To amend title XIX of the Social Security Act to establish a definition of essential health system in statute and for other related purposes.

HR 7145 defines "essential health systems" as hospitals serving large numbers of Medicaid and low-income patients, specifically targeting non-Federal, nonprofit, or government-run hospitals that meet one of three criteria for at least two of the past three years (e.g., high Medicaid patient percentage, high uncompensated care, or top 16th percentile in state rankings for low-income care). The bill requires MACPAC to annually publish an "essential health system index" ranking qualifying hospitals nationally, by state, and within local areas, using data from Medicare reporting. Hospitals designated as essential health systems receive a five-year designation, renewable if they maintain eligibility. This framework aims to identify facilities providing critical community care for vulnerable populations through standardized metrics.