Care Over Profits Act of 2026
Sponsored By: Representative Barrett, Tom [R-MI-7]
Introduced
Summary
Raise the minimum Medical Loss Ratio (MLR) to 85%. The bill would also create steep new civil and criminal penalties for agents and brokers who submit false or misleading enrollment information for plans on ACA Exchanges.
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- Insurers in the small group and individual markets would be required to meet an MLR floor of 85 percent instead of 80 percent for plan years beginning January 1, 2026.
- Agents and brokers would face civil penalties of $10,000 to $50,000 per enrollee for negligent or rule-disregard errors, and up to $200,000 per enrollee for knowing and willful misrepresentations. Knowing and willful acts could also carry criminal penalties including fines and up to 10 years in prison.
- The bill tightens enforcement around enrollment information for Qualified Health Plans sold through an Exchange and makes these civil penalties additional to other penalties allowed by law.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Stronger penalties for broker fraud
If enacted, insurance agents and brokers who give incorrect enrollment information for marketplace plans would face large civil fines and possible criminal charges. For negligent or careless failures to provide correct information, civil fines would be $10,000 to $50,000 for each person named in the application. For knowing and willful false or fraudulent information, civil fines could be up to $200,000 per person and the conduct could also bring criminal penalties, including fines and up to 10 years in prison. These penalties would apply to Exchange enrollments for plan years that begin on or after January 1, 2027, and would be in addition to other legal penalties.
Higher care spending by insurers
If enacted, insurers in the individual and small-group markets would have to spend at least 85% of premium dollars on medical care and quality. This would replace the current 80% Medical Loss Ratio floor for plan years that begin on or after January 1, 2026. Plans that fail to meet the rule would be required to give rebates or shift more dollars to care and consumer-facing benefits. The typical household effect would likely be modest, probably under $500 per year.
Sponsors & CoSponsors
Sponsor
Barrett, Tom [R-MI-7]
MI • R
Cosponsors
Riley (NY)
NY • D
Sponsored 3/9/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov