ENROLL Act of 2025
- Bill Number
- H.R. 3907
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-06-11: Referred to the House Committee on Energy and Commerce.
- Last Updated
- 2025-12-05T06:26:21Z
AI-Generated Summary
Purpose
The ENROLL Act of 2025 aims to strengthen the navigator program under the Affordable Care Act (ACA) by improving grant selection, expanding navigator duties, ensuring stable funding, and enhancing in-person assistance. Navigators are trained helpers who assist people in understanding and enrolling in health insurance options through Health Insurance Marketplaces (also called Exchanges).
Key Provisions
- Grant Selection for Federally-Facilitated Exchanges: When the federal government runs an Exchange in a state (due to the state not operating its own), grants must be awarded based on an entity's ability to perform required duties. Selection cannot consider whether the entity provides information about employer-sponsored group health plans that are not qualified health plans (QHPs, which are ACA-approved individual or small-group plans sold on Exchanges). At least one grant per year must go to a community- and consumer-focused nonprofit group.
- Expanded Duties of Navigators:
- Provide information on QHPs, as well as Medicaid (a joint federal-state program for low-income individuals) and the Children's Health Insurance Program (CHIP, which covers uninsured children in families with incomes too high for Medicaid).
- Conduct public education activities in simple, everyday language to raise awareness of QHP requirements and consumer protections (e.g., rules ensuring fair treatment by insurers).
- Perform these duties at any time during the year, not just during open enrollment periods.
- Eligibility and Operational Requirements: Navigators must maintain a physical office or presence in the state to offer in-person help to consumers. The bill adjusts conflict-of-interest rules, potentially allowing more types of organizations (like certain nonprofits) to serve as navigators while prohibiting direct ties to health insurance sellers.
- Funding: For Exchanges run by the federal government (via the Department of Health and Human Services, or HHS), $100 million must be allocated annually starting in fiscal year 2026 from fees paid by participating health insurers. This funding remains available until spent.
The changes apply to health plan years starting on or after January 1, 2026.
Significant Changes to Existing Law
- Selection and Inclusivity: Previously, grant awards had fewer mandates for nonprofits or capacity-based criteria; now, federally-run Exchanges must prioritize capable entities and include at least one nonprofit annually, reducing potential bias toward for-profit groups.
- Scope of Assistance: Navigators' duties previously focused mainly on QHPs; the bill broadens this to include Medicaid and CHIP, and adds ongoing public education, with flexibility to operate year-round instead of being limited to enrollment seasons.
- Operational Rules: Adds a requirement for in-person presence, which was not explicitly mandated before. It also modifies conflict-of-interest prohibitions (e.g., by rephrasing rules to potentially broaden eligible navigator types while barring insurer affiliations).
- Funding Stability: Introduces a dedicated $100 million annual pot for federal Exchanges, sourced from insurer user fees—a new commitment not in prior law, which relied more on variable appropriations.
Potential Impacts
- On Government Agencies: HHS will need to manage increased funding and oversight for federally-run Exchanges (covering about 30 states), potentially straining administrative resources but improving program efficiency. State-run Exchanges may see indirect benefits through aligned standards.
- On Citizens: Low-income and underserved individuals, including families eligible for Medicaid or CHIP, could gain easier access to enrollment help and education, reducing confusion and uninsured rates. In-person assistance may particularly benefit older adults, rural residents, or those without reliable internet.
- On International Relations: No direct impacts, as the bill focuses on domestic health policy.
Main Stakeholders Affected
- Consumers and Enrollees: Individuals shopping for or enrolling in health coverage, especially in federally-run states and those eligible for public programs like Medicaid/CHIP.
- Navigator Organizations: Nonprofits, community groups, and other entities providing assistance; they gain funding opportunities and clearer duties but must meet new in-state presence rules.
- Health Insurance Issuers: Insurers pay into the funding pool via user fees and may face more informed consumers due to expanded education efforts.
- Government Entities: HHS (federal oversight) and state agencies (for Medicaid/CHIP coordination); nonprofits focused on health equity benefit from mandated grant inclusion.
Notable Legal, Constitutional, or Political Implications
- Legal: Reinforces the ACA's navigator framework without altering core Marketplace operations, ensuring compliance with federal grant rules. The funding mechanism (user fees) avoids new taxpayer spending, potentially sidestepping budget disputes.
- Constitutional: No major challenges; it aligns with Congress's authority under the Commerce Clause to regulate interstate health insurance and spending power for public programs like Medicaid.
- Political: Could enhance ACA accessibility in Republican-led states with federal Exchanges, promoting bipartisan health access goals. Mandating nonprofit involvement may appeal to advocates for equity but could spark debate over funding levels or insurer fee burdens.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Recent Actions
- 2025-06-11: Referred to the House Committee on Energy and Commerce.
- 2025-06-11: Introduced in House
- 2025-06-11: Introduced in House
Bill Versions
- Expand Navigators’ Resources for Outreach, Learning, and Longevity Act of 2025 — issued 2025-06-11 — PDF (5 pages)