Great American Healthcare Plan

Expanded HSA Benefits and Flexibility: Individuals may benefit from increased contribution limits for HSAs (Section 102), the ability to use funds for "qualified wellness expenses" like healthy food, vitamins, and fitness (Section 108), the ability to roll over funds to family members (Section 107), and the ability to roll over funds from health care FSAs and HRAs (Section 111).

Increased Price Transparency: Patients could gain better insight into costs through new requirements for hospitals (Section 302), clinical diagnostic laboratories (Section 303), imaging services (Section 304), and ambulatory surgical centers (Section 305) to publish standard charges and negotiated rates.

Improved Insurance Information and Communication: Individuals may find it easier to understand coverage through self-service tools for real-time responses regarding in-network rates and cost-sharing (Section 306). Furthermore, group health plans and insurance issuers must provide notifications in plain language including applicable billing codes and specific amounts the individual is responsible for (SEC. s310(a)(1) and (2)).

Detailed Billing and Financial Protections: Healthcare providers must provide written, itemized bills with plain language descriptions and prices (SEC. 311(a)(1)). Providers are prohibited from taking collection actions if they fail to provide these bills or if charges exceed a good faith estimate without documented medical necessity (SEC. 311(a)(2)). Additionally, HSA funds would receive bankruptcy protections equivalent to retirement funds (Section 109).

New Marketplace Options: The creation of "health marketplace pools" allows entities to offer group health plans or insurance coverage to their members (Section 202).

Pricing Transparency for Health Plans: Health plan service providers must provide detailed calculation methodologies, fee schedules, and rebate information to group health plans at no cost (SEC. 2799A-12(b)(1)), allowing plans to accurately assess agreements.

Lower Costs for Specific Drugs: Drug manufacturers are required to pay rebates for selected drugs to the Federal Supplementary Medical Insurance Trust Fund (SEC. 402(a)(1)(B)).

Improved Access to Medication: The bill allows for "expanded-access prescription drugs," such as antibiotics or maintenance drugs for chronic conditions, to be dispensed and administered by covered individuals like pharmacists or nurse practitioners (SEC. 501(a)(3)).

Increased Costs and Compliance Burdens for Providers: Hospitals, laboratories, and other providers face new, strict transparency requirements and significant administrative burdens to compile and publish pricing data in machine-readable formats (Sections 302, 303, 304, 305, and 306).

Strict Compliance Penalties: Healthcare providers or facilities that fail to provide required itemized bills can face penalties of up to $10,000 per instance (SEC. 311(b)(1)). Additionally, health plan service providers that fail to disclose required information to group health plans can be assessed a penalty of $100,000 per day (SEC. 2799A-12(d)(2)).

State Restrictions on Expanded Access: While the bill allows for expanded access to certain drugs, States have the authority to opt-out by maintaining laws that prohibit or limit the prescribing or dispensing of such drugs by covered individuals (SEC. 501(a)(3)(E)(ii)).