To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, to amend the Patient Protection and Affordable Care Act to make certain adjustments to the operation of the Exchanges established under such Act, and for other purposes.
Sponsors
Legislative Progress
IntroducedMrs. Kiggans of Virginia (for herself, Mr. Gottheimer, Mr. Lawler, …
Summary
What This Bill Does
The CommonGround for Affordable Health Care Act extends the enhanced Affordable Care Act premium tax credits through 2026, helping millions of Americans afford health insurance purchased through ACA Exchanges. It also implements comprehensive anti-fraud measures targeting insurance agents, brokers, and marketing organizations, and adds new transparency requirements for pharmacy benefit managers (PBMs) in Medicare Part D.
Who Benefits and How
Low and moderate-income Americans purchasing health insurance through ACA Exchanges will continue receiving substantial premium subsidies, with those earning up to 150% of the federal poverty level paying nothing for premiums and those earning up to 1000% FPL receiving graduated assistance. Health insurance companies benefit from increased enrollment driven by the subsidies. Medicare beneficiaries and independent pharmacies may benefit from PBM transparency rules that could reduce hidden markups and anti-competitive practices by large pharmacy benefit managers.
Who Bears the Burden and How
Health insurance agents, brokers, and marketing organizations face significant new compliance requirements including mandatory registration with HHS, consent documentation for enrollments, marketing material approval, and potential civil penalties of up to ,000 or criminal penalties of up to 10 years imprisonment for fraud. Pharmacy benefit managers like CVS Health, Cigna/Express Scripts, and UnitedHealth/OptumRx face extensive reporting requirements and restrictions on collecting fees beyond bona fide service fees, potentially reducing their profitability. Taxpayers bear the cost of extended premium subsidies, estimated at billions of dollars annually.
Key Provisions
- Extends enhanced ACA premium tax credits through 2026 for individuals earning up to 1000% of the federal poverty level
- Creates civil penalties of ,000-,000 for insurance agent/broker negligence and up to ,000 for knowing fraud
- Establishes criminal penalties of up to 10 years imprisonment for willful enrollment fraud
- Requires HHS to verify agent/broker enrollment consent and maintain suspended/terminated agent lists
- Mandates PBM transparency including full pass-through of manufacturer rebates and detailed annual reporting
- Extends the 2026 open enrollment period through March 19, 2026
- Establishes expedited Congressional procedures for bipartisan healthcare reform bills with a July 1, 2026 deadline
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Extends and modifies the enhanced Affordable Care Act premium tax credits through 2026 while implementing comprehensive anti-fraud measures for health insurance agents and brokers operating through ACA Exchanges.
Policy Domains
Legislative Strategy
"Combine popular premium subsidy extension with fraud prevention measures to create bipartisan appeal, addressing both healthcare affordability and program integrity concerns."
Likely Beneficiaries
- Individuals and families earning up to 1000% of the federal poverty level who purchase health insurance through ACA Exchanges
- Low-income individuals (up to 150% FPL) who receive 100% premium subsidies
- Healthcare consumers protected from fraudulent enrollment practices
- Legitimate licensed insurance agents and brokers who comply with regulations
- State insurance departments receiving federal cooperation on fraud enforcement
Likely Burden Bearers
- Health insurance agents and brokers facing new compliance requirements, registration mandates, and civil/criminal penalties
- Field marketing organizations and third-party marketing organizations subject to new oversight and reporting requirements
- Federal government (HHS/CMS) bearing increased administrative costs for verification, audits, and enforcement
- Qualified health plans required to implement new verification databases and systems
- Taxpayers funding the extended premium tax credits estimated at billions in subsidies
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
Any steps taken from marketing to such individual, to such individual making an enrollment decision with respect to a qualified health plan offered through an Exchange.
With respect to a contract between an agent or broker and a field marketing organization, third-party marketing organization, or health insurance issuer, means the ending or expiration of such contract not replaced by a substantially similar agreement.
An organization or individual that directly employs or contracts with agents and brokers, or contracts with carriers, to provide functions relating to enrollment of individuals in qualified health plans offered through an Exchange as part of the chain of enrollment.
Materials relating to a qualified health plan offered through an Exchange or benefits offered through an Exchange that are intended to draw attention to such plan or influence enrollment decisions, and include content regarding benefits, premiums, or cost sharing.
An organization or individual that is compensated to perform lead generation, marketing, or sales relating to enrollment of individuals in qualified health plans offered through an Exchange as part of the chain of enrollment.
The use of marketing materials to provide information to current and prospective enrollees in a qualified health plan offered through an Exchange.
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