THE HEALTHCARE MARKET LIBERATION AND PLAN B REDUCTION AND SOCIAL SECURITY INTEGRITY ACT

​PILLAR 1: THE MARKET LIBERATION ACT

​TITLE I — DEFINITIONS AND STANDARDS

​SEC. 101. QUALIFIED HEALTH COVERAGE (QHC).

​MANDATORY CERTIFICATION: To be certified as QHC, a health plan must be Guaranteed Issue, ensuring no individual is denied coverage based on health history or pre-existing conditions.

​PATIENT LIABILITY CAPS: The Maximum Out-of-Pocket (MOOP) cost shall not exceed $2,500 for an individual or $5,000 for a family per calendar year.

​SEC. 101.4. CHIROPRACTIC PARITY: Chiropractic care is hereby defined as an essential medical service. QHC plans are prohibited from:

​Requiring a medical doctor’s referral for chiropractic treatment.

​Placing "visit caps" on chiropractic care that are more restrictive than those placed on physical therapy or primary care office visits.

​SEC. 101.5. THE 80% "CLEAN CARE" RATIO:

​THE MANDATE: Insurers must expend a minimum of 80% of all premium revenue on Direct Patient Care.

​INCLUDED EXPENSES (THE 80%): Clinical services provided by doctors, hospitals, licensed chiropractors, and pharmacies; medical equipment; and direct care coordination.

​EXCLUDED EXPENSES (THE 20%): Marketing, advertising, executive salaries and bonuses, lobbying, corporate office space, and general overhead.

​CLAWBACK: Any funds spent below the 80% threshold must be returned directly to the enrollees' HSAs within 60 days of the end of the fiscal year.

​SEC. 102. THE RATING VARIABLES.

Premiums for QHC plans are strictly limited to the following variance ratios:

​AGE RATING: No more than a 2-to-1 ratio.

​TOBACCO RATING: No more than a 1.5-to-1 ratio.

​LOCATION RATING: No more than a 1.5-to-1 ratio.

​TITLE II — DISMANTLING VERTICAL INTEGRATION & PBM REFORM

​SEC. 201. MANDATORY STRUCTURAL SEPARATION.

​PROHIBITION: No corporate entity or parent company shall simultaneously own or control a Health Insurance Carrier, a Pharmacy Benefit Manager (PBM), and a Hospital or Provider Group.

​DIVESTITURE: All integrated healthcare conglomerates have 24 months from the date of enactment to complete full divestiture into separate, independent companies.

​SEC. 203. PBM ACCOUNTABILITY.

​100% REBATE PASS-THROUGH: PBMs are prohibited from retaining manufacturer rebates. 100% of the rebate must be applied at the point of sale to lower the patient’s cost.

​BAN ON SPREAD PRICING: PBMs are prohibited from charging a health plan more for a prescription drug than the amount paid to the pharmacy.

​SEC. 205. FRONT-LINE PRESCRIPTIVE AUTHORITY.

The following professionals are authorized to renew non-controlled maintenance medications for stable patients with a documented history:

​NPs & PAs: Full independent authority within scope.

​REGISTERED NURSES (RN): Authorized for a 180-day refill.

​LICENSED PRACTICAL NURSES (LPN): Authorized for a 90-day refill if patient vitals are stable.

​PHARMACISTS: Authorized for "Test and Treat" (Strep, Flu, UTI) and clinical dosage adjustments.

​TITLE III — THE ESI CONVERSION & THE PLAN B PREMIUM REDUCTION FUND

​SEC. 301. THE ESI DEFINITION.

Employer-Sponsored Insurance (ESI) is the total cash amount an employer pays for an employee's health plan. It is earned compensation belonging to the worker.

​SEC. 302. THE 15.3% FICA-EQUIVALENT EXTRACTION.

​THE MATH: 15.3% of the total ESI value shall be deducted.

​THE DESTINATION: These funds shall be deposited into The Plan B Premium Reduction Fund, which is authorized under this Act.

​THE PURPOSE: Used exclusively to reduce monthly Plan B premiums for seniors and reduce premium expectations for States.

​SEC. 303. THE WORKER REDIRECTION.

​THE DEPOSIT: The remaining 84.7% of the ESI plus 100% of the worker’s current paycheck contribution shall be deposited directly into the worker’s personal HSA.

​TAX STATUS: The worker’s current contribution to healthcare shall be tax-free.

​TITLE IV — 1099 PARITY & INTERSTATE COMPETITION

​SEC. 106.3. THE 1099 SELF-REIMBURSEMENT MANDATE.

​THE REDIRECTION: Because a 1099 worker acts as both employer and employee, the 7.65% employer-share of their self-employment tax shall be redirected from the Treasury back into the worker’s personal HSA fund.

​PURPOSE OF FUNDS: Specifically designated to purchase a QHC plan or cover medical expenses.

​SEC. 403. FEDERAL PASSPORT.

Any QHC-certified plan approved in one state may be sold in all 50 states, preempting state-level mandates.

​TITLE V — THE PRICE TRANSPARENCY HAMMER

​SEC. 501. TELEHEALTH FREEDOM.

​FEDERAL RECIPROCITY: Providers licensed in one state may treat patients in all 50 states via telehealth.

​BAN ON PHYSICAL OFFICE MANDATES: States cannot require a "brick-and-mortar" presence in the patient’s state.

​SEC. 502. THE CON HAMMER.

States must repeal Certificate of Need laws within 12 months or lose 5% of federal funding; 10% after 18 months.

​SEC. 503. SIMPLE MENU PRICE STANDARD.

Providers must post True Cash Prices for the 300 Most Common Procedures (including imaging, labs, and surgery).

​SEC. 504. THE $0 BILL.

If a provider fails to post prices or overcharges the posted menu price, the bill is legally rendered $0.00.

​TITLE IX — INSEVERABILITY

​SEC. 905. THE "ALL OR NOTHING" INSEVERABILITY MANDATE.

If any section, sentence, or clause of this Act is held invalid or unconstitutional, the entire Act shall be rendered void in its entirety immediately.

​Prepared by: John Dady

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