CommonGround for Affordable Health Care Act

Bill Number: H.R. 6575
Origin Chamber: House
Congress: 119th Congress, Session 1
Policy Area: Taxation
Status: Introduced
Latest Action: 2025-12-10: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, 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: 2026-04-22T20:10:05Z

AI-Generated Summary

Purpose of the Legislation

The "CommonGround for Affordable Health Care Act" (H.R. 6575) aims to make health insurance more affordable and accessible by extending and adjusting financial assistance for premiums, strengthening protections against fraud in health insurance marketplaces (called Exchanges under the Affordable Care Act, or ACA), extending the enrollment period for 2026, increasing transparency and accountability for pharmacy benefit managers (PBMs, which are companies that help manage prescription drug benefits for insurers), and creating a fast-track process in Congress for future reforms to premium assistance programs.

Key Provisions

Extension and Modification of Enhanced Premium Tax Credit (Section 2):

This extends temporary enhanced subsidies (financial help to lower monthly health insurance premiums) for one more year, through 2026. It adjusts eligibility and subsidy amounts based on household income as a percentage of the federal poverty line (a measure of low income used to determine aid). For example:

Subsidies cap premiums at 0% of income for those up to 150% of poverty (fully covered).
Caps rise gradually, reaching 10% for incomes up to 1,000% of poverty (previously capped at 400%).

These changes apply to tax years starting after December 31, 2025.

Guardrails to Prevent Fraud in Exchanges (Section 3):
Imposes new civil penalties ($10,000–$50,000 per case for negligence; up to $200,000 for knowing fraud) and criminal penalties (fines and up to 10 years in prison) on agents and brokers who provide false information during enrollment.
Requires verification processes for broker-assisted enrollments in federally run Exchanges, including proof of consumer consent, delayed commission payments until issues are resolved, and notifications to consumers about changes.
Regulates "field marketing organizations" (groups that employ or contract with agents/brokers for enrollment) and "third-party marketing organizations" (entities paid for lead generation or sales), requiring licensing, transparent marketing materials, and reporting of terminations.
Mandates quarterly checks against the Death Master File (a government database of deceased persons) to remove dead individuals from plans and stop improper payments.
Allows Exchanges to notify enrollees of their exact premium tax credit amount before enrollment starts in 2027.
Establishes audits based on complaints or fraud patterns, and creates a list of suspended/terminated agents shared with plans and states.

Extended Open Enrollment Period for 2026 (Section 4):

Extends the annual sign-up window for health plans through Exchanges from the usual January 15 end date to March 19, 2026. The Department of Health and Human Services (HHS) must conduct outreach to inform eligible people.

Modernizing and Ensuring PBM Accountability (Section 5):

Applies to Medicare Part D (prescription drug coverage for seniors) and Medicare Advantage plans with drug coverage, starting in 2029:

PBMs can only receive "bona fide service fees" (fair-market-value payments for actual services, not tied to drug prices or sales volume); they must disgorge (return) any improper payments.
Requires annual detailed reports to plans and HHS on drug dispensing, costs, rebates (manufacturer discounts), out-of-pocket spending, and affiliations (e.g., if a PBM owns pharmacies). Reports must justify favoring brand-name drugs over generics or biosimilars (lower-cost alternatives).
Allows plans to audit PBMs yearly, with access to records.
Bans retaliation against those reporting violations and requires certifications of compliance.
Funds implementation with $113 million for HHS and $20 million for its Inspector General; also appropriates $1 million for related studies.
Directs a Government Accountability Office (GAO) study on price-based compensation in the drug supply chain (due in 2 years) and Medicare Payment Advisory Commission (MedPAC) reports on PBM agreements (initial in ~2 years, final ~4 years).

Expedited Consideration of Future Reform Bills (Section 6):

Creates a fast-track process for "enhanced premium tax credit reform bills" (bills with at least 10 bipartisan cosponsors focused on premium subsidies). Committees must report bills within 5 days; floor votes occur quickly (within 3–5 days in House, similar in Senate). No amendments allowed; aims for final passage by July 1, 2026. This is a congressional rule change, applicable only to these bills.

Significant Changes to Existing Law

Premium Tax Credits (Internal Revenue Code Section 36B): Previously set to expire after 2025, now extended to 2026 with expanded eligibility (up to 1,000% of poverty vs. 400%) and a new sliding scale of premium caps (e.g., 8.5% for 400–600% of poverty, adding tiers up to 1,000%). Removes automatic adjustments based on silver plan premiums for 2026.
ACA Fraud Protections (Sections 1311, 1312, 1411): Adds specific penalties and verification for agents/brokers (previously general); introduces regulation of marketing organizations (not previously detailed); mandates Death Master File checks (expands existing anti-fraud tools); lowers proof standard for terminating bad actors in federal Exchanges to "preponderance of evidence" (more than 50% likelihood, easier than "beyond reasonable doubt").
Medicare Part D PBM Rules (Social Security Act Sections 1860D-12, 1857): New subsection requires PBMs to limit income sources, provide exhaustive transparency (e.g., on generics/biosimilars, affiliate dealings), and face audits—far beyond current disclosure rules. Exempts from Paperwork Reduction Act for faster rollout; clarifies rebates/discounts if passed through fully.
Enrollment Regulations (45 CFR 155.410): One-time extension for 2026; no permanent change.
Congressional Procedures: New expedited path overrides usual committee/floor rules for specific bipartisan bills, treating them as privileged.

Potential Impacts

On Citizens: Could lower premiums for middle- and upper-middle-income households (e.g., families earning up to ~$300,000 qualify for some aid in 2026), reduce fraud-related enrollment errors or unauthorized changes, and protect Medicare beneficiaries from opaque PBM practices that might inflate drug costs. Extended enrollment gives more time to shop, potentially increasing coverage. However, PBM changes might indirectly affect drug prices/co-pays starting 2029.
On Government Agencies: HHS and IRS gain enforcement tools (e.g., audits, databases) but face implementation costs (covered by appropriations); increased reporting/oversight workload. Centers for Medicare & Medicaid Services (CMS) must develop formats and processes by 2028. GAO/MedPAC studies inform future policy. No direct international relations impacts, as this is domestic health policy.
Broader Effects: May reduce improper payments (e.g., to deceased enrollees) and boost Exchange enrollment; PBM reforms could lower Medicare spending on drugs long-term but require upfront investments.

Main Stakeholders Affected

Individuals and Families: Exchange users (especially those with incomes 400–1,000% of poverty) benefit from extended subsidies and fraud protections; Medicare Part D enrollees gain from PBM transparency.
Health Insurers and Plans: Must adapt to verification, notifications, and PBM reporting; federally run Exchanges (in 30+ states) face new operational requirements.
Agents, Brokers, and Marketing Organizations: Subject to stricter licensing, penalties, audits, and consent rules; risk termination for violations.
Pharmacy Benefit Managers (PBMs): Major compliance burden with reporting, audits, and remuneration limits; largest (e.g., CVS Caremark, Express Scripts) most impacted.
Drug Manufacturers, Pharmacies, and Wholesalers: Affected by PBM disclosures on rebates, generics/biosimilars, and supply chain studies; potential shifts in negotiations.
Government Entities: HHS/CMS (oversight/enforcement), IRS (tax credits), states (Exchange operations), and Congress (fast-track process).

Notable Legal, Constitutional, or Political Implications

Legal: Strengthens civil/criminal enforcement against fraud (e.g., tying penalties to Social Security Act procedures for consistency); ensures consumer consent prioritizes coverage continuity, aligning with ACA's consumer protection goals. PBM rules include anti-retaliation protections and confidentiality safeguards to encourage reporting without legal risks.
Constitutional: Falls within Congress's powers to tax/regulate interstate commerce (health insurance/drugs) and spend on welfare (Medicare subsidies); no apparent free speech or due process issues, as regulations target fraud/misrepresentation.
Political: Bipartisan introduction (30+ cosponsors from both parties) signals compromise on ACA enhancements amid expiration pressures. Fast-track provision could streamline reforms but limits debate/amendments, potentially controversial as a rules change favoring specific bills; expires implicitly after 2026 deadline.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Kiggans, Jennifer A. [R-VA-2]

Cosponsors (38)

Rep. Gottheimer, Josh [D-NJ-5], Rep. Lawler, Michael [R-NY-17], Rep. Cuellar, Henry [D-TX-28], Rep. Bresnahan, Robert P. [R-PA-8], Rep. Suozzi, Thomas R. [D-NY-3], Rep. Mackenzie, Ryan [R-PA-7], Rep. Lee, Susie [D-NV-3], Rep. Salazar, Maria Elvira [R-FL-27], Rep. Landsman, Greg [D-OH-1], Rep. Van Drew, Jefferson [R-NJ-2], Rep. Case, Ed [D-HI-1], Rep. Ciscomani, Juan [R-AZ-6], Rep. Costa, Jim [D-CA-21], Rep. Valadao, David G. [R-CA-22], Rep. Riley, Josh [D-NY-19], Rep. Hurd, Jeff [R-CO-3], Rep. Scholten, Hillary J. [D-MI-3], Rep. Bacon, Don [R-NE-2], Rep. Wilson, Frederica S. [D-FL-24], Rep. Gimenez, Carlos A. [R-FL-28], Rep. Goodlander, Maggie [D-NH-2], Rep. De La Cruz, Monica [R-TX-15], Rep. Soto, Darren [D-FL-9], Rep. LaLota, Nick [R-NY-1], Rep. Gray, Adam [D-CA-13], Rep. Kiley, Kevin [R-CA-3], Rep. Gonzalez, Vicente [D-TX-34], Rep. Kean, Thomas H. [R-NJ-7], Rep. Figures, Shomari [D-AL-2], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Pappas, Chris [D-NH-1], Rep. Liccardo, Sam T. [D-CA-16], Rep. Davis, Donald G. [D-NC-1], Rep. Moskowitz, Jared [D-FL-23], Rep. Panetta, Jimmy [D-CA-19], Rep. Peters, Scott H. [D-CA-50], Rep. Golden, Jared F. [D-ME-2], Rep. Perez, Marie Gluesenkamp [D-WA-3]

Recent Actions

2025-12-10: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, 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.
2025-12-10: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, 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.
2025-12-10: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Rules, 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.
2025-12-10: Introduced in House
2025-12-10: Introduced in House

Bill Versions

CommonGround for Affordable Health Care Act — issued 2025-12-10 — PDF (66 pages)