To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes.
Sponsored By: Representative Liccardo
Introduced
Summary
A temporary, income-based premium tax credit would be added for 2026–2027 while Medicare Advantage risk adjustment and enrollment rules for marketplace plans would be tightened to cut fraud and improve payments.
Show full summary
- Families and households: The bill would replace the current premium tax credit table with a six-tier, income-based schedule tied to the federal poverty line. It would set premium percentages from 0.0% up to 8.5% for households up to 600% of poverty for taxable years beginning after December 31, 2025 and before January 1, 2028.
- Medicare Advantage plans and providers: Risk adjustment would require two years of diagnostic data when available for 2026 and later. The bill would exclude chart-review and health risk assessment diagnoses from payment adjustments and require the Secretary to study and publicly report coding-pattern differences and fully account for them in adjustments.
- Consumers, agents, and brokers: The bill would create new verification rules and an audit regime for agent- and broker-assisted enrollments, expand state and federal oversight of Field Marketing Organizations and third-party marketers, and raise penalties for bad actors to civil fines ($10,000–$50,000 for negligence, up to $200,000 for knowing violations) and criminal penalties including fines and up to 10 years imprisonment.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 2 benefits, 0 costs, 1 mixed.
Bigger marketplace premium credits, 2026–2027
If enacted, for tax years 2026 and 2027 the premium tax credit would use a new six‑tier table tied to your income as a share of the federal poverty level. You would pay 0% of the benchmark premium up to 150% of poverty. From 150%–200% it would be 0% to 2%; 200%–250%: 2% to 4%; 250%–300%: 4% to 6%; 300%–400%: 6% to up to 8.5%; and 400%–600%: 8.5%. People with incomes up to 600% of poverty could qualify during this period. This would lower monthly premiums for many marketplace shoppers.
Stronger checks on marketplace enrollments
For plan years starting on a date the Secretary sets, but no later than January 1, 2028, federal marketplaces would add new checks for agent‑ and broker‑assisted enrollments. Agents and brokers would need proof of your consent, report marketers they use, and send clear, timely notices of changes. Commissions could be paid only after you fix any data inconsistencies. The government would run audits, share lists of suspended or terminated agents with plans and States, and let States set and enforce minimum standards for FMOs and TPMOs. Penalties could include $10,000–$50,000 per person for negligent errors, up to $200,000 per person for knowing violations, and criminal fines or up to 10 years in prison.
Medicare Advantage coding and payment checks
Starting in 2026, Medicare would use two years of diagnostic data, when available, to set Medicare Advantage payments. The agency would not count diagnoses taken only from chart reviews or health risk assessments when adjusting payments. Each year, it would study and publicly report coding differences and adjust payments to fully account for them, which could include plan‑level adjustments. These steps could change plan payments and may affect plan options or costs for enrollees.
Sponsors & CoSponsors
Sponsor
Liccardo
CA • D
Cosponsors
Kiley (CA)
CA • R
Sponsored 11/10/2025
Bacon
NE • R
Sponsored 11/10/2025
Goodlander
NH • D
Sponsored 11/10/2025
Ross
NC • D
Sponsored 11/10/2025
Lawler
NY • R
Sponsored 11/25/2025
Nunn (IA)
IA • R
Sponsored 11/25/2025
Khanna
CA • D
Sponsored 12/1/2025
Newhouse
WA • R
Sponsored 12/2/2025
Gray
CA • D
Sponsored 12/2/2025
Van Drew
NJ • R
Sponsored 12/5/2025
Gonzalez, V.
TX • D
Sponsored 12/5/2025
Roll Call Votes
No roll call votes available for this bill.
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