HR6575119th CongressWALLET

CommonGround for Affordable Health Care Act

Sponsored By: Representative Kiggans (VA)

Introduced

Summary

expand the enhanced premium tax credit while adding fraud guardrails for agents and new transparency rules for pharmacy benefit managers. This bill would raise eligibility for advance credits and tighten enrollment and PBM oversight to protect consumers and federal programs.

Show full summary
  • Families and households: The bill would raise the advance premium tax credit income cap for 2026 from 400% of the Federal Poverty Line to 1000% and set a 2026 premium-percent table that reduces required premium shares at lower incomes.
  • Consumers and Exchanges: It would require verification for agent-submitted enrollments, quarterly checks for deceased enrollees, advance notice of premium tax credit amounts starting 2027, and an extended open enrollment from Nov. 1, 2025 to Mar. 19, 2026.
  • Agents and brokers: New standards would impose civil penalties of $10,000 to $50,000 for negligence, up to $200,000 for knowing violations, and criminal penalties including fines and up to 10 years imprisonment for willful misconduct.
  • PBMs, plans, and Medicare enrollees: The bill would force broad PBM definitions, strict limits on remuneration, annual machine‑readable reporting, mandatory audits, and apply many rules to Medicare Part D and MA‑PD plans for plan years beginning on or after Jan. 1, 2029.

*It would appropriate $113 million to the CMS Program Management Account and $20 million to the HHS Inspector General for FY2026 to implement PBM provisions.*

Bill Overview

Analyzed Economic Effects

5 provisions identified: 4 benefits, 0 costs, 1 mixed.

New limits on Medicare drug middlemen

Starting with plan years on or after January 1, 2029, pharmacy benefit managers for Medicare drug plans would only be paid flat, fair‑market service fees. They would have to file detailed, machine‑readable reports for each plan and drug by July 1 each year, allow audits, and return improper payments. The same rules would also apply to Medicare Advantage plans with drug coverage. To enforce this, the bill would provide $113 million to CMS and $20 million to the HHS Inspector General for fiscal year 2026.

Bigger 2026 Marketplace premium tax credits

For the 2026 tax year only, the bill would let households with income up to 1,000% of the poverty line get the premium tax credit. It would also set a special 2026 table for your expected share of premiums. Up to 150% FPL: 0.0%; 150–200%: 0.0%–2.0%; 200–250%: 2.0%–4.0%; 250–300%: 4.0%–6.0%. 300–400%: 6.0%–8.5%; 400–600%: 8.5%; 600–900%: 8.5%–9.25%; 900–1000%: 9.25%–10.0%.

Longer 2026 Marketplace sign-up window

For plan year 2026, open enrollment would run from November 1, 2025 through March 19, 2026. The Secretary would also do outreach so people know about the longer window. This could make it easier to get coverage or change plans.

Stronger rules for Marketplace enrollments

The bill would set tough oversight for agents and brokers by January 1, 2029. Fines could be $10,000 to $50,000 per person for negligence and up to $200,000 per person for knowing fraud, plus up to 10 years in prison for willful fraud. Enrollments they submit would need verified consent, and commissions would be withheld until problems are fixed; consumers would get timely notices and be able to access account info. Starting January 1, 2027, Marketplaces would have to tell you your advance premium tax credit amount before you enroll. The Secretary would also check death records within 90 days and then quarterly to remove deceased enrollees, and Marketplaces would report when an insurer terminates.

Faster votes on premium savings bills

Congress would use a fast‑track process for certain bills that focus only on health insurance premium savings. To qualify, a bill would need at least 10 cosponsors from each party when offered. Debate and timing would be limited, and both Houses would have to vote by July 1, 2026. This speeds consideration but does not itself change your benefits.

Sponsors & CoSponsors

Sponsor

Kiggans (VA)

VA • R

Cosponsors

  • Gottheimer

    NJ • D

    Sponsored 12/10/2025

  • Lawler

    NY • R

    Sponsored 12/10/2025

  • Cuellar

    TX • D

    Sponsored 12/10/2025

  • Bresnahan

    PA • R

    Sponsored 12/10/2025

  • Suozzi

    NY • D

    Sponsored 12/10/2025

  • Mackenzie

    PA • R

    Sponsored 12/10/2025

  • Lee (NV)

    NV • D

    Sponsored 12/10/2025

  • Salazar

    FL • R

    Sponsored 12/10/2025

  • Landsman

    OH • D

    Sponsored 12/10/2025

  • Van Drew

    NJ • R

    Sponsored 12/10/2025

  • Case

    HI • D

    Sponsored 12/10/2025

  • Ciscomani

    AZ • R

    Sponsored 12/10/2025

  • Costa

    CA • D

    Sponsored 12/10/2025

  • Valadao

    CA • R

    Sponsored 12/10/2025

  • Riley (NY)

    NY • D

    Sponsored 12/10/2025

  • Hurd (CO)

    CO • R

    Sponsored 12/10/2025

  • Scholten

    MI • D

    Sponsored 12/10/2025

  • Bacon

    NE • R

    Sponsored 12/10/2025

  • Wilson (FL)

    FL • D

    Sponsored 12/10/2025

  • Gimenez

    FL • R

    Sponsored 12/10/2025

  • Goodlander

    NH • D

    Sponsored 12/10/2025

  • De La Cruz

    TX • R

    Sponsored 12/10/2025

  • Soto

    FL • D

    Sponsored 12/10/2025

  • LaLota

    NY • R

    Sponsored 12/10/2025

  • Gray

    CA • D

    Sponsored 12/10/2025

  • Kiley (CA)

    CA • R

    Sponsored 12/10/2025

  • Gonzalez, V.

    TX • D

    Sponsored 12/10/2025

  • Kean

    NJ • R

    Sponsored 12/10/2025

  • Figures

    AL • D

    Sponsored 12/10/2025

  • Fitzpatrick

    PA • R

    Sponsored 12/10/2025

  • Pappas

    NH • D

    Sponsored 12/10/2025

  • Liccardo

    CA • D

    Sponsored 12/10/2025

  • Davis (NC)

    NC • D

    Sponsored 12/10/2025

  • Moskowitz

    FL • D

    Sponsored 12/10/2025

  • Panetta

    CA • D

    Sponsored 12/10/2025

  • Peters

    CA • D

    Sponsored 12/10/2025

  • Golden (ME)

    ME • D

    Sponsored 12/10/2025

  • Perez

    WA • D

    Sponsored 12/11/2025

Roll Call Votes

No roll call votes available for this bill.

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