Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by t…
For plan years beginning January 1, 2026, this bill requires group and individual private health plans to cover selected insulin products for enrollees age 26 and younger with no deductible and cost-sharing capped per 30-day supply at the lesser of $35 or 25% of the negotiated price net of concessions. Cost-sharing under the rule counts toward deductibles and out-of-pocket maximums; the bill applies across the Public Health Service Act, ERISA, and the Internal Revenue Code, adds special rules for catastrophic plans, and allows HHS, Labor, and Treasury to issue implementation guidance. "Selected insulin products" means at least one dosage form of each insulin type chosen by the plan; non-selected products are not required to be covered under these terms.
Liberals emphasize affordability for youth and eliminating deductibles
Relative to its intended legislative type, this bill is a clearly articulated substantive policy change with well-specified benefit-level mechanics and strong statutory integration across multiple affected codes.
For plan years beginning January 1, 2026, this bill requires group and individual private health plans to cover selected insulin products for enrollees age 26 and younger with no deductible and cost-sharing capped per 30-day supply at the lesser of $35 or 25% of the negotiated price net of concessions.
Cost-sharing under the rule counts toward deductibles and out-of-pocket maximums; the bill applies across the Public Health Service Act, ERISA, and the Internal Revenue Code, adds special rules for catastrophic plans, and allows HHS, Labor, and Treasury to issue implementation guidance. "Selected insulin products" means at least one dosage form of each insulin type chosen by the plan; non-selected products are not required to be covered under these terms.
Content is narrow and popular (protecting youth) which helps prospects, but private-market mandates and stakeholder resistance make enactment uncertain without broader vehicle.
Relative to its intended legislative type, this bill is a clearly articulated substantive policy change with well-specified benefit-level mechanics and strong statutory integration across multiple affected codes. It establishes concrete per‑unit caps, definitions, and an effective date and delegates implementation authority to relevant agencies.
Liberals emphasize affordability for youth and eliminating deductibles
These are examples from the analysis, not a ranked list of the most-affected groups.
Liberals emphasize affordability for youth and eliminating deductibles
Likely supportive because it reduces out-of-pocket insulin costs for young people and improves access.
Will welcome no deductible and a $35-per-month cap as meaningful relief, while criticizing limits on which insulin products plans must select and the age cutoff at 26.
Generally favorable to targeted relief for children and young adults, but cautious about cost-shifting to employers and insurers.
Will look for data on premium impacts, PBM behavior, and whether the selected-product rule limits access.
Skeptical of a federal mandate imposed on private plans and employers, viewing it as government overreach that could increase premiums.
May accept targeted aid for young people in principle, but prefers market or state-based solutions and voluntary employer initiatives.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
Still ahead
Still ahead
Content is narrow and popular (protecting youth) which helps prospects, but private-market mandates and stakeholder resistance make enactment uncertain without broader vehicle.
The bill has not accumulated any surfaced votes yet.
Liberals emphasize affordability for youth and eliminating deductibles
Content is narrow and popular (protecting youth) which helps prospects, but private-market mandates and stakeholder resistance make enactme…
Relative to its intended legislative type, this bill is a clearly articulated substantive policy change with well-specified benefit-level mechanics and strong statutory integration across multiple affected codes. It est…
Go beyond the headline summary with full stakeholder mapping, legislative design analysis, passage barriers, and lens-by-lens tradeoff breakdowns.