Bipartisan Health Insurance Affordability Act
Sponsored By: Representative Fitzpatrick, Brian K. [R-PA-1]
Introduced
Summary
Expands premium tax credits to make marketplace coverage cheaper for many households by replacing the 400% poverty-line cap with eligibility up to 700% of the Federal Poverty Line and changing how premiums scale with income. The bill would also tighten enrollment oversight, impose new rules on pharmacy benefit managers, and add Health Savings Account options tied to Exchange plans.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 3 benefits, 0 costs, 1 mixed.
Temporary bigger premium tax credits
If enacted, the bill would temporarily expand premium tax credits for tax years after Dec. 31, 2025 and before Jan. 1, 2028 and raise eligibility to 700% of the poverty line. It sets a new percent‑of‑income schedule for multiple income ranges (for example, 200%–250%: 2.0%→4.0%; 250%–300%: 4.0%→6.0%; 300%–400%: 6.0%→8.5%; 600%–700%: 8.5%→9.25%) and a special rule for households at or below 150% of poverty that reduces the enrollee share by $5. Beginning with plan years in 2026, enrollees with advance determinations could elect a $5 per month prepay option (the prepay is $5×12 if determined in the annual open enrollment period, otherwise $5× months remaining). The Secretary would set open enrollment for plan year 2026 from Nov. 1, 2025 through Mar. 1, 2026.
Tighter PBM rules and oversight
If enacted, the bill would tighten how pharmacy benefit managers (PBMs) are paid and require much more reporting. For Medicare Part D and MA‑PD plans, PBMs generally could only keep flat bona fide service fees starting with plan years on or after Jan. 1, 2029, and they must file annual drug‑level reports to plans and the Secretary beginning July 1, 2029. For employer group plans (effective 30 months after enactment), PBMs would have to remit 100% of drug‑related rebates and similar payments to the plan, with quarterly remittances due within 90 days of each quarter and stricter audit rights for plans. The bill would also fund studies and oversight, including about $113 million to CMS, $20 million to the HHS Inspector General, and $1 million to MedPAC for fiscal year 2026 to support implementation and review.
Stronger verification for marketplace enrollments
If enacted, the Secretary would set up a verification process for agent or broker enrollments in the health insurance Marketplace by a date no later than Jan. 1, 2029. Agents and brokers would need written evidence of an enrollee's consent and would have to report any third‑party marketing groups used. Commissions could be withheld until consumers resolve inconsistencies. The bill would add civil fines ($10,000–$50,000 per person for negligent or reckless errors; up to $200,000 per person for knowing fraud) and criminal penalties (fines and up to 10 years in prison) for false or fraudulent enrollment information.
New HSA eligibility and premium split option
If enacted, people who are "qualified Exchange enrollees" would be treated as HSA‑eligible for tax years after Dec. 31, 2025, except for months they elect a prepay annual premium option. Starting with plan years in 2026, people who get advance premium tax credits could choose to have 50% of the advance paid monthly to their insurer and 50% put into their HSA, but those HSA deposits would count against the annual HSA limit and would not be deductible. Treasury and HHS must report to Congress within one year about how to implement and expand HSA access.
Sponsors & CoSponsors
Sponsor
Fitzpatrick, Brian K. [R-PA-1]
PA • R
Cosponsors
Rep. Golden, Jared F. [D-ME-2]
ME • D
Sponsored 12/9/2025
Rep. Bacon, Don [R-NE-2]
NE • R
Sponsored 12/9/2025
Rep. Suozzi, Thomas R. [D-NY-3]
NY • D
Sponsored 12/9/2025
Bresnahan
PA • R
Sponsored 12/9/2025
Davis (NC)
NC • D
Sponsored 12/9/2025
Rep. Malliotakis, Nicole [R-NY-11]
NY • R
Sponsored 12/9/2025
Rep. Perez, Marie Gluesenkamp [D-WA-3]
WA • D
Sponsored 12/9/2025
Rep. Lawler, Michael [R-NY-17]
NY • R
Sponsored 12/9/2025
Salazar
FL • R
Sponsored 12/9/2025
Rep. Mackenzie, Ryan [R-PA-7]
PA • R
Sponsored 12/9/2025
Kean
NJ • R
Sponsored 12/9/2025
Van Drew
NJ • R
Sponsored 12/9/2025
Rep. Valadao, David G. [R-CA-22]
CA • R
Sponsored 12/9/2025
Ciscomani
AZ • R
Sponsored 12/9/2025
LaLota
NY • R
Sponsored 12/9/2025
Rep. Kiggans, Jennifer A. [R-VA-2]
VA • R
Sponsored 12/10/2025
Peters
CA • D
Sponsored 12/10/2025
Rep. Davids, Sharice [D-KS-3]
KS • D
Sponsored 12/10/2025
Costa
CA • D
Sponsored 12/10/2025
Gonzalez, V.
TX • D
Sponsored 12/11/2025
Rep. Hurd, Jeff [R-CO-3]
CO • R
Sponsored 12/12/2025
Wilson (FL)
FL • D
Sponsored 12/16/2025
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov