Restoring Patient Protections and Affordability Act of 2025
Sponsored By: Senator Sen. Blunt Rochester, Lisa [D-DE]
Introduced
Summary
Expanded, longer-lasting premium subsidies and stronger enrollment protections. The bill extends enhanced premium tax credits and tightens enrollment and notice rules while restoring navigator funding and adding new special enrollment paths.
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- Families and enrollees: Extends enhanced premium tax credits for higher-income households through 2029 and repeals the rule that disallowed credits for certain special enrollments for plan years beginning after Dec 31, 2025.
- Exchanges and navigators: Extends the 2026 open enrollment period through May 1, 2026 and restores the Navigator program for State and Federal exchanges. The Secretary must obligate $100 million from issuer user fees for the Federal Exchange for fiscal year 2026.
- Protections and enforcement: Requires issuers to send fast notices and reports, creates civil penalties of $1,000 per enrollee per day for notice or reporting failures, and adds consumer-friendly rules like a monthly special enrollment period for households expected to be at or below 150 percent of the poverty line and Bronze-to-Silver reenrollment options for 2026.
*Includes a $100 million obligation from issuer user fees for the Federal Exchange for fiscal year 2026.*
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 3 benefits, 0 costs, 2 mixed.
Extended and capped premium tax credits
If enacted, the temporary higher premium tax credits would be extended through January 1, 2029 for tax years after December 31, 2025. The bill would also remove the special rule that sometimes denied credits for certain special enrollments starting with plan years after December 31, 2025. At the same time, it would cap how much your advance premium tax credit can increase each year if your household income is under 400% of the poverty line: $600 (under 200% FPL), $1,500 (200–299% FPL), and $2,500 (300–399% FPL). Caps would be halved for taxpayers whose tax is determined under section 1(c), indexed each year using the specified COLA method, and any increase rounded down to the next lowest multiple of $50. The bill would also remove the explicit requirement that applicants provide or verify enrollment information for reenrollment for tax years after December 31, 2027.
Stronger insurer notices and penalties
If enacted, issuers that sold Exchange plans for 2025 or 2026 would have to notify enrollees about eligibility and enrollment changes. Notices for 2025 enrollees must go out within 15 days after enactment. Issuers would need to attest compliance within 90 days and HHS must submit a consolidated report to Congress within 120 days. HHS could fine issuers $1,000 for each affected person for each day a required notice or report is late, effective upon enactment.
More enrollment access and protections
If enacted, Exchanges would get new ways to keep people covered and let more low-income people enroll. People with expected household income at or below 150% of the poverty line would get a special enrollment period once per month starting for plan years beginning January 1, 2026. Exchanges could reenroll someone from a Bronze plan into a Silver plan when they are reenrolled for plan years beginning January 1, 2026. An Exchange could only find you ineligible for advance premium tax credits after you or your spouse fail to file and reconcile prior credits for two consecutive years, starting with plan years beginning January 1, 2026. The open enrollment period for plan year 2026 would be extended through May 1, 2026. Individuals who were denied APTC while pending verification would be allowed a special enrollment period starting with plan years beginning January 1, 2028.
More free navigator help funded
If enacted, the federal Exchange would get $100,000,000 from issuer user fees for Navigator activities in fiscal year 2026. Those funds would remain available until spent. The bill would also bar navigators and navigator organizations from charging any fees or accepting payments from applicants or enrollees upon enactment. This would expand free outreach and enrollment help on the federal Exchange.
Tighter Silver plan pricing rules
If enacted, the bill would change how Exchanges and issuers measure plan value and allowed premium adjustments. For calendar year 2026 and later, the minimum premium adjustment percentage would be tied to the lower bound used in 2022 projections. For plan years beginning January 1, 2026, the allowed actuarial value variation would match 2025 limits and 'de minimis' variation for Silver plans would mean minus 0 to plus 2 percentage points. These rules would narrow how much Silver plans can vary in value and could limit allowed premium changes.
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Sponsors & CoSponsors
Sponsor
Sen. Blunt Rochester, Lisa [D-DE]
DE • D
Cosponsors
Sen. Wyden, Ron [D-OR]
OR • D
Sponsored 12/4/2025
Sen. Booker, Cory A. [D-NJ]
NJ • D
Sponsored 12/4/2025
Sen. Merkley, Jeff [D-OR]
OR • D
Sponsored 12/4/2025
Sen. Smith, Tina [D-MN]
MN • D
Sponsored 12/4/2025
Sen. Gillibrand, Kirsten E. [D-NY]
NY • D
Sponsored 12/8/2025
Amy Klobuchar
MN • D
Sponsored 12/8/2025
Charles Schumer
NY • D
Sponsored 12/16/2025
Sen. Alsobrooks, Angela D. [D-MD]
MD • D
Sponsored 1/29/2026
Roll Call Votes
No roll call votes available for this bill.
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