A Congressional Legislative Assistant's job involves a substantial amount of reading, synthesis, strategizing and writing: tasks for which modern LMMs like Gemini are purpose-built. Could we build a proof-of-concept "Agentic Legislative Assistant" that works on behalf of a human LA to monitor CSPAN's coverage of Congress (other agents would monitor other information sources), identifies hearings, briefings and other events of relevance to its specific portfolio and writes summaries, briefings, backgrounders, policy memos, constituent impact briefings, and even legislative drafts and strategic plans for the LA to review? Here we demonstrate using Gemini 2.5 Flash Thinking, Gemini 2.5 Pro and Gemini 3 Pro to assess a bipartisan healthcare plan briefing led by Reps. Josh Gottheimer (D-NJ) and Jennifer Kiggans (R-VA) yesterday, asking each model to first assess whether the briefing is of relevance to different LA Agents managing their respective portfolios, then generate targeted summaries, background memos and even propose draft legislation and strategic plans to support or oppose the plan.
Our proof-of-concept Agentic Legislative Assistant starts by watching each CSPAN broadcast and deciding whether it is relevant to the portfolio of the human LA it represents. Once it decides the briefing is relevant, we demonstrate generating various targeted summaries, backgrounders, policy and consistent impact memos, then demonstrate having Gemini craft strategic plans and proposed legislation that would either support or oppose the proposed plan – all of it 100% autonomous and operating without any human in the loop, silently monitoring, analyzing, strategizing and advising on each portfolio area.
Under this Agentic Legislative Assistant model, each human LA in the office would have a team of Agentic LA's working for them around the clock. Let's look at three fictional LA's in an imaginary US Representative's office: one covering national security and foreign policy, one covering domestic issues and one covering women's issues. Obviously in a real Congressional office, these LA's would have much broader portfolios than these single narrow issues, but we'll use these narrow portfolios to make our examples clearer in this proof-of-concept.
Let's start with a Legislative Assistant who serves as the national security advisor to a US Representative. Their CSPAN LA Agent has been monitoring CSPAN all day and comes across this bipartisan healthcare plan briefing. Its first task is to determine whether the briefing is of any relevance to the human staffer it supports. We'll test each of the three Gemini models to see how it performs. As seen below, the three models all correctly assess that this domestic healthcare-related briefing is of little relevance to this LA and thus not likely worth their time to review in detail:
You are a staffer for a US Representative whose portfolio primarily encompasses national security, foreign policy and the armed services. Is the briefing below of significant relevance to your portfolio? Answer YES or NO. If your answer is YES, give a one-sentence description/argument of why this briefing is of relevance and how significantly relevant it is to your portfolio.
The results:
- Gemini 2.5 Flash Thinking: NO
- Gemini 2.5 Pro: NO
- Gemini 3 Pro: NO
What about an LA focused on domestic issues? Notice how our description of our LA's portfolio never mentions anything related to "healthcare" or "ACA", but Gemini is able to understand that an LA focused on domestic issues will likely find a briefing about a bipartisan healthcare plan to be of significant relevance.
You are a staffer for a US Representative whose portfolio primarily encompasses domestic issues. Is the briefing below of significant relevance to your portfolio? Answer YES or NO. If your answer is YES, give a one-sentence description/argument of why this briefing is of relevance and how significantly relevant it is to your portfolio.
The results:
- Gemini 2.5 Flash Thinking: YES. This briefing is highly relevant as it details a bipartisan legislative effort to address significant domestic issues like healthcare affordability, the expiration of ACA premium tax credits, and broader healthcare reforms impacting millions of American families.
- Gemini 2.5 Pro: YES. This briefing is of high relevance as it details a major, time-sensitive bipartisan legislative proposal from House members to address the imminent expiration of healthcare premium tax credits, a critical domestic issue directly impacting the affordability of health insurance for millions of Americans.
- Gemini 3 Pro: YES. This briefing is of high relevance as it details a bipartisan legislative framework to extend expiring enhanced health insurance premium tax credits and implement cost-saving reforms, a critical domestic policy priority requiring immediate Congressional action to prevent premium spikes for millions of constituents.
What about an LA focused on women's issues? Again, despite no mention of healthcare in the staffer's portfolio description, Gemini is able to instantly recognize the substantial relevance, making some interesting arguments, including the fascinating bullet point that women make up more than half of all marketplace enrollees.
You are a staffer for a US Representative whose portfolio primarily encompasses women's issues. Is the briefing below of significant relevance to your portfolio? Answer YES or NO. If your answer is YES, give a one-sentence description/argument of why this briefing is of relevance and how significantly relevant it is to your portfolio.
The results:
- Gemini 2.5 Flash Thinking: YES, this briefing is highly relevant to a women's issues portfolio because affordable healthcare is critical for women, who often manage family health decisions, are primary caregivers, and can be disproportionately impacted by rising premiums and healthcare costs, as highlighted by multiple female Representatives in the briefing.
- Gemini 2.5 Pro: YES. This briefing is highly relevant because the affordability of health insurance is a critical women's issue, directly impacting their economic security and access to essential services like preventative screenings, maternal care, and family planning.
- Gemini 3 Pro: YES. The briefing is significantly relevant to your portfolio because the proposed extension of Affordable Care Act premium tax credits and the inclusion of pediatric care reforms directly affect health care affordability for women, who are the primary health care decision-makers for families and comprise a majority of ACA marketplace enrollees.
Now that we know that this briefing is of relevance to our two domestic and women's issues LA staffers, let's ask for a one-page key details summary:
Give me a one page summary of this briefing that captures all of the key details.
Gemini 2.5 Flash Thinking:
Here is a one-page summary of the press briefing on the bipartisan healthcare plan.
Summary of Bipartisan Press Briefing on "Common Ground 2025" Healthcare Plan
Event Overview
On December 5, 2025, a bipartisan group of over a dozen House members, led by Rep. Josh Gottheimer (D-NJ) and Rep. Jennifer Kiggins (R-VA), held a press conference to unveil the "Common Ground 2025" framework. The proposal is designed to prevent a massive spike in health insurance premiums for millions of Americans by extending expiring tax credits while implementing key reforms.
The Core Problem: An Impending "Healthcare Cliff"
The central issue is the scheduled expiration of the enhanced premium tax credits (originally part of the Affordable Care Act and expanded during the pandemic) at the end of the year. Lawmakers warned that inaction would lead to catastrophic premium increases for the 22 million Americans who rely on them.
Projected Impact: Speakers cited potential premium increases of 175% in states like New Jersey, costing an average family of four an additional $20,000 per year.
Urgency: The group stressed that "time is not on our side" and that a vote is needed by December 18th to prevent premiums from rising in January. The recurring message was that "doing nothing is not an option."
The Proposed Solution: The "Common Ground 2025" Framework
The framework is a two-step, two-year process designed to provide immediate relief and lay the groundwork for long-term stability.
Step 1: Immediate Action (Vote by December 18th)
This phase focuses on preventing the immediate crisis with a two-year extension of premium savings, but with significant modifications to gain bipartisan support.
Extend Premium Tax Credits: Continue the subsidies to keep insurance affordable.
Add "Guardrails" and Reforms: Implement targeted income caps and other modifications to root out fraud, waste, and abuse. Several members noted the plan would be fully paid for.
PBM Reform: Include reforms targeting Pharmacy Benefit Managers (PBMs).
Step 2: Longer-Term Reforms (To be agreed upon by Summer 2026)
The second phase involves a "menu of longer-term reforms" that the bipartisan group would continue to negotiate, with the goal of passing them before the midterm elections.
Hospital Billing Transparency: Increase transparency in hospital pricing.
Elimination of $0 Premiums: End plans with no monthly premiums but include provisions for need-based support to ensure access for low-income individuals.
HSA-Based Plans: Implement Health Savings Account (HSA) based plans, citing the Cassidy bill as a model that could eventually eliminate the need for tax credits.
Give the Kids a Chance Act: Pass legislation to accelerate pediatric cancer treatments and therapies for children with rare diseases.
Key Themes and Messages
Bipartisanship is Essential: Every speaker emphasized that this is not a red or blue issue, but a "red, white, and blue" American issue. They presented their framework as a pragmatic, compromise solution capable of getting the 60 votes needed in the Senate and strong majority support in the House, unlike purely partisan proposals.
Call to Leadership: The group explicitly urged House and Senate leadership on both sides to take up their proposal, arguing it provides a viable path forward to avoid a crisis.
Focus on Affordability: The speakers, from diverse districts across the country, framed the issue as a core component of the affordability crisis facing American families, alongside costs for housing, food, and energy.
Making Congress Work: Several members lamented the partisan gridlock in Congress and positioned their effort as proof that lawmakers can "put aside the BS," challenge their own parties, and work together to deliver real solutions for the American people.
Gemini 2.5 Pro:
Summary of Bipartisan Briefing on "Common Ground 2025" Healthcare Framework
Overview
On December 5, 2025, a bipartisan coalition of House members, led by Rep. Josh Gottheimer (D-NJ) and Rep. Jennifer Kiggins (R-VA), unveiled a legislative framework titled "Common Ground 2025" aimed at preventing a massive spike in health insurance premiums for millions of Americans. The press conference featured numerous speakers from both parties who emphasized the urgency of the situation and their commitment to finding a pragmatic, compromise solution before a critical end-of-year deadline.
The Core Problem: The "Healthcare Cliff"
The central issue driving the proposal is the impending expiration of the enhanced Affordable Care Act (ACA) premium tax credits at the end of the year. Speakers warned that if Congress fails to act, an estimated 22 million Americans who purchase insurance through the ACA marketplace will face catastrophic increases in their monthly premiums starting in January.
Financial Impact: Rep. Gottheimer highlighted that families in his home state of New Jersey could see a 175% increase, translating to an additional $20,000 per year for a family of four. Other members cited examples of constituents whose annual premiums could rise from approximately $11,000 to over $30,000.
Human Cost: Several members, including Rep. Kiggins (a nurse practitioner), stressed that this is a "life and death" issue. They argued that unaffordable premiums would force many families, small business owners, and independent contractors to make the "risky choice" to go without health insurance, leading to worse health outcomes and higher costs for everyone in the long run.
The Proposed Solution: The "Common Ground 2025" Framework
The group presented a two-step plan designed to provide immediate relief while creating a pathway for more significant, long-term reforms. They called on House and Senate leadership to bring a bill based on this framework to a vote by December 18th.
Step 1: Immediate Action (Short-Term Bridge)
This phase is focused on averting the immediate crisis with a two-year solution that incorporates reforms sought by both parties.
Extend Premium Tax Credits: Continue the premium savings for American families for two years.
Add Guardrails and Reforms: The extension would not be a simple continuation. It includes targeted modifications to address Republican concerns, such as:
Implementing income caps to ensure aid is targeted.
Adding measures to root out fraud and abuse within the system.
Step 2: Longer-Term Bipartisan Reforms
The framework commits the group to working together on a menu of more substantial, structural reforms to be passed before the midterm elections. Key proposals include:
PBM (Pharmacy Benefit Manager) Reform: Addressing the role of middlemen in driving up prescription drug costs.
Hospital Billing Transparency: Requiring clear and upfront pricing for medical services.
Elimination of $0 Premiums: Modifying plans to end $0 premium options, while still providing need-based support for low-income individuals.
HSA-Based Alternatives: Implementing Health Savings Account-based plans, referencing the Cassidy-Hassan bill, to eventually reduce the need for tax credits.
"Get the Kids a Chance Act": A specific provision aimed at accelerating the development of treatments for pediatric cancer and other rare childhood diseases.
Key Themes from the Briefing
Urgency and "Doing Nothing is Not an Option": Every speaker underscored that time is running out and inaction would have devastating consequences for their constituents. The looming January premium hikes were framed as a crisis that politicians created and therefore have a responsibility to solve.
Pragmatism Over Ideology: Several Republican members explicitly stated their opposition to the ACA ("Obamacare") but acknowledged the reality that millions of people depend on it. They positioned the framework as a necessary "bridge" to protect Americans while working toward better long-term solutions.
A Call for Bipartisanship and Compromise: The event was a deliberate showcase of cross-party collaboration. Rep. Kiggins quoted the dictionary definition of "compromise," and others lamented that the "muscle memory of bipartisanship has atrophied." They presented their group as a model for how Congress should function—finding common ground to solve real-world problems rather than scoring political points.
Direct Appeal to Leadership: The group made a clear and direct appeal to House and Senate leadership to take their proposal seriously, arguing it represents a viable plan that can secure the 60 votes needed in the Senate and pass the House, unlike more partisan alternatives.
Gemini 3.0 Pro:
Briefing Summary: Bipartisan “Common Ground 2025” Healthcare Framework
Date: December 5, 2025
Location: U.S. Capitol, House of Representatives
Key Leaders: Rep. Josh Gottheimer (D-NJ) and Rep. Jen Kiggans (R-VA)
Participants: A coalition of Democrats and Republicans (approx. 15 Republicans and 28 Democrats total in the group), including Reps. Mike Lawler (R-NY), Don Bacon (R-NE), Wiley Nickel (D-NC), and others.
The Urgent Crisis
The briefing addressed the looming expiration of Enhanced Premium Tax Credits (ACA subsidies) at the end of the year.
Without congressional action, health insurance premiums for millions of Americans (approx. 20–22 million) will spike beginning in January.
Speakers cited potential cost increases of 60% to 175%, with some families facing premium hikes from $11,000 to over $30,000 annually.
The group emphasized that "doing nothing is not an option" and that failure to act constitutes a failure of government responsiveness.
** The Solution: “Common Ground 2025” Framework**
The lawmakers presented a two-step bipartisan legislative framework designed to prevent these cost increases and introduce systemic reforms.
Step 1: Immediate Stabilization (Short-Term)
Extension: A two-year extension of the Enhanced Premium Tax Credits to prevent the January price cliff.
Funding & Guardrails: The extension is "paid for" through measures to root out fraud, PBM (Pharmacy Benefit Manager) reform, and income caps to ensure the aid targets those most in need.
Step 2: Structural Reform (Long-Term)
A commitment to work on a menu of permanent reforms by summer 2026 (before the midterms).
Proposed reforms include:
Fee schedule increases.
Hospital billing transparency (site-neutral billing).
Elimination of $0 premiums with need-based provisions.
Implementation of HSA (Health Savings Account) expansions (based on the Cassidy bill).
Passage of the "Give Kids a Chance Act" for pediatric cancer/rare diseases.
Key Arguments & Sentiment
Bipartisanship: The speakers stressed that healthcare costs are an American issue, not a "Red or Blue" issue. Rep. Kiggans read the definition of "compromise," criticizing the current political environment where compromise is viewed as a weakness.
Frustration with Leadership: Multiple members expressed frustration with House and Senate leadership for dragging their feet. They are demanding a vote by December 18 to ensure coverage continues uninterrupted.
Economic Impact: Members highlighted that high premiums force families to choose between healthcare and other necessities, or to drop coverage entirely, which drives up costs for everyone else in the system.
Rejection of Gridlock: Rep. Mike Lawler and others emphasized that voters are tired of "political wins" and want actual governance, noting this framework is the only proposal currently capable of garnering the necessary 60 votes in the Senate.
Next Steps
The coalition is formally requesting that House Speaker Mike Johnson and Minority Leader Hakeem Jeffries, as well as Senate leadership, engage with this framework immediately to pass legislation before the end-of-year deadline.
Those summaries are a bit long for a staffer in a hurry to read, so let's ask for a more concise briefing:
Give me a really short and succinct summary with key details for a staffer in a hurry who needs to know the high level summary in as few words as possible.
Gemini 2.5 Flash Thinking:
A bipartisan House group (led by Reps. Gottheimer & Kiggans) unveiled the "Common Ground 2025" healthcare framework. It aims to prevent health insurance premium spikes from enhanced ACA premium tax credits expiring year-end. The two-step plan proposes a two-year extension of credits with reforms (income caps, fraud, PBM reform) and longer-term solutions (billing transparency, HSA models). They urge Congress to vote by December 18th, stressing bipartisan action is critical as "doing nothing is not an option."
Gemini 2.5 Pro:
A bipartisan group of House members, led by Rep. Josh Gottheimer (D-NJ) and Rep. Jen Kiggins (R-VA), unveiled a healthcare framework called "Common Ground 2025."
The plan aims to prevent a massive spike in health insurance premiums when enhanced ACA tax credits expire at the end of the year.
Key Points:
Step 1 (Immediate): Pass a short-term extension of the premium tax credits with targeted modifications (like income caps and fraud prevention) before the end of the year. They are calling for a vote by December 18.
Step 2 (Longer-Term): Work on a menu of broader reforms by summer 2026, including PBM reform and hospital price transparency.
The group is urging House and Senate leadership to act on this bipartisan solution to avoid an affordability crisis for millions of Americans.
Gemini 3.0 Pro:
topic: “Common Ground 2025” Bipartisan Health Care Framework
Lead Sponsors: Reps. Josh Gottheimer (D-NJ) and Jen Kiggans (R-VA) led a bipartisan coalition urging House and Senate Leadership to act before year-end.
The Crisis: Enhanced Premium Tax Credits (ACA subsidies) expire Dec 31, threatening massive premium hikes for ~22 million Americans.
The Proposal:
Short-Term: A 2-year extension of tax credits to prevent January 1st cost spikes.
Offsets/Reforms: Includes income caps, PBM reform, and guardrails against fraud to pay for the extension.
Long-Term: Commits to a menu of broader reforms (e.g., hospital billing transparency, HSA expansion) to be addressed by summer.
Call to Action: The group requests a floor vote by Dec 18, claiming a bipartisan majority currently exists to pass the measure if Leadership allows it.
What about a more targeted summary for our domestic issues LA that ties the briefing to their specific portfolio, rather than this more generic summary?
Give me a really short and succinct summary with key details for a Legislative Assistant staffer who focuses on domestic issues and is in a hurry who needs to know the high level summary in as few words as possible that summaries the briefing as it relates to their specific portfolio.
Gemini 2.5 Flash Thinking:
Bipartisan House Group Unveils "Common Ground 2025" Healthcare Plan: Led by Reps. Gottheimer (D-NJ) and Kiggans (R-VA), the framework proposes a 2-year extension of expiring ACA premium tax credits to prevent massive premium spikes for 22M Americans. It includes immediate reforms (PBMs, anti-fraud, income caps) and a roadmap for longer-term changes (hospital transparency, HSA-based models). They urge a vote by December 18th to act before premiums rise in January, emphasizing bipartisan compromise on healthcare affordability.
Gemini 2.5 Pro:
TO: Legislative Assistant (Domestic Issues)
FROM: [Your Name]
DATE: [Current Date]
RE: High-Level Summary of Bipartisan House Health Care Presser
Top Line: A large, bipartisan House group (led by Reps. Gottheimer (D-NJ) and Kiggans (R-VA)) unveiled a two-step framework, "Common Ground 2025," to prevent a massive health insurance premium spike when enhanced ACA tax credits expire at year-end.
The Proposal: "Common Ground 2025"
Step 1 (Immediate Action):
Extend the enhanced premium tax credits for two years to avoid the "premium cliff."
Add GOP-requested reforms: targeted income caps and guardrails to root out fraud and abuse.
They state the extension is paid for.
Step 2 (Longer-Term Reforms):
Commit to a second package of reforms to be passed by Summer 2025.
Includes a "menu" of options like PBM reform, hospital price transparency, and exploring HSA-based plans.
Urgent Ask: The group is urging House and Senate leadership to bring their framework for a vote by December 18 to prevent premiums from rising in January.
Key Takeaway: They are positioning this as the only viable, bipartisan path forward that can pass both chambers, stressing compromise is necessary to deliver a solution for the millions of constituents who will otherwise face unaffordable health care costs.
Gemini 3.0 Pro:
Subject: Summary: Bipartisan "Common Ground 2025" Healthcare Framework
The Crisis: ACA Enhanced Premium Tax Credits expire Dec 31; without action, premiums for ~20M Americans will spike (avg. 60-100% increase) in January.
The Proposal:
Immediate Action: A 2-year extension of the tax credits to bridge the gap.
Cost Controls: Includes new "guardrails" to pay for it, specifically income caps and strict fraud prevention measures.
Timeline: The group (led by Reps. Gottheimer & Kiggans) is calling for a floor vote by December 18.
Long-Term Policy Goals:
The framework commits to a second legislative phase by Summer 2026 to enact broader reforms, including PBM reform, hospital billing transparency, site-neutrality, and HSA expansion.
Political Context: Bipartisan coalition (approx. 15 R / 28 D) positioning this as the only viable path to 60 Senate votes before the YE deadline.
What about our women's issues LA?
Give me a really short and succinct summary with key details for a Legislative Assistant staffer who focuses on women's issues and is in a hurry who needs to know the high level summary in as few words as possible that summaries the briefing as it relates to their specific portfolio.
Gemini 2.5 Flash Thinking:
Bipartisan lawmakers propose extending enhanced healthcare premium tax credits to prevent crippling cost spikes, specifically highlighting the impact on working families and mothers struggling with affordability (e.g., Rep. Heller).
Gemini 2.5 Pro:
TO: Legislative Assistant (Women's Issues)
FROM: Bipartisan Presser
RE: High-Level Summary of "Common Ground 2025" Healthcare Framework
A bipartisan House group is pushing a framework to prevent a massive spike in health insurance premiums when enhanced ACA tax credits expire at year-end.
Key Impacts on Your Portfolio:
Family Affordability: The core message is that inaction will devastate family budgets. Speakers repeatedly cited examples of a family of four facing premium increases of over $20,000 per year.
Mothers & Working Families: Rep. Hillary Scholten (D-MI) framed it directly: "As a mom of two school-age kids [in a] working family, I can tell you firsthand the affordability crisis is crippling the American Dream."
Children's Health: The long-term plan includes the "Get the Kids a Chance Act" to accelerate pediatric cancer treatments and therapies for children with rare diseases.
Bottom Line: This is being framed as an urgent economic issue for working families, with women and mothers positioned as those most directly impacted by the potential cost increases.
Gemini 3.0 Pro:
Subject: Bipartisan “Common Ground 2025” Healthcare Framework
Executive Summary:
A bipartisan House coalition unveiled a framework to extend enhanced ACA premium tax credits for two years, preventing immediate cost spikes for families.
Key Impacts for Women & Families:
Pediatric Health: The framework incorporates the "Get the Kids a Chance Act" to accelerate pediatric cancer and rare disease therapies (highlighted by Rep. Jen Kiggans, a Nurse Practitioner).
Affordability: Rep. Hillary Scholten emphasized the framework’s necessity for working mothers and preventing family bankruptcies.
Timeline: The group is pushing leadership for a floor vote by December 18.
What about for their Member?
You are a staffer for a US Rep. Give me a really short and succinct summary with key details, designed to give to your Member to update them on this briefing and what it said. Keep it really short and concise with only the key details of interest to the Member. This isn't a policy memo, it is a really brief one paragraph or less concise key detail summary just to update the Member on the briefing.
Gemini 2.5 Flash Thinking:
Reps. Gottheimer and Kiggins, leading a bipartisan group, unveiled their "Common Ground 2025" healthcare framework today. The plan calls for a two-year extension of enhanced ACA premium tax credits, set to expire at year-end, to prevent significant premium spikes for millions of Americans. It also proposes longer-term reforms to combat fraud and increase transparency, urging House and Senate leadership to pass a bill by December 18th.
Gemini 2.5 Pro:
A large bipartisan House group, led by Reps. Gottheimer (D-NJ) and Kiggins (R-VA), held a press conference to unveil their "Common Ground 2025" healthcare framework. The plan addresses the ACA's enhanced premium tax credits that expire at year's end. Their two-step proposal calls for an immediate two-year extension of the credits with new income caps and fraud-prevention guardrails, followed by negotiations on longer-term reforms like PBMs and price transparency. They are urging House and Senate leadership to bring a bill to a vote by December 18 to prevent a massive spike in insurance premiums for millions of Americans in January.
Gemini 3.0 Pro:
Reps. Josh Gottheimer (D-NJ) and Jen Kiggans (R-VA) led a bipartisan coalition today to unveil the "Common Ground 2025" framework, aimed at extending the expiring ACA Enhanced Premium Tax Credits for two years. The proposal pairs this extension with fiscal guardrails—specifically income caps, fraud prevention measures, and PBM reform—rather than a clean extension. The group is urging leadership to schedule a vote by December 18 to prevent premium spikes in January, arguing that this compromise holds the necessary bipartisan support to pass both chambers where current leadership plans do not.
What if their Member was just elected to Congress and isn't as familiar with all the nitty gritty policy details of the healthcare debate? Let's have the LA Agent write a brief "backgrounder" policy for the LA staffer to provide to their member that brings them up to speed on the policy specifics of the debate to help them make a decision where to stand on this proposed plan:
You are a staffer for a US Representative who was just elected to Congress and is not familiar with the details of the healthcare debate. Write a brief one-page or less policy memo for your Member that gives them a basic overview of the healthcare debate as it relates to this briefing that is sufficient to help the Member understand why this briefing focuses on the specific things it does and helps the Member decide whether they want to support or oppose it. This memo is primarily a backgrounder to bring the Member up to speed on the healthcare debate's points as they relate to the plan outlined in this briefing.
Gemini 2.5 Flash Thinking:
MEMORANDUM
To: Representative [Your Member's Name]
From: [Your Name], Legislative Staff
Date: December 5, 2025
Subject: Overview of the "Common Ground 2025" Bipartisan Healthcare Framework Briefing
I. Executive Summary
This memo provides a background on the "Common Ground 2025" Bipartisan Healthcare Framework, presented today by a bipartisan group of House lawmakers, including Representatives Josh Gottheimer (D-NJ) and Jennifer Kiggans (R-VA). The core issue addressed is the impending expiration of enhanced premium tax credits (EPTCs) at the end of this year, which would lead to significant increases in health insurance premiums for millions of Americans. The proposed framework aims to extend these EPTCs for two years while implementing immediate reforms to address fraud and PBMs, and setting a path for longer-term, bipartisan healthcare solutions. This briefing emphasizes the urgency of action to prevent a healthcare affordability crisis for constituents.
II. Background: The Looming Healthcare Affordability Crisis
The Affordable Care Act (ACA) introduced premium tax credits to help individuals and families afford health insurance purchased through the marketplace. During the COVID-19 pandemic, these credits were "enhanced" to make coverage even more affordable and accessible. These Enhanced Premium Tax Credits (EPTCs) are currently set to expire on December 31, 2025.
Why this matters now:
Significant Premium Spikes: If EPTCs expire, health insurance premiums are projected to "skyrocket" for an estimated 20-24 million Americans. Speakers cited potential increases of 175% in some areas (e.g., New Jersey), leading to thousands of dollars in additional annual costs for families and seniors (e.g., $20,000 for a family of four, $33,000 for a senior couple).
Risk of Uninsured Americans: This would force many to choose between paying for essential healthcare and other necessities, potentially leading to increased personal bankruptcies and a rise in the uninsured population.
Political Urgency: Lawmakers emphasized "time is ticking" and "doing nothing is not an option," with calls for a vote by December 18th to pre-empt January premium hikes.
III. The "Common Ground 2025" Bipartisan Framework
This framework is presented as a two-step process:
A. Step 1: Immediate-Term Solutions (Focused on EPTC Extension and Initial Reforms)
The primary goal of Step 1 is to prevent the immediate premium spikes by extending the enhanced premium tax credits. This is packaged with initial reforms aimed at improving the system and garnering bipartisan support.
Extension of Premium Tax Credits: A two-year extension of the EPTCs is proposed.
Income Caps/Guardrails: Modifications to income eligibility to ensure aid is targeted.
Abuse Issues: Measures to root out fraud and abuse within the healthcare system.
PBM Reform: Addressing the role of Pharmacy Benefit Managers to lower prescription drug costs.
"Paid For" Provisions: The plan is asserted to be paid for, partly by addressing fraud. (Further details on financing beyond fraud were not explicitly detailed in the briefing but would be critical to understand).
Call for Action: Urges both the House and Senate leadership to bring this framework to a vote before December 18th.
B. Step 2: Longer-Term Healthcare Reforms
This step outlines a commitment to continue working on broader, structural reforms by Summer 2026 (before the midterm elections). These include:
Fee schedule increases
Hospital billing transparency
Elimination of $0 premiums (with provisions for need-based support)
Implementation of HSA-based models (citing the Cassidy Bill, with the eventual goal of reducing reliance on EPTCs)
"Get the Kids a Chance Act" (accelerating pediatric cancer treatments and therapies for rare diseases).
IV. Why this Briefing Focused on These Points / Considerations for Your Stance
The briefing focused intensely on the EPTC expiration because it is an immediate, tangible crisis affecting millions of constituents, regardless of political affiliation. The bipartisan nature of the group (15 Republicans and 28 Democrats mentioned) highlights the perceived necessity and broad appeal of addressing this issue.
Arguments for Supporting the Framework:
Constituent Impact: Directly prevents significant healthcare cost increases for millions, fulfilling a basic need for affordable care.
Bipartisan Compromise: Demonstrates Congress's ability to work across the aisle on critical issues, a point many members emphasized as vital for public trust.
Addresses Immediate Crisis: Avoids a "do nothing" scenario which could lead to widespread hardship.
Includes Reforms: The plan isn't just a simple extension; it incorporates measures to address fraud and PBMs, which are common bipartisan concerns about healthcare costs and efficiency.
Path to Longer-Term Solutions: Sets the stage for more comprehensive healthcare reforms, rather than just kicking the can down the road.
Potential Considerations/Arguments Against (or for nuance):
ACA's Foundation: While including reforms, the plan fundamentally extends a component of the ACA. Some Republican members expressed general disapproval of the ACA itself (e.g., Rep. Roy stated, "I do not like the Affordable Care Act. I don't. It's fraught with all kinds of problems."). Supporting the extension, even with reforms, might be seen by some as validating a system they wish to replace.
Temporary Solution: The two-year extension provides immediate relief but doesn't fully resolve the long-term question of healthcare affordability or the role of government subsidies.
Details of "Paid For": While stated as "paid for," the specifics of funding beyond fraud reduction would require closer scrutiny.
V. Recommendation for Your Decision:
This framework represents a pragmatic, immediate response to a looming crisis that will directly impact your constituents' wallets and access to healthcare. Your decision will likely hinge on whether the immediate benefit of preventing premium spikes and demonstrating bipartisan action outweighs potential concerns about extending a component of the ACA, even with included reforms. Further inquiry into the exact legislative language for the reforms and funding mechanisms would be advisable.
Gemini 2.5 Pro:
MEMORANDUM
TO: The Honorable Member of Congress
FROM: Legislative Staff
DATE: December 5, 2025
SUBJECT: Background on the Bipartisan "Common Ground 2025" Healthcare Framework
Purpose
This memo provides a background on the key healthcare policy debate surrounding the expiration of enhanced insurance subsidies, which is the focus of the "Common Ground 2025" proposal you saw presented today by a bipartisan group of House members. Understanding this context is essential for evaluating their plan.
Background: The Looming "Premium Cliff"
The central issue is the scheduled expiration of Enhanced Premium Tax Credits (EPTCs) on December 31, 2025. To understand this, here is a brief overview:
The Affordable Care Act (ACA): The ACA created online health insurance marketplaces (e.g., HealthCare.gov) where individuals who don't get insurance through an employer can buy coverage.
Premium Tax Credits (PTCs): To make this coverage affordable, the ACA provides tax credits (subsidies) to lower the monthly premiums for low- and middle-income families. Originally, these subsidies were capped, meaning families earning over 400% of the federal poverty level did not qualify.
Enhanced Premium Tax Credits (EPTCs): During the COVID-19 pandemic, Congress passed legislation that "enhanced" these subsidies in two key ways: 1) it increased the subsidy amount for those already eligible, and 2) it removed the 400% income cap, making subsidies available to higher-income individuals if their insurance premiums exceeded 8.5% of their income.
These enhancements were intended to be temporary but have been extended since. They are now set to expire at the end of this year. If Congress does not act, millions of Americans will face a sudden and significant increase in their health insurance premiums in January 2026—an event often called the "premium cliff." Projections cited by the members today suggest increases of over 100%, costing an average family thousands of dollars per year.
The Bipartisan Proposal: "Common Ground 2025"
The bipartisan group, led by Reps. Gottheimer (D-NJ) and Kiggins (R-VA), has proposed a two-phase framework to avert this cliff while also addressing Republican concerns about the cost and scope of the subsidies.
Phase 1: Immediate Action (Vote by Dec. 18)
This is the core compromise designed to pass before the deadline.
For Democrats: The plan extends the premium tax credits for two years, preventing the immediate premium spike for over 20 million Americans.
For Republicans: In exchange, the extension is not a simple renewal. It includes "guardrails" and "targeted modifications" such as:
Reinstating an income cap on subsidy eligibility to focus aid on lower- and middle-income families.
Implementing stronger verification and anti-fraud measures.
Beginning reforms of Pharmacy Benefit Managers (PBMs), who are criticized by both parties for their role in high drug prices.
Phase 2: Longer-Term Reforms (By Summer 2026)
The framework commits the group to working on a broader package of structural healthcare reforms, including:
Increased hospital price transparency.
Eliminating plans with $0 premiums to ensure consumers have "skin in the game" (while providing need-based support).
Creating Health Savings Account (HSA) based plans as an alternative to the current subsidy structure.
Key Political Dynamics
The Urgency: The hard deadline of December 31 creates immense pressure for a deal. "Doing nothing is not an option" was a common refrain, as Members in both parties fear constituent backlash from massive premium hikes.
The Compromise: This is a classic "Problem Solvers" approach. Democrats get their top priority (extending subsidies), while Republicans secure conservative-leaning reforms (fiscal guardrails, market-based solutions).
The Goal: The group is explicitly trying to build a coalition that can achieve 60 votes in the Senate, acknowledging that a purely partisan bill from either side is dead on arrival. They are pressuring House and Senate leadership to consider their framework as the most viable path forward.
This proposal represents a pragmatic attempt to find a middle ground on a contentious issue, driven by a politically potent deadline. Your decision on whether to support it will involve weighing the immediate benefit of preventing the premium cliff against the specific policy concessions made by both sides in the framework.
Gemini 3.0 Pro:
MEMORANDUM
TO: Representative-Elect [Name]
FROM: Staff
DATE: December 5, 2025
SUBJECT: Background on Expiring ACA Tax Credits and the "Common Ground 2025" Framework
Executive Summary
A bipartisan group of House Members, led by Reps. Josh Gottheimer (D-NJ) and Jennifer Kiggans (R-VA), held a press conference today regarding the looming expiration of Enhanced Premium Tax Credits for Affordable Care Act (ACA) marketplace plans. Without legislative action by year-end, millions of Americans will see significant premium spikes in January.
This memo outlines the current debate and the "Common Ground 2025" compromise framework proposed by the group to help you decide on a position.
The Core Issue: Expiring Subsidies
During the COVID-19 pandemic, Congress passed "Enhanced Premium Tax Credits" to lower the cost of health insurance on the individual market. These credits:
Increased the amount of financial assistance available.
Expanded eligibility to middle-income families who previously did not qualify.
Current Status: These enhanced credits are set to expire on December 31, 2025. If they expire, premiums are projected to nearly double for some constituents (e.g., a family of four could see a $20,000 annual increase).
The "Common Ground 2025" Proposal
The briefing focused on a specific compromise designed to attract Republican support for spending money on ACA subsidies. The group argues that a "clean" extension cannot pass the current House. Instead, they propose a two-step plan:
Step 1: Immediate Action (The "Bridge")
To pass a vote by December 18, the group proposes extending the tax credits for two years, but with new conservative "guardrails" to offset costs and reduce fraud:
Income Caps: Limiting eligibility so the wealthiest do not receive subsidies.
Fraud Prevention: Strict verification to ensure only eligible individuals receive credits.
PBM Reform: Reforming Pharmacy Benefit Managers to lower drug costs and pay for the extension.
Step 2: Long-Term Reform (By Summer 2026)
To secure votes from members wary of "throwing money at a broken system," the framework promises a vote on structural reforms before the next midterm election, including:
Hospital Price Transparency: Ending surprise billing.
HSA Expansion: Based on the Cassidy bill (allowing wider use of Health Savings Accounts).
"Get the Kids a Chance Act": Accelerating pediatric cancer treatments.
Decision Factors for the Member
Argument for Support: This prevents a massive tax hike/premium spike on your constituents immediately upon taking office. It offers "political cover" by including fraud prevention and income caps, separating you from the "big government" spending critique usually associated with the ACA.
Argument for Opposition: The plan extends federal subsidies for a system (ACA) that many conservatives view as fundamentally broken. While it includes "guardrails," it still represents significant federal spending.
Conclusion
The briefing focused heavily on fraud prevention and income caps specifically to make the tax credit extension palatable to Republicans. The group is positioning this as the only viable legislative vehicle to prevent a healthcare cost crisis in January.
While these backgrounders provide a general overview of the healthcare debate, the most important information a Member needs to know is how a proposed plan will impact their specific constituents. Let's pretend our staffer represents the US Representative for Illinois' 13th congressional district, which encompasses Champaign-Urbana, home of the University of Illinois and ask for a policy memo that outlets how this proposed plan would impact those specific constituents.
You are a staffer for a US Representative who represents Illinois' 13th congressional district. Write a one-page policy memo that outlines how the proposed plan would impact constituents in Illinois' 13th congressional district. Do NOT provide generic statements that could apply to any congressional district - make sure that your memo focuses on how the plan will impact the unique needs of constituents in Illinois' 13th congressional district. Provide detailed evidence. Again, make sure that your statements are not generic that could apply to any congressional district - they MUST focus on how the plan would impact the unique needs of constituents in Illinois' 13th congressional district.
Gemini 2.5 Flash Thinking:
MEMORANDUM
TO: Representative [Your Rep's Last Name]
FROM: [Your Name], Legislative Assistant
DATE: December 5, 2025
SUBJECT: Analysis of Bipartisan "Common Ground 2025" Healthcare Framework Impact on Illinois' 13th Congressional District Constituents
I. Executive Summary
This memo outlines the direct and anticipated impacts of the proposed bipartisan "Common Ground 2025" healthcare framework on constituents within Illinois' 13th Congressional District. The framework, which seeks to extend enhanced Premium Tax Credits (PTCs) and implement targeted reforms, is critical for maintaining healthcare affordability and access for thousands in our diverse district, which spans urban centers like Champaign-Urbana and Springfield, as well as significant rural agricultural communities. Our analysis indicates that the plan directly addresses acute affordability concerns prevalent in IL-13, preventing substantial premium spikes and laying groundwork for long-term cost containment.
II. Key Provisions and Specific Impact on IL-13 Constituents
A. Extension of Enhanced Premium Tax Credits (PTCs) & Affordability:
The most immediate and profound impact for IL-13 lies in the proposed two-year extension of enhanced PTCs. If these credits expire by the end of the year, as is currently scheduled, we anticipate a severe affordability crisis for tens of thousands of our constituents.
Preventing Premium Spikes: While the transcript notes a potential 175% increase in New Jersey, Illinois faces similar significant hikes. According to estimates from the Center on Budget and Policy Priorities, many Illinois residents receiving marketplace subsidies could see their annual premium costs double or triple if the enhanced PTCs lapse. For the estimated 30,000-40,000 residents in IL-13 currently utilizing the "Get Covered Illinois" marketplace, including many self-employed farmers, small business owners, and individuals transitioning between jobs, this would translate into an average increase of hundreds of dollars per month, or potentially thousands annually. For a family of four, as cited in the press conference, this could easily exceed 15,000-15,000−20,000 in additional out-of-pocket expenses, making insurance untenable.
Support for Diverse Earning Households: IL-13 contains a mix of income levels. The PTCs have been crucial for working-class families in communities like Decatur, where median incomes may not keep pace with rising healthcare costs, and for graduate students or contract workers in the University of Illinois and SIUE communities who rely on marketplace plans.
Avoiding Under- and Uninsurance: Without this extension, many constituents would be forced to make the "risky choice" (as described by Rep. Houchin) to forgo insurance, leading to increased uncompensated care burdens on local hospitals and clinics, particularly in underserved rural areas of our district.
B. Cost Containment and Transparency Reforms:
The framework's commitment to longer-term reforms—such as PBM reform, hospital billing transparency, and eliminating fraud—holds particular relevance for IL-13:
PBM Reform: Given IL-13's significant aging population, particularly in rural counties like Macon, Christian, and Montgomery, prescription drug costs are a major concern. PBM reforms could directly lower out-of-pocket drug expenses for seniors and those managing chronic conditions, which are prevalent throughout the district.
Hospital Billing Transparency: Our district is served by large hospital systems (e.g., Memorial Health in Springfield, Carle Foundation Hospital in Champaign-Urbana, OSF HealthCare in Danville, and smaller rural hospitals like Sarah Bush Lincoln Health System in Mattoon). Increased transparency would empower our constituents to better understand and challenge charges, fostering greater accountability from these major healthcare providers.
Fraud Reduction: By rooting out fraud, the plan aims to reduce overall systemic costs, which can indirectly contribute to more stable premiums for everyone in IL-13, including those on employer-sponsored plans.
C. Long-Term Market Reforms and Access:
The inclusion of options like HSA-based plans (Cassidy Bill) and the "Kids a Chance Act" speaks to a broader, more sustainable vision:
HSA-Based Options: For healthier, higher-earning constituents, particularly faculty and staff at our universities or entrepreneurs, HSA-based plans offer consumer-directed choices and tax advantages. This expands the menu of options, catering to a diverse set of needs and preferences within the district.
Pediatric Healthcare Investment: While not specific to IL-13, the "Kids a Chance Act" would ensure that families in our district whose children are battling rare diseases or pediatric cancers have access to crucial, lifesaving therapies, providing immense relief during unimaginable challenges.
III. Strategic Considerations for IL-13
The bipartisan nature of this framework is a significant asset in a district like IL-13, which has a history of electing representatives who prioritize pragmatic solutions over partisan divides. Constituents across our district, regardless of their political affiliation, consistently voice concerns about healthcare costs. Supporting a "common ground" approach demonstrates a commitment to effective governance and addresses an emergency that directly impacts the financial well-being of thousands of families.
IV. Recommendation
I strongly recommend that the Representative publicly endorse and actively advocate for the "Common Ground 2025" bipartisan healthcare framework. This plan offers a vital short-term solution to prevent catastrophic premium increases for IL-13 constituents and establishes a foundation for essential long-term reforms, directly aligning with our constituents' urgent need for affordable, accessible, and transparent healthcare. The urgency of a vote before December 18th is paramount to secure these critical benefits.
Gemini 2.5 Pro:
MEMORANDUM
TO: The Honorable Representative, Illinois' 13th Congressional District
FROM: Legislative Staff
DATE: December 6, 2025
SUBJECT: Analysis of "Common Ground 2025" Healthcare Plan and its Impact on Illinois' 13th District
Executive Summary
The "Common Ground 2025" bipartisan healthcare framework offers a critical, time-sensitive solution to a looming affordability crisis that will disproportionately affect key constituencies within Illinois' 13th District. By proposing a two-year extension of enhanced Affordable Care Act (ACA) premium tax credits, the plan would directly prevent catastrophic premium increases for our district's significant agricultural producers, self-employed small business owners, and near-retirees. The framework’s inclusion of fiscal guardrails and longer-term reforms, such as hospital price transparency, addresses core concerns about both immediate costs and the future of healthcare in our mixed urban-rural district. This memo outlines the specific impacts on IL-13 residents.
Background
As detailed in the December 5th press conference, a bipartisan group of House members introduced the "Common Ground 2025" framework. The plan is a two-step process designed to prevent the expiration of enhanced premium tax credits at the end of this year. Without action, an estimated 22 million Americans, including tens of thousands of IL-13 residents, will face dramatic increases in their health insurance premiums beginning in January 2026. The plan calls for an immediate vote by December 18th to extend the credits for two years while adding targeted reforms, followed by a second phase of longer-term solutions to be negotiated by summer 2026.
Specific Impacts on Illinois' 13th District Constituents
This plan is not a generic solution; its provisions directly address the unique economic and demographic profile of IL-13.
Critical Support for Agricultural Producers and the Self-Employed: IL-13 is home to some of the most productive agricultural land in the nation, with thousands of family farmers across Macon, Champaign, Sangamon, and Piatt counties. These constituents are typically self-employed and do not have access to employer-sponsored insurance, making them uniquely reliant on the ACA Marketplace. The expiration of tax credits would be devastating. For example, a farming family of four in rural Champaign County with a fluctuating annual income around $130,000 could see their annual premiums spike from approximately $11,000 to over $25,000. This framework’s extension of credits is the single most important factor in ensuring they can afford coverage while managing the inherent financial volatility of their profession.
Protecting Near-Retirees in Communities like Springfield and Decatur: A significant portion of our district’s population is between the ages of 55 and 64—too young for Medicare but often facing higher health costs. These are former state workers in Springfield or manufacturing sector retirees from Decatur who may have retired before age 65. The press conference highlighted a 60-year-old couple facing premiums of $33,000 annually. This scenario is a direct threat to our constituents. This plan’s premium support provides a vital two-year bridge, preventing them from having to choose between their retirement savings and necessary health insurance.
Stabilizing Coverage for Graduate Students and Service Workers in Champaign-Urbana: As home to the University of Illinois, our district has a large population of graduate students, contract employees, and service sector workers who support the university community. Many graduate students live on modest stipends that place them squarely in the demographic that benefits most from enhanced subsidies. Without these credits, a PhD student would be forced to purchase a plan that consumes an unsustainable portion of their income or go uninsured. The plan ensures continued access to care for this vital part of our district’s primary economic engine.
Long-Term Reforms Address Local Market Dynamics: The framework’s "Step 2" menu of reforms includes proposals directly relevant to the healthcare market in IL-13. Provisions for hospital billing transparency are particularly salient given that our district’s healthcare landscape is dominated by large systems like Carle Foundation Hospital and OSF HealthCare. Constituents frequently express frustration over opaque billing practices. Advocating for this reform addresses a persistent local concern and demonstrates a commitment to tackling the root causes of high healthcare costs in Central Illinois.
Recommendation
It is recommended that the office publicly support the "Common Ground 2025" framework and actively engage with its bipartisan sponsors. The plan provides an essential short-term lifeline that is specifically tailored to the needs of IL-13’s farmers, near-retirees, and university community. Its structure allows us to prevent an immediate financial crisis for our constituents while committing to longer-term, commonsense reforms that address the unique dynamics of our local healthcare market.
Gemini 3.0 Pro:
MEMORANDUM
TO: Representative Nikki Budzinski (IL-13)
FROM: Health Policy Legislative Assistant
DATE: December 5, 2025
SUBJECT: Local Impact Analysis: "Common Ground 2025" Bipartisan Health Care Framework
Overview
The "Common Ground 2025" framework, unveiled today by the Problem Solvers Caucus and bipartisan allies, proposes a two-year extension of the Enhanced Premium Tax Credits (EPTC) coupled with fiscal guardrails and PBM reform. Without this intervention, the expiration of EPTCs on December 31 will trigger a massive affordability crisis. Based on the transcript of the press conference and current district demographics, this memo outlines the specific impacts on Illinois’ 13th District, particularly regarding our agricultural workforce, the Metro East commuter corridor, and university-affiliated populations.
Specific Impacts on IL-13 Constituents
1. Protecting Self-Employed Farmers in the Central Counties
During the press conference, Rep. Adam Gray (CA-13) highlighted the burden on agricultural districts. IL-13 mirrors this vulnerability. A significant portion of our constituency in Macoupin, Piatt, and Christian counties consists of self-employed farmers and independent contractors who do not have employer-sponsored plans.
The Threat: As noted by Rep. Gottheimer, the expiration of credits could result in a 175% premium increase. For a farming family of four in rural Sangamon County earning slightly above the federal poverty line, this could mean premiums skyrocketing from manageability to the $30,000 range cited by Rep. Lawler.
The Fix: This framework prevents the return of the "subsidy cliff," ensuring that our agricultural producers are not forced to choose between insuring their families and financing next year’s crop.
2. Relief for Working Families in the Metro East and Decatur
The framework targets the specific "affordability crisis" described by Rep. Hillary Scholten, where health care costs drive personal bankruptcy. In the Metro East (Belleville, East St. Louis) and Decatur, we have a high concentration of service industry workers and gig economy participants whose income fluctuates.
The Cliff: Without the EPTC extension, a median-income household in the Metro East (earning ~55,000−55,000−60,000) would lose subsidy eligibility entirely.
The Plan’s Impact: By maintaining the cap on premiums at 8.5% of income, this plan ensures that families in Decatur’s working-class neighborhoods retain spending power for other essentials like housing and food, rather than having it absorbed entirely by insurance premiums.
3. Assessing PBM Reform for Independent Pharmacies
The framework includes "PBM reform" as a "pay-for" to offset costs. This is uniquely relevant to IL-13, where independent pharmacies in our rural towns (e.g., Monticello, Taylorville) are closing due to Pharmacy Benefit Manager price gouging.
District Relevance: While the transcript touches generally on "waste and fraud," the inclusion of PBM reform directly addresses a primary complaint we receive from local pharmacists who serve our aging population in areas where chain pharmacies are non-existent.
4. Stability for University Communities (Champaign-Urbana)
Rep. Vasquez highlighted the need to "Make America Affordable Again" for younger demographics. In Champaign-Urbana, graduate students, researchers, and young entrepreneurs often rely on the ACA marketplace as they transition off university plans or start businesses.
Impact: The proposed "Common Ground" framework safeguards the University of Illinois innovation ecosystem. If premiums double as predicted in the briefing, we risk driving young talent out of the district toward corporate employment solely for benefits, stifling the startup incubation currently thriving in Champaign.
Recommendation
The "Common Ground 2025" plan aligns with your priority of pragmatic, bipartisan economic relief. It addresses the immediate threat to the 22 million Americans mentioned by Rep. Salazar—a significant percentage of whom reside in our district's rural and post-industrial hubs. Supporting this framework protects IL-13’s farmers and working families from an immediate, catastrophic tax increase disguised as a premium hike.
How do we transform this to action for a US Representative who wants to help support this framework?
You are a staffer for a US Rep who supports this framework. Give me a two paragraph policy brief for your Member that outlines what they should do to support it.
Gemini 2.5 Flash Thinking:
Policy Brief: Support for the Common Ground 2025 Bipartisan Healthcare Framework
The looming expiration of enhanced Premium Tax Credits (EPTCs) at the end of the year threatens to drastically increase healthcare premiums for millions of American families, seniors, and small business owners, potentially forcing them to go without essential coverage. As our constituents face average premium increases that could be as high as 175%, doing nothing is not an option. The Common Ground 2025 Bipartisan Healthcare Framework, developed through extensive cross-aisle collaboration, offers a pragmatic, two-step solution. It proposes an immediate two-year extension of EPTCs, coupled with critical reforms to address abuse issues, PBM reform, and improved accountability, all paid for by rooting out fraud. This framework is a vital lifeline to ensure healthcare affordability and prevent a national crisis, demonstrating that Congress can work together on issues that profoundly impact everyday Americans.
To effectively support this critical initiative, our office should actively engage House and Senate leadership, emphasizing the overwhelming bipartisan consensus evident among 15 Republicans and 28 Democrats already backing the framework. We must highlight the urgency of securing a vote by December 18th to prevent premium spikes in January and publicly underscore the framework's commitment to both short-term affordability and longer-term reforms, including increased transparency and reduced waste. By recruiting additional co-sponsors and using our platform to share constituent stories about the impact of rising healthcare costs, we can demonstrate the broad support and pressing need for this legislation, urging our colleagues to prioritize this "Red, White, and Blue issue" over partisan wins and deliver real solutions for the American people.
Gemini 2.5 Pro:
TO: The Honorable Member of Congress
FROM: Staff
DATE: December 5, 2025
SUBJECT: Action Plan for the "Common Ground 2025" Bipartisan Healthcare Framework
This brief outlines recommended next steps for actively supporting the "Common Ground 2025" bipartisan framework to prevent the looming healthcare premium cliff. With the enhanced premium tax credits set to expire at the end of the year, millions of American families, including thousands in our district, face catastrophic premium spikes. The framework you joined presents a pragmatic, two-step solution: first, an immediate, paid-for, two-year extension of these credits with common-sense guardrails to target relief and eliminate fraud; second, a commitment to negotiate longer-term structural reforms like PBM reform and price transparency by next summer. This is the only viable, bipartisan plan with the demonstrated support necessary to pass both chambers, making it our best vehicle to deliver certainty to our constituents and prove Congress can solve urgent problems.
To build momentum, we must immediately pivot from announcement to action. The primary objective is to pressure House and Senate leadership to bring this framework to the floor for a vote before the December 18th target date. Recommended actions include: 1) Direct Engagement: Personally engage with your colleagues on the fence, leveraging the framework's bipartisan nature to grow our coalition of supporters. 2) Leadership Push: Coordinate with other framework members to jointly and individually press leadership in both parties to adopt this as the starting point for negotiations. 3) Public Messaging: Utilize floor time, social media, and local media interviews to amplify the core message: "Doing nothing is not an option." We should highlight the specific, devastating financial impact on families in our district and frame this as a common-sense solution to protect them from a massive, preventable cost increase.
Gemini 3.0 Pro:
Policy Brief: Common Ground 2025 Healthcare Framework
Context & Urgency
The expiration of Enhanced Premium Tax Credits at the end of this year presents an immediate affordability crisis, with health insurance premiums projected to nearly double for millions of Americans and rise by up to $20,000 for families of four in some districts. To prevent this shock, the bipartisan "Common Ground 2025" framework proposes a fully paid-for, two-year extension of these credits paired with necessary fiscal guardrails, including income caps to target relief and measures to root out fraud. This proposal, backed by a coalition of Democrats and Republicans, serves as a bridge to ensure coverage continuity while committing to a second phase of structural reforms—such as PBM reform, hospital billing transparency, and HSA implementation—to be addressed by mid-2025.
Recommended Action
You should immediately join the coalition in pressuring House Leadership to schedule a floor vote on this framework by the targeted December 18 deadline, emphasizing that inaction will result in an unacceptable cost-of-living spike for constituents. To broaden support among fiscal conservatives, your advocacy should highlight that this plan is distinct from a "clean extension" by focusing on the included anti-fraud guardrails and offsets. Furthermore, you should utilize upcoming media appearances to frame this not as a partisan litigation of the ACA, but as a pragmatic, bipartisan emergency measure to protect families from inflation, signaling your willingness to engage in the longer-term cost-reduction reforms outlined in the proposal’s second phase.
What about a US Representative who opposes the framework?
You are a staffer for a US Rep who opposes this framework. Give me a two paragraph policy brief for your Member that outlines what they should do to most effectively oppose it.
Gemini 2.5 Flash Thinking:
Policy Brief: Opposition to Common Ground 2025 Bipartisan Healthcare Framework
The "Common Ground 2025" framework, while presented as a bipartisan solution to healthcare affordability, fundamentally extends and entrenches the problematic Affordable Care Act (ACA) subsidy structure without addressing the core issues driving escalating healthcare costs. This approach fails to introduce the necessary free-market mechanisms, robust deregulation, or true price transparency that would genuinely lower costs for all Americans. The proposed "reforms" are largely cosmetic, serving to legitimize a flawed model that empowers insurance companies and federal spending, ultimately perpetuating a system where taxpayers increasingly subsidize rising premiums rather than tackling market inefficiencies and empowering individual choice.
To effectively oppose this framework, our office should articulate a clear, principled stance emphasizing that a temporary extension of subsidies is not genuine reform. We must highlight the long-term fiscal burden this imposes and advocate for market-based alternatives that foster competition, reduce regulatory overreach, and give patients direct control over their healthcare decisions. This includes actively engaging in public discourse and internal party discussions to rally like-minded members, demanding a more comprehensive legislative package that truly dismantles the ACA's failures and puts patients, not the federal government or insurance corporations, first. Our message must be that while compromise is important, it must not come at the expense of sound policy that delivers sustainable, long-term healthcare solutions.
Gemini 2.5 Pro:
TO: The Honorable [Member's Name]
FROM: Legislative Staff
DATE: December 5, 2025
SUBJECT: Opposition Strategy for "Common Ground 2025" Healthcare Framework
The bipartisan "Common Ground 2025" framework presents a significant challenge, as it leverages the fear of expiring ACA subsidies to push for a costly, short-term extension of a flawed policy. Our core message must be that this proposal is not a solution but an irresponsible bridge to nowhere, doubling down on a system that inflates costs by masking them with massive government subsidies. We must reject the premise that doing nothing is the only alternative; the true failure would be to extend these "temporary" pandemic-era enhanced tax credits without enacting the fundamental, market-based reforms necessary to address the root causes of high healthcare costs. Our opposition should frame this not as a commonsense compromise, but as a fiscally reckless continuation of policies that have failed to make healthcare truly affordable, while enriching insurance companies and trapping families in a cycle of government dependency.
To effectively counter this, we recommend a two-pronged approach. First, we must publicly and repeatedly challenge the proponents' claim that the framework is "paid for," demanding a full CBO score and specific details on the supposed offsets and fraud prevention measures, which are likely insufficient to cover the multi-billion dollar cost of the extension. Second, we must immediately coordinate with the Republican Study Committee and conservative leadership to coalesce around an alternative vision that emphasizes real, long-term solutions like comprehensive price transparency, expanded Health Savings Accounts (HSAs), and dismantling regulations that stifle competition. By presenting a clear, fiscally sound alternative, we can reframe the debate from their urgent, emotional appeal into a substantive choice between a temporary, budget-busting patch and a permanent, conservative solution to lower healthcare costs for all Americans.
Gemini 3.0 Pro:
TO: Representative [Name]
FROM: Legislative Policy Staff
DATE: December 5, 2025
RE: Opposing the "Common Ground 2025" Healthcare Framework
To effectively oppose the "Common Ground 2025" framework, we must immediately reframe the extension of these enhanced premium tax credits not as "family relief," but as an inflationary bailout for large insurance monopolies that cements temporary COVID-era spending into a permanent entitlement. While proponents like Rep. Gottheimer and Rep. Kiggans argue this prevents a "cliff," the reality is that these subsidies hide the true cost of healthcare by transferring the burden to the taxpayer, incentivizing insurers to raise premiums further to capture government cash. You should highlight the admission by supporters within the transcript, such as Rep. Gosar, who acknowledged the ACA is "fraught with problems" and "corruption"; use this to argue that extending these credits merely subsidizes a broken system rather than enacting the market-based reforms necessary to actually lower costs. We must characterize this as throwing gas on the inflation fire for the sake of a short-term political win.
Legislatively, your most effective tactic is to leverage the tight timeline before the December 18 target date by demanding strict, hard-dollar spending offsets rather than the vague "rooting out fraud" pay-fors currently suggested by the coalition. You should rally the fiscal hardliners in the conference to inform Leadership that any inclusion of this extension in the year-end spending package will threaten the passage of the broader bill unless it is accompanied by significant structural cuts to other mandatory spending. Additionally, attack the "two-step" nature of their plan; argue that passing the extension now removes all leverage for the "Step Two" reforms (like HSA implementation and transparency) that the group claims they will address next summer. Insist that no money flows without the structural reforms happening first, effectively stalling the proposal until the deadline passes.
How can we move from discussion to action, to actually make this framework a legislative reality?
You are a staffer for a US Rep who supports this framework. Give me a proposed bill for your Member that best and most effectively enacts it legislatively.
Gemini 2.5 Flash Thinking:
Okay, here is a proposed bill for your Member, aiming to encapsulate the "Common Ground 2025 Bipartisan Healthcare Framework" as described by the various Representatives, prioritizing both the immediate need for premium relief and the longer-term structural reforms they discussed.
A BILL
To extend enhanced premium tax credits under the Affordable Care Act, to implement pharmacy benefit manager reforms, to increase healthcare price transparency, and for other purposes.
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.—This Act may be cited as the "Common Ground 2025 Bipartisan Healthcare Affordability Act."
(b) Table of Contents.—The table of contents for this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and purpose.
TITLE I—IMMEDIATE PREMIUM RELIEF AND COST CONTAINMENT
Subtitle A—Extension of Enhanced Premium Tax Credits
Sec. 101. Two-year extension of enhanced premium tax credits.
Sec. 102. Targeting of premium tax credits and abuse prevention.
Subtitle B—Pharmacy Benefit Manager (PBM) Reforms
Sec. 111. PBM transparency and fiduciary duties.
Subtitle C—Fraud Prevention and Program Integrity
Sec. 121. Enhanced program integrity for federal health programs.
Subtitle D—Offsets and Budget Neutrality
Sec. 131. Savings provisions.
TITLE II—LONG-TERM STRUCTURAL REFORMS AND INNOVATION
Subtitle A—Healthcare Price Transparency
Sec. 201. Strengthening and expanding healthcare price transparency.
Sec. 202. Site-neutral payment policies study and recommendations.
Subtitle B—Modernizing Health Savings Accounts (HSAs)
Sec. 211. HSA reforms based on the Cassidy Bill.
Subtitle C—Addressing Zero-Dollar Premium Plans
Sec. 221. Reform of zero-dollar premium exchange plans.
Subtitle D—Expanding Access to Life-Saving Therapies
Sec. 231. Acceleration of pediatric cancer treatments and rare disease therapies.
Subtitle E—Accountability and Market Reforms
Sec. 241. Study on vertical integration in the healthcare market.
SECTION 2. FINDINGS AND PURPOSE.
(a) Findings.—Congress finds the following:
(1) The expiration of enhanced premium tax credits under section 36B of the Internal Revenue Code of 1986, as modified by the Affordable Care Act, threatens to significantly increase healthcare premiums for millions of Americans, disproportionately impacting working families, seniors, and small business owners.
(2) Healthcare costs remain a leading concern for American families, hindering financial stability and access to necessary medical care.
(3) A bipartisan consensus exists within Congress that inaction on rising healthcare costs and expiring subsidies is not an option.
(4) It is imperative that Congress act swiftly to prevent premium spikes while simultaneously laying the groundwork for sustainable, long-term reforms to address fundamental issues within the healthcare system, including transparency, fraud, and market dynamics.
(5) Compromise and collaboration across the political aisle are essential to deliver meaningful solutions for the American people on critical issues such as healthcare.
(b) Purpose.—The purpose of this Act is to—
(1) provide immediate relief to American families by extending enhanced premium tax credits;
(2) implement targeted reforms to ensure federal subsidies are efficient and well-utilized;
(3) advance bipartisan, long-term solutions to make healthcare more affordable, accessible, and transparent; and
(4) demonstrate Congress's ability to find common ground and legislate effectively on behalf of the American people.
TITLE I—IMMEDIATE PREMIUM RELIEF AND COST CONTAINMENT
Subtitle A—Extension of Enhanced Premium Tax Credits
SEC. 101. TWO-YEAR EXTENSION OF ENHANCED PREMIUM TAX CREDITS.
Section 36B(b)(3) of the Internal Revenue Code of 1986 is amended by striking "2025" and inserting "2027" in each place it appears.
(This directly extends the enhanced premium tax credits for two additional years, through December 31, 2027, addressing the "two-year process" and looming expiration.)
SEC. 102. TARGETING OF PREMIUM TAX CREDITS AND ABUSE PREVENTION.
(a) Income Thresholds and Guardrails.—The Secretary of the Treasury, in consultation with the Secretary of Health and Human Services, shall, not later than 90 days after the date of enactment of this Act, issue guidance and promulgate regulations to implement reasonable income thresholds and guardrails to ensure that enhanced premium tax credits are appropriately targeted to those individuals and families for whom healthcare costs represent a significant financial burden. Such guidance shall aim to prevent the provision of subsidies to individuals with substantial financial resources or those whose plan choices are clearly outside the spirit of the program's intent.
(This addresses the call for "income caps" and "guardrails" to ensure the credits are effectively targeted.)
(b) Verification Requirements.—The Secretary of Health and Human Services shall enhance existing verification processes for eligibility for premium tax credits and special enrollment periods to minimize erroneous payments and prevent abuse of the system.
(This tackles the "abuse issues" and "root out fraud" mentioned by multiple Members.)
Subtitle B—Pharmacy Benefit Manager (PBM) Reforms
SEC. 111. PBM TRANSPARENCY AND FIDUCIARY DUTIES.
(a) Transparency.—The Federal Trade Commission, in consultation with the Department of Health and Human Services, shall promulgate regulations requiring pharmacy benefit managers (PBMs) to—
(1) disclose to health plans and payers all sources of revenue related to prescription drug transactions, including rebates, administrative fees, and discounts;
(2) provide transparent pricing models that differentiate between acquisition costs, dispensing fees, and PBM compensation; and
(3) submit an annual report to Congress detailing their aggregate financial performance and pricing practices.
(b) Prohibition on Spread Pricing.—Beginning January 1, 2027, PBMs are prohibited from engaging in spread pricing practices for prescription drugs covered under federal health programs or plans receiving federal subsidies, requiring PBMs to pass through the actual cost of the drug to the plan sponsor, plus a transparent administrative fee.
(This addresses the call for PBM reform and transparency, a common bipartisan concern.)
Subtitle C—Fraud Prevention and Program Integrity
SEC. 121. ENHANCED PROGRAM INTEGRITY FOR FEDERAL HEALTH PROGRAMS.
The Secretary of Health and Human Services shall—
(1) dedicate additional resources to combat fraud, waste, and abuse across all federal health programs, including the Affordable Care Act marketplaces;
(2) implement advanced data analytics and predictive modeling to identify and prevent fraudulent claims and practices; and
(3) increase coordination between federal and state agencies to prosecute individuals and entities engaged in healthcare fraud.
(Reinforces the "root out fraud" and "reduce waste and fraud" mandates.)
Subtitle D—Offsets and Budget Neutrality
SEC. 131. SAVINGS PROVISIONS.
(a) Identification of Savings.—The Director of the Congressional Budget Office, in consultation with the Secretary of the Treasury and the Secretary of Health and Human Services, shall identify existing programmatic inefficiencies and non-essential expenditures within federal healthcare programs and tax expenditures that, through reform, could generate savings sufficient to offset the costs associated with the extension of enhanced premium tax credits under this Act.
(This addresses the critical requirement for the plan to be "paid for" and "budget neutral.")
(b) Mandatory Reductions.—If, by December 1, 2026, the identified savings under subsection (a) are insufficient to fully offset the costs of Title I of this Act, the Director of the Office of Management and Budget shall implement a uniform reduction in federal discretionary spending across all non-defense agencies, excluding vital national security and emergency response programs, to achieve full offset.
(Adds a mechanism to ensure budget neutrality, showing a commitment to responsible fiscal policy.)
TITLE II—LONG-TERM STRUCTURAL REFORMS AND INNOVATION
Subtitle A—Healthcare Price Transparency
SEC. 201. STRENGTHENING AND EXPANDING HEALTHCARE PRICE TRANSPARENCY.
(a) Hospital Price Transparency.—The Secretary of Health and Human Services shall strengthen enforcement of existing hospital price transparency regulations and require hospitals to publish more granular, patient-friendly information on standard charges, including discounted cash prices, gross charges, and payer-specific negotiated charges, in a standardized, machine-readable format.
(Directly addresses "hospital billing transparency.")
(b) Insurer Price Transparency.—Health insurance issuers offering group or individual health insurance coverage shall make publicly available clear, accessible information regarding costs and quality of items and services, including tools that allow consumers to compare prices for common procedures and prescription drugs across different providers and plans.
SEC. 202. SITE-NEUTRAL PAYMENT POLICIES STUDY AND RECOMMENDATIONS.
(a) Study.—The Secretary of Health and Human Services shall conduct a comprehensive study on the impact of site-neutral payment policies on healthcare costs, quality of care, and access to services. The study shall analyze differences in payment rates for the same services delivered in hospital outpatient departments, physician offices, and other settings.
(b) Recommendations.—Not later than 18 months after the date of enactment of this Act, the Secretary shall submit a report to Congress detailing the findings of the study and providing recommendations for implementing or expanding site-neutral payment policies where appropriate to reduce healthcare costs without compromising patient access or quality.
(Addresses "cost drivers" and is a common bipartisan reform idea for long-term savings.)
Subtitle B—Modernizing Health Savings Accounts (HSAs)
SEC. 211. HSA REFORMS BASED ON THE CASSIDY BILL.
(a) Expanded Eligibility.—Section 223(c)(1)(A) of the Internal Revenue Code of 1986 is amended to expand eligibility for Health Savings Accounts (HSAs) to individuals enrolled in certain primary care arrangements, direct primary care, or those receiving limited health services outside of a high-deductible health plan.
(Directly incorporates the intent of the "Cassidy Bill" to make HSAs more accessible and robust, eventually reducing reliance on PTCs.)
(b) Increased Contribution Limits.—Section 223(b)(2) of the Internal Revenue Code of 1986 is amended to increase the annual contribution limits for HSAs to allow individuals and families to save more for future healthcare expenses.
(c) Use of HSA Funds.—Section 223(d)(2) of the Internal Revenue Code of 1986 is amended to expand the permissible use of HSA funds to include a broader range of preventive care services, health and wellness programs, and certain over-the-counter medications without a prescription.
Subtitle C—Addressing Zero-Dollar Premium Plans
SEC. 221. REFORM OF ZERO-DOLLAR PREMIUM EXCHANGE PLANS.
(a) Nominal Premium Requirement.—Beginning January 1, 2027, health insurance issuers offering plans on the Affordable Care Act marketplaces shall be prohibited from offering plans with a zero-dollar premium, requiring all plans to have a nominal monthly premium.
(b) Need-Based Support.—The Secretary of Health and Human Services shall ensure that robust premium subsidies are available for low-income individuals and families to prevent undue financial burden resulting from the nominal premium requirement, maintaining affordability and access to coverage for those who need it most.
(Directly implements "elimination of $0 premiums with provisions for need based support.")
Subtitle D—Expanding Access to Life-Saving Therapies
SEC. 231. ACCELERATION OF PEDIATRIC CANCER TREATMENTS AND RARE DISEASE THERAPIES.
(a) Codification of the "Get the Kids a Chance Act."—The "Get the Kids a Chance Act" (Public Law [Insert Public Law Number if available, otherwise leave as placeholder]) is hereby codified and amended to further streamline the regulatory review process for pediatric cancer treatments and therapies for rare diseases.
(b) Incentives for Research and Development.—The Secretary of Health and Human Services shall establish new incentives, including grants and expedited review pathways, for pharmaceutical companies to develop innovative treatments and therapies for pediatric cancers and rare diseases.
(Directly includes the "Get the Kids a Chance Act.")
Subtitle E—Accountability and Market Reforms
SEC. 241. STUDY ON VERTICAL INTEGRATION IN THE HEALTHCARE MARKET.
(a) Study.—The Federal Trade Commission, in consultation with the Department of Justice, shall conduct a comprehensive study on the impact of vertical integration within the healthcare industry, including the acquisition of primary care practices, pharmacies, and other healthcare providers by large insurance companies and PBMs, on competition, pricing, patient choice, and quality of care.
(b) Recommendations.—Not later than 2 years after the date of enactment of this Act, the Federal Trade Commission shall submit a report to Congress detailing the findings of the study and providing recommendations for legislative or regulatory action to promote competition and prevent anti-competitive practices in the healthcare market.
(Addresses Rep. Deluzio's specific concern about insurance companies owning primary practices and Rep. Nickel's call for accountability.)
Proposed Action for Your Member:
This bill directly reflects the "Common Ground 2025 Bipartisan Healthcare Framework." As a staffer, you would advise your Member to:
Introduce the Bill: Co-sponsor this bill immediately with a bipartisan group, explicitly referencing it as the legislative embodiment of the "Common Ground 2025" framework.
Champion the "December 18th" Deadline: Emphasize the urgency of a vote on Title I before premiums spike, pushing leadership for inclusion in any end-of-year legislative package.
Advocate for Title II as a "Phase 2" Commitment: Frame Title II as the necessary next step, fulfilling the promise of longer-term reforms and a "two-year process," pushing for committee hearings and eventual votes on these provisions.
Highlight Bipartisan Support: Continuously point to the broad coalition behind this framework as evidence that compromise is possible and necessary.
Engage Leadership: Work with the lead sponsors (Gottheimer, Kiggins, etc.) to directly lobby House and Senate leadership for floor time and a vote on this specific proposal.
Public Messaging: Use public appearances and media opportunities to explain how this bill directly addresses constituents' concerns about rising healthcare costs through a responsible, bipartisan approach.
Gemini 2.5 Pro:
Of course. Here is a proposed bill draft and an accompanying internal memo for your Member of Congress that effectively translates the "Common Ground 2025" framework into legislative text.
INTERNAL MEMORANDUM
TO: The Honorable [Member's Name]
FROM: [Your Name], Legislative Staff
DATE: December 6, 2025
SUBJECT: Proposed Bill Draft: "The Common Ground Health Affordability and Reform Act of 2025"
Boss,
Following yesterday's successful press conference, I have drafted the attached legislative text to formally enact the principles of the "Common Ground 2025" framework.
This bill, titled "The Common Ground Health Affordability and Reform Act of 2025," is designed to achieve our two primary objectives:
Prevent the imminent healthcare premium cliff by extending affordability measures.
Enact meaningful, bipartisan reforms to address the underlying drivers of healthcare costs.
The legislation is structured in two main titles, mirroring the "two-step" process we laid out publicly.
Key Provisions:
Title I: Immediate Premium Relief and Program Integrity
Sec. 101: Two-Year Extension of Enhanced Premium Tax Credits: This is the core of the immediate solution. It extends the enhanced Affordable Care Act (ACA) premium tax credits through December 31, 2027, providing certainty for the 22 million Americans who rely on them.
Sec. 102: Common Sense Guardrails and Modifications: This section addresses key Republican concerns and demonstrates our commitment to fiscal responsibility. It:
Reinstates a modified income cap to target subsidies to those most in need.
Strengthens verification processes to root out fraud and abuse.
Phases out $0 premium plans by requiring a modest, means-tested contribution, ensuring individuals have "skin in the game" while protecting the lowest-income enrollees.
Title II: Long-Term Affordability and Transparency Reforms
Sec. 201: Pharmacy Benefit Manager (PBM) Reform: Increases transparency in prescription drug pricing and bans deceptive practices like "spread pricing" in government health plans.
Sec. 202: Hospital Price Transparency: Gives the Department of Health and Human Services (HHS) stronger enforcement tools and higher penalties for hospitals that fail to comply with price transparency rules.
Sec. 203: Health Savings Account (HSA) Pathway: Directs HHS to create a framework for an HSA-based, high-quality insurance plan, modeled on the principles of the Cassidy bill, to serve as a future market-based alternative to the current subsidy structure.
Sec. 204: The "Get the Kids a Chance Act": Enacts the bipartisan proposal to accelerate the development and approval of lifesaving therapies for children with rare cancers and diseases.
Political Strategy & Talking Points:
Urgency: "Doing nothing is not an option." This bill is a responsible, proactive solution to a crisis that will hit millions of families in January.
Bipartisan Compromise: This is not a Democratic or Republican bill; it is an American bill. It pairs immediate relief (a Democratic priority) with program integrity and market-based reforms (a Republican priority).
A Bridge, Not a Blank Check: We are providing a two-year bridge for American families while simultaneously enacting the long-term reforms needed to fix our broken system.
Fiscal Responsibility: The bill is designed to be paid for by rooting out fraud and increasing transparency, which will generate savings over the long term.
Next Steps:
I recommend we immediately circulate this draft among the members of our bipartisan working group to gather feedback and build a strong coalition of original co-sponsors. We should then formally request a meeting with House Leadership to present this as a viable, bicameral path forward for a vote before December 18th.
This bill is our opportunity to prove Congress can work. Let's get it done.
DRAFT LEGISLATIVE TEXT
H.R. [Number]
To prevent catastrophic increases in health insurance premiums for American families, to enact commonsense reforms to improve program integrity and transparency, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
[Date]
Mr./Ms. [Member's Name] (for himself/herself and [List of Bipartisan Co-sponsors]) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce.
A BILL
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “Common Ground Health Affordability and Reform Act of 2025”.
TITLE I — IMMEDIATE PREMIUM RELIEF AND PROGRAM INTEGRITY
SEC. 101. EXTENSION OF ENHANCED PREMIUM TAX CREDITS.
Section 36B(b)(3)(A) of the Internal Revenue Code of 1986 is amended by striking “in 2025” and inserting “in 2025, 2026, and 2027”. This section shall provide a two-year extension of the enhanced credits to prevent premium spikes for individuals and families purchasing coverage on the health insurance marketplace.
SEC. 102. MODIFICATIONS AND GUARDRAILS FOR AFFORDABILITY PROGRAMS.
(a) Targeted Eligibility. The Secretary of Health and Human Services, in consultation with the Secretary of the Treasury, shall establish a modified upper-income eligibility threshold for premium tax credits to ensure assistance is targeted to low- and middle-income families.
(b) Enhanced Program Integrity. The Secretary of Health and Human Services shall implement strengthened income and eligibility verification processes for individuals enrolling in a qualified health plan through an Exchange to prevent fraud and misallocation of funds.
(c) Elimination of Zero-Dollar Premiums with Need-Based Support.
(1) No qualified health plan offered through an Exchange shall have a premium of $0 after the application of premium tax credits.
(2) All enrollees shall be responsible for a modest, means-tested monthly premium contribution to promote consumer engagement.
(3) The Secretary shall establish protections to ensure that premium contributions remain affordable for individuals and families with incomes below 200 percent of the federal poverty line.
TITLE II — LONG-TERM AFFORDABILITY AND TRANSPARENCY REFORMS
SEC. 201. PHARMACY BENEFIT MANAGER (PBM) REFORM.
The Secretary of Health and Human Services shall promulgate regulations to:
(1) Increase transparency by requiring PBMs to disclose all sources of income, fees, and rebates related to their services for Medicare Part D and other federal health plans.
(2) Prohibit the practice of “spread pricing,” whereby a PBM charges a health plan more than it reimburses a pharmacy for a specific drug.
SEC. 202. HOSPITAL PRICE TRANSPARENCY ENFORCEMENT.
Section 2718(e) of the Public Health Service Act is amended to:
(1) Increase the maximum civil monetary penalties for hospitals that fail to comply with the requirement to publish standard charges for items and services.
(2) Grant the Secretary of Health and Human Services enhanced authority to audit and enforce compliance, ensuring American patients have access to clear, upfront pricing information.
SEC. 203. PATHWAY TO HEALTH SAVINGS ACCOUNT (HSA) BASED COVERAGE.
(a) Study and Framework. Not later than one year after the date of enactment of this Act, the Secretary of Health and Human Services shall develop and report to Congress a framework for offering qualified health plans that are paired with Health Savings Accounts and designed to eventually reduce or eliminate the need for premium tax credits.
(b) Principles. This framework shall be based on the principles of consumer choice, market competition, and providing Americans with ownership over their healthcare dollars, reflecting the goals of proposals such as the “Health Savings Accounts for All Act.”
SEC. 204. ACCELERATING PEDIATRIC CANCER TREATMENTS.
This section may be cited as the “Get the Kids a Chance Act”.
(1) The Secretary of Health and Human Services shall establish a priority review pathway for drugs and therapies intended to treat rare pediatric cancers and diseases.
(2) This pathway shall accelerate the development and approval of life-saving treatments for children, providing hope for families battling the most challenging illnesses.
Gemini 3.0 Pro:
MEMORANDUM
TO: Representative [Name]
FROM: Legislative Director
DATE: December 5, 2025
RE: Draft Legislation: The Common Ground Health Care Affordability Act of 2025
Per your request, and based on the bipartisan press conference held today with Reps. Gottheimer, Kiggans, Lawler, and others, I have drafted the legislative text for the Common Ground 2025 Framework.
Legislative Strategy:
The transcript outlines a "two-step process." To ensure this bill is the effective vehicle for the December 18th deadline mentioned by Rep. Gottheimer, this draft focuses on Step One (Immediate Action) while codifying the agreements necessary to bring Republicans on board (Pay-fors, Fraud Prevention, and PBM Reform).
Key Provisions Included:
2-Year Extension of Enhanced Premium Tax Credits (PTC): Prevents the January 1st spike.
Income Targeting/Caps: Reintroduces an income cap for the enhanced portion of the credit to ensure high earners do not receive unnecessary subsidies, addressing the "targeted modification" requirement.
Program Integrity (Anti-Fraud): Addresses the "unauthorized agent" and broker fraud issues raised by Rep. Kiggans and Rep. Lawler.
PBM Reform: Includes transparency and "delinking" provisions to lower drug costs and serve as a pay-for.
"Give Kids a Chance": Includes the pediatric cancer trial provisions requested by Rep. Kiggans.
Hospital Price Transparency: Codifies federal transparency rules to lower costs.
119TH CONGRESS
1ST SESSION
H. R. ______
To amend the Internal Revenue Code of 1986 to extend the temporary expansion of health insurance premium tax credits, to provide for program integrity and reforms to pharmacy benefit managers, to authorize pediatric cancer research, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
______________________ introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means.
A BILL
To amend the Internal Revenue Code of 1986 to extend the temporary expansion of health insurance premium tax credits, to provide for program integrity and reforms to pharmacy benefit managers, to authorize pediatric cancer research, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “Common Ground Health Care Affordability Act of 2025”.
TITLE I—AFFORDABILITY AND EXTENSION
SEC. 101. EXTENSION OF ENHANCED PREMIUM ASSISTANCE IMPROVEMENTS.
(a) In General.—Clause (iii) of section 36B(b)(3)(A) of the Internal Revenue Code of 1986 is amended by striking “2026” and inserting “2028”.
(b) Effective Date.—The amendment made by this section shall apply to taxable years beginning after December 31, 2025.
SEC. 102. TARGETED INCOME MODIFICATIONS AND ELIGIBILITY GUARDRAILS.
(a) Recapture of Excess Advance Payments for High Earners.—Section 36B(f)(2) of the Internal Revenue Code of 1986 is amended by adding at the end the following new subparagraph:
“(C) SPECIAL RULE FOR HIGH INCOME INDIVIDUALS.—In the case of a taxpayer whose household income exceeds 600 percent of the poverty line for the size of the family involved for the taxable year, the amount of the increase under subparagraph (A) shall be 100 percent of the excess advance payments.”
(b) Verification of Income.—The Secretary of the Treasury, in consultation with the Secretary of Health and Human Services, shall strengthen verification procedures to ensure that individuals claiming the credit under section 36B generally meet the income eligibility requirements prior to enrollment, reducing the reliance on self-attestation.
TITLE II—PROGRAM INTEGRITY AND FRAUD PREVENTION
SEC. 201. PREVENTING UNAUTHORIZED ENROLLMENT AND BROKER FRAUD.
(a) Prohibition on Unauthorized Switching.—The Secretary of Health and Human Services shall implement technological safeguards within the Federal Data Services Hub and HealthCare.gov to prevent an agent, broker, or web-broker from—
(1) creating a new application for a consumer who already has an active application without a distinct, authenticated authorization from the consumer; or
(2) changing the plan selection of a consumer without documented consent.
(b) Suspension of Bad Actors.—The Secretary shall establish a mechanism to immediately suspend the National Producer Number (NPN) of any agent or broker found to have exhibited a pattern of unauthorized enrollments or switching of plans, pending an investigation.
TITLE III—LOWERING COSTS THROUGH REFORM
SEC. 301. PBM TRANSPARENCY AND REFORM.
(a) Prohibition on Spread Pricing in Medicaid.—Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended to require that pharmacy benefit managers (PBMs) contracting with State Medicaid programs pass through all rebates and discounts received from manufacturers directly to the State, and are reimbursed only for the actual cost of the drug plus a fixed administrative fee.
(b) Transparency Requirements.—PBMs operating in the commercial market and Medicare Part D shall be required to report aggregate data to the Secretary of Health and Human Services regarding—
(1) the aggregate amount of rebates collected from pharmaceutical manufacturers; and
(2) the aggregate amount of such rebates that were retained by the PBM and not passed through to the plan sponsor or consumer.
SEC. 302. HOSPITAL PRICE TRANSPARENCY CODIFICATION.
Section 2718(e) of the Public Health Service Act (42 U.S.C. 300gg–18(e)) is amended—
(1) by striking “Each hospital” and inserting the following:
“(1) IN GENERAL.—Each hospital”; and
(2) by adding at the end the following new paragraph:
“(2) REQUIREMENTS.—A hospital shall make public a machine-readable file containing a list of all standard charges for all items and services provided by the hospital, including gross charges, payer-specific negotiated charges, de-identified minimum and maximum negotiated charges, and discounted cash prices.
“(3) ENFORCEMENT.—The Secretary shall impose a civil monetary penalty on any hospital that fails to comply with paragraph (2).”.
TITLE IV—PEDIATRIC CARE AND INNOVATION
SEC. 401. SHORT TITLE.
This title may be cited as the “Give Kids a Chance Act”.
SEC. 402. RESEARCH INTO PEDIATRIC CANCER COMBINATION THERAPIES.
Section 505B of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355c) is amended to authorize the Secretary of Health and Human Services to require that pediatric investigations of new molecularly targeted drugs include an evaluation of the drug in combination with other appropriate drugs or biological products, to accelerate the development of therapies for pediatric cancer and rare diseases.
TITLE V—SENSE OF CONGRESS ON FUTURE REFORMS
SEC. 501. SENSE OF CONGRESS REGARDING STEP TWO HEALTH CARE REFORMS.
It is the sense of Congress that, following the enactment of this short-term extension, the House and Senate should work toward a bipartisan agreement before the end of the 119th Congress to implement long-term structural reforms, including—
(1) the implementation of Health Savings Account (HSA) expansions;
(2) the elimination of zero-dollar premiums to ensure appropriate utilization; and
(3) site-neutral payment reforms to ensure patients pay the same price for a service regardless of where it is performed.
And the opposite? Legislation to prevent it from becoming reality?
You are a staffer for a US Rep who opposes this framework. Give me a proposed bill for your Member that best and most effectively prevents it from becoming reality?
Gemini 2.5 Flash Thinking:
Okay, Representative. Based on the "Common Ground 2025" framework presented by Reps. Gottheimer and Kiggans, their primary goal is a short-term extension of Enhanced Premium Tax Credits (EPTCs) with some modifications and a promise of longer-term reforms. They are framing it as a necessary, bipartisan compromise to prevent premium spikes and avert an immediate crisis.
Our strategy must be to offer an alternative that addresses the same immediate crisis but does so in a way that aligns with our Member's principles (e.g., less government intervention, more market-based solutions, genuine cost reduction, moving away from ACA reliance) and undermines the rationale for simply extending the current EPTC structure. We need to be seen as offering a better, more sustainable solution, not just opposing action.
Proposed Bill: The "American Healthcare Choice and Cost Reduction Act"
Goal: To prevent healthcare premium spikes by replacing temporary, unsustainable subsidies with market-driven, consumer-centric mechanisms and real cost-saving reforms, rather than extending the existing flawed framework.
Short Title: "The Affordable Choices and Real Reform Act"
Preamble/Findings (for legislative text & talking points):
Whereas the Affordable Care Act (ACA) has failed to control healthcare costs, leading to soaring premiums and limited choices for many Americans;
Whereas temporary, pandemic-era Enhanced Premium Tax Credits (EPTCs) artificially inflate demand without addressing underlying cost drivers, creating a fiscal cliff for millions;
Whereas a true solution requires empowering American families with choice, increasing market competition, and demanding price transparency from healthcare providers and insurers;
Be it Enacted…
Key Provisions:
TITLE I – Immediate and Targeted Premium Relief & Transition to Sustainable Credits
Phase-Out & Replacement of Enhanced Premium Tax Credits (EPTCs):
Section 101: One-Year, Declining Transitional Block Grant for States: Instead of extending federal EPTCs directly, establish a one-year, declining block grant program for states. States can use these funds to provide direct, means-tested financial assistance to residents (up to 200% FPL, or a higher state-defined threshold with state matching funds) to purchase any qualified private health insurance plan (not limited to ACA exchange plans) or to establish high-risk pools. This shifts the administrative burden and flexibility to states, limits federal liability, and phases out federal EPTCs.
Section 102: Permanent, Age-Adjusted, Refundable Healthcare Tax Credit: Establish a new, permanent, and refundable federal tax credit (e.g.,
1
,
500
−
1,500−
5,000 annually, adjusted for age bands) that individuals can use to purchase any qualified private health insurance plan in the individual market, regardless of whether it's offered on an ACA exchange. This credit would be indexed to inflation, provide greater choice, and be strictly income-capped (e.g., up to 400% FPL, with a sharper phase-out than current EPTCs) to ensure assistance is targeted to those truly in need. This eliminates the "subsidy cliff" and offers a long-term, stable solution independent of the ACA structure.
Expanding Health Savings Accounts (HSAs):
Section 103: Expanded HSA Contribution Limits & Flexibility: Significantly increase annual contribution limits for HSAs. Allow HSA funds to be used for a broader range of medical expenses, including direct primary care fees, health insurance premiums for high-deductible plans, and over-the-counter medications without a prescription. This empowers individuals to save for and manage their own healthcare costs.
TITLE II – Market-Based Reforms for True Cost Reduction
Promoting Competition and Choice:
Section 201: Interstate Health Insurance Sales: Allow health insurers licensed in one state to sell policies in any other state, subject to the laws of the originating state, fostering a more competitive national market.
Section 202: Expanded Association Health Plans (AHPs): Liberalize regulations to allow more small businesses, professional associations, and even civic groups to band together to purchase large-group health insurance, leveraging greater purchasing power.
Section 203: Freedom to Innovate in Insurance Markets: Remove federal mandates on specific benefits for non-group plans, allowing insurers to offer a wider variety of plans tailored to different needs and budgets, thereby increasing consumer choice and affordability.
True Price Transparency & Accountability:
Section 204: All-Payer Price Transparency: Mandate that all hospitals, healthcare providers, and insurers publicly disclose all negotiated prices for services and procedures in a clear, standardized, and machine-readable format, enabling patients to shop for care. This goes beyond the current framework's implied transparency, demanding full transparency.
Section 205: Pharmacy Benefit Manager (PBM) Reform: Prohibit spread pricing by PBMs, require fiduciary duty to clients, and mandate disclosure of all rebates and fees received from pharmaceutical manufacturers. Promote direct contracting between pharmacies and health plans. (Aligns with the framework but goes further in detail).
Medical Malpractice Reform:
Section 206: Caps on Non-Economic Damages: Establish federal caps on non-economic damages in medical malpractice lawsuits (e.g., $250,000), reducing defensive medicine practices and lowering liability insurance costs for providers, which ultimately reduces healthcare costs.
TITLE III – Repeal & Offset
Section 301: Repeal of Specified ACA Taxes and Mandates: Repeal remaining ACA taxes that burden consumers and businesses (e.g., the "Cadillac tax" if still relevant, or other industry-specific taxes). Eliminate individual and employer mandates, further reducing federal intervention and allowing for more flexible plan designs.
Section 302: Independent Congressional Budget Office (CBO) Score: Mandate a CBO score demonstrating the bill's fiscal neutrality or cost savings over a 10-year window, primarily through reduced federal spending on subsidies, increased market efficiency, and reduced administrative costs.
Strategic Framing & Talking Points for Your Member:
"Mr./Madam Speaker, and my colleagues, I stand before you today not to offer another temporary patch to a broken system, but to present a path to real, sustainable healthcare affordability for the American people. The so-called 'Common Ground 2025' framework, while well-intentioned in acknowledging the looming crisis, is nothing more than an extension of the very policies that have driven costs sky-high and limited patient choice. It props up an unsustainable system with more taxpayer dollars, offering a temporary reprieve before families face the same crisis again in two years.
Our bill, the 'Affordable Choices and Real Reform Act,' offers a fundamentally different, and better, path forward:
It empowers patients, not Washington bureaucrats: Instead of extending temporary, federal subsidies tied to restrictive exchange plans, our bill gives states the flexibility to help their most vulnerable residents immediately through a transitional block grant. More importantly, it establishes a permanent, refundable healthcare tax credit that individuals can use to purchase the plan that best fits their family's needs and budget, on any market. This is true patient choice.
It tackles the root causes of high costs: We agree that PBMs and transparency are critical, but our bill goes further. We demand all-payer price transparency from every hospital and provider, so patients can finally shop for care. We unleash market competition by allowing insurance sales across state lines and expanding Association Health Plans. We empower individuals to save and manage their own care with expanded Health Savings Accounts.
It’s a long-term solution, not a short-term political fix: The 'Common Ground' framework offers a two-year extension. What happens after that? Our bill provides structural reforms that will lower costs and increase access for generations, moving us away from government dependency towards true, market-based affordability.
It's fiscally responsible: Our reforms are designed to reduce federal spending in the long run, and we explicitly call for repealing burdensome ACA taxes and mandates that restrict innovation and drive up costs. We demand a fiscally sound solution, not just kicking the can down the road.
We understand the urgency of the moment. We must act before the end of the year. But let us not make the mistake of choosing a temporary, insufficient solution when a robust, patient-centered, and fiscally responsible alternative is on the table. I urge our leadership, and my colleagues on both sides of the aisle, to put aside the comfort of the status quo and embrace real reform that delivers genuine affordability and choice for every American family."
Gemini 2.5 Pro:
Of course. To best and most effectively prevent the "Common Ground 2025" framework from becoming reality, the strategy is not to simply say "no." The most effective counter is to introduce a compelling alternative that peels away their Republican support and re-frames the debate on more favorable, conservative terms.
Here is a proposed bill and the accompanying strategic memo for your Member.
MEMORANDUM
TO: The Honorable Member of Congress
FROM: Legislative Staff
DATE: December 6, 2025
SUBJECT: Counter-Proposal to "Common Ground 2025" Framework: The Health Care Affordability and Real Transparency (HART) Act
1. Strategic Objective
The bipartisan "Common Ground 2025" group is attempting to seize the political center by framing their proposal as the only reasonable solution to the expiring Enhanced Premium Tax Credits (APTCs). Their strategy relies on the urgency of the deadline and the shield of bipartisanship to force leadership’s hand.
Our objective is to kill their framework by:
Introducing a superior conservative alternative that addresses the "premium cliff" without extending a core component of the Affordable Care Act (ACA).
Peeling away their Republican members by offering them a principled, market-based off-ramp.
Shifting the narrative from "extending subsidies" to "enacting permanent reforms for real affordability."
2. The Proposed Bill: The Health Care Affordability and Real Transparency (HART) Act
This bill is designed to be the conservative answer to the affordability crisis. It offers a temporary, targeted bridge for those facing the premium cliff while immediately implementing the structural reforms the Common Ground plan vaguely promises for "later."
Bill Title: H.R. ____, The Health Care Affordability and Real Transparency (HART) Act
Key Provisions:
Title I: The Patient Transition and Stability Program
Section 101: One-Year Transitional Assistance. Authorizes a one-year, non-renewable extension of premium tax credits, but with significant reforms:
Hard Income Cap: Credits are available only to individuals/families earning up to 250% of the Federal Poverty Level (FPL), down from the current 400%+ cliff removal. This targets aid to the truly needy and cuts spending.
Work/Activity Requirement: Mandates that able-bodied, working-age adults without dependents must be employed, seeking employment, or engaged in skills training to receive subsidies, mirroring successful welfare reform principles.
Strict Verification: Implements robust, upfront eligibility verification to eliminate the fraud and abuse the Common Ground plan only gestures at.
Title II: Long-Term Affordability and Choice
Section 201: Unleashing Health Savings Accounts (HSAs).
Doubles the maximum annual contribution limits for all HSAs.
Allows HSA funds to be used to pay for insurance premiums and direct primary care membership fees.
Decouples HSAs from high-deductible health plans, making them universally available.
Section 202: Nationwide Health Insurance Markets. Allows any American to purchase health insurance licensed for sale in any of the 50 states, creating a national market to drive down prices through competition.
Section 203: Empowering Small Businesses through Association Health Plans (AHPs). Re-establishes and expands rules allowing small businesses, sole proprietors, and independent contractors to band together across state lines to purchase insurance with the same leverage and lower costs as large corporations.
Section 204: Mandatory “All-In” Price Transparency. Requires hospitals, insurers, and providers to publish and provide patients with the full, binding price of any medical service, procedure, or test before the service is rendered. This price must be the final amount the patient or their insurer will be billed. Non-compliance results in a nullification of the bill.
Title III: Fiscal Responsibility and Offsets
Section 301: Pay-Fors. The entire cost of the one-year transitional program and any new spending is fully offset by:
A full clawback of all unobligated federal COVID-19 relief funds.
Projected savings from the robust anti-fraud measures in Title I.
Ending federal funding for the ACA's public relations and "navigator" programs.
3. Strategic Rollout and Talking Points
Core Message: "Their plan is a temporary band-aid on a broken system. The HART Act is a permanent cure that lowers costs for everyone."
How to Counter Their Arguments:
When they say: "You are creating a cliff and taking away people's healthcare!"
Our Response: "Absolutely not. We are providing a responsible, one-year bridge for the truly needy while we enact the real, permanent reforms that will lower healthcare costs for every single American. Their plan just kicks the can down the road for another two years, guaranteeing another crisis right before the next election. We are solving the problem for good."
When they say: "You are being partisan and refusing to compromise."
Our Response: "We are putting forward a serious, detailed legislative proposal. Their 'framework' is a two-page wish list that continues a failed policy now and vaguely promises reforms later. We invite our colleagues on both sides to debate the substance. The HART Act includes ideas with broad support, like price transparency and more choices for small businesses. That is real common ground."
When they say: "Our plan is paid for and fiscally responsible."
Our Response: "Their plan is paid for with budget gimmicks. The HART Act is paid for with common-sense rescissions of unspent emergency funds from a pandemic that ended years ago. Furthermore, by focusing on market-based solutions instead of open-ended subsidies, our plan is the only one that addresses the underlying drivers of government spending on healthcare."
Action Plan:
Introduce the Bill Immediately: Hold a press conference with like-minded conservative colleagues to present the HART Act as the "real solution."
Target Their Coalition: Send a "Dear Colleague" letter to all Republican offices. Directly message the Republicans on their stage (Lugo, Kiley, LaMalfa, etc.) with the question: "Why would you vote to extend Obamacare subsidies for two years when we have a conservative plan that provides a responsible transition and enacts the free-market reforms we all campaigned on?"
Media Blitz: Book the Member on conservative news outlets. Publish an op-ed contrasting our "patient-empowerment" plan with their "government-subsidy" plan. Emphasize that we are the ones offering a serious, long-term vision.
By presenting the HART Act, you are not just an opponent—you are the author of a better alternative. This forces the debate onto our terms and makes it politically difficult for Republicans in their coalition to justify extending an ACA program over implementing conservative reforms.
Gemini 3.0 Pro:
MEMORANDUM
TO: Representative [Name]
FROM: Legislative Director
DATE: December 5, 2025
RE: Draft Legislation: The Health Care Freedom and Fiscal Responsibility Act of 2025
Strategy & Overview:
The "Common Ground 2025" framework presented by Reps. Gottheimer and Kiggans relies entirely on the premise that the "temporary" COVID-era subsidies (Enhanced Premium Tax Credits) must be extended to prevent a crisis. To effectively kill this framework, we must reject the premise that government subsidies are the only way to lower costs.
This counter-proposal does three things to dismantle their framework:
Hard Sunset: It explicitly codifies the expiration of the enhanced subsidies, restoring the pre-2021 income eligibility caps (the "400% cliff") to ensure high-earners (making $100k+) are removed from the welfare rolls.
Defunds the Administration: It prevents HHS and the IRS from using funds to update systems for an extension, creating a logistical roadblock for the bipartisan plan.
Market Deregulation: It provides the "off-ramp" by codifying Trump-era rules for Short-Term Limited Duration plans (STLDI) and Association Health Plans (AHPs), offering the cheaper alternative that the bipartisan group refuses to consider.
This bill frames the bipartisan plan not as "relief," but as an "Insurance Company Bailout."
119TH CONGRESS
1ST SESSION
H. R. ______
To restore fiscal responsibility to the health insurance market by allowing temporary premium tax credit expansions to expire, to codify access to affordable short-term health plans, and to prohibit the use of funds for insurance company bailouts.
IN THE HOUSE OF REPRESENTATIVES
______________________ introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means.
A BILL
To restore fiscal responsibility to the health insurance market by allowing temporary premium tax credit expansions to expire, to codify access to affordable short-term health plans, and to prohibit the use of funds for insurance company bailouts.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “Health Care Freedom and Fiscal Responsibility Act of 2025”.
TITLE I—ENDING THE INFLATIONARY SUBSIDIES
SEC. 101. RESTORATION OF INCOME ELIGIBILITY CAPS.
(a) Findings.—Congress finds that the temporary expansion of premium tax credits under the American Rescue Plan Act and the Inflation Reduction Act has led to massive inflation in health care costs and provided taxpayer-funded subsidies to households earning over $300,000 a year, while enriching large insurance conglomerates.
(b) Sunset Confirmed.—Notwithstanding any other provision of law, the temporary percentages and eligibility rules established under section 36B(b)(3)(A)(iii) of the Internal Revenue Code of 1986 shall expire as scheduled on December 31, 2025.
(c) Restoration of the 400 Percent Cap.—Effective January 1, 2026, the Secretary of the Treasury shall enforce the limitation that no premium tax credit shall be allowed to any taxpayer whose household income exceeds 400 percent of the poverty line, restoring the eligibility threshold in effect prior to the American Rescue Plan Act of 2021.
SEC. 102. PROHIBITION ON ADMINISTRATIVE EXTENSION.
No funds authorized or appropriated by Federal law may be used by the Secretary of the Treasury or the Secretary of Health and Human Services to—
(1) implement any regulatory extension of the enhanced premium tax credits beyond December 31, 2025; or
(2) modify the Federal Data Services Hub or HealthCare.gov to accommodate an extension of such credits without explicit, new statutory authorization enacted after the date of this Act.
TITLE II—PROGRAM INTEGRITY AND RECOUPMENT
SEC. 201. MANDATORY AUDIT OF IMPROPER PAYMENTS.
(a) In General.—Not later than June 1, 2026, the Inspector General of the Department of the Treasury shall conduct a comprehensive audit of all Premium Tax Credit payments made during tax years 2021 through 2025.
(b) Clawback of Fraudulent Subsidies.—The Secretary of the Treasury shall immediately initiate recoupment proceedings against any taxpayer or insurance broker found to have:
(1) Understated income to qualify for enhanced subsidies; or
(2) Enrolled individuals in plans without their explicit consent (zero-premium schemes).
(c) Asset Freeze for Fraudulent Brokers.—Any insurance broker or agent found to have engaged in the "switching" or "unauthorized enrollment" described in findings by the Inspector General shall be permanently barred from the Federally Facilitated Marketplace and subject to immediate forfeiture of commissions earned on such policies.
TITLE III—UNLEASHING MARKET ALTERNATIVES
SEC. 301. CODIFICATION OF SHORT-TERM LIMITED DURATION INSURANCE.
(a) In General.—To provide an immediate affordable alternative to high-cost ACA plans, the definition of "short-term limited duration insurance" shall be codified as follows:
(1) Such coverage may have an initial contract term of less than 12 months; and
(2) Such coverage may be renewed or extended for a duration of up to 36 months.
(b) Preemption.—No State may prohibit the sale of short-term limited duration insurance plans that meet the Federal standards established in subsection (a).
SEC. 302. EXPANSION OF ASSOCIATION HEALTH PLANS.
The Department of Labor rule titled “Definition of ‘Employer’ Under Section 3(5) of ERISA-Association Health Plans” (83 Fed. Reg. 28912; June 21, 2018) shall have the force and effect of law, treating Association Health Plans as large group health plans for purposes of the Employee Retirement Income Security Act of 1974 (ERISA), thereby exempting them from the cost-driving mandates of the Affordable Care Act.
TITLE IV—BUDGETARY DISCIPLINE
SEC. 401. DEFICIT NEUTRALITY POINT OF ORDER.
(a) Point of Order.—It shall not be in order in the House of Representatives or the Senate to consider any bill, joint resolution, amendment, motion, or conference report that extends the enhanced premium tax credits under section 36B of the Internal Revenue Code unless such legislation is fully offset by spending cuts in other non-defense discretionary accounts.
(b) Waiver.—Subsection (a) may be waived or suspended in the Senate only by an affirmative vote of three-fifths of the Members, duly chosen and sworn.