Care Over Profits Act of 2026
Summary
What This Bill Does
The Care Over Profits Act of 2026 adds penalties specifically for insurance agents and brokers who submit incorrect, false, or fraudulent information in applications for qualified health plans offered through an Affordable Care Act Exchange. For negligent errors or disregard of federal rules, the civil penalty is at least $10,000 and at most $50,000 for each individual whose application contains the incorrect information.
An agent or broker who knowingly and willfully provides false or fraudulent information faces a civil monetary penalty of up to $200,000 for each affected individual, in addition to other penalties. The bill applies specified Social Security Act penalty procedures. The same knowing and willful conduct may also be punished by a criminal fine, imprisonment for up to 10 years, or both.
The amendments apply to Exchange applications for plan years beginning on or after January 1, 2027. The penalties cover both information already required under ACA enrollment-verification rules and other application information specified by the Secretary.
Who Benefits and How
ACA Exchange enrollees benefit from stronger deterrence against false or negligent broker-submitted applications. Consumers whose identities or coverage choices might be misused face lower risk. Qualified health plans and Exchange program-integrity officers benefit from more accurate enrollment information. Federal premium-assistance programs may avoid costs associated with fraudulent enrollments.
Who Bears the Burden and How
Insurance agents and brokers face per-person civil exposure, and knowing violators face criminal prosecution and imprisonment. Broker compliance officers must strengthen training, review, documentation, and quality controls. HHS enforcement staff must investigate cases and calculate penalties. Federal prosecutors and courts must handle criminal cases and incorporated civil-penalty procedures.
Key Provisions
- Establishes civil penalties for negligent or rule-disregarding broker application errors.
- Sets the negligent-error range at $10,000 to $50,000 per affected individual.
- Adds civil penalties of up to $200,000 per individual for knowing and willful false information.
- Authorizes criminal fines and imprisonment of up to 10 years for knowing and willful fraud.
- Applies existing Social Security Act procedures to the new civil monetary penalties.
- Extends the rules to application information specified by the Secretary.
- Applies the penalties beginning with plan years on or after January 1, 2027.
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
Creates substantial per-enrollee civil and criminal penalties for ACA Exchange agents and brokers who negligently provide incorrect application information or knowingly and willfully provide false or fraudulent information beginning with 2027 plan years.
Key Policy Areas
Affordable Care Act Exchanges, Insurance Agents and Brokers, Enrollment Integrity, Civil Penalties, Criminal Enforcement
Primary Purpose
Creates substantial per-enrollee civil and criminal penalties for ACA Exchange agents and brokers who negligently provide incorrect application information or knowingly and willfully provide false or fraudulent information beginning with 2027 plan years.
Policy Domains
Section 3 ACA Exchange agent and broker penalties
Identified Gains
- ACA Exchange enrollees
- Consumers targeted by fraudulent Exchange applications
- Qualified health-plan enrollment programs
- Exchange program-integrity officers
- Federal premium-assistance programs
Identified Costs
- Insurance agents submitting Exchange applications
- Insurance brokers submitting Exchange applications
- Broker compliance officers
- HHS Exchange enforcement staff
- Federal attorneys prosecuting broker fraud
- Federal courts hearing broker-penalty cases
Sponsors
Tom Barrett
R-MI | Primary Sponsor
Legislative Progress
In CommitteeReferred to the House Committee on Energy and Commerce.
Introduced in House
Mr. Barrett (for himself and Mr. Riley of New York) …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
ACA Exchange enrollees, Consumers targeted by fraudulent Exchange applications, Qualified health-plan enrollment programs
Exchange program-integrity officers, Federal premium-assistance programs, HHS Exchange enforcement staff
Positive-direction: Exchange program-integrity officers, Federal premium-assistance programs
Negative-direction: HHS Exchange enforcement staff
Broker compliance officers, Insurance agents submitting Exchange applications, Insurance brokers submitting Exchange applications
Federal attorneys prosecuting broker fraud
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "secretary"
- → Secretary specifying covered Exchange application information
- "agent_or_broker"
- → Insurance agent or broker submitting a qualified-health-plan application
- "affected_individual"
- → Person whose application contains incorrect, false, or fraudulent information
Key Definitions
Terms defined in this bill
Incorrect required or specified application information attributable to negligence or disregard of federal rules.
False or fraudulent Exchange application information knowingly and willfully provided by an agent or broker.
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