HOPE Act
- Bill Number
- H.R. 6232
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-20: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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
- 2026-04-22T20:10:06Z
AI-Generated Summary
Purpose of the Legislation
The Bipartisan Healthcare Optimization, Protection, and Extension Act (HOPE Act) aims to extend and adjust the enhanced premium tax credit (a financial help for buying health insurance) beyond its current expiration, while adding safeguards against fraud in health insurance marketplaces (called Exchanges) established under the Affordable Care Act (ACA). It also extends the signup period for health plans in 2026 to give people more time to enroll.
Key Provisions
- Extension and Modification of Premium Tax Credit (Section 2):
- Extends the enhanced premium tax credit through the end of 2027 for people buying insurance through Exchanges.
- Adjusts how much people pay for premiums based on their income as a percentage of the federal poverty line (FPL, a measure of low income used to determine eligibility for aid).
- Allows credits for households with incomes up to 935% of FPL (about $140,000 for a family of four in 2025), up from the current 400% limit.
- Sets new sliding-scale premium costs: for example, 0% for incomes up to 200% FPL, rising to 9.35% for 800-935% FPL.
- Fraud Prevention in Exchanges (Section 3):
- Penalties for Agents and Brokers: Imposes civil fines ($10,000–$50,000 for negligent errors; up to $200,000 for knowing fraud) and criminal penalties (fines and up to 10 years in prison) on insurance agents or brokers who provide false information during enrollment.
- Verification Process: For federally run Exchanges, requires agents/brokers to prove they have the person's consent for enrollments or changes starting no later than 2029; delays commission payments until issues are fixed; ensures notifications to individuals about changes.
- Regulation of Marketing Groups: Defines and regulates "field marketing organizations" (groups that hire agents) and "third-party marketing organizations" (groups that generate leads or handle sales); requires licensing, truthful marketing, and reporting of terminations.
- Audits and Oversight: Mandates periodic audits of agents/brokers based on complaints or fraud patterns; shares results with states; creates a list of suspended or terminated agents.
- Removal of Deceased Enrollees: Requires quarterly checks against the government's Death Master File to remove deceased people from plans within 90 days.
- Notifications: Exchanges must inform people of their premium tax credit amount before enrollment starting in 2027; lowers the proof needed to terminate bad agents (from "clear evidence" to "more likely than not").
- Extended Enrollment Period (Section 4):
- For 2026 coverage, shifts the annual open enrollment from January 15 to May 15, 2026 (starting November 1, 2025), giving an extra four months to sign up.
Significant Changes to Existing Law
- Premium Tax Credit (Internal Revenue Code Section 36B): Previously set to expire after 2025 with aid limited to 400% FPL and fixed premium percentages; now extends to 2027, expands eligibility to 935% FPL, and introduces a new income-based table for premium shares, ignoring inflation adjustments during this period.
- ACA Exchange Rules (Sections 1311, 1312, 1411, 1412): Adds specific fraud penalties and consent requirements not previously detailed; introduces definitions and criteria for marketing organizations; mandates death file checks and agent audits, which were optional or absent; eases termination standards for federal Exchanges and requires credit notifications.
- These changes build on temporary COVID-era enhancements to the tax credit (from the 2021 American Rescue Plan) by making them semi-permanent while adding anti-fraud measures absent in prior law.
Potential Impacts
- On Citizens: Low- and middle-income individuals (up to about $140,000 for a family) could save more on premiums, making insurance more affordable and encouraging enrollment; extended 2026 signup period aids those who miss the usual deadline; stronger fraud protections reduce risks of unauthorized enrollments or scams, improving trust in the system.
- On Government Agencies: The Department of Health and Human Services (HHS) gains new duties for verifications, audits, databases, and regulations by 2029, increasing administrative workload and costs; the IRS handles expanded tax credit claims; states with their own Exchanges may need to align with federal criteria, potentially raising oversight expenses.
- On International Relations: No direct impacts, as the bill focuses on domestic health insurance.
Main Stakeholders Affected
- Individuals and Families: Primary beneficiaries of extended tax credits and fraud protections; those using agents/brokers for enrollment face stricter consent rules.
- Insurance Agents, Brokers, and Marketing Organizations: Subject to new licensing, reporting, audits, and penalties; must prove best-interest actions and submit materials for review.
- Health Insurance Issuers and Exchanges: Required to access agent lists, handle delayed commissions, and report terminations; federally run Exchanges (in 30+ states) bear most new verification burdens.
- Federal and State Governments: HHS and IRS implement and enforce changes; states gain tools for oversight but may incur coordination costs.
- Taxpayers: Fund expanded credits through federal spending, estimated to increase subsidies without offsetting revenue.
Notable Legal, Constitutional, or Political Implications
- Legal: Enhances enforcement by specifying penalties and procedures, potentially reducing fraud lawsuits; aligns with existing ACA anti-fraud tools (e.g., Social Security Act procedures) but adds criminal elements under U.S. Code Title 18; the "preponderance of evidence" standard for terminations simplifies due process compared to higher bars in some regulations.
- Constitutional: No major challenges apparent; supports equal protection by expanding aid access without discriminating; fraud measures respect due process via audits and appeals.
- Political: Bipartisan sponsorship signals cross-party effort to stabilize ACA Exchanges amid expiring subsidies; could reduce uninsured rates but faces debate over costs (no funding mechanism specified) and broker regulations, which might limit industry flexibility.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Suozzi, Thomas R. [D-NY-3]
Cosponsors (9)
Rep. Bacon, Don [R-NE-2], Rep. Gottheimer, Josh [D-NJ-5], Rep. Hurd, Jeff [R-CO-3], Rep. Lawler, Michael [R-NY-17], Rep. Liccardo, Sam T. [D-CA-16], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Cuellar, Henry [D-TX-28], Rep. Soto, Darren [D-FL-9], Rep. Gonzalez, Vicente [D-TX-34]
Recent Actions
- 2025-11-20: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
- 2025-11-20: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
- 2025-11-20: Introduced in House
- 2025-11-20: Introduced in House
Bill Versions
- Bipartisan Healthcare Optimization, Protection, and Extension Act — issued 2025-11-20 — PDF (22 pages)