HR6501-119

What This Bill Does

The Bipartisan Health Insurance Affordability Act combines subsidy extension, anti-fraud, pharmacy benefit manager, and HSA provisions. Section 2 extends enhanced premium tax credit rules for taxable years after 2025 and before 2028, with very low-income households at or below 150 percent of poverty owing only a $5 monthly amount, a sliding transition for 150 to 200 percent of poverty, and a replacement percentage table through 700 percent of poverty. Section 3 adds Exchange fraud guardrails: agents or brokers who negligently provide incorrect information can face $10,000 to $50,000 penalties per affected individual, knowing false submissions can carry civil penalties up to $200,000 per affected individual, and knowing and willful false submissions can be fined or punished by up to 10 years in prison. It also requires an enrollment verification process in federally operated Exchanges by no later than January 1, 2029, including consent documentation, delayed commissions until inconsistencies are resolved, database access for qualified health plans, consumer notices, account access, and reporting of third-party marketing organizations. Section 5 creates Part D PBM accountability rules beginning in 2029, including written agreements with PDP sponsors, limits on remuneration outside bona fide service fees or permitted flat incentive payments, pass-through of rebates and other concessions, audit rights, and accountability requirements. Section 6 adds ERISA full rebate pass-through rules and a safe harbor for responsible plan fiduciaries that did not know a covered service provider failed to remit required amounts and act after discovery. Sections 7 and 8 let qualified Exchange enrollees establish HSAs in specified bronze or silver plans, create a $5 premium prepayment option for certain enrollees, and let some advance premium support flow into HSA-related accounts. Section 9 requires Treasury and HHS to report to Congress within one year on implementation and HSA accessibility recommendations.

Who Benefits and How

Lower-income Exchange enrollees benefit because enhanced premium tax credit support continues through 2027 and reduces premiums using poverty-level tiers up to 700 percent. Exchange applicants benefit from consent documentation, unauthorized-activity notices, and delayed broker commissions that reduce fraudulent or inaccurate enrollment activity. Medicare Part D enrollees and plan sponsors can benefit if PBM rebates, concessions, and compensation are passed through more transparently. Responsible plan fiduciaries benefit from a safe harbor when they did not know about remittance failures and promptly request correction. Qualified Exchange enrollees benefit from expanded HSA eligibility and options to combine premium support with account-based savings.

Who Bears the Burden and How

Federal taxpayers bear higher subsidy and tax-preference costs from extended premium credits and broader HSA treatment. Exchange brokers and agents face documentation duties, delayed commissions, larger civil penalties, and possible criminal exposure for willful fraud. PBMs, PBM affiliates, covered service providers, PDP sponsors, Exchange issuers, and employer plan administrators must change contracts, remittance practices, audits, consumer notices, account tools, and compliance systems. CMS, Treasury, HHS, and ERISA regulators must build verification, penalty, PBM, HSA, and reporting procedures.

Key Provisions

• Extends enhanced premium tax credits through 2027 with $5 monthly amounts for households up to 150 percent of poverty and a replacement table through 700 percent of poverty.
• Creates civil and criminal penalties for Exchange agents or brokers that submit incorrect, false, fraudulent, or willfully false enrollment information.
• Requires federally operated Exchange verification processes by no later than January 1, 2029, including consent evidence, commission timing, consumer notices, and third-party marketing reporting.
• Requires Part D PBM written agreements, compensation limits, pass-through rules, audit rights, and accountability standards beginning in 2029.
• Adds ERISA rebate pass-through rules and an innocent fiduciary safe harbor after discovery and written correction requests.
• Expands HSA eligibility for qualified Exchange enrollees and creates premium prepayment or account-payment options.
• Requires Treasury and HHS to report within one year on implementation and HSA access expansion.