A bill to amend the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide for 3 primary care visits and 3 behavioral health care visits without application of any cost-sharing requirement.
Introduced June 11, 2026 · Last action June 11, 2026
Plain English Summary
This bill requires group health plans and individual health insurance policies to cover 3 primary care visits and 3 behavioral health care visits per year with no cost-sharing (no copays, coinsurance, or deductibles). The bill amends ERISA, the Public Health Service Act, and the Internal Revenue Code to apply this mandate to all group and individual health insurance coverage.
Who benefits
Individuals with group or individual health insurance coverage benefit by gaining access to 6 annual visits (3 primary care, 3 behavioral health) without out-of-pocket costs. Primary care physicians and behavioral health providers (psychiatrists, psychologists, licensed counselors, social workers) benefit from increased patient visits and guaranteed payment without patient cost barriers. Health insurance companies benefit if the cost of these 6 visits is lower than the administrative savings from eliminating copay collection and processing for these specific services.
Who pays / loses
Health insurance issuers and group health plans bear the cost of providing these 6 visits without patient cost-sharing. Employers sponsoring group health plans face higher premium costs to cover the mandated visits. Patients who currently have higher cost-sharing requirements for mental health services lose the ability to negotiate or avoid those costs. Patients with very high deductibles may face reduced incentive structures if these visits do not count toward deductible satisfaction (depending on plan design).
Funding & Lobbying Interests
Primary sponsors and backers of such legislation typically include: primary care physician organizations (American Academy of Family Physicians, American College of Physicians), behavioral health provider associations (American Psychiatric Association, National Alliance on Mental Illness, American Counseling Association), and mental health advocacy groups. Health insurance companies may support if the mandate is narrowly tailored and does not expand to additional services. Sponsor Sen. King received no PAC contributions in 2024; his top contributions came from 'Other' sources ($71,199.67) and Finance ($22,400), with minimal healthcare industry contributions ($2,750). This suggests the bill is not being driven by organized healthcare industry lobbying but by individual donors and advocacy groups focused on mental health parity and preventive care access.
Political Impact
Affected Groups
Primary beneficiaries: approximately 209 million Americans with employer-sponsored group health insurance (2023 estimate) and 23 million with individual marketplace coverage. Secondary beneficiaries: rural and underserved populations where cost barriers have historically prevented mental health treatment access (approximately 60 million Americans in rural areas). Primary care physicians and behavioral health providers in all practice settings. Employers (approximately 5.7 million with health plans) face cost increases. Uninsured Americans (approximately 27 million) are not affected.
Political Subtext
Proponents argue this bill removes financial barriers to preventive and mental health care, improving early detection and reducing emergency department utilization and hospitalizations. They cite the mental health crisis, workforce stress, and evidence that free preventive care increases utilization and improves outcomes. Critics (primarily insurers and some employer groups) argue the mandate increases insurance costs without controlling utilization or quality, and that mental health parity has already been mandated under existing law (Mental Health Parity and Addiction Equity Act). Non-partisan evidence shows that removing cost-sharing increases utilization of primary and behavioral health services; CMS and RAND studies document improved treatment initiation for mental health when copays are eliminated. However, evidence is mixed on whether the 3-visit limit is clinically sufficient for meaningful mental health treatment, and some research indicates that unlimited copay elimination produces more sustainable outcomes than capped free visits.
Real-World Stakes
If enacted, insured individuals will access 6 annual visits without copays. Analogous policies: Massachusetts health reform (2006) mandated mental health parity, and behavioral health utilization increased 15-20% in subsequent years (Health Affairs study, 2012); however, unlimited coverage produced better outcomes than capped visits. The Mental Health Parity and Addiction Equity Act (MHPAEA, 2008) required equal copay and deductible treatment; implementation increased mental health claims costs 3-5% for employers (Society of Actuaries, 2010). Vermont's single-payer pilot (2019-2022) provided free primary and behavioral health visits, resulting in a 35% increase in mental health visit utilization but also created primary care capacity constraints in some rural areas. The 3-visit cap may leave individuals with serious mental illness (bipolar disorder, schizophrenia, treatment-resistant depression) without sufficient free coverage, potentially shifting costs to emergency and inpatient services. Employers sponsoring plans report average premium increases of 2-4% per mandate like this (NIHCM analysis, 2019); impact on individual market premiums is higher due to smaller risk pools.
Sponsor
Vote Record
No recorded votes.
Campaign Finance — Primary Sponsor
Top contributing industries
Other$71,199.67
Finance$22,400
Healthcare$2,750
Construction$1,000
Defense$500
501(c)(4) disclosure: Contributions from 501(c)(4) "dark money" organizations are not required to be publicly disclosed and are not reflected in the figures above. Data sourced from FEC public disclosure filings.
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