Sponsors (23)
Official title: 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.
Introduced December 9, 2025 by Brian K. Fitzpatrick · Last progress December 9, 2025
The bill expands near‑term premium assistance and increases transparency (especially for PBMs and Marketplace enrollments), which should lower costs and fraud for many low- and moderate‑income consumers, but it raises federal spending, adds significant administrative and compliance burdens, creates new complexity around HSAs and enrollment systems, and may shift some costs or risks onto agents, insurers, and taxpayers.
Low- and moderate-income households (up to 400% FPL) will pay substantially lower Marketplace premiums in 2026–2027 because temporary enhancements cap or phase down advance premium tax credit (APTC) payments, reducing monthly premium burden for eligible enrollees.
Medicare beneficiaries, independent/specialty pharmacies, and plan sponsors gain greater PBM transparency and rebate passthrough (including audits and enforcement), which should lower out‑of‑pocket drug costs for some beneficiaries and protect smaller pharmacies from discriminatory practices.
Exchanges must tighten enrollment verification, notify applicants of the dollar value of advance premium tax credits before enrollment, and provide consumer controls and penalties for fraud — making enrollments harder to game and giving consumers clearer cost information to avoid surprise charges.
Expanding and temporarily enhancing premium tax credits for 2026–2027 increases federal spending and could raise deficits or require offsets, imposing fiscal pressure on taxpayers and the budget.
The bill creates substantial administrative and compliance burdens across federal agencies, state Exchanges, issuers, PBMs, agents/brokers, and plan sponsors (verification systems, reporting, audits, remittance changes, IT updates), raising operating costs that are likely to be passed to consumers, plans, or taxpayers and complicating implementation.
HSA-related changes introduce complexity and eligibility limits (monthly eligibility rules, §223 caps, ineligibility in months receiving advance payments, reconciliation challenges) that can reduce HSA contribution/deduction benefits for some and complicate tax filings.
Based on analysis of 9 sections of legislative text.
Modifies 2026–2027 premium tax credits, tightens Exchange fraud penalties, regulates PBMs/Part D and ERISA plans, and allows certain APTC/HSAs interactions (split/prepay).
Creates a package of changes to make health coverage more affordable, curb Exchange enrollment fraud, regulate pharmacy benefit managers (PBMs) and Medicare Part D/MA‑PD plan practices, and expand how advance premium tax credit (APTC) payments can interact with Health Savings Accounts (HSAs). It extends and modifies enhanced premium tax credits for 2026–2027, imposes new civil/criminal penalties and verification rules for agents/brokers and marketing organizations, sets a longer open enrollment window for plan year 2026, tightens PBM transparency and passthrough requirements for Medicare drug plans and ERISA plans, allows certain Exchange enrollees to be HSA‑eligible and to split or prepay APTCs, and directs an HHS/Treasury report on HSA implementation.