Sponsors (12)
The bill expands short-term affordability and program-integrity measures for marketplace enrollees and adjusts MA payment accuracy, at the cost of higher federal outlays, added administrative complexity and compliance burdens for plans, brokers, and agencies, and some disruption to plan payments and middle‑income subsidy expectations.
Low- and moderate-income taxpayers and uninsured people would pay lower net marketplace premiums in 2026–2027 because the bill makes premium tax credits more generous, improving affordability and likely reducing uninsured rates and uncompensated care burdens on hospitals.
Consumers and IRS administrators get a clearer eligibility threshold (reinstating a 400% FPL cap for 2026–2027), which simplifies determination of subsidy eligibility for IRS administration.
Medicare beneficiaries would face more accurate Medicare Advantage (MA) payments and lower incentives for upcoding because the Secretary must evaluate coding differences and adjust payments to better reflect true clinical risk, which can reduce inappropriate utilization and overpayments.
All taxpayers may face higher federal spending and upward pressure on deficits because the more generous premium tax credits increase federal outlays for 2026–2027.
Households with incomes above 400% of the federal poverty level (who expected eligibility under a 600% interpretation) could lose subsidy eligibility and face higher net premiums if the 400% cap is enforced for 2026–2027.
The bill creates increased administrative complexity and transitional rules (different subsidy tables/thresholds and new verification/adjustment processes) that raise compliance costs and error risk for the IRS, plans, brokers, and taxpayers.
Based on analysis of 3 sections of legislative text.
Temporarily tightens premium-credit rules for 2026–27, changes Medicare Advantage risk-adjustment and diagnosis coding rules starting 2026, and adds civil/criminal penalties plus broker verification for Exchange enrollments.
Changes premium tax-credit rules for 2026–2027 to use a temporary premium percentage table and to substitute a 400% income cap in place of 600% for certain calculations. Updates Medicare Advantage risk-adjustment rules starting in 2026 to use two years of diagnostic data, forbid using diagnoses from chart reviews and health risk assessments for payments, and require CMS to evaluate and adjust for coding differences. Strengthens enforcement for agents and brokers who submit Exchange enrollment information by adding civil and criminal penalties and requiring a verification process for agent/broker-submitted enrollments by January 1, 2028.
Introduced November 10, 2025 by Sam T. Liccardo · Last progress November 10, 2025