Chapter 2 in the Medicare section is all about strengthening eligibility requirements. Starting in section 71201 it limits Medicare eligibility to only U.S. citizens, lawful permanent residents and a few others. The Social Security Administration must review all current enrollees and remove those who don’t qualify. It temporarily boosts doctor’s Medicare payments by 2.5% for services provided in 2026 to help with financial strain. Finally, it updates Medicare’s drug price negotiation rules so that orphan drugs (drugs that treat rare diseases) treating more than one rare disease still qualify for exemption, but if they later treat common conditions, they can be added to the negotiation list.
Chapter 3 is about taxation for health care, some of this I get, some is confusing. Starting in section 71301 it says there are new rules about who can get health insurance help and how certain plans work. From 2027, only certain lawfully present immigrants, like green card holders, Cuban and Haitian entrants, and some Pacific Islanders, can get premium tax credits to help pay for insurance, while others will not qualify. Beginning in 2026, if someone loses Medicaid because of their immigration status, they can’t get those tax credits during that time. By 2028, health insurance marketplaces must verify eligibility before giving tax credits. Also starting in 2026, people using special enrollment periods based only on income changes won’t qualify for tax credits, and the government can reclaim unlimited overpaid tax credits. High deductible health plans won’t lose that status if they don’t charge deductibles for telehealth visits, which will make it easier to use Health Savings Accounts (HSAs). From 2026, “bronze” and “catastrophic” marketplace plans will count as high deductible plans eligible for HSAs. Finally, paying a fixed monthly fee directly to a primary care doctor for basic care (up to $150 per person per month) won’t count as full insurance but can be treated as medical expenses for tax accounts like HSAs. These changes are meant to ensure help goes to eligible people and clarify plan rules.
Chapter 4 is protecting rural hospitals. It creates a $50 billion program to help states improve health care in rural areas. Each year, $10 billion will be given to states that apply and submit plans by the end of 2025 showing how they will improve rural hospitals, health outcomes, access to care, use of technology, workforce recruitment, and financial stability. States don’t need to provide matching funds and must use the money for at least three specific goals, like improving chronic disease care, upgrading technology, or expanding mental health and addiction treatment. States cannot use the money to cover their share of Medicaid costs. If a state misuses the funds, the federal government can take the money back. Half the money will be split equally among approved states, and the other half will be divided based on rural need. There’s also $200 million for the program’s setup in 2025.
