Bill · S. 5496· Senate(119-S-5496)
Health CARE Act of 2026
- Introduced
- 9/24/2026
- Last activity
- 9/24/2026 — Read twice and referred to the Committee on Finance.
- Sponsored by
- Mark Warner
- Cosponsors
- None
- Introduced
- In Committee
What this bill would do
The Health CARE Act of 2026 aims to expand access to and lower the cost of healthcare across the United States. It creates a new low-cost health plan available through exchanges starting in 2028 and extends enhanced health insurance tax credits. The bill expands Medicare drug price negotiation limits, caps out-of-pocket prescription drug costs at $2,000 for group and individual health plans, and caps monthly insulin cost-sharing at $35. It strengthens price transparency requirements for hospitals, clinical laboratories, imaging providers, and ambulatory surgical centers. Finally, the legislation reforms pharmacy benefit managers, prevents abusive spread pricing in Medicaid, and adds hearing care coverage to Medicare.
Yes· 3 of 27
Does this lower the price of prescription medicines?+9
The bill caps out-of-pocket prescription drug costs at $2,000, caps monthly insulin prices at $35, and expands Medicare drug price negotiation.
Would people over 65 be better off under this?+8
Seniors gain coverage for hearing aids and audiology services under Medicare, alongside prescription drug price protections.
Would households on low incomes be better off under this?+8
Low-income households benefit from enhanced Medicaid support during economic downturns and permanently extended health insurance tax credits.
The opposite
Would business owners be better off under this?-2
Business owners face increased regulatory compliance burdens and reporting requirements regarding group health plans.
Who it would affect, and how
Potential Positive Impacts for People
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Out-of-Pocket Prescription Drug Limit: Section 403 establishes an annual out-of-pocket cap of $2,000 on prescription drug expenditures for individuals enrolled in group health plans and group and individual health insurance coverage, which will protect patients from catastrophic medication expenses.
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Affordable Insulin Costs: Section 404 requires group health plans and health insurance issuers to cover selected insulin products without applying a deductible and limits cost-sharing to no more than $35 per 30-day supply, making life-saving diabetes treatment much more affordable.
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Medicare Hearing Care Coverage: Section 504 expands the Medicare program to cover hearing aids and audiology services for individuals diagnosed with moderately severe, severe, or profound hearing loss, helping seniors access necessary hearing health care.
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Medication Step Therapy Exceptions: Section 501 requires group health plans to implement clear and prompt exception processes for medication step therapy protocols, allowing patients to bypass restrictive hurdles when specific medical conditions or previous treatment failures warrant it.
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Expanded Medicare Drug Price Negotiation: Section 401 increases the number of negotiation-eligible drugs for the Medicare drug price negotiation program up to 50 drugs for initial price applicability years, helping lower prescription drug prices for the people.
Potential Negative Impacts for People
- Increased Regulatory and Compliance Burdens: The extensive new reporting, transparency, and data disclosure requirements placed on hospitals, laboratories, imaging providers, and group health plans throughout Titles V and VI could lead to higher administrative overhead costs that might ultimately be passed down to everyday healthcare consumers in the form of higher overall healthcare expenses.
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Demographic And Interest Groups
- Good For Low Income Households+8Good For Seniors+8Good For Middle Class Households+7Good For People With Disabilities+7Good For Retirees+7Good For Middle Aged+6Good For Rural Residents+6Good For Women+6Good For Young Adults+6Good For African Americans+5Good For Hispanic Americans+5Good For Union Workers+5Good For Veterans+5Good For Urban Residents+4Good For Children+3Good For Business Owners-2
- Healthcare
- Reduces Prescription Drug Costs+9Improves Healthcare Access+8Increases Affordable Care Act Support+7Increases Medicaid Funding+6Reduces Private Insurance Premiums+5Improves Opioid Crisis Response+4Reduces Hospital Costs+4Increases Medicare Funding+2
- Economy And Finance
- Improves Consumer Protection+6Improves Economic Growth+3
- Governance And Ideology
- Improves Government Transparency+7
- Social Issues And Justice
- Improves Poverty Reduction+4
- 9/24/2026
- Read twice and referred to the Committee on Finance.
- Introduced in Senate