HouseH.R. 10730119th Congress
Healthy Communities Act of 2026
Full Text
Official text as published. Use Ctrl+F / Cmd+F to search within the document.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10730 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 10730
To amend the Internal Revenue Code of 1986 to modify the premium tax
credit, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 5, 2026
Ms. Davids of Kansas introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the
Committee on Ways and Means, for a period to be subsequently determined
by the Speaker, in each case for consideration of such provisions as
fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend the Internal Revenue Code of 1986 to modify the premium tax
credit, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Healthy Communities Act of 2026''.
SEC. 2. MODIFICATION OF PREMIUM TAX CREDIT.
(a) Increase in Eligibility for Credit.--Subparagraph (A) of
section 36B(c)(1) of the Internal Revenue Code of 1986 is amended by
striking ``but does not exceed 400 percent''.
(b) Applicable Percentages.--
(1) In general.--Subparagraph (A) of section 36B(b)(3) of
such Code is amended to read as follows:
``(A) Applicable percentage.--The applicable
percentage for any taxable year shall be the percentage
such that the applicable percentage for any taxpayer
whose household income is within an income tier
specified in the following table shall increase, on a
sliding scale in a linear manner, from the initial
premium percentage to the final premium percentage
specified in such table for such income tier:
------------------------------------------------------------------------
The initial The final
``In the case of household income (expressed premium premium
as a percent of poverty line) within the percentage percentage
following income tier: is-- is--
------------------------------------------------------------------------
Up to 150 percent............................. 0 0
150 percent up to 200 percent................. 0 2.0
200 percent up to 250 percent................. 2.0 4.0
250 percent up to 300 percent................. 4.0 6.0
300 percent up to 400 percent................. 6.0 8.5
400 percent and higher........................ 8.5 8.5.''.
------------------------------------------------------------------------
(2) Conforming amendments relating to affordability of
coverage.--
(A) Paragraph (1) of section 36B(c) of such Code is
amended by striking subparagraph (E).
(B) Subparagraph (C) of section 36B(c)(2) of such
Code is amended by striking clause (iv).
(C) Paragraph (4) of section 36B(c) of such Code is
amended by striking subparagraph (F).
(c) Repeal of Certain Amendments Made by Public Law 119-21.--
Section 36B(c) of such Code, as amended by sections 71303 and 71304 of
Public Law 119-21, is amended--
(1) by amending paragraph (3)(A) to read as follows:
``(A) Qualified health plan.--The term `qualified
health plan' has the meaning given such term by section
1301(a) of the Patient Protection and Affordable Care
Act, except that such term shall not include a
qualified health plan which is a catastrophic plan
described in section 1302(e) of such Act.'', and
(2) by striking paragraphs (5) and (6).
(d) Effective Date.--The amendments made by this section shall
apply to taxable years and plan years beginning after December 31,
2025.
SEC. 3. APPLICATION OF PREMIUM TAX CREDIT IN CASE OF MEDICAID COVERAGE
GAP INDIVIDUALS.
(a) In General.--Section 36B of the Internal Revenue Code of 1986
is amended by redesignating subsection (h) as subsection (i) and by
inserting after subsection (g) the following new subsection:
``(h) Special Rule for Medicaid Coverage Gap Individuals.--
``(1) In general.--For purposes of this section, in the
case of a taxpayer who is a Medicaid coverage gap individual
for any month of a taxable year--
``(A) such taxpayer shall be treated for the
taxable year as an applicable taxpayer whose household
income for the taxable year is equal to 100 percent of
the poverty line for a family of the size involved, and
``(B) the applicable percentage for such taxpayer
for the taxable year shall be 0 percent.
``(2) Medicaid coverage gap individual defined.--For
purposes of this subsection, the term `Medicaid coverage gap
individual' means an individual--
``(A) who would be eligible for minimum essential
coverage (as defined in section 5000A(f), determined
without regard to paragraph (1)(C) thereof) but for the
fact that the State in which such individual resides
has not elected to provide medical assistance under the
State Medicaid plan under title XIX of the Social
Security Act (or a waiver of such plan) to all
individuals described in section
1902(a)(10)(A)(i)(VIII) of such Act, and
``(B) whose household income for the taxable year
is less than 100 percent of the poverty line for a
family of the size involved.
``(3) Application of joint return requirement.--Paragraph
(1)(A) shall not affect the application of subsection
(c)(1)(C).''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after December 31, 2026.
SEC. 4. RESTORING AND EXPANDING TEMPORARY FMAP INCREASE TO CERTAIN
STATE PLANS UNDER MEDICAID.
(a) In General.--Section 1905(ii) of the Social Security Act (42
U.S.C. 1396d(ii)) is amended--
(1) in paragraph (1)--
(A) by striking ``8-quarter'' and inserting ``24-
quarter''; and
(B) by striking ``5'' and inserting ``10''; and
(2) in paragraph (3), by striking ``which'' and all that
follows through the end and inserting ``which did not expend
amounts for all individuals described in section
1902(a)(10)(A)(i)(VIII) before January 1, 2026.''.
(b) Effective Date.--The amendments made by subsection (a)(1) shall
apply with respect to quarters occurring during a period described in
section 1905(ii)(1) of the Social Security Act (42 U.S.C. 1396d(ii)(1))
that begins on or after January 1, 2026.
SEC. 5. REPEAL OF CERTAIN RECONCILIATION HEALTH PROVISIONS.
Sections 71107, 71112, 71119, and 71120 of the Act titled ``An Act
to provide for reconciliation pursuant to title II of H. Con. Res. 14''
(Public Law 119-21) are hereby repealed, and any law or regulation
referred to in such sections shall be applied as if such sections and
the amendments made by such sections had not been enacted.
SEC. 6. CODIFYING OPEN ENROLLMENT PERIOD DATES UNDER THE AFFORDABLE
CARE ACT.
Section 1311(c)(6)(B) of the Patient Protection and Affordable Care
Act (42 U.S.C. 18031(c)(6)(B)) is amended by inserting ``and before
2026, and, for calendar years beginning with 2026, that begin on
November 1 of each such year and end on the following January 15''
after ``initial enrollment period''.
SEC. 7. GUARDRAILS TO PREVENT FRAUD IN EXCHANGES.
(a) Reduction of Fraudulent Enrollment in Qualified Health Plans.--
(1) Penalties for agents and brokers.--Section 1411(h)(1)
of the Patient Protection and Affordable Care Act (42 U.S.C.
18081(h)(1)) is amended--
(A) in subparagraph (A)--
(i) by redesignating clause (ii) as clause
(iv);
(ii) in clause (i)--
(I) by striking ``If--'' and all
that follows through the ``such
person'' and inserting ``If any person
(other than an agent or broker) fails
to provide correct information under
subsection (b) and such failure is
attributable to negligence or disregard
of any rules or regulations of the
Secretary, such person''; and
(II) in the second sentence, by
striking ``For purposes'' and inserting
the following:
``(iii) Definitions of negligence,
disregard.--For purposes'';
(iii) by inserting after clause (i) the
following:
``(ii) Civil penalties for certain
violations by agents or brokers.--If any agent
or broker fails to provide correct information
under subsection (b) or section 1311(c)(8), or
other information as part of an application for
enrollment in a qualified health plan offered
through an Exchange, as specified by the
Secretary, and such failure is attributable to
negligence or disregard of any rules or
regulations of the Secretary, such agent or
broker shall be subject, in addition to any
other penalties that may be prescribed by law,
including subparagraph (C), to a civil penalty
of not less than $10,000 and not more than
$50,000 with respect to each individual who is
the subject of an application for which such
incorrect information is provided.''; and
(iv) in clause (iv) (as so redesignated),
by inserting ``or (ii)'' after ``clause (i)'';
(B) in subparagraph (B)--
(i) by inserting ``including subparagraph
(C),'' after ``law,'';
(ii) by striking ``Any person'' and
inserting the following:
``(i) In general.--Any person''; and
(iii) by adding at the end the following:
``(ii) Civil penalties for knowing and
willful violations by agents or brokers.--
``(I) In general.--Any agent or
broker who knowingly and willfully
provides false or fraudulent
information under subsection (b) or
section 1311(c)(8), or other false or
fraudulent information as part of an
application for enrollment in a
qualified health plan offered through
an Exchange, as specified by the
Secretary, shall be subject, in
addition to any other penalties that
may be prescribed by law, including
subparagraph (C), to a civil penalty of
not more than $200,000 with respect to
each individual who is the subject of
an application for which such false or
fraudulent information is provided.
``(II) Procedure.--The provisions
of section 1128A of the Social Security
Act (other than subsections (a) and (b)
of such section) shall apply to a civil
monetary penalty under subclause (I) in
the same manner as such provisions
apply to a penalty or proceeding under
section 1128A of the Social Security
Act.''; and
(C) by adding at the end the following:
``(C) Criminal penalties.--Any agent or broker who
knowingly and willfully provides false or fraudulent
information under subsection (b) or section 1311(c)(8),
or other false or fraudulent information as part of an
application for enrollment in a qualified health plan
offered through an Exchange, as specified by the
Secretary, shall be fined under title 18, United States
Code, imprisoned for not more than 10 years, or
both.''.
(2) Consumer protections.--
(A) In general.--Section 1311(c) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(c))
is amended by adding at the end the following new
paragraph:
``(8) Agent- or broker-assisted enrollment in qualified
health plans in certain exchanges.--
``(A) In general.--For plan years beginning on or
after such date specified by the Secretary, but not
later than January 1, 2029, in the case of an Exchange
that the Secretary operates pursuant to section
1321(c)(1), the Secretary shall establish a
verification process for new enrollments of individuals
in, and changes in coverage for individuals under, a
qualified health plan offered through such Exchange,
which are submitted by an agent or broker in accordance
with section 1312(e) and for which the agent or broker
is eligible to receive a commission.
``(B) Requirements.--The enrollment verification
process under subparagraph (A) shall include--
``(i) a requirement that the agent or
broker provide with the new enrollment or
coverage change such documentation or evidence
(such as a standardized consent form) or other
sources as the Secretary determines necessary
to establish that the agent or broker has the
consent of the individual for the new
enrollment or coverage change;
``(ii) a requirement that any commissions
due to a broker or agent for such new
enrollment or coverage change are paid after
the enrollee has resolved all inconsistencies
in accordance with paragraphs (3) and (4) of
section 1411(e);
``(iii) a requirement that the information
required under clause (i) and, as applicable,
the date on which inconsistencies are resolved
as described in clause (ii), is accessible to
the applicable qualified health plan through a
database or other resource, as determined by
the Secretary, so that any commissions due to a
broker or agent for such enrollment can be
effectuated at the appropriate time;
``(iv) a requirement that individuals are
notified of any changes to enrollment,
coverage, the agent of record, or premium tax
credits in a timely manner and that such notice
provides plain language instructions on how
individuals can cancel unauthorized activity;
``(v) a requirement that individuals be
able to access their account information on a
website or other technology platform, as
defined by the Secretary, when used to submit
an enrollment or plan change, in lieu of the
Exchange website described in subsection
(d)(4)(C), including information on the agent
of record, the qualified health plan, and when
any changes are made to the agent of record or
the qualified health plan, on a consumer-facing
website or through a toll-free telephone
hotline; and
``(vi) a requirement that the agent or
broker report to the Secretary any third-party
marketing organization or field marketing
organization (as such terms are defined in
section 1312(e)) involved in the chain of
enrollment (as so defined) with respect to such
new enrollment or coverage change.
``(C) Consumer protection.--The Secretary shall
ensure that the enrollment verification process under
subparagraph (A) prioritizes continuity of coverage and
care for individuals, including by not disenrolling
individuals from a qualified health plan without the
consent of the individual, regardless of whether the
broker, agent, or qualified health plan is in violation
of any requirement under this paragraph.''.
(B) Required reporting.--Section 1311(c)(1) of the
Patient Protection and Affordable Care Act (42 U.S.C.
18031(c)(1)) is amended--
(i) in subparagraph (H), by striking
``and'' at the end;
(ii) in subparagraph (I), by striking the
period at the end and inserting ``; and''; and
(iii) by adding at the end the following:
``(J) report to the Secretary the termination (as
defined in section 1312(e)(1)(C)) of an issuer.''.
(3) Authority to regulate field marketing organizations and
third-party marketing organizations.--Section 1312(e) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18032(e))
is amended--
(A) by redesignating paragraphs (1) and (2) as
subclauses (I) and (II), respectively, and adjusting
the margins accordingly;
(B) in subclause (II) (as so redesignated), by
striking the period at the end and inserting ``; and'';
(C) by striking the subsection designation and
heading and all that follows through ``brokers--'' and
inserting the following:
``(e) Regulation of Agents, Brokers, and Certain Marketing
Organizations.--
``(1) Agents, brokers, and certain marketing
organizations.--
``(A) In general.--The Secretary shall establish
procedures under which a State may allow--
``(i) agents or brokers--''; and
(D) by adding at the end the following:
``(ii) field marketing organizations and
third-party marketing organizations to
participate in the chain of enrollment for an
individual with respect to qualified health
plans offered through an Exchange.
``(B) Criteria.--For plan years beginning on or
after such date specified by the Secretary, but not
later than January 1, 2029, the Secretary, by
regulation, shall establish criteria for States to use
in determining whether to allow agents and brokers to
enroll individuals and employers in qualified health
plans as described in subclause (I) of subparagraph
(A)(i) and to assist individuals as described in
subclause (II) of such subparagraph and field marketing
organizations and third-party marketing organizations
to participate in the chain of enrollment as described
in subparagraph (A)(ii). Such criteria shall, at a
minimum, require that--
``(i) an agent or broker act in accordance
with a standard of conduct that includes a duty
of such agent or broker to act in the best
interests of the enrollee;
``(ii) a field marketing organization or
third-party marketing organization agree to
report the termination of an agent or broker to
the applicable State and the Secretary,
including the reason for termination; and
``(iii) an agent, broker, field marketing
organization, or third-party marketing
organization--
``(I) meet such marketing
requirements as are required by the
Secretary;
``(II) meet marketing requirements
in accordance with other applicable
Federal or State law;
``(III) does not employ practices
that are confusing or misleading, as
determined by the Secretary;
``(IV) submit all marketing
materials to the Secretary for, as
determined appropriate by the
Secretary, review and approval;
``(V) is a licensed agent or broker
or meets other licensure requirements,
as required by the State;
``(VI) register with the Secretary;
and
``(VII) does not compensate any
individual or organization for
referrals or any other service relating
to the sale of, marketing for, or
enrollment in qualified health plans
unless such individual or organization
meets the criteria described in
subclauses (I) through (VI).
``(C) Definitions.--In this paragraph:
``(i) Chain of enrollment.--The term `chain
of enrollment', with respect to enrollment of
an individual in a qualified health plan
offered through an Exchange, means any steps
taken during the period beginning with
marketing to such individual and ending with
such individual making an enrollment decision
with respect to such a plan.
``(ii) Field marketing organization.--The
term `field marketing organization' means an
organization or individual that directly
employs or contracts with agents and brokers,
or contracts with carriers, to provide
functions relating to enrollment of individuals
in qualified health plans offered through an
Exchange as part of the chain of enrollment.
``(iii) Marketing.--The term `marketing'
means the use of marketing materials to provide
information to current and prospective
enrollees in a qualified health plan offered
through an Exchange.
``(iv) Marketing materials.--The term
`marketing materials' means materials relating
to a qualified health plan offered through an
Exchange or benefits offered through an
Exchange that--
``(I) are intended--
``(aa) to draw an
individual's attention to such
plan or the premium tax credits
or cost-sharing reductions for
such plan or plans offered
through an Exchange;
``(bb) to influence an
individual's decision-making
process when selecting a
qualified health plan in which
to enroll; or
``(cc) to influence an
enrollee's decision to stay
enrolled in such plan; and
``(II) include or address content
regarding the benefits, benefit
structure, premiums, or cost sharing of
such plan.
``(v) Termination.--The term `termination',
with respect to a contract or business
arrangement between an agent or broker and a
field marketing organization, third-party
marketing organization, or health insurance
issuer, means--
``(I) the ending of such contract
or business arrangement, either
unilaterally by one of the parties or
on mutual agreement; or
``(II) the expiration of such
contract or business arrangement that
is not replaced by a substantially
similar agreement.
``(vi) Third-party marketing
organization.--The term `third-party marketing
organization' means an organization or
individual that is compensated to perform lead
generation, marketing, or sales relating to
enrollment of individuals in qualified health
plans offered through an Exchange as part of
the chain of enrollment.''.
(4) Transparency.--Section 1312(e) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18032(e)), as
amended by paragraph (3), is further amended by adding at the
end the following new paragraphs:
``(2) Audits.--
``(A) In general.--For plan years beginning on or
after such date specified by the Secretary, but not
later than January 1, 2029, the Secretary, in
coordination with the States and in consultation with
the National Association of Insurance Commissioners,
shall implement a process for the oversight and
enforcement of agent and broker compliance with this
section and other applicable Federal and State law
(including regulations) that shall include--
``(i) periodic audits of agents and brokers
based on--
``(I) complaints filed with the
Secretary by individuals enrolled by
such an agent or broker in a qualified
health plan offered through an
Exchange;
``(II) an incident or enrollment
pattern that suggests fraud; and
``(III) other factors determined by
the Secretary; and
``(ii) a process under which the Secretary
shall share audit results and refer potential
cases of fraud to the relevant State department
of insurance.
``(B) Effect.--Nothing in this paragraph limits or
restricts any referrals made under section 1311(i)(3)
or any enforcement actions under section 1411(h).
``(3) List.--The Secretary shall develop a process to
regularly provide to qualified health plans, Exchanges, and
States a list of suspended and terminated agents and
brokers.''.
(b) Removal of Deceased Individuals From Exchange Plans.--Section
1311(c) of the Patient Protection and Affordable Care Act (42 U.S.C.
18031(c)), as amended by subsection (a), is further amended by adding
at the end the following new paragraph:
``(9) Removal of deceased individuals from exchange
plans.--
``(A) In general.--Not later than 90 days after the
date of the enactment of this paragraph, and on a
quarterly basis thereafter, the Secretary shall conduct
a check of the Death Master File (as such term is
defined in section 203(d) of the Bipartisan Budget Act
of 2013) for purposes of identifying individuals
enrolled in a qualified health plan through an Exchange
who are deceased.
``(B) Process.--The Secretary shall--
``(i) establish a process to verify that an
individual identified pursuant to a check
described in subparagraph (A) is deceased; and
``(ii) require an Exchange to terminate
such individual's enrollment under a qualified
health plan.''.
(c) Standard of Proof for Terminating Agents and Brokers.--Section
1312(e) of the Patient Protection and Affordable Care Act (42 U.S.C.
18032(e)), as amended by subsection (a), is further amended by adding
at the end the following new paragraph:
``(4) Standard for termination for certain exchanges.--In
the case of an agent or broker with an agreement in effect with
an Exchange operated by the Secretary pursuant to section
1321(c) to perform activities described in paragraph (1)(A)(i)
with respect to such Exchange, the Secretary may terminate such
agreement for cause if the Secretary finds, based on a
preponderance of the evidence, that such agent or broker has
violated such agreement, otherwise applicable law, or any other
requirement applicable to such agent or broker.''.
(d) Requirement for Exchange To Notify Individuals of Value of
Premium Tax Credits.--Section 1412(c)(2) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18082(c)(2)) is amended by adding at the
end the following new subparagraph:
``(C) Exchange responsibilities.--Beginning January
1, 2027, if an Exchange is notified under paragraph (1)
of an advance determination under section 1411 with
respect to the eligibility of an individual for a
premium tax credit under section 36B of the Internal
Revenue Code of 1986, the Exchange shall, prior to
enrolling such individual in a qualified health plan,
clearly notify such individual of the amount of such
tax credit.''.
(e) Effective Date.--The amendments made by subsection (a)(1) shall
apply with respect to applications for enrollment in a qualified health
plan offered through an Exchange for plan years beginning on or after
January 1, 2027.
<all>