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HR6501119th CongressWALLET
Bipartisan Health Insurance Affordability Act
Sponsored By: Representative Fitzpatrick, Brian K. [R-PA-1]
Introduced
Summary
Extends and expands premium tax credits to households up to 700% of the federal poverty line. It would also tighten Exchange oversight, force rebate pass-through to group plans, increase PBM transparency in Medicare Part D, and create new HSA and premium prepayment options for certain Exchange enrollees.
Show full summary
- Families and individual enrollees: Would extend and modify the enhanced premium tax credit for taxable years beginning in 2026 and 2027, raise the eligibility cap from 400% to 700% of poverty, change the premium-share sliding scale, and extend the 2026 open enrollment period through March 1, 2026.
- Medicare beneficiaries and PBMs: Would impose new Medicare Part D requirements for plan years starting on or after January 1, 2029, including annual drug-level and plan-level PBM reporting, limits on PBM compensation other than bona fide service fees, fair-market-value standards, and authority to disgorge improper remuneration.
- Employers, group plans, and HSA users: Would require 100% remittance of rebates and related remuneration to group health plans with a phased ban beginning 30 months after enactment and quarterly remittances. It would create a "qualified Exchange enrollee" HSA category, allow an optional annual premium prepayment, and let some enrollees direct 50% of an advance premium tax credit into an HSA subject to contribution limits.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 3 benefits, 0 costs, 1 mixed.
Premium tax credit up to 700%
If enacted, households with income up to 700% of the federal poverty level could qualify for the premium tax credit for tax years starting after Dec 31, 2025 and before Jan 1, 2028. The bill changes the percentage schedule used to compute premium assistance, with special rules for incomes at or below 150% and a new tiered table for incomes above 200% up to 700% of FPL.
More PBM transparency for Medicare
If enacted, PBMs in Medicare Part D would have to send detailed drug- and plan-level reports each year by July 1 starting in 2029. Part D plan sponsors could audit PBMs at least once per year and choose the auditor. The same PBM rules would apply to Medicare Advantage drug plans for plan years starting January 1, 2029. The bill would provide $113 million to CMS and $20 million to the HHS OIG for PBM enforcement in fiscal year 2026. The GAO would study how price-tied payments and fees flow in the retail Part D chain.
PBMs must pass rebates to plans
If enacted, pharmacy benefit managers for group health plans would have to remit 100% of rebates and drug-related payments to the plan starting 30 months after enactment. Plans must receive quarterly remittances within 90 days after each quarter and fix underpayments within 90 days of notice. Plan sponsors would get annual audit access to rebate records. The bill also clarifies a long list of services that count as covered service provider services under ERISA. It creates a limited safe harbor for fiduciaries who reasonably relied on a provider, asked in writing, and notified the Secretary if the provider still failed to pay within 90 days.
New Exchange rules and HSA options
If enacted, some Exchange enrollees could treat months enrolled in qualifying Exchange plans as HSA-eligible beginning for tax years after Dec 31, 2025. Starting with 2026 plan years, eligible people could elect to put half of their advance premium tax credit into an HSA, up to annual HSA limits. The bill also creates a $5-per-month advance prepayment option that reduces premium assistance by $5 per month if chosen. The Secretary would set rules to verify enrollments submitted by agents and brokers, delay commission payments while problems are resolved, and impose civil and criminal penalties for fraud. For the 2026 plan year, open enrollment would run Nov 1, 2025 through Mar 1, 2026.
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
Rep. Bresnahan, Robert P. [R-PA-8]
PA • R
Sponsored 12/9/2025
Rep. Davis, Donald G. [D-NC-1]
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
Rep. Salazar, Maria Elvira [R-FL-27]
FL • R
Sponsored 12/9/2025
Rep. Mackenzie, Ryan [R-PA-7]
PA • R
Sponsored 12/9/2025
Rep. Kean, Thomas H. [R-NJ-7]
NJ • R
Sponsored 12/9/2025
Rep. Van Drew, Jefferson [R-NJ-2]
NJ • R
Sponsored 12/9/2025
Rep. Valadao, David G. [R-CA-22]
CA • R
Sponsored 12/9/2025
Rep. Ciscomani, Juan [R-AZ-6]
AZ • R
Sponsored 12/9/2025
Rep. LaLota, Nick [R-NY-1]
NY • R
Sponsored 12/9/2025
Rep. Kiggans, Jennifer A. [R-VA-2]
VA • R
Sponsored 12/10/2025
Rep. Peters, Scott H. [D-CA-50]
CA • D
Sponsored 12/10/2025
Rep. Davids, Sharice [D-KS-3]
KS • D
Sponsored 12/10/2025
Rep. Costa, Jim [D-CA-21]
CA • D
Sponsored 12/10/2025
Rep. Gonzalez, Vicente [D-TX-34]
TX • D
Sponsored 12/11/2025
Rep. Hurd, Jeff [R-CO-3]
CO • R
Sponsored 12/12/2025
Rep. Wilson, Frederica S. [D-FL-24]
FL • D
Sponsored 12/16/2025
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov