Primary and Behavioral Health Care Access Act of 2026

Overview

S 4754 is a Senate bill introduced in Session 119 that would amend multiple federal statutes to ensure that group health plans and health insurance issuers offering group or individual coverage must cover a limited number of primary care and behavioral health visits without any cost-sharing (i.e., no deductibles, copayments, or coinsurance). The bill has one identified sponsor with a co-sponsor: Angus King. It was read twice and referred to the Senate Committee on Health, Education, Labor, and Pensions on June 11, 2026.

Purpose and intent

• To remove financial barriers for initial and ongoing access to essential health services by guaranteeing free access to a specified number of primary care and behavioral health care visits.
• To align with policies that emphasize early and preventive care, behavioral health integration, and reduced patient out-of-pocket costs for foundational health services.

Key provisions and changes

• Coverage requirement: Group health plans and health insurance issuers offering group or individual coverage must provide:
  • 3 primary care visits per plan year without any cost-sharing.
  • 3 behavioral health care visits per plan year without any cost-sharing.
• Cost-sharing exemption: For these specified visits, enrollees would not pay deductibles, copayments, coinsurance, or any other cost-sharing amounts.
• Statutory framework: The requirement would be implemented by amending:
  • The Employee Retirement Income Security Act of 1974 (ERISA).
  • Title XXVII of the Public Health Service Act (PHSA).
  • The Internal Revenue Code of 1986 (IRC).
• Scope: Applies to both group health plans and health insurance issuers offering either group or individual coverage, ensuring uniform access across plan types.
• Compliance and enforcement: The bill would establish the framework for implementing the cost-sharing exemption within the mentioned statutes, potentially including rules, penalties, or oversight mechanisms as determined by the relevant federal agencies (though specific enforcement details are not provided in the summary).

Who would be affected

• Enrollees in employer-sponsored group health plans.
• Individuals with coverage purchased through health insurance issuers offering group or individual health insurance plans.
• Employers and plan sponsors administering ERISA-regulated plans, as well as issuers of PHSA-regulated and IRC-referenced health plans.
• Healthcare providers and facilities delivering primary care and behavioral health services, who would be responsible for ensuring services are billed without cost-sharing when these qualifying visits occur.

Procedural and timeline aspects

• Introduction and referral: Introduced in the Senate and referred to the Committee on Health, Education, Labor, and Pensions on June 11, 2026.
• Next steps: The committee would consider the bill, possibly mark up amendments, and vote before sending it to the full Senate. If advanced, it would proceed through the usual legislative process (floor considerations, potential conference with the House, and presidential action).
• Effective dates: The summary does not specify a effective date; typical legislation may include a phased implementation or a fixed effective date after enactment, which would be defined in the bill text or accompanying statements.

Notes

• As the bill is in early stages, exact regulatory details (e.g., how “visits” are defined, whether telehealth counts, or whether annual limits reset) would be clarified in the statutory language and any implementing regulations.
• The impact would depend on plan design and current practice around cost-sharing for primary and behavioral health visits across different plans and jurisdictions.