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119-hr-10730119th CongressWALLET

Healthy Communities Act of 2026

Sponsored By: Representative Davids, Sharice [D-KS-3]

Introduced

Summary

Expands Premium Tax Credit eligibility. The bill would open the tax credit to people above 400% of the federal poverty line and tighten enrollment rules and broker oversight to reduce fraud and errors.

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Bill Overview

Analyzed Economic Effects

6 provisions identified: 4 benefits, 0 costs, 2 mixed.

Bigger marketplace tax credits

If enacted, the bill would remove the 400% of poverty limit so people above that line could qualify for premium tax credits for plan and tax years after December 31, 2025. It would replace the current premium-share schedule with a new sliding schedule: 0% at or below 150% of poverty; 0%–2% for 150–200%; 2%–4% for 200–250%; 4%–6% for 250–300%; 6%–8.5% for 300–400%; and 8.5% for 400% and above. The bill would also exclude catastrophic plans from the credit definition.

Help for Medicaid coverage gap

If enacted, the bill would give a special Premium Tax Credit rule for people in the Medicaid coverage gap for tax years beginning after December 31, 2026. A coverage-gap individual would be treated as having income equal to 100% of the poverty line for their family size and an applicable percentage of 0% for that year. The joint-return rule for claiming the credit would still apply.

More federal Medicaid matching support

If enacted, the bill would expand specified enhanced Federal Medical Assistance Percentage (FMAP) rules from an 8-quarter period to 24 quarters and change a related count parameter from 5 to 10. The change would apply to quarters beginning on or after January 1, 2026, for qualifying State plans that did not spend amounts for the expansion group before January 1, 2026. States could receive higher federal matching for a longer period under these rules.

Tighter checks on enrollments and brokers

If enacted, the bill would require a verification process for enrollments or changes submitted by commission-eligible agents or brokers by plan years no later than January 1, 2029. Exchanges would have to tell applicants their advance premium tax credit amount before enrollment starting January 1, 2027. The bill would set civil penalties of $10,000–$50,000 per affected person for negligent errors, up to $200,000 per person for knowing fraud, and possible criminal penalties including fines and up to 10 years imprisonment. The Secretary would also set standards for agents, brokers, FMOs, and TPMOs and run regular audits and lists of suspended or terminated agents. The Secretary would check death records within 90 days of enactment and quarterly after that and would end enrollment only after verifying a death.

Fixed annual open enrollment window

If enacted, the bill would set the Exchange open enrollment period to run November 1 through January 15 for calendar years beginning in 2026 and later. You would use this period to sign up for or change Exchange coverage. The change does not itself change premiums or tax-credit calculations.

Repeal of four prior reconciliation items

If enacted, the bill would repeal sections 71107, 71112, 71119, and 71120 of Public Law 119-21 and direct that any laws or regulations referenced in those sections be applied as if those sections had not been enacted. The text does not describe the specific effects of those repeals, so the household impact is unclear from this provision alone.

Sponsors & CoSponsors

Sponsor

Davids, Sharice [D-KS-3]

KS • D

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

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