ACA Copay Cost and Affordability for Patients Act of 2025; ACA Copay CAP Act of 2025
Summary
H.R. 6171, the ACA Copay Cost and Affordability for Patients Act of 2025, aims to amend the Patient Protection and Affordable Care Act (ACA) by establishing an out-of-pocket limit on spending for prescription drugs. This bill introduces an annual limitation on cost-sharing for prescription drugs under health plans, starting January 1, 2027. The limit is set at $2,000 for self-only coverage in 2027, with adjustments for subsequent years based on premium adjustment percentages.
Expected Effects
The primary effect of this bill will be to cap the amount individuals and families spend out-of-pocket on prescription drugs annually. This cap is designed to protect individuals from high drug costs. It will also likely shift some financial burden from individuals to insurance companies and potentially impact premium costs.
Potential Benefits
- Reduces financial burden on individuals with high prescription drug costs.
- Provides predictability in healthcare spending for consumers.
- May improve adherence to prescription drug regimens due to affordability.
- Could lead to better health outcomes by ensuring access to necessary medications.
- Simplifies healthcare budgeting for families.
Potential Disadvantages
- May increase health insurance premiums for all consumers.
- Could lead to changes in formulary design by insurance companies to manage costs.
- Potential for increased government spending on subsidies to offset costs.
- Possible impact on pharmaceutical company revenues and R&D investment.
- Administrative complexities in implementing and monitoring the out-of-pocket limit.
Constitutional Alignment
This bill appears to align with the general welfare clause of the US Constitution, as it aims to improve access to healthcare and reduce financial burdens related to prescription drugs. The Constitution grants Congress the power to enact laws that "promote the general Welfare." (Preamble). However, the specific mechanisms and effects of the bill would need to be carefully considered to ensure they do not infringe upon other constitutional rights or principles.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).