Sponsors (6)
The bill strengthens consumer protections and enrollment integrity through strict penalties, oversight, and continuity safeguards, but does so at the cost of increased legal, financial, and administrative burdens on agents, brokers, and government agencies that could reduce in-person assistance and raise costs for taxpayers.
Uninsured individuals and current enrollees gain stronger protection from fraud and erroneous enrollments because the bill creates steep civil and criminal penalties for knowingly false or reckless submissions, deterring misconduct and protecting taxpayer funds.
State regulators and consumers benefit from tighter oversight because the bill requires agent/broker registration, audits, reporting of terminations, and marketing review to reduce misleading sales practices and improve enrollment integrity.
Patients—especially those with ongoing care needs—are less likely to suffer sudden interruptions in coverage because the bill bars disenrollment without an enrollee's consent, preserving continuity of care during enforcement actions.
Agents and brokers face large new financial and legal exposure—including per-applicant civil fines and potential criminal penalties—which could reduce agent participation, limit in-person enrollment help, and make it harder for some consumers to get assistance.
Agents and brokers will incur higher administrative burdens and cash-flow pressures because the bill requires documentation, registration, marketing pre-approval, and may delay commission payments, which could raise costs or reduce service availability for consumers.
State agencies and Exchanges will need to spend resources to implement verification, audits, registration systems, and databases, creating new administrative costs likely borne by state budgets and taxpayers.
Based on analysis of 2 sections of legislative text.
Imposes new civil ($10k–$50k negligent; up to $200k knowing fraud per person) and criminal (fines and up to 10 years) penalties on agents/brokers who provide incorrect or fraudulent Exchange enrollment information.
Official title: To amend the Patient Protection and Affordable Care Act to reduce fraudulent enrollments in qualified health plans, and for other purposes.
Introduced March 11, 2025 by Deborah K. Ross · Last progress March 11, 2025
Creates new civil and criminal penalties for agents and brokers who provide incorrect, false, or fraudulent information on applications for enrollment in Exchange-qualified health plans. It establishes a new negligence-based civil penalty ($10,000–$50,000 per affected individual), a higher civil penalty for knowing fraud (up to $200,000 per affected individual), and a criminal penalty (fines and up to 10 years imprisonment) while leaving existing criminal sanctions intact.