To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes.
Summary
What This Bill Does
The bill creates extension and modification of enhanced premium tax credits under IRC Section 36B for ACA marketplace plans in 2026 and 2027, expanding income eligibility from 400% to 600% of poverty line and reducing premium, requires reform of Medicare Advantage risk adjustment methodology under Section 1853 of the Social Security Act, requiring use of 2 years of diagnostic data, excluding chart review and health risk assessment diagnoses, and requires comprehensive anti-fraud framework for ACA marketplace enrollment, establishing civil and criminal penalties for agents and brokers providing false information, enrollment verification processes, regulation. It relies on reporting requirements, regulatory standard, tax credits, and eligibility change. The main policy areas are Finance, Healthcare, and Government.
Who Benefits and How
Low- and moderate-income individuals and families (up to 600% FPL) could see lower costs, Health insurance marketplace enrollees could see lower costs, and ACA marketplace consumers and enrollees could face reduced risk.
Who Bears the Burden and How
Health insurance agents and brokers would take on compliance duties, Third-party marketing organizations would take on compliance duties, and Field marketing organizations would take on compliance duties.
Key Provisions
- Creates extension and modification of enhanced premium tax credits under IRC Section 36B for ACA marketplace plans in 2026 and 2027, expanding income eligibility from 400% to 600% of poverty line and reducing premium...
- Requires reform of Medicare Advantage risk adjustment methodology under Section 1853 of the Social Security Act, requiring use of 2 years of diagnostic data, excluding chart review and health risk assessment diagnoses...
- Requires comprehensive anti-fraud framework for ACA marketplace enrollment, establishing civil and criminal penalties for agents and brokers providing false information, enrollment verification processes, regulation...
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
The bill creates extension and modification of enhanced premium tax credits under IRC Section 36B for ACA marketplace plans in 2026 and 2027, expanding income eligibility from 400% to 600% of poverty line and reducing premium, requires reform of Medicare Advantage risk adjustment methodology under Section 1853 of the Social Security Act, requiring use of 2 years of diagnostic data, excluding chart review and health risk assessment diagnoses, and requires comprehensive anti-fraud framework for ACA marketplace enrollment, establishing civil and criminal penalties for agents and brokers providing false information, enrollment verification processes, regulation.
Key Policy Areas
Finance, Healthcare, Government
Primary Purpose
The bill creates extension and modification of enhanced premium tax credits under IRC Section 36B for ACA marketplace plans in 2026 and 2027, expanding income eligibility from 400% to 600% of poverty line and reducing premium, requires reform of Medicare Advantage risk adjustment methodology under Section 1853 of the Social Security Act, requiring use of 2 years of diagnostic data, excluding chart review and health risk assessment diagnoses, and requires comprehensive anti-fraud framework for ACA marketplace enrollment, establishing civil and criminal penalties for agents and brokers providing false information, enrollment verification processes, regulation.
Policy Domains
Whole bill
Identified Gains
- Low- and moderate-income individuals and families (up to 600% FPL)
- Health insurance marketplace enrollees
- ACA marketplace consumers and enrollees
- Traditional Medicare program (CMS)
- Health insurance issuers on ACA exchanges
Identified Costs
- Health insurance agents and brokers
- Third-party marketing organizations
- Field marketing organizations
- Federal government (Treasury)
- Health and Human Services (Secretary)
Sponsors
Legislative Progress
In CommitteeMr. Liccardo (for himself, Mr. Kiley of California, Mr. Bacon, …
Referred to the Committee on Ways and Means, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Field marketing organizations, Health insurance agents and brokers, Health insurance issuers on ACA exchanges
Positive-direction: Health insurance issuers on ACA exchanges, Health insurance marketplace enrollees
Negative-direction: Field marketing organizations, Health insurance agents and brokers, Third-party marketing organizations
ACA marketplace consumers and enrollees, Low- and moderate-income individuals and families (up to 600% FPL), Medicare beneficiaries
Federal government (Treasury), Health and Human Services (Secretary), Traditional Medicare program
Positive-direction: Traditional Medicare program
Negative-direction: Federal government (Treasury), Health and Human Services (Secretary)
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology