Healthcare Market Liberation & Affordability Act

Prepared by John Dady – citizensagainsttyranny.net

(Includes: Full Bill • Statutory Summary • “For the People” Explainer)

SECTION 1 – Full Bill

Title I — Consumer Protection & Guaranteed Coverage

Sec. 101. Findings and Purpose

The purpose of this Act is to achieve universal, guaranteed, and financially secure healthcare access by ensuring every American can obtain comprehensive coverage with minimal financial risk, while reforming economic incentives in the healthcare delivery system to achieve sustainable cost reduction.

Sec. 102. Prohibition on Discrimination Based on Health Status

(a) Guaranteed Issue and Renewability

1. A Qualified Health Plan (QHP) issuer or plan administrator shall not deny enrollment to any individual based on health status, medical history, claims history, genetic information, disability, or pre-existing conditions.

2. QHPs must offer guaranteed renewability except in cases of fraud, intentional misrepresentation, or non-payment of premiums.

(b) Prohibition on Pre-Existing Condition Exclusions

No QHP may impose pre-existing-condition exclusions or waiting periods. Coverage begins on the effective date of enrollment.

(c) Adjusted Community Rating and Premium Calculation

1. No health-based premium rating.

2. Allowable rating factors:

A. Age (max 3:1 ratio oldest to youngest)

B. Geographic area (approved by HHS)

C. Family composition (individual / family)

D. Tobacco use

3. No premium mark-ups tied to health status or medical condition.

Sec. 103. Essential Health Benefits

All QHPs in the individual and small-group markets must cover the 10 ACA-defined essential health-benefit categories, with no annual or lifetime dollar limits.

Sec. 104. Limits on Consumer Cost-Sharing

(a) Out-of-Pocket Maximum: not to exceed $2,500 (individual) / $5,000 (family) for covered in-network benefits.

(b) Deductible limit: may not exceed the OOP maximum — the same caps apply.

(c) Simplified cost-sharing: once deductible met, all in-network essential benefits paid 100 % by the plan.

Title II — The Health Stipend & Payroll-Tax Parity

Sec. 201. Non-Taxable Health Stipend

Employer-paid premiums must be converted to a cash stipend paid directly to the worker.

Stipend is income-tax-free to the worker but subject to FICA payroll tax, strengthening Social-Security & Medicare trust funds.

Employer may continue to deduct stipend as labor expense.

Sec. 202. Tax Treatment

Stipend excluded from federal income-tax base.

Included in FICA base to support Medicare solvency.

Sec. 203. State & Local Tax Protection

Stipend is exempt from state/local income & payroll taxes to preserve full value for the worker.

Title III — Competition Mandates

Repeal all Certificate-of-Need (CON) laws nationwide.

Mandatory real-time price transparency for all providers and payers.

Interstate licensure recognition for physicians and other licensed professionals.

Title IV — Medicare Solvency & Premium Relief

Reduce or eliminate Medicare Part B monthly premium for all beneficiaries.

Fund reductions using new FICA revenue generated under Title II.

Statutory Authority & Enforcement Appendix

I. Constitutional Authority

Spending Clause (Art I § 8 cl 1) — Congress may attach clear, proportionate conditions to federal funds.

Commerce Clause (Art I § 8 cl 3) — health-insurance and provider markets substantially affect interstate commerce; federal pre-emption justified.

Supremacy Clause (Art VI cl 2) — valid federal reforms pre-empt conflicting state law.

II. Key Statutory Precedents

42 U.S.C. § 1396c — HHS may withhold/reduce Medicaid matching funds from non-compliant states.

26 U.S.C. § 4980H & § 36B — existing federal power over employer/insurer obligations & subsidies.

23 U.S.C. §§ 104-106, 402 — historical conditional highway funding.

South Dakota v. Dole (1987) — upheld conditional funding if clear, germane, proportionate.

NFIB v. Sebelius (2012) — spending conditions must be unambiguous, germane, not unduly coercive.

III. Application to This Act

Title I: QHP protections — Commerce Clause.

Title II: Stipend tax shift — Taxing & Spending.

Title III: Repeal CON/licensure — Commerce Clause.

Title IV: Medicare Part B & trust-fund — Taxing & Spending.

Enforcement: States failing to repeal CON laws or adopt licensure reciprocity within timeline incur automatic 20 % reduction in federal Medicaid matching payments until compliance.

IV. Severability

If any provision is struck down, the rest remains in effect.

SECTION 2 – Statutory Summary

Purpose: Protect patients, cut costs by competition, and give workers control of their healthcare dollars.

Key Reforms: Guaranteed coverage regardless of health status; out-of-pocket caps $2,500 / $5,000; employer premiums converted to cash stipend for workers; repeal state CON laws; price transparency; interstate licensure; eliminate or reduce Medicare Part B premium funded by new FICA revenue.

Authority: Commerce Clause & Spending Clause with statutory precedents (42 U.S.C. § 1396c, South Dakota v. Dole, etc.).

Enforcement: States failing to comply face 20 % Medicaid-funding reduction; other federal tools as specified.

SECTION 3 – For the People Explainer

You keep your coverage — just at fairer prices. Insurers can’t drop you or charge more for pre-existing conditions.

Families save big: your max yearly out-of-pocket drops to $5,000 (down from today’s typical $10–14k+).

You get the money, not your boss: employer’s premium dollars become a tax-free healthcare stipend you control.

Real prices at last: hospitals & clinics must post cash prices up front so you can shop like any other service.

More doctors, more clinics: red-tape laws that block new providers are repealed — more competition means better service & lower bills.

Seniors win: Medicare Part B premiums reduced or eliminated, funded without new income taxes.

Accountability: states that try to block competition lose a share of federal Medicaid funding until they comply.