and Expansion Act of 2026 or the Health CARE Act of 2026.

(b) Table of contents. The table of contents for this Act is as follows: Sec. 1. Short title; table of contents.TITLE I—Restoring health care and lowering costsSec. 101. Repeal of reconciliation health provisions.Sec. 102. Permanent extension of enhanced tax credit.Sec. 103. Promoting consumer outreach and education.TITLE II—Pathway to universal coverageSec. 201. Establishment of health plan.Sec. 202. Availability of plan.Sec. 203. Affordability.Sec. 204. Participating providers.Sec. 205. Provider payment rates.Sec. 206. No effect on Medicare benefits or Medicare trust funds.TITLE III—Strengthening MedicaidSec. 301. Increased FMAP for medical assistance to newly eligible individuals.Sec. 302. Supporting State Medicaid programs through economic downturns.TITLE IV—Lowering drug costsSec. 401. Expanding Medicare drug price negotiation.Sec. 402. Application of prescription drug inflation rebates to drugs furnished in the commercial market.Sec. 403. Establishing an out-of-pocket limit on expenditures for prescription drugs under group health plans and group and individual health insurance coverage.Sec. 404. Requirements with respect to cost-sharing for insulin products.TITLE V—Ensuring quality health insurance and removing barriers to careSec. 501. Required exceptions process for medication step therapy protocols.Sec. 502. Establishing requirements with respect to the use of prior authorization under Medicare Advantage plans.Sec. 503. Special enrollment period for provider terminations.Sec. 504. Providing coverage for hearing care under the Medicare program.TITLE VI—Lowering the cost of careSec. 601. Strengthening hospital price transparency.Sec. 602. Clinical diagnostic laboratory price transparency.Sec. 603. Imaging services price transparency.Sec. 604. Ambulatory surgical center price transparency.Sec. 605. Strengthening health coverage transparency requirements.Sec. 606. Increasing group health plan access to health data.Sec. 607. Oversight of administrative service providers.Sec. 608. State preemption only in event of conflict.Sec. 609. Requirement for explanation of benefits.Sec. 610. Transparency in billing.Sec. 611. Technical amendments.Sec. 612. Implementation and enforcement funding.TITLE VII—Reforming PBMs and Protecting PharmaciesSec. 701. Ensuring accurate payments to pharmacies under Medicaid.Sec. 702. Preventing the use of abusive spread pricing in Medicaid.