Sponsor
Charles Ernest Grassley
Senator · R-IA
Senator · R-IA
The bill strengthens detection, reporting, and oversight to reduce improper advance premium tax credits and protect taxpayers and consumers, but it also raises the risk of added verification burdens, potential recoupments for some beneficiaries, and higher administrative work for HHS.
Taxpayers will face fewer improper advance premium tax credit (APTC) payments because strengthened detection and prevention should reduce waste and lower taxpayer costs.
Consumers enrolled in marketplace plans (including uninsured individuals seeking APTC) will get more accurate eligibility decisions, reducing the risk of later recoupment or penalties.
State governments and taxpayers gain greater transparency and oversight because annual GAO-framed assessments to Congress and the HHS Inspector General will highlight weaknesses and enable corrective action.
Taxpayers and marketplace enrollees could face increased financial liability if heightened scrutiny results in more determinations being reversed or APTCs being recouped.
Taxpayers and applicants (including uninsured individuals) may experience application delays or additional documentation burdens if verification controls are tightened.
Federal employees at HHS will face increased administrative workload and possible resource reallocation to prepare the required annual GAO-framed assessments.
Based on analysis of 2 sections of legislative text.
Requires HHS (with Treasury) to produce a GAO‑framework fraud risk assessment for advance premium tax credit and cost‑sharing determinations by Dec 31, 2025 and annually thereafter.
Requires HHS, working with the Treasury Secretary, to produce a fraud risk assessment of advance determinations for premium tax credits and cost‑sharing reductions under the Affordable Care Act by December 31, 2025 and then annually. The assessment must list all controls HHS uses to prevent fraud in advance premium tax credit claims, follow the GAO fraud‑risk framework, and be submitted to the HHS Inspector General and specified congressional committees.
Official title: Require the Secretary of Health and Human Services to complete fraud risk assessments of the advance premium tax credit, and for other purposes.
Introduced December 8, 2025 by Charles Ernest Grassley · Last progress December 8, 2025