Sponsors (2)
The bill increases financial protection for many Exchange enrollees by moving subsidy and CSR calculations to gold-level benchmarks and guaranteeing CSR funding, but does so at the cost of substantially higher federal spending and the risk of market and transitional disruptions that could raise costs for some consumers.
Low- and moderate-income Exchange enrollees (including those ~150%–300% FPL) will get stronger financial protection because cost-sharing reductions and premium assistance are recalculated using gold-level benchmarks beginning in 2028, lowering out-of-pocket costs and aligning subsidies with higher-value plans.
Insurers and enrollees gain payment certainty because CSR payments are made available via indefinite appropriations, which should stabilize insurer revenue flows and reduce the risk of premium spikes tied to payment interruptions.
State Basic Health Program (BHP) enrollees and states see benchmark alignment to gold plans after 2028, simplifying benefit parity between BHP and Exchange subsidies and reducing mismatches between program benefit designs.
All taxpayers may face higher federal costs because CSR payments and higher subsidy calculations are funded via open-ended 'such sums as may be necessary' appropriations and by using a higher-cost benchmark, increasing federal outlays without a specified limit.
People who enroll in silver or lower-tier plans could receive smaller premium tax credits under a gold benchmark, raising their net premiums and out-of-pocket monthly costs relative to the current silver-based subsidy measure.
Insurers and marketplaces may need to redesign plan offerings and premiums in response to a new gold reference tier and upgraded CSRs, creating short-term market disruption, potential administrative costs for states and carriers, and the risk of reduced plan choice or uneven premium changes.
Based on analysis of 3 sections of legislative text.
Changes subsidy and cost-sharing calculations to use the second-lowest-cost gold plan instead of silver and adjusts CSR percentages, effective 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 beginning January 1, 2028. The bill also updates income-based cost-sharing percentages, modifies a related State Basic Health Program reference, amends the Internal Revenue Code to use the gold benchmark for premium tax credit calculations for taxable years after 2027, and authorizes indefinite Treasury appropriations to cover payments under the affected ACA provision.
Introduced January 20, 2026 by Kim Schrier · Last progress January 20, 2026