Sponsors (13)
The bill expands and clarifies short-term premium subsidies and strengthens program integrity (including Medicare Advantage payment accuracy and broker oversight) to make coverage more affordable and reliable for many, but it raises federal costs, adds administrative complexity and compliance burdens, and risks higher premiums or reduced coverage for some households, plans, and providers.
Low- and moderate-income taxpayers will pay lower net premiums in 2026–2027 because the bill temporarily raises premium subsidies, improving marketplace affordability and reducing out-of-pocket costs for those families.
Improved marketplace affordability should reduce the number of uninsured people and lower uncompensated care burdens on hospitals and communities, easing strain on local health systems.
Medicare Advantage payments are likely to better reflect true patient risk and discourage upcoding—using two years of diagnostic data and required evaluations should produce fairer, more stable payments and reduce inappropriate plan-driven utilization.
Federal spending will increase in 2026–2027 to cover larger premium tax credit outlays, creating upward pressure on the budget and potentially on deficits paid for by taxpayers.
Some households above 400% of the federal poverty level who expected subsidies under a 600% interpretation could lose eligibility and face substantially higher premiums, hitting middle-class families.
Temporary/complex rule changes and new verification/adjustment processes increase administrative complexity for the IRS, Exchanges, plans, agents/brokers, and beneficiaries, raising compliance costs and the risk of errors on returns or enrollments.
Based on analysis of 3 sections of legislative text.
Temporarily tightens premium tax credit rules for 2026–2027, revises Medicare Advantage coding/payment rules starting 2026, and creates new penalties and verification requirements for Exchange agents/brokers.
Changes marketplace premium tax credit rules for 2026–2027, tightens Medicare Advantage risk-adjustment coding and payments starting in 2026, and creates new civil and criminal penalties plus verification requirements for agents or brokers who submit incorrect Exchange enrollment information. The bill phases in tax-code changes for taxable years beginning after Dec 31, 2025, requires new Medicare Advantage coding rules and reporting beginning 2026, and directs the Secretary to establish agent/broker verification processes by Jan 1, 2028.
Official title: To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes.
Introduced November 10, 2025 by Sam T. Liccardo · Last progress November 10, 2025