1. United States
2. Hawaii
3. Letter

I urge you to oppose the Health Care Freedom for Patients Act of 2025, also known as the Cassidy-Crapo bill. This legislation creates dangerous barriers to healthcare access while discriminating against vulnerable populations under the guise of consumer-directed healthcare reform. The bill's citizenship verification requirements for Medicaid and CHIP will delay or deny critical medical care to lawfully present individuals during verification periods. This administrative burden falls hardest on children and families who need immediate access to healthcare, potentially creating life-threatening delays. States will face substantial new costs implementing verification systems across millions of beneficiaries, straining already limited resources while shifting uncompensated care costs to safety-net providers and emergency rooms. The comprehensive exclusion of gender-affirming medical procedures from essential health benefits and federal healthcare programs represents discriminatory policy that denies medically necessary care to transgender individuals. These restrictions apply across exchange plans, Medicaid, and CHIP, eliminating coverage for procedures recognized by major medical associations as appropriate treatment. The narrow exceptions for specific chromosomal conditions create clinical ambiguity that will lead to inconsistent application and force providers to navigate unclear legal territory when making treatment decisions. The HSA contribution program, while providing $1,000 to $1,500 annually to individuals purchasing bronze or catastrophic plans, creates perverse incentives encouraging minimal coverage rather than comprehensive insurance. The $20 billion appropriation over two fiscal years may prove insufficient given uncertain enrollment projections, and the funding sunset in September 2028 creates program instability that will strand beneficiaries who depend on these contributions. This legislation raises serious constitutional concerns regarding equal protection and due process while imposing federal mandates that override state healthcare policy decisions. The result will be increased healthcare costs through emergency room utilization, discrimination against transgender Americans, and barriers to care for immigrant families. I ask you to vote against the Health Care Freedom for Patients Act and instead support policies that expand healthcare access rather than restrict it.