Sponsors
The bill increases oversight of advance premium tax credits to reduce improper payments and improve consumer outcomes, at the cost of added administrative work, federal spending, and some risk of exposing sensitive fraud‑control details.
Taxpayers: Regular fraud‑risk assessments aim to improve detection and prevention of improper advance premium tax credit (APTC) payments, potentially reducing improper payments and saving federal funds.
Consumers seeking ACA coverage: Strengthened program integrity for advance determinations reduces errors that could affect eligibility, coverage, or year‑end reconciliation for enrollees.
Lawmakers, auditors, and oversight bodies: Requiring documented controls and annual risk assessments gives Congress and the HHS Inspector General clearer evidence to monitor program integrity and inform oversight.
HHS and Treasury: Producing the required initial and annual fraud‑risk assessments will require staff time and administrative effort, especially given the Dec. 31, 2025 deadline.
Taxpayers/federal budget: The new oversight and assessment requirements add costs that may be borne by federal budgets without directly expanding services.
Consumers and program security: Detailed fraud‑control information, if disclosed or handled poorly, could increase the risk of exposing system vulnerabilities or enable bad actors to game controls.
Based on analysis of 2 sections of legislative text.
Requires HHS, with Treasury, to produce annual fraud risk assessments of advance eligibility determinations and advance premium tax credit claims and report controls to oversight bodies.
Requires the Secretary of Health and Human Services, working with the Secretary of the Treasury, to prepare a fraud risk assessment of advance eligibility determinations for marketplace coverage and advance premium tax credit claims. The assessment must follow the GAO fraud-risk framework, list HHS controls used to prevent fraud, be submitted to the HHS Inspector General and specified congressional committees, be completed by December 31, 2025, and be updated annually thereafter.
Introduced December 8, 2025 by Charles Ernest Grassley · Last progress December 8, 2025