Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for c…
This bill—HOPE and Mental Wellbeing Act of 2025—would require Medicare (fee‑for‑service and Medicare Advantage) and Medicaid to waive cost sharing for the first three “primary care visits” per beneficiary each year beginning in 2026. It adds a definition of “primary care visit” that includes outpatient mental and behavioral health services, nonspecialty medical services, and care coordination.
Scope: inclusion of mental/behavioral health seen as pro‑equity vs scope creep
Relative to its intended legislative type, this bill delivers a focused substantive change by inserting explicit statutory amendments to require zero cost-sharing for the first three primary care visits per year across Medicare, Medicare Advantage, and Medicaid (effective 2026) and by adding a statutory definition for 'primary care visit.' The statutory integration is precise, but the bill omits fiscal analysis, detailed definitional granularity, administrative implementation instructions, safeguards against misuse, and monitoring/reporting requirements.
This bill—HOPE and Mental Wellbeing Act of 2025—would require Medicare (fee‑for‑service and Medicare Advantage) and Medicaid to waive cost sharing for the first three “primary care visits” per beneficiary each year beginning in 2026.
It adds a definition of “primary care visit” that includes outpatient mental and behavioral health services, nonspecialty medical services, and care coordination.
For Medicare fee‑for‑service providers the payment would be 100% of the lesser of the actual charge or the otherwise recognized outpatient payment amount.
Technically straightforward and low controversy, but creates uncouched fiscal effects and federal-state budget implications that raise legislative friction.
Relative to its intended legislative type, this bill delivers a focused substantive change by inserting explicit statutory amendments to require zero cost-sharing for the first three primary care visits per year across Medicare, Medicare Advantage, and Medicaid (effective 2026) and by adding a statutory definition for 'primary care visit.' The statutory integration is precise, but the bill omits fiscal analysis, detailed definitional granularity, administrative implementation instructions, safeguards against misuse, and monitoring/reporting requirements.
Scope: inclusion of mental/behavioral health seen as pro‑equity vs scope creep
These are examples from the analysis, not a ranked list of the most-affected groups.
Scope: inclusion of mental/behavioral health seen as pro‑equity vs scope creep
Likely strongly supportive: reduces financial barriers to primary care and mental health for seniors and low‑income people.
Sees the mental/behavioral health inclusion as an equity and access win.
Would want stronger provisions on reimbursement and broader coverage beyond only three visits.
Generally favorable but cautious: appreciates reduced barriers and program alignment, while wanting clarity on costs, overlap with existing benefits, and measurable outcomes.
Would press for fiscal estimates and an evaluation plan before broad expansion.
Likely skeptical or opposed: views the bill as an expansion of entitlement benefits that increases federal spending and reduces cost‑sharing that controls utilization.
May accept limited, budget‑neutral targeted help but generally worries about precedent and program growth.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
Still ahead
Still ahead
Technically straightforward and low controversy, but creates uncouched fiscal effects and federal-state budget implications that raise legislative friction.
The bill has not accumulated any surfaced votes yet.
Scope: inclusion of mental/behavioral health seen as pro‑equity vs scope creep
Technically straightforward and low controversy, but creates uncouched fiscal effects and federal-state budget implications that raise legi…
Relative to its intended legislative type, this bill delivers a focused substantive change by inserting explicit statutory amendments to require zero cost-sharing for the first three primary care visits per year across…
Go beyond the headline summary with full stakeholder mapping, legislative design analysis, passage barriers, and lens-by-lens tradeoff breakdowns.