To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes.
- Bill Number
- H.R. 6010
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-10: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-06-24T08:08:48Z
AI-Generated Summary
Purpose of the Legislation
This bill (H.R. 6010) aims to make health insurance more affordable and reliable by extending and adjusting financial help for premiums under the Affordable Care Act (ACA), improving how payments are calculated for Medicare Advantage plans (private alternatives to traditional Medicare), and strengthening rules to prevent fraud in ACA health plan enrollments.
Key Provisions
- Extension and Modification of Premium Tax Credits (Section 1):
- Temporarily changes the "premium percentages" (the share of income households pay for health insurance premiums after tax credits) for tax years 2026 and 2027.
- Applies a new table for household incomes up to 600% of the federal poverty line (FPL), with lower percentages for lower incomes (e.g., 0% initial and final for up to 150% FPL, rising gradually to 8.5% for 400-600% FPL).
- Extends eligibility for these enhanced credits (subsidies that reduce premium costs) beyond the current 400% FPL limit during this period.
- Improvements to Medicare Advantage Risk Adjustment (Section 2):
- Requires using two years of diagnostic data (health condition information) for calculating risk scores starting in 2026, when available, to better assess enrollee health needs.
- Excludes diagnoses (medical condition identifications) gathered from routine chart reviews or health risk assessments (questionnaires) to avoid inflating risk scores.
- Mandates evaluation of coding differences (how doctors record diagnoses) between Medicare Advantage plans and traditional Medicare Parts A and B, with public reporting and adjustments to ensure fair payments.
- Reducing Fraud in ACA Qualified Health Plan Enrollments (Section 3):
- Imposes new penalties on agents and brokers (insurance salespeople) for incorrect or fraudulent enrollment information:
- Civil penalties of $10,000–$50,000 per person for negligence.
- Civil penalties up to $200,000 per person for knowing fraud, with procedures similar to Social Security Act penalties.
- Criminal penalties including fines and up to 10 years in prison for willful fraud.
- Establishes a verification process for agent/broker-assisted enrollments in federally run ACA Exchanges (marketplaces) by January 1, 2028, including consent forms, delayed commission payments until issues are resolved, notifications to enrollees, online access to account info, and reporting of marketing organizations.
- Regulates "field marketing organizations" (groups that hire or contract with agents) and "third-party marketing organizations" (groups paid for leads or sales), requiring licensure, ethical standards (acting in enrollees' best interests), submission of marketing materials for review, and bans on misleading practices.
- Adds requirements for audits based on complaints or fraud patterns, sharing results with states, and providing lists of suspended/terminated agents to plans and Exchanges.
- Prioritizes keeping coverage continuous, even if violations occur, to protect enrollees.
Significant Changes to Existing Law
- Premium Tax Credits (Internal Revenue Code Section 36B): Extends enhanced subsidies set to expire after 2025, raises the income cap from 400% to 600% FPL temporarily, and lowers contribution rates for middle-income households (e.g., from 6.3–8.5% to as low as 0–8.5% depending on income tier).
- Medicare Advantage Risk Adjustment (Social Security Act Section 1853): Shifts from one year to two years of data for accuracy; bans certain diagnosis sources to curb overpayments; strengthens coding adjustments with mandatory evaluations, potentially reducing or refining the current 5.7% payment cut for coding differences.
- ACA Fraud Penalties and Oversight (Patient Protection and Affordable Care Act Sections 1311, 1312, 1411): Introduces specific penalties for agents/brokers (previously more general); adds verification and regulation for marketing entities not previously defined or overseen in detail; expands reporting and audit requirements, including issuer terminations.
Potential Impacts
- On Citizens: Low- and middle-income individuals (up to 600% FPL, roughly $80,000 for a family of four) could see reduced premium costs, making ACA marketplace plans more affordable. Medicare Advantage enrollees may benefit from fairer payments leading to stable or improved benefits. Enrollees gain protections against unauthorized changes or fraud, with easier access to account details and cancellation options.
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) and IRS face increased administrative burdens for verification processes, audits, data evaluations, and marketing reviews, potentially raising costs but improving program integrity. States operating ACA Exchanges may need to align with new criteria.
- On International Relations: No direct impacts, as the bill focuses on domestic health policy.
- Broader Effects: Could increase ACA enrollment and Medicare Advantage stability, but higher subsidies might raise federal spending (estimated in billions annually); fraud reductions could save taxpayer money lost to improper enrollments.
Main Stakeholders Affected
- Individuals and Families: Especially those buying ACA marketplace insurance or in Medicare Advantage, benefiting from affordability and anti-fraud measures.
- Health Insurers and Plans: Medicare Advantage providers gain from refined risk adjustments; ACA issuers face stricter agent oversight but reduced fraud risks.
- Agents, Brokers, and Marketing Organizations: Subject to new penalties, licensing, ethical duties, and audits, which could limit bad actors but increase compliance costs for legitimate ones.
- Government Entities: CMS (oversight and enforcement), IRS (tax credit administration), states (Exchange operations and insurance regulation), and the Department of Justice (criminal penalties).
- Consumer Advocates and Enrollees: Protected through verification, notifications, and continuity rules.
Notable Legal, Constitutional, or Political Implications
- Legal: Enhances enforcement under the ACA and Social Security Act without creating new courts or agencies; penalties align with existing civil and criminal frameworks (e.g., title 18 fines, Social Security procedures), reducing challenges. Definitions for terms like "chain of enrollment" and "marketing materials" clarify ambiguous areas, potentially aiding litigation.
- Constitutional: No apparent issues, as it involves congressional spending and regulation powers under the Commerce Clause; focuses on federal programs without infringing state rights excessively (states can opt into agent criteria).
- Political: Builds on ACA expansions (e.g., via the 2021 American Rescue Plan), appealing to supporters of affordable care but facing opposition from those favoring ACA repeal or deregulation. Temporary provisions (e.g., 2026–2027 subsidies) allow future Congresses flexibility; anti-fraud measures could garner bipartisan support by addressing waste in entitlement programs.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Liccardo, Sam T. [D-CA-16]
Cosponsors (12)
Rep. Kiley, Kevin [R-CA-3], Rep. Bacon, Don [R-NE-2], Rep. Goodlander, Maggie [D-NH-2], Rep. Ross, Deborah K. [D-NC-2], Rep. Lawler, Michael [R-NY-17], Rep. Nunn, Zachary [R-IA-3], Rep. Khanna, Ro [D-CA-17], Rep. Newhouse, Dan [R-WA-4], Rep. Gray, Adam [D-CA-13], Rep. Van Drew, Jefferson [R-NJ-2], Rep. Gonzalez, Vicente [D-TX-34], Rep. Gallagher, James [R-CA-1]
Recent Actions
- 2025-11-10: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-11-10: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-11-10: Introduced in House
- 2025-11-10: Introduced in House
Bill Versions
- To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes. — issued 2025-11-10 — PDF (20 pages)