The "More Affordable Care Act" introduces a Health Freedom Waiver Program, enabling states to waive specific requirements of the Patient Protection and Affordable Care Act (ACA) for plan years beginning in 2026. To qualify, a state must maintain an invisible high-risk insurance pool or a similar program designed to mitigate insurance premium risks. States can opt out of ACA provisions related to health insurance coverage, premium tax credits, cost-sharing reductions, and the individual mandate.

A key feature is the "Money Follows the Person" provision, which redirects federal funds. If a state waives ACA subsidies, the aggregate amount that would have been paid as premium tax credits and cost-sharing reductions will instead be deposited into new Trump Health Freedom Accounts for eligible residents. These payments are calculated based on the national average annual premium for a silver tier benchmark plan in non-waiver states.

Trump Health Freedom Accounts are specialized health savings accounts with particular rules, including the ability to purchase health insurance directly from the account. However, these accounts come with significant restrictions: funds cannot be used to pay for premiums or services related to an extensive list of "gender transition procedures" or "abortion services." The bill provides detailed definitions for these prohibited services, with specific exclusions for medically necessary treatments or procedures related to rape or incest.

For small employers in waiver states, the bill modifies the existing small employer health insurance credit. It increases the credit amount to 50 percent, expands the definition of an eligible small employer to include those with up to 50 employees, and removes the average wage and two-year credit period limitations. Any health plan authorized by the state insurance commissioner in a waiver state is considered a qualified health plan for this credit.

Finally, the legislation mandates improved price transparency and outcomes data reporting. Within 90 days of enactment, the Secretary of Health and Human Services must update regulations to require the disclosure of actual prices, not just estimates, and ensure pricing information is standardized and easily comparable. The bill also calls for updated enforcement policies for transparent reporting and requires the public reporting of outcomes data by providers, while explicitly preserving existing consumer protections, including those for pre-existing conditions.