[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6501 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 6501
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 9, 2025
Mr. Fitzpatrick (for himself, Mr. Golden of Maine, Mr. Bacon, Mr.
Suozzi, Mr. Bresnahan, Mr. Davis of North Carolina, Ms. Malliotakis,
Ms. Perez, Mr. Lawler, Ms. Salazar, Mr. Mackenzie, Mr. Kean, Mr. Van
Drew, Mr. Valadao, Mr. Ciscomani, and Mr. LaLota) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Ways and Means, and
Education and Workforce, for a period to be subsequently determined by
the Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Bipartisan Health Insurance
Affordability Act''.
SEC. 2. EXTENSION AND MODIFICATION OF ENHANCED PREMIUM TAX CREDIT.
(a) Extension and Modification of Rules To Increase Premium
Assistance Amounts.--Section 36B(b)(3)(A)(iii) of the Internal Revenue
Code of 1986 is amended--
(1) by redesignating subclauses (I) and (II) as items (aa)
and (bb), respectively, and adjusting the margins accordingly,
(2) by striking ``Temporary percentages for 2021 through
2025.--In the case of'' and inserting ``Temporary rules for
certain years.--
``(I) Before 2026.--In the case
of'', and
(3) by adding at the end the following:
``(II) After 2025 for taxpayers
whose household income does not exceed
150 percent of poverty line.--In the
case of a taxable year beginning after
December 31, 2025, and before January
1, 2028, if any taxpayer's household
income does not exceed 150 percent of
the poverty line for such taxable year,
the premium assistance amount
determined under subsection (b)(2),
with respect to any coverage month, is
the excess of the lesser of the amount
described in paragraph (2)(A) or the
amount described in paragraph
(2)(B)(i), over $5.
``(III) After 2025 for taxpayers
whose household income does not exceed
200 percent of poverty line.--In the
case of a taxable year beginning after
December 31, 2025, and before January
1, 2028, if any taxpayer's household
income exceeds 150 percent of the
poverty line but does not exceed 200
percent of the poverty line for such
taxable year, the premium assistance
amount determined under subsection
(b)(2), with respect to any coverage
month, shall be such that the premium
assistance amount for such a taxpayer
shall decrease, on a sliding scale in a
linear manner, from the amount that
would result if determined in
accordance with subclause (II) to the
amount that would result under
subsection (b)(2) by substituting `2
percent' for `the applicable
percentage' in subparagraph (B)(ii)
thereof.
``(IV) After 2025 for taxpayers
whose household income exceeds 200
percent of poverty line.--In the case
of a taxable year beginning after
December 31, 2025, and before January
1, 2028, if any taxpayer's household
income exceeds 200 percent of the
poverty line for such taxable year--
``(aa) clause (ii) shall
not apply for purposes of
adjusting premium percentages
under this subparagraph, and
``(bb) the following table
shall be applied in lieu of the
table contained in clause (i):
----------------------------------------------------------------------------------------------------------------
The initial The final
``In the case of household income (expressed as a percent of poverty line) within the premium premium
following income tier: percentage percentage
is- is-
----------------------------------------------------------------------------------------------------------------
200% up to 250% 2.0% 4.0%
250% up to 300% 4.0% 6.0%
300% up to 400% 6.0% 8.5%
400% up to 600% 8.5% 8.5%
600% up to 700% 8.5% 9.25%''.
----------------------------------------------------------------------------------------------------------------
(b) Extension and Modification of Rule To Allow Credit to Taxpayers
Whose Household Income Exceeds 400 Percent of Poverty Line.--Section
36B(c)(1)(E) of such Code is amended--
(1) by striking ``Temporary rule for 2021 through 2025.--In
the case of'' and inserting ``Temporary rule for certain
years.--
``(i) Before 2026.--In the case of'', and
(2) by adding at the end the following:
``(ii) After 2025.--In the case of a
taxable year beginning after December 31, 2025,
and before January 1, 2028, subparagraph (A)
shall be applied by substituting `but does not
exceed 700 percent' for `but does not exceed
400 percent'.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2025.
SEC. 3. GUARDRAILS TO PREVENT FRAUD IN EXCHANGES.
(a) Reduction of Fraudulent Enrollment in Qualified Health Plans.--
(1) Penalties for agents and brokers.--Section 1411(h)(1)
of the Patient Protection and Affordable Care Act (42 U.S.C.
18081(h)(1)) is amended--
(A) in subparagraph (A)--
(i) by redesignating clause (ii) as clause
(iv);
(ii) in clause (i)--
(I) in the matter preceding
subclause (I), by striking ``If--'' and
all that follows through the ``such
person'' in the matter following
subclause (II) and inserting the
following: ``If any person (other than
an agent or broker) fails to provide
correct information under subsection
(b) and such failure is attributable to
negligence or disregard of any rules or
regulations of the Secretary, such
person''; and
(II) in the second sentence, by
striking ``For purposes'' and inserting
the following:
``(iii) Definitions of negligence,
disregard.--For purposes'';
(iii) by inserting after clause (i) the
following:
``(ii) Civil penalties for certain
violations by agents or brokers.--If any agent
or broker fails to provide correct information
under subsection (b) or section 1311(c)(8) or
other information, as specified by the
Secretary, and such failure is attributable to
negligence or disregard of any rules or
regulations of the Secretary, such agent or
broker shall be subject, in addition to any
other penalties that may be prescribed by law,
including subparagraph (C), to a civil penalty
of not less than $10,000 and not more than
$50,000 with respect to each individual who is
the subject of an application for which such
incorrect information is provided.''; and
(iv) in clause (iv) (as so redesignated),
by inserting ``or (ii)'' after ``clause (i)'';
(B) in subparagraph (B)--
(i) by inserting ``including subparagraph
(C),'' after ``law,'';
(ii) by striking ``Any person'' and
inserting the following:
``(i) In general.--Any person''; and
(iii) by adding at the end the following:
``(ii) Civil penalties for knowing
violations by agents or brokers.--
``(I) In general.--Any agent or
broker who knowingly provides false or
fraudulent information under subsection
(b) or section 1311(c)(8), or other
false or fraudulent information as part
of an application for enrollment in a
qualified health plan offered through
an Exchange, as specified by the
Secretary, shall be subject, in
addition to any other penalties that
may be prescribed by law, including
subparagraph (C), to a civil penalty of
not more than $200,000 with respect to
each individual who is the subject of
an application for which such false or
fraudulent information is provided.
``(II) Procedure.--The provisions
of section 1128A of the Social Security
Act (other than subsections (a) and (b)
of such section) shall apply to a civil
monetary penalty under subclause (I) in
the same manner as such provisions
apply to a penalty or proceeding under
section 1128A of the Social Security
Act.''; and
(C) by adding at the end the following:
``(C) Criminal penalties.--Any agent or broker who
knowingly and willfully provides false or fraudulent
information under subsection (b) or section 1311(c)(8),
or other false or fraudulent information as part of an
application for enrollment in a qualified health plan
offered through an Exchange, as specified by the
Secretary, shall be fined under title 18, United States
Code, imprisoned for not more than 10 years, or
both.''.
(2) Consumer protections.--
(A) In general.--Section 1311(c) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(c))
is amended by adding at the end the following new
paragraph:
``(8) Agent- or broker-assisted enrollment in qualified
health plans in certain exchanges.--
``(A) In general.--For plan years beginning on or
after such date specified by the Secretary, but not
later than January 1, 2029, in the case of an Exchange
that the Secretary operates pursuant to section
1321(c)(1), the Secretary shall establish a
verification process for new enrollments of individuals
in, and changes in coverage for individuals under, a
qualified health plan offered through such Exchange,
which are submitted by an agent or broker in accordance
with section 1312(e) and for which the agent or broker
is eligible to receive a commission.
``(B) Requirements.--The enrollment verification
process under subparagraph (A) shall include--
``(i) a requirement that the agent or
broker provide with the new enrollment or
coverage change such documentation or evidence
(such as a standardized consent form) or other
sources as the Secretary determines necessary
to establish that the agent or broker has the
consent of the individual for the new
enrollment or coverage change;
``(ii) a requirement that any commissions
due to a broker or agent for such new
enrollment or coverage change are paid after
the enrollee has resolved all inconsistencies
in accordance with paragraphs (3) and (4) of
section 1411(e);
``(iii) a requirement that the information
required under clause (i) and, as applicable,
the date on which inconsistencies are resolved
as described in clause (ii), is accessible to
the applicable qualified health plan through a
database or other resource, as determined by
the Secretary, so that any commissions due to a
broker or agent for such enrollment can be
effectuated at the appropriate time;
``(iv) a requirement that individuals are
notified of any changes to enrollment,
coverage, the agent of record, or premium tax
credits in a timely manner and that such notice
provides plain language instructions on how
individuals can cancel unauthorized activity;
``(v) a requirement that individuals be
able to access their account information on a
website or other technology platform, as
defined by the Secretary, when used to submit
an enrollment or plan change, in lieu of the
Exchange website described in subsection
(d)(4)(C), including information on the agent
of record, the qualified health plan, and when
any changes are made to the agent of record or
the qualified health plan, on a consumer-facing
website or through a toll-free telephone
hotline; and
``(vi) a requirement that the agent or
broker report to the Secretary any third-party
marketing organization or field marketing
organization (as such terms are defined in
section 1312(e)) involved in the chain of
enrollment (as so defined) with respect to such
new enrollment or coverage change.
``(C) Consumer protection.--The Secretary shall
ensure that the enrollment verification process under
subparagraph (A) prioritizes continuity of coverage and
care for individuals, including by not disenrolling
individuals from a qualified health plan without the
consent of the individual, regardless of whether the
broker, agent, or qualified health plan is in violation
of any requirement under this paragraph.''.
(B) Required reporting.--Section 1311(c)(1) of the
Patient Protection and Affordable Care Act (42 U.S.C.
18031(c)(1)) is amended--
(i) in subparagraph (H), by striking
``and'' at the end;
(ii) in subparagraph (I), by striking the
period at the end and inserting ``; and''; and
(iii) by adding at the end the follo