Stop ACA Enrollment Fraud Act of 2026
Summary
What This Bill Does
The Stop ACA Enrollment Fraud Act directs the Department of Health and Human Services to create, within 60 days, a Social Security number matching process across Affordable Care Act Exchanges. The process must identify when the same person is enrolled in more than one qualified health plan for the same coverage period and prevent duplicate advance premium tax-credit payments.
For plan years beginning January 1, 2027, an enrollment or coverage change submitted by an insurance agent or broker cannot take effect until the individual or employer confirms consent through a mechanism operated by HHS. An agent's or broker's own attestation cannot substitute for evidence from the person or employer whose coverage is being changed.
Who Benefits and How
Exchange consumers and employers benefit from a direct-consent safeguard against unauthorized agent or broker activity. People whose identities could be used for duplicate coverage face lower risk of conflicting plans or tax-credit records. Qualified health plans and federal premium-tax-credit accounts benefit when duplicate subsidized enrollments are detected before payment.
Who Bears the Burden and How
Insurance agents and brokers must obtain verifiable client consent through the HHS mechanism before their transactions take effect. Consumers and employers must complete an additional confirmation step, which may delay legitimate enrollment changes. HHS and Exchange technology teams must build Social Security number matching, consent collection, identity verification, and transaction-blocking systems. Qualified health plans must respond to duplicate-enrollment findings and delayed agent-submitted transactions.
Key Provisions
- Requires cross-Exchange Social Security number matching within 60 days.
- Identifies overlapping qualified health-plan enrollment for the same person and coverage period.
- Prevents duplicative advance premium tax-credit payments.
- Requires direct individual or employer consent for agent- or broker-submitted transactions.
- Applies the consent rule to plan years beginning January 1, 2027.
- Bars an agent or broker attestation from serving as the required evidence of consent.
- Requires HHS to operate the consent-verification mechanism.
- Adds verification steps that may delay otherwise legitimate broker-assisted enrollment.
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
Requires federal Affordable Care Act Exchanges to prevent duplicate subsidized coverage through Social Security number matching and to obtain direct individual or employer consent before an agent or broker enrollment takes effect.
Key Policy Areas
Health Insurance, Affordable Care Act Exchanges, Enrollment Integrity, Premium Tax Credits, Insurance Agents and Brokers
Primary Purpose
Requires federal Affordable Care Act Exchanges to prevent duplicate subsidized coverage through Social Security number matching and to obtain direct individual or employer consent before an agent or broker enrollment takes effect.
Policy Domains
Section 3 direct consent for agent and broker transactions
Identified Gains
- Consumers using Exchange coverage
- Employers using Exchange coverage
- Consumers targeted by unauthorized enrollments
- Qualified health plans receiving verified transactions
Identified Costs
- Insurance agents using ACA Exchanges
- Insurance brokers using ACA Exchanges
- HHS consent-system staff
- Consumers completing consent verification
- Employers completing consent verification
Section 2 cross-Exchange duplicate-enrollment controls
Identified Gains
- Exchange enrollees vulnerable to identity misuse
- Qualified health plans avoiding duplicate enrollment
- Federal premium-tax-credit accounts
- Exchange program-integrity investigators
Identified Costs
- HHS Exchange technology staff
- ACA Exchange operators
- Qualified health-plan enrollment staff
- Consumers resolving duplicate matches
Sponsors
Legislative Progress
In CommitteeReferred to the Committee on Energy and Commerce, and in …
Introduced in House
Mr. Barrett introduced the following bill; which was referred to …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Consumers completing consent verification, Consumers resolving duplicate matches, Consumers targeted by unauthorized enrollments
Positive-direction: Consumers targeted by unauthorized enrollments, Consumers using Exchange coverage, Exchange enrollees vulnerable to identity misuse
Negative-direction: Consumers resolving duplicate matches
Exchange program-integrity investigators, Federal premium-tax-credit accounts, HHS Exchange technology staff
Positive-direction: Exchange program-integrity investigators, Federal premium-tax-credit accounts
Negative-direction: HHS Exchange technology staff, HHS consent-system staff
ACA Exchange operators, Qualified health plans avoiding duplicate enrollment, Qualified health-plan enrollment staff
Positive-direction: Qualified health plans avoiding duplicate enrollment
Negative-direction: ACA Exchange operators, Qualified health-plan enrollment staff
Employers completing consent verification, Employers using Exchange coverage
Insurance agents using ACA Exchanges, Insurance brokers using ACA Exchanges
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "hhs"
- → Department of Health and Human Services
- "exchange_enrollee"
- → Individual seeking coverage through an ACA Exchange
- "qualified_health_plan"
- → Qualified health plan participating in an Exchange
- "hhs"
- → Department of Health and Human Services operating the consent mechanism
- "agent_or_broker"
- → Insurance agent or broker submitting an Exchange enrollment or change
- "consenting_party"
- → Individual or employer whose coverage transaction is submitted
Key Definitions
Terms defined in this bill
Enrollment of the same Social Security number in multiple qualified health plans for an overlapping coverage period.
Consent provided by the covered individual or employer through an HHS-operated mechanism rather than an agent or broker attestation.
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