Sponsors (2)
Official title: To ensure affordable health insurance coverage for low-income individuals in States that have not expanded Medicaid.
Introduced May 7, 2025 by Terri Sewell · Last progress May 7, 2025
The bill greatly increases short‑term affordability and enrollment support for low‑income and newly eligible people but does so with substantial near‑term federal spending, insurer and administrative costs, and uncertainty for states and markets when enhanced provisions step down after 2028.
Low-income people (especially those at or below 138% of the federal poverty level) will face much lower premiums and near-zero cost‑sharing in 2026–2028 thanks to enhanced silver rules, expanded premium tax credit eligibility (including some with employer offers or QSEHRAs), and extended credit availability for those under 100% FPL.
Easier enrollment and outreach: guaranteed continuous/special enrollment and expanded open‑enrollment windows for very low‑income enrollees, plus targeted outreach and navigator grants and improved Exchange-to-IRS reporting to help non‑filers reconcile advance payments — all should raise take‑up among eligible people.
Capping recapture exposure (max $300 / $150 for separate filers) reduces the risk that low‑income taxpayers under 200% FPL face large unexpected tax liabilities when reconciling advance premium tax credits.
Federal spending rises (expanded premium tax credit eligibility, reimbursements to issuers, navigator grants and other appropriations), increasing budgetary outlays and potential pressure on deficits or the need for offsets.
Private insurers must cover extra benefits and provide near‑zero cost‑sharing for specified enrollees in 2026–2027 and absorb related administrative changes, raising insurer costs that could lead to higher premiums, increased issuer fees, or reduced plan participation over time.
Temporary nature and step‑down of enhanced benefits and FMAPs (largely limited to 2026–2028) creates coverage and budgeting uncertainty for enrollees, issuers, and states and could trigger coverage changes or cost‑shifting when provisions expire.
Based on analysis of 4 sections of legislative text.
Temporarily expands ACA premium tax credits and cost‑sharing protections for low‑income people (2026–2028) and sets enhanced FMAP rates for newly eligible Medicaid individuals (2026–2029+).
Creates a temporary bridge of expanded Affordable Care Act (ACA) subsidies and Medicaid matching funds to reduce out‑of‑pocket costs and extend eligibility for low‑income people from 2026 through 2028 (with some FMAP changes into 2029). It (1) raises and clarifies eligibility and cost‑sharing rules for Exchange silver plans and requires federal reimbursement to insurers for near‑Medicaid enrollees, (2) temporarily expands premium tax credit eligibility and limits recapture for low‑income taxpayers, and (3) sets enhanced Federal Medical Assistance Percentage (FMAP) rates for newly eligible Medicaid individuals for calendar years 2026–2029 and thereafter.