Sponsors (12)
The bill tightens protections and oversight to reduce improper enrollments and protect consumers, but does so by imposing substantial penalties, verification rules, and compliance burdens that raise legal/financial risks and could reduce or delay enrollment assistance for consumers.
Low‑income consumers and people with chronic conditions gain stronger protection from fraudulent or negligent enrollment assistance because agents/brokers face steep civil and criminal penalties and exchanges gain greater oversight and audit authority to detect and deter abuse.
Consumers receive better continuity of coverage: verification/registration rules aim to reduce improper enrollments and the bill prohibits disenrollment without consumer consent, lowering risk of unintended loss of coverage.
Individuals get improved transparency and recourse—timelier notices, access to account history, and a hotline/website to review enrollments and cancel unauthorized activity—which makes it easier to spot and correct improper enrollments.
Agents, brokers, and small producer entities face large per‑person civil fines and potential criminal exposure (including penalties up to $200k), substantially increasing legal and financial risk for the producer workforce and potentially reducing available assistance.
Aggressive enforcement or audit false positives could temporarily disrupt enrollments or create barriers to consumer assistance, risking delays or gaps in coverage for low‑income individuals and people with chronic conditions.
Verification and payment‑withholding rules can delay agents' commissions and cash flow (and slow issuers' commission processing) while alleged inconsistencies are resolved, creating short‑term financial strain on producers.
Based on analysis of 2 sections of legislative text.
Imposes per-person civil fines for negligent misinformation ($10K–$50K), larger civil fines (up to $200K per person), and criminal penalties (up to 10 years) for fraudulent Exchange enrollment assistance.
Creates new civil and criminal penalties for insurance agents and brokers who give wrong or fraudulent information related to Health Insurance Marketplace (Exchange) enrollments. It adds per-person civil fines for negligent misinformation and much larger civil and criminal penalties when false information is provided knowingly and willfully. Reorganizes and renames parts of the existing statutory paragraph to add definitions and procedural placement for these penalties, and ties civil-penalty procedures to existing Social Security Act enforcement provisions.
Official title: Amend the Patient Protection and Affordable Care Act to reduce fraudulent enrollments in qualified health plans, and for other purposes.
Introduced March 12, 2025 by Ronald Lee Wyden · Last progress March 12, 2025