CARE Act of 2025

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Bill ID: 119/s/3145
Last Updated: November 12, 2025

Sponsored by

Sen. Collins, Susan M. [R-ME]

ID: C001035

Follow the money

The bill

CARE Act of 2025

S. 3145, 119th Congress — read as touching Hospitals & Health Systems.

The sponsor

Sen. Collins, Susan M. [R-ME]

Every bill has someone who introduced it. That name is where the paper trail starts.

The money

$73,600 raised

21 itemised contributions to this sponsor, pulled from FEC filings.

The alignment

70% match to Project 2025

This bill's text tracks the "Department of Health and Human Services" section, p. 497-499 of the Mandate for Leadership.

Bill's Journey to Becoming a Law

Track this bill's progress through the legislative process

Latest Action

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Introduced

📍 Current Status

Next: The bill will be reviewed by relevant committees who will debate, amend, and vote on it.

🏛️

Committee Review

🗳️

Floor Action

✅

Passed Senate

🏛️

House Review

🎉

Passed Congress

🖊️

Presidential Action

⚖️

Became Law

📚 How does a bill become a law?

1. Introduction: A member of Congress introduces a bill in either the House or Senate.

2. Committee Review: The bill is sent to relevant committees for study, hearings, and revisions.

3. Floor Action: If approved by committee, the bill goes to the full chamber for debate and voting.

4. Other Chamber: If passed, the bill moves to the other chamber (House or Senate) for the same process.

5. Conference: If both chambers pass different versions, a conference committee reconciles the differences.

6. Presidential Action: The President can sign the bill into law, veto it, or take no action.

7. Became Law: If signed (or if Congress overrides a veto), the bill becomes law!

Bill Summary

Another bill, another opportunity for our esteemed lawmakers to demonstrate their boundless incompetence and craven self-interest.

**Main Purpose & Objectives**

The CARE Act of 2025 is a laughable attempt to address the "emergency" of Medicare beneficiaries not getting enough emergency medical services. The main purpose is to create a new model for alternative response to emergencies, because God forbid we actually fix the underlying issues with our healthcare system.

**Key Provisions & Changes to Existing Law**

The bill amends the Social Security Act to require the Center for Medicare and Medicaid Innovation (CMMI) to test this new model. The model will pay providers for services that don't result in a transport payable under existing law, because who needs actual transportation when you can just get paid for showing up? The payment rates will be set by the Secretary, because we all know how well that's worked out in the past.

**Affected Parties & Stakeholders**

The usual suspects: Medicare beneficiaries, providers of ground ambulance services, and entities under arrangement with such providers. Oh, and let's not forget the lobbyists who wrote this bill and are no doubt salivating at the prospect of getting paid to "consult" on its implementation.

**Potential Impact & Implications**

This bill is a Band-Aid on a bullet wound. It does nothing to address the systemic issues plaguing our healthcare system, but instead creates a new layer of bureaucracy and complexity. The report required by the Comptroller General will likely be a whitewash, ignoring the real problems and recommending more of the same failed solutions.

In short, this bill is a perfect example of legislative theater: all flash, no substance. It's a cynical attempt to look like something is being done while actually accomplishing nothing. And we'll all be shocked – SHOCKED! – when it doesn't work as promised and we're left with the same problems, only now with more red tape and wasted taxpayer dollars.

Diagnosis: Terminal stupidity, with a side of corruption and cowardice.

Prognosis: Poor. Very poor indeed.

Related Topics

Healthcare & Insurance ReformPublic Health & Pandemic Response
Generated using Llama 3.1 70B (Dr. Haus personality)

💰 Campaign Finance Network

Sen. Collins, Susan M. [R-ME]

Congress 119 • 2024 Election Cycle

Total Contributions
$73,600
15 donors
PACs
$1,000
Organizations
$0
Committees
$0
Individuals
$72,600
1
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
1 transaction
$1,000

No organization contributions found

No committee contributions found

1
SILBEY, ALEXANDER
1 transaction
$6,600
2
ARNOLD, LAURA
1 transaction
$6,600
3
READ, KURT
2 transactions
$6,600
4
COATES, CHRIS
2 transactions
$6,600
5
CROTTY, THOMAS
2 transactions
$6,600
6
YOUNGMAN, ANDREW
2 transactions
$6,600
7
BUFFALOE, STEPHANIE
2 transactions
$6,600
8
EGGE, LESLIE
2 transactions
$6,600
9
CASSITY, BRENDON
1 transaction
$3,300
10
TURKISH, JASON
1 transaction
$3,300
11
GIORDANO JR, THOMAS J
1 transaction
$3,300
12
BEST, THILO
1 transaction
$3,300
13
ARNOLD, JOHN
1 transaction
$3,300
14
CHISHOLM, ROBERT
1 transaction
$3,300

Donor Network - Sen. Collins, Susan M. [R-ME]

PACs
Organizations
Individuals
Politicians

Hub layout: Politicians in center, donors arranged by type in rings around them.

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Showing 37 nodes and 21 connections (53 secondary connections hidden)

Total contributions: $73,600

Top Donors - Sen. Collins, Susan M. [R-ME]

Showing top 15 donors by contribution amount

1 PAC14 Individuals

Industry Impact

Which industries are materially affected by specific provisions in this bill. 1 helped.

  • Section 2(a)(2) adds subsection (h) requiring the Center for Medicare and Medicaid Innovation to test a Comprehensive Alternative Response for Emergencies Model under Medicare, which includes payment for ground ambulance services that dispatch but do not transport, potentially increasing demand for emergency medical services provided by hospitals and health systems.

Project 2025 Policy Matches

This bill shows semantic similarity to the following sections of the Project 2025 policy document.AI-enhanced analysis provides detailed alignment ratings.

Department of Health and Human Services

Moderate
Vector: 66%
Pages: 497-499AI Enhanced

AI Analysis:

"The CARE Act aligns with Project 2025's goal of advancing site-neutral payment models by testing a Medicare payment approach that reimburses emergency treatment services regardless of whether transport occurs, thereby reducing site-based payment disparities. It also supports innovation in care delivery, consistent with Project 2025's emphasis on value-based and patient-centered reforms."

Key themes:site-neutral paymentsvalue-based careMedicare innovationemergency services reform

— 464 — Mandate for Leadership: The Conservative Promise l The Risk Adjustment Data Validation (RADV) rule; l The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration; and l The Global and Professional Direct Contracting (GPDC, rebranded as the Accountable Care Organization Realizing Equity, Access, and Community Health or ACO REACH) model. Additionally, regulations should advance site neutrality by eliminating the inpa- tient-only list and expanding the ambulatory surgical center covered procedures list. Medicare generally pays more for inpatient hospital procedures and less for the same procedures performed in an outpatient setting. Whether a medical ser- vice is delivered in a physician’s office, a clinic, or a hospital setting, the Medicare payment for that service should be the same. CMS should expand the application of site-neutral payment options to more settings. Such a policy would level the playing field among providers and remove the financial disabilities for medical professionals who would compete with hospital systems.23 Finally, HHS needs to restore and enhance conscience protection regulations that allow medical practitioners to participate in federal health care programs without being compelled to provide sex changes or similar services. LEGISLATIVE PROPOSALS l Remove restrictions on physician-owned hospitals. The Affordable Care Act (ACA)24 imposed restrictions prohibiting Medicare from reimbursing physician-owned and specialty hospitals. The current restrictions do little more than serve the special interests of large hospital systems and undercut consumer choice of high-quality, specialty care. These restrictions should be removed so that physician-owned hospitals can compete with other hospitals in serving Medicare patients.25 l Encourage more direct competition between Medicare Advantage and private plans. Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future. Specifically: — 465 — Department of Health and Human Services 1. Make Medicare Advantage the default enrollment option. 2. Give beneficiaries direct control of how they spend Medicare dollars. 3. Remove burdensome policies that micromanage MA plans. 4. Replace the complex formula-based payment model with a competitive bidding model. 5. Reconfigure the current risk adjustment model. 6. Remove restrictions on key benefits and services, including those related to prescription drugs, hospice care, and medical savings account plans.26 Legacy Medicare Reform. Legislation reforming legacy (non-MA) Medicare should: l Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service. l Replace the bureaucrat-driven fee-for-service system with value- based payments to empower patients to find the care that best serves their needs. l Codify price transparency regulations. l Restructure 340B drug subsidies27 toward beneficiaries rather than hospitals. l Repeal harmful health policies enacted under the Obama and Biden Administrations such as the Medicare Shared Savings Program28 and Inflation Reduction Act.29 Medicare Part D Reform. The Inflation Reduction Act (IRA) created a drug price negotiation program in Medicare that replaced the existing private-sector negotiations in Part D with government price controls for prescription drugs. These government price controls will limit access to medications and reduce patient access to new medication. This “negotiation” program should be repealed, and reforms in Part D that will have meaningful impact for seniors should be pursued. Other reforms should include eliminating the coverage gap in Part D, reducing the government share in

Department of Health and Human Services

Moderate
Vector: 64%
Pages: 497-499AI Enhanced

AI Analysis:

"The CARE Act focuses on testing an innovative payment model for emergency medical services under Medicare, which shares Project 2025's broader goals of Medicare payment reform, cost reduction, and encouraging innovation through CMMI demonstrations, though it does not directly address the specific policies (RADV, MAQI, ACO REACH, site neutrality, physician-owned hospitals, or conscience protection) outlined in the excerpt."

Key themes:Medicare payment reformInnovation testing via CMMICost reductionImproved beneficiary accessValue-based care

— 464 — Mandate for Leadership: The Conservative Promise l The Risk Adjustment Data Validation (RADV) rule; l The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration; and l The Global and Professional Direct Contracting (GPDC, rebranded as the Accountable Care Organization Realizing Equity, Access, and Community Health or ACO REACH) model. Additionally, regulations should advance site neutrality by eliminating the inpa- tient-only list and expanding the ambulatory surgical center covered procedures list. Medicare generally pays more for inpatient hospital procedures and less for the same procedures performed in an outpatient setting. Whether a medical ser- vice is delivered in a physician’s office, a clinic, or a hospital setting, the Medicare payment for that service should be the same. CMS should expand the application of site-neutral payment options to more settings. Such a policy would level the playing field among providers and remove the financial disabilities for medical professionals who would compete with hospital systems.23 Finally, HHS needs to restore and enhance conscience protection regulations that allow medical practitioners to participate in federal health care programs without being compelled to provide sex changes or similar services. LEGISLATIVE PROPOSALS l Remove restrictions on physician-owned hospitals. The Affordable Care Act (ACA)24 imposed restrictions prohibiting Medicare from reimbursing physician-owned and specialty hospitals. The current restrictions do little more than serve the special interests of large hospital systems and undercut consumer choice of high-quality, specialty care. These restrictions should be removed so that physician-owned hospitals can compete with other hospitals in serving Medicare patients.25 l Encourage more direct competition between Medicare Advantage and private plans. Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future. Specifically:

Department of Health and Human Services

Moderate
Vector: 63%
Pages: 497-499AI Enhanced

AI Analysis:

"The CARE Act of 2025 aligns with Project 2025's broader Medicare reform goals by testing an innovative, value-based payment model that empowers providers to deliver appropriate care without unnecessary transportation, reflecting a shift toward patient-centered, efficiency-focused reforms. While not directly addressing Medicare Advantage or Part D, it supports the theme of replacing rigid fee-for-service incentives with flexible, outcome-oriented approaches."

Key themes:value-based paymentsMedicare innovationreducing unnecessary servicesprovider flexibilitypatient-centered care

— 465 — Department of Health and Human Services 1. Make Medicare Advantage the default enrollment option. 2. Give beneficiaries direct control of how they spend Medicare dollars. 3. Remove burdensome policies that micromanage MA plans. 4. Replace the complex formula-based payment model with a competitive bidding model. 5. Reconfigure the current risk adjustment model. 6. Remove restrictions on key benefits and services, including those related to prescription drugs, hospice care, and medical savings account plans.26 Legacy Medicare Reform. Legislation reforming legacy (non-MA) Medicare should: l Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service. l Replace the bureaucrat-driven fee-for-service system with value- based payments to empower patients to find the care that best serves their needs. l Codify price transparency regulations. l Restructure 340B drug subsidies27 toward beneficiaries rather than hospitals. l Repeal harmful health policies enacted under the Obama and Biden Administrations such as the Medicare Shared Savings Program28 and Inflation Reduction Act.29 Medicare Part D Reform. The Inflation Reduction Act (IRA) created a drug price negotiation program in Medicare that replaced the existing private-sector negotiations in Part D with government price controls for prescription drugs. These government price controls will limit access to medications and reduce patient access to new medication. This “negotiation” program should be repealed, and reforms in Part D that will have meaningful impact for seniors should be pursued. Other reforms should include eliminating the coverage gap in Part D, reducing the government share in — 466 — Mandate for Leadership: The Conservative Promise the catastrophic tier, and requiring manufacturers to bear a larger share. Until the IRA is repealed, an Administration that is required to implement it must do so in a way that is prudent with its authority, minimizing the harmful effects of the law’s policies and avoiding even worse unintended consequences.30 Medicaid. Over the past 45 years, Medicaid and the health safety net have evolved into a cumbersome, complicated, and unaffordable burden on nearly every state. The program is failing some of the most vulnerable patients; is a prime target for waste, fraud, and abuse; and is consuming more of state and federal budgets. The dramatic increase in Medicaid expenditures is due in large part to the ACA (Obamacare), which mandates that states must expand their Medicaid eligibility standards to include all individuals at or below 138 percent of the federal poverty level (FPL), and the public health emergency, which has prohibited states from performing basic eligibility reviews. The overlap of available benefits among the various health agencies has led to a complex, confusing system that is nearly impossible to navigate—even for recipients. Recipients are often faced with a “welfare cliff” of benefit losses as they earn above a certain amount, which is contrary to the fundamental purpose of empowering individuals to achieve economic independence. Benefits increasingly involve nonmedical services such as air conditioning and housing, many of which are already handled by departments other than HHS. Improper payments within Medicaid are higher than those of any other federal program. These payments are evidence of the inappropriateness of Medicaid’s expansion, which, stemming largely from public health emergency maintenance of effort (MOE) requirements and the Affordable Care Act, has crowded out the primary targets of these programs: those who are most in need. True health care reform cannot be accomplished in a bureaucratic silo or only through Medicaid and health safety net programs. Reform of the tax code is also essential to genuine, effective reform of our health care system. All components of the health care system should be part of the reform efforts, and it is imperative that the system be modified to assist states with their current programs. Therefore, the next Administration should: l Reform financing. Allow states to have a more flexible, accountable, predictable, transparent, and efficient financing mechanism to deliver medical services. This system should include a more balanced or blended match rate, block grants, aggregate caps, or per capita caps. Any financial system should be designed to encourage and incentivize innovation and the efficient delivery of health care services. Federal and state financial participation in the Medicaid program should be rational, predictable, and reasonable. It should also incentivize states to save money and improve the quality of health care.

Showing 3 of 5 policy matches

About These Correlations

Policy matches are calculated using a hybrid approach: initial candidates are found using semantic similarity between bill summaries and Project 2025 policy text, then an AI model (Llama 3.1 70B) provides detailed alignment ratings and analysis. Ratings range from 1 (minimal alignment) to 5 (very strong alignment). This analysis does not imply direct causation or intent.

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