Sponsors (2)
The bill increases financial assistance and cost‑sharing protection for low- and moderate-income marketplace enrollees (improving affordability and coverage generosity), but does so at higher federal cost and with a risk of higher premiums or reduced choice for unsubsidized/middle-income consumers and added state administrative burdens.
Low- and moderate-income marketplace enrollees (roughly 150%–300% FPL and other subsidy-eligible people) will see larger premium tax credits and lower monthly premiums beginning in 2028 because credits are calculated against the second-lowest-cost gold plan.
Low- and moderate-income enrollees eligible for CSRs will face lower out-of-pocket costs and potentially more generous coverage because CSR reference shifts from silver to gold and CSR generosity is expanded starting in 2028.
The bill authorizes an open-ended appropriation ('such sums as may be necessary') for CSR payments, reducing uncertainty about federal funding and helping ensure timely payments to insurers and continuity of marketplace coverage.
Taxpayers and the federal budget will face materially higher costs because both expanded CSR generosity and larger premium tax credits increase federal outlays, raising deficit pressure or the need for offsets.
Middle-income and other unsubsidized consumers may see higher premiums or reduced plan value because insurers could raise rates or redesign offerings toward higher-actuarial-value (gold) plans when the subsidy and CSR reference shifts.
States that operate Basic Health Programs (BHPs) will face administrative complexity and transitional workload to recalculate premiums and cost-sharing comparisons when the benchmark switches to the second‑lowest‑cost gold plan.
Based on analysis of 3 sections of legislative text.
Replaces the silver benchmark with the gold benchmark for premium tax credits and CSR calculations, increasing subsidies and plan generosity starting in 2028.
Changes how Affordable Care Act marketplace subsidies and cost-sharing reductions are calculated by switching the reference benchmark from the second-lowest-cost silver plan to the second-lowest-cost gold plan. For plan years starting on or after January 1, 2028, this raises the actuarial value targets for certain income bands, changes which metal level receives CSR-type protections, and requires Treasury to provide “such sums as may be necessary” for CSR payments. For tax purposes, it tells the Internal Revenue Code to use the second-lowest-cost gold plan when calculating premium tax credits for taxable years beginning after December 31, 2027. The result is larger federal subsidies, more generous plan designs for many enrollees, and a likely increase in federal spending starting with 2028 plan and tax years.
Introduced January 20, 2026 by Kim Schrier · Last progress January 20, 2026