The bill tightens consumer protections, fraud detection, and enrollment transparency in the Exchanges—helping vulnerable enrollees keep coverage—but raises compliance costs and substantial legal risk for agents, which could reduce available enrollment assistance and cause short-term disruptions.
Patients with chronic conditions and low-income consumers are more likely to keep coverage because the bill bars disenrollment without the consumer's consent and adds verification steps to reduce improper cancellations.
Low-income consumers gain stronger protection from fraudulent or negligent enrollment assistance because agents and brokers face steep civil and criminal penalties for providing false or negligent information.
Consumers (especially low-income individuals) get timelier notices, access to enrollment account history, and a hotline/website to review and cancel unauthorized enrollments, improving transparency and recourse.
Agents, brokers, and small producer businesses face large civil fines ($10k–$50k per individual) and possible criminal exposure (up to $200k), substantially increasing legal and financial risk to the producer workforce.
Vulnerable consumers could face temporary disruptions or reduced help enrolling if audits produce false positives or enforcement is applied aggressively, creating barriers to obtaining coverage.
Brokers and issuers may experience delayed income and cash-flow problems because verification and payment‑withholding rules can postpone commission payments until inconsistencies are resolved.
Based on analysis of 2 sections of legislative text.
Imposes per-individual civil fines ($10k–$50k) for negligent agent/broker errors and much larger civil ($≤$200k per person) and criminal penalties (up to 10 years) for knowing fraud in Exchange enrollments.
Adds new civil and criminal penalties for insurance agents and brokers who give incorrect or fraudulent Exchange enrollment or eligibility information. Negligent mistakes can trigger civil fines of $10,000–$50,000 per affected individual; knowingly false or fraudulent submissions can lead to civil fines up to $200,000 per individual and criminal penalties (fines and up to 10 years in prison). The bill also reorganizes and clarifies related statutory language and procedure references.
Introduced March 12, 2025 by Ronald Lee Wyden · Last progress March 12, 2025