Care Over Profits Act of 2026
Sponsored By: Representative Barrett
Introduced
Summary
Would raise the medical loss ratio to 85% for small group and individual market plans so more premium dollars go to medical care and quality. It would also create steep civil and criminal penalties for agents and brokers who submit false or negligent enrollment information for Exchange plans.
Show full summary
- Families and consumers: More of each premium dollar would be required to go toward medical care and quality improvement, which could change how insurers allocate spending.
- Insurers and plans: Small group and individual market plans would face an 85% minimum medical loss ratio for plan years beginning January 1, 2026.
- Agents and brokers: New enforcement rules would allow civil penalties up to $200,000 per application and criminal penalties including fines or up to 10 years in prison for knowing and willful false enrollment information.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Stronger penalties for marketplace brokers
If enacted, agents and brokers who give false or fraudulent information on applications for marketplace health plans would face new civil and criminal penalties. Negligent or disregard-based errors would carry civil fines of $10,000 to $50,000 per affected application. Knowing and willful false information could bring civil fines up to $200,000 per person and enforcement under procedures like section 1128A. Knowing and willful fraud could also lead to fines under title 18, up to 10 years in prison, or both. These rules would apply to enrollments for plan years that begin on or after January 1, 2027.
Higher medical-loss rule for plans
If enacted, insurers selling small-group and individual market plans would have to spend at least 85% of premiums on medical care and quality improvement. That raises the minimum from 80% to 85%. The change would apply to plan years that begin on or after January 1, 2026. Small employers and people who buy their own coverage would be affected.
Sponsors & CoSponsors
Sponsor
Barrett
MI • R
Cosponsors
Riley (NY)
NY • D
Sponsored 3/9/2026
Roll Call Votes
No roll call votes available for this bill.
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