Providing for consideration of the bill (H.R. 185) to advance responsible policies.
- Bill Number
- H.Res. 902
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Congress
- Status
- Introduced
- Latest Action
- 2025-11-20: Referred to the House Committee on Rules.
- Last Updated
- 2026-04-22T20:09:51Z
AI-Generated Summary
Purpose of the Legislation
The Bipartisan Healthcare Optimization, Protection, and Extension Act (HOPE Act) aims to extend and refine aspects of the Affordable Care Act (ACA) by enhancing financial assistance for health insurance premiums, strengthening safeguards against fraud in health insurance marketplaces (called Exchanges), and adjusting enrollment timelines to improve access and integrity in the system.
Key Provisions
- Extension of Premium Tax Credits: Extends enhanced premium tax credits (subsidies that reduce the cost of health insurance premiums for eligible individuals) through 2027. It modifies eligibility to cover household incomes up to 935% of the federal poverty level (a measure of economic need based on family size and location) and introduces a new sliding scale of required premium contributions based on income tiers, starting at 0% for lower incomes and rising gradually.
- Fraud Prevention Measures:
- Imposes civil penalties ($10,000–$50,000 for negligence, up to $200,000 for knowing violations) and criminal penalties (fines and up to 10 years in prison) on agents, brokers, and marketing organizations for providing false information during enrollment in Exchange plans.
- Requires verification processes for agent/broker-assisted enrollments in federally operated Exchanges, including consent documentation, delayed commission payments until issues are resolved, notifications to consumers, and access to account information.
- Mandates regulation of field marketing organizations (entities that employ or contract with agents for enrollment activities) and third-party marketing organizations (entities paid for lead generation or sales), including licensing, marketing material reviews, and bans on misleading practices.
- Establishes audits based on complaints or fraud patterns, shares results with states, and creates a list of suspended or terminated agents/brokers.
- Requires quarterly checks against the Death Master File (a government database of deceased persons) to remove deceased individuals from Exchange plans.
- Sets a "preponderance of the evidence" standard (meaning more likely than not) for terminating agent/broker agreements in federal Exchanges.
- Obligates Exchanges to notify individuals of their premium tax credit amount before enrollment starting in 2027.
- Extended Open Enrollment: Lengthens the 2026 open enrollment period for Exchanges from the usual dates to November 1, 2025, through May 15, 2026, allowing more time for people to sign up or change plans.
Significant Changes to Existing Law
- Premium Tax Credits: Previously set to expire after 2025 under the American Rescue Plan Act, these are now extended to 2027 with expanded income eligibility (from 400% to 935% of poverty level) and a revised contribution table that reduces out-of-pocket premium costs for middle-income households (e.g., 8.5% cap for 300–600% of poverty level, versus higher rates before).
- Fraud and Oversight: Adds specific penalties and verification rules for agents/brokers not previously detailed in the ACA (Patient Protection and Affordable Care Act of 2010). Introduces new definitions (e.g., "chain of enrollment" for the full process from marketing to signup) and regulatory criteria for marketing organizations, which were previously unregulated at the federal level. Also formalizes death file checks and consumer notifications, building on but expanding existing ACA verification requirements.
- Enrollment Period: Alters federal regulations to extend the 2026 period beyond the standard November 1–January 15 window, providing flexibility not present in prior rules.
These changes apply to taxable years after December 31, 2025, and plan years starting no later than 2029 for some provisions.
Potential Impacts
- On Government Agencies: The Department of Health and Human Services (HHS) and Internal Revenue Service (IRS) will face increased administrative burdens, including implementing verification systems, conducting audits, regulating marketing entities, and processing extended enrollments. This could raise costs for oversight but reduce long-term fraud losses (estimated in billions annually from improper enrollments).
- On Citizens: Low- and middle-income individuals (up to 935% of poverty) may see lower premium costs, potentially increasing enrollment in Exchange plans and improving health coverage access. Consumers gain protections against unauthorized changes or fraud, with easier ways to monitor accounts and cancel issues. However, longer enrollment periods might delay plan changes for some.
- On International Relations: No direct impacts, as this is domestic healthcare policy.
Main Stakeholders Affected
- Individuals and Families: Especially those relying on Marketplace insurance, including subsidized buyers, who benefit from extended aid and fraud protections but may encounter stricter enrollment verifications.
- Agents, Brokers, and Marketing Organizations: Face new compliance requirements, penalties, and potential terminations, which could disrupt operations but promote ethical practices.
- Health Insurers and Exchanges: Must integrate verification tools, handle delayed commissions, and adjust to extended enrollment; issuers also report terminations.
- States: Involved in regulating agents and receiving audit referrals; states operating their own Exchanges may adopt similar rules.
- Federal Agencies (HHS, IRS): Responsible for enforcement, audits, and system updates.
Notable Legal, Constitutional, or Political Implications
- Legal: Enhances ACA enforcement without altering its core structure, using existing tax code and ACA sections. New penalties align with federal fraud laws (e.g., referencing Social Security Act procedures), but could face challenges if seen as overly burdensome on private actors. The "preponderance of evidence" standard lowers the bar for federal terminations compared to criminal "beyond reasonable doubt," potentially streamlining oversight.
- Constitutional: No apparent issues, as it involves congressional authority over taxation, interstate commerce (health insurance), and spending; it does not infringe on free speech (marketing rules target deception) or due process (procedures for penalties mirror established laws).
- Political: Bipartisan sponsorship signals cross-aisle support for ACA tweaks amid debates on affordability and waste. Extending subsidies continues post-pandemic relief but sets a 2027 expiration, possibly fueling future reform discussions. Fraud focus addresses criticisms of Marketplace vulnerabilities, potentially reducing partisan attacks on the ACA.
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 (1)
Recent Actions
- 2025-11-20: Referred to the House Committee on Rules.
- 2025-11-20: Submitted in House
- 2025-11-20: Submitted in House
Bill Versions
- Providing for consideration of the bill (H.R. 185) to advance responsible policies. — issued 2025-11-20 — PDF (23 pages)