Three Democrats in Congress are trying to lighten the load of high deductibles on people with commercial health coverage.

The lawmakers have reintroduced the Primary and Behavioral Healthcare Access Act bill, which would require health insurers and employers’ self-insured plans to cover at least three primary care visits per year before the patient had reached the deductible, and without imposing co-payment requirements, coinsurance requirements or other out-of-pocket costs on the patient.

The bill would apply the “free” visit mandate to employers’ self-insured health plans, as well as to fully insured plans, by adding a section to the Employee Retirement Income Security Act.

The full text of the new bill is not yet available at Congress.gov, but the version introduced in 2024 used standard Healthcare Common Procedure Coding System codes to define the services that would be classified as primary care services.

The bill is under the jurisdiction of the House Energy and Commerce Committee, the House Education and Workforce Committee, and the House Ways and Means Committee and under the jurisdiction of the Senate Health, Education, Labor and Pensions Committee in the Senate.

King and Underhill have been introducing similar bills since 2020.

What it means: Lawmakers have held several health care cost hearings recently and have been talking about health care cost bills. The hearings and bill introductions may be a sign that members of Congress think they have a chance to pass some kind of health care cost legislation package in the next few months.

The backdrop: Major medical coverage designers have responded to Affordable Care Act benefits requirements and other plan requirements by using high deductibles to keep premiums low.

The Affordable Care Act requires major medical plans to cover basic preventive services, including checkups, without imposing cost-sharing requirements on the insureds.

Defenders of high-deductible plans argue that people should use insurance mainly to pay for catastrophic care and that they should use health savings accounts to pay for everyday expenses.

Critics of high-deductible plans note that some now have deductibles over $10,000, meaning that the plans may provide no coverage for routine sick care, or efforts to follow up on bad results coming out of the “free” preventive care screenings, for patients with those plans.

King said in a comment included in the bill introduction announcement that paying for some routine outpatient care should help plans hold expenses down.

“The cheapest medical procedure is the one that doesn’t have to happen because the problem was caught early,” King said.

Republican leaders in Congress are trying to come up with $200 billion in funding for U.S. military action in Iran.

That could create a new chance for supporters of individual coverage health reimbursement arrangements and health savings accounts to get ICHRA and HSA provisions through Congress.

The vehicle would be a “budget reconciliation bill,” or a special kind of bill that can move through the Senate with just 51 votes, rather than the 60-vote majority normally required for ordinary bills.

The subsidy helps low-income ACA exchange plan users pay their deductibles and coinsurance bills.

House Energy & Commerce Committee Chairman Brett Guthrie, R-Ky., who shares jurisdiction over health legislation with other committees, told a Politico reporter that he thinks the new reconciliation bill could include some of the health provisions that were cut out of the One Big Beautiful Bill Act last summer.

The missing OBBBA health provisions: One health provision cut out of the House version of OBBBA would have increased health savings account contribution limits to $8,000 per year for an individual and $17,100 for a family, up from $4,000 for an individual and $8,550 for a family today.

Another would let workers ages 55 and older contribute an extra $1,000 per year to their HSAs.

The highest-profile health provision eliminated might have been a section that would have added a federal ICHRA plan statute.

ICHRAs help workers use employer cash to pay for individual or family health coverage.

The ICHRA provision in the OBBBA bill would have renamed ICHRAs Custom Health Option and Individual Care Expense arrangements.

Today, an employer with an ICHRA plan cannot let workers choice between using the ICHRA plan and a traditional group health plan.

An employer with a CHOICE arrangement plan could let workers choose between using a cash-for-coverage plan and a traditional group health plan.

The U.S. Department of Labor has trimmed references to civil monetary penalties — and most references to criminal investigations — out of the Employee Benefits Security Administration budget proposal for 2027.

The administration of President Donald Trump is asking for $181.1 million in funding for EBSA for the coming year.

The new request is part of a large collection of documents associated with the Trump administration’s $8.1 trillion spending request for the federal government for 2027.

All of the requests are for the federal government’s own federal fiscal year 2027, which will start Oct. 1, 2026.

But EBSA — the DOL agency in charge of issues such as whether employers can put private credit assets on 401(k) plan menus and what happens when few of the mental health providers in a self-insured health plan’s provider directory are accepting new patients — now mentions the criminal provisions of the Employee Retirement Income Security Act only in a section describing EBSA’s statutory responsibilities.

The 2027 budget proposal leaves out a section in the 2026 EBSA budget proposal that talked about EBSA’s enforcement program.

In 2026, EBSA noted that one focus of its investigative program has been a major cases program. It mentioned that it referred some cases to the DOL legal team for litigation.

This year, EBSA says nothing about major cases or the DOL’s legal team.

EBSA has included three new examples of ways it has helped benefit plan participants.

One refers to an effort by an EBSA advisor to help a patient with COBRA coverage who was about to have cancer surgery clear up confusion about her coverage.

Another refers to EBSA advisor calls that led to a plan helping an employer plan participant pay a $50,000 air ambulance bill.

A third refers to a $20 million settlement agreement involving allegations that a health plan administrator had “systematically and improperly denied patient claims for emergency room services and drug screenings.”

But EBSA also reported that the value of the No Surprises Act claim disputes it helped patients and providers resolve fell to $468.9 million in federal fiscal year 2025, from $544 million in federal fiscal year 2024.

What it means: EBSA might take a gentler approach to benefits law enforcement in 2027, but might not.

EBSA officials said in January that they hoped to crack down on barriers to mental health care and improve the No Surprises Act health claim dispute resolution system.

The 2027 federal budget: The Trump administration predicted in the spending and revenue supplements that come with the budget proposal that total federal revenue will increase 8.1% in 2027, to $5.9 trillion.

The $8.1 trillion spending total would be just 7.3% higher than the 2026 spending total.

But the deficit would still increase to about $2.2 trillion, from $2.1 trillion.

The deficit would amount to about 37% of federal revenue and 6.4% of U.S. gross domestic product, or national income.

This year, the deficit is on track to amount to 38% of federal revenue and 6.3% of $32.5 trillion in U.S. GDP.

The United States has a total net worth of about $225 trillion, and the 2027 federal deficit would amount to about 1% of total U.S. net worth.

The Affordable Care Act exchange system: The federal government interacts with employers through Affordable Care Act programs as well as through EBSA.

ACA rules set benefits standards for all employer health coverage that has been purchased or significantly modified since 2010, and some workers get health coverage directly through the ACA public exchange system — the government’s online supermarket for private health coverage.

The ACA exchange system generates about $2 billion per year in revenue from health insurance company user fees, data sales and other commercial activities.

The U.S. Department of Health and Human Services’ 2027 budget proposal shows that HHS has requested $2.134 billion in funding for parts of the Centers for Medicare & Medicaid Services that run the ACA exchange system and handle other ACA programs.

The request for 2027 is 1% higher than what HHS requested for the ACA programs for 2026 but 2% lower than what Congress provided for the programs for 2026, according to a comparison of the new proposal with the 2026 budget proposal.

Spending levels on most items in the new proposal appear to be similar to the levels included in the 2026 request.

One exception is exchange administration. Exchange administration spending could increase to $155.8 million, from $129 million.

Nontraditional and value-added products and services are generating a lot of buzz in the voluntary benefits marketplace, while the traditional mainstays of life and disability continue to capture the lion’s share of sales. But if the industry were a horse race, you’d see supplemental medical products including hospital indemnity, critical illness and accident coming up fast on the inside rail.

If you’re like most brokers, these products are no strangers to you. Critical illness and accident plans are among the top three voluntary products brokers sell and hospital indemnity also is in the top five for voluntary brokers, according to our most recent “Voluntary Hospital Indemnity and Supplemental Medical Products” Spotlight™ report. Sales of these products combined are up 29% since 2021 — and in 2024 they accounted for 38% of all voluntary benefit sales.

Close to one-third (28%) of employees surveyed own a hospital indemnity or supplemental medical product, according to the 2025 Eastbridge “MarketVision: The Employee Viewpoint” study, the largest percentage of them sharing the cost of premiums with their employers. And although the majority of employees don’t yet own this coverage, a significant number show strong interest in obtaining it, even if they have to pay the full cost themselves: 31% of those surveyed who don’t currently own these products indicate they’d be interested in purchasing them on a voluntary, 100% employee-paid basis.

Carriers see strong market potential

The “Voluntary Hospital Indemnity and Supplemental Medical Products” Spotlight™ report shows the number of carriers selling supplemental medical products continues to increase, with group products the norm. In fact, hospital indemnity, critical illness and accident are the plans voluntary carriers are most likely to include in their portfolios, outpacing even traditional voluntary products such as short-term disability and term life. Not coincidentally, they’re also among the products carriers cite as very profitable, and least likely to classify as only average or somewhat profitable. No surprise then that carriers consistently list these plans as their top growth products over the past eight years, as well as those they expect to lead industry growth in the next several years.

Carriers are far more likely to revise or introduce new voluntary hospital indemnity, critical illness and accident plans than any other type of coverage. About two-thirds of carriers surveyed for Eastbridge’s 2024 “Voluntary Product Trends” Frontline™ report planned to change these products, usually by revising and refiling an existing product to create competitive differentiation. The majority of plans have been on the market for less than 10 years, and increased competition has driven many carriers to revise their products in the last two or three years with broader coverage, higher benefit amounts and rate adjustments.

More carriers are covering well-baby/newborn care, observation unit stays, mental health and substance abuse, and both inpatient and outpatient benefits in response to market demand. Fertility and reproductive care benefits are also a new trend in benefits. The number of plans offering these types of family-building benefits is still low, but carriers mention increased market pressure to include them.

The primary product differentiator may be flexibility. For many carriers, this means going beyond expanded benefits to offer flexible underwriting guidelines, claims payment and pricing, and both HSA-compatible and non-HSA-compatible plans.

Supplemental health isn’t “supplemental” any more

Voluntary hospital indemnity and supplemental medical products continue to evolve to meet the needs of today’s employers and employees — filling gaps left by major medical coverage and providing a way to offset other out-of-pocket costs associated with high-deductible health plans. It seems clear accident, critical illness and hospital indemnity insurance will play an increasingly vital role in helping employees manage the financial impact of serious, unexpected medical events.

Some state insurance regulators are uneasy about how they and their colleagues are regulating life insurance policies and annuity contracts that include long-term care benefits.

Concerns about the regulatory environment for LTC hybrid products surfaced last month at a Senior Issues Task Force session at the National Association of Insurance Commissioners’ spring national meeting in San Diego

An NAIC staff member is compiling a guide summarizing how each state handles LTC hybrids.

Ned Gaines, a Nevada regulator and the task force chair, suggested that states may need to work toward taking a more consistent approach to matters such as LTC hybrid pricing and consumer protections.

What it means: State regulators could start to develop new rules for products that some older clients may be using to try to protect themselves against the risk of facing big bills for nursing home care, assisted living facility stays, home care or other forms of long-term care.

State differences: Meeting participants suggested that some states may let insurers increase premiums for LTC riders attached to life insurance policies and that other states may not allow premium increases for life-LTC hybrids.

Some states may exempt LTC benefits riders from the reviews they would impose on stand-alone long-term care insurance policies, participants said.

Participants talked about starting a project to collect states’ LTC hybrid product filings and have regulators see how each state is handling them.