H.R. 6010

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6010 Introduced in House (IH)]

<DOC>

119th CONGRESS
1st Session
H. R. 6010

To amend the Internal Revenue Code of 1986 to extend and modify the 
enhanced premium tax credit, and for other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

November 10, 2025

Mr. Liccardo (for himself, Mr. Kiley of California, Mr. Bacon, Ms. 
Goodlander, and Ms. Ross) introduced the following bill; which was 
referred to the Committee on Ways and Means, and in addition to the 
Committee on Energy and Commerce, 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 extend and modify the 
enhanced 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. TEMPORARY PREMIUM PERCENTAGES FOR 2026 AND 2027.

(a) In General.--Section 36B(b)(3)(A)(iii) of the Internal Revenue 
Code of 1986 is amended to read as follows:
``(iii) Temporary percentages for 2026 and 
2027.--In the case of a taxable year beginning 
after December 31, 2025, and before January 1, 
2028, the following table shall be applied in 
lieu of the table contained in clause (i):

------------------------------------------------------------------------
``In the case of household income
(expressed as a percent of poverty The initial The final
line) within the following income premium premium
tier: percentage is-- percentage is--
------------------------------------------------------------------------
Up to 150 percent.................... 0.0 0.0
150 percent up to 200 percent........ 0.0 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 up to 600 percent........ 8.5 8.5''.
------------------------------------------------------------------------

(b) Conforming Amendment.--Section 36B(c)(1)(E) of such Code is 
amended to read as follows:
``(E) Temporary rule for 2026 and 2027.--In the 
case of a taxable year beginning after December 31, 
2025, and before January 1, 2028, subparagraph (A) 
shall be applied by substituting `600 percent' for `400 
percent'.''.
(c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2025.

SEC. 2. IMPROVING RISK ADJUSTMENT UNDER MEDICARE ADVANTAGE.

(a) Use of 2 Years of Diagnostic Data.--Section 1853(a)(3)(C)(iii) 
of the Social Security Act (42 U.S.C. 1395w-23(a)(3)(C)(iii)) is 
amended--
(1) by striking ``methodology.--Such risk'' and inserting 
``methodology.--
``(I) In general.--Subject to 
subclause (II), such risk''; and
(2) by adding at the end the following new subclause:
``(II) Use of health status data.--
For 2026 and each subsequent year, the 
Secretary shall use 2 years of 
diagnostic data (when available) under 
such risk adjustment methodology.''.
(b) Exclusion of Diagnoses Collected From Chart Reviews and Health 
Risk Assessments.--Section 1853(a)(1)(C) of such Act (42 U.S.C. 1395w-
23(a)(1)(C)) is amended by adding at the end the following new clause:
``(iv) Exclusion of diagnoses collected 
from chart reviews and health risk 
assessments.--
``(I) In general.--For 2026 and 
each subsequent year, for purposes of 
establishing the payment adjustment 
factors and adjusting payment based on 
health status under clause (i), the 
Secretary shall not take into account a 
diagnosis collected from a chart review 
or a health risk assessment.
``(II) Identification of diagnoses 
collected from chart reviews and health 
risk assessments.--The Secretary shall 
establish procedures to provide for the 
identification and verification of 
diagnoses collected from chart reviews 
and health risk assessments.''.
(c) Application of Coding Adjustment.--Section 1853(a)(1)(C)(ii) of 
such Act (42 U.S.C. 1395w-23(a)(1)(C)(ii)) is amended--
(1) in subclause (III), by striking ``In calculating'' and 
inserting ``Subject to subclause (V), in calculating''; and
(2) by adding at the end the following new subclause:
``(V) In calculating such 
adjustment for 2026 and each subsequent 
year, the Secretary shall evaluate the 
impact on risk scores for Medicare 
Advantage enrollees of differences in 
coding patterns between Medicare 
Advantage plans and providers under 
parts A and B and publicly report the 
results of such evaluation. The 
Secretary shall ensure that such 
adjustment, which may include 
adjustment on a plan or contract level, 
fully accounts for the impact of coding 
pattern differences not otherwise 
accounted for to the extent that the 
Secretary identifies such differences 
through annual evaluation.''.

SEC. 3. REDUCTION OF FRAUDULENT ENROLLMENT IN QUALIFIED HEALTH PLANS.

(a) 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--
(1) in subparagraph (A)--
(A) by redesignating clause (ii) as clause (iv);
(B) in clause (i)--
(i) in the matter preceding subclause (I), 
by striking ``If--'' and all that follows 
through the ``such person'' in the matter 
following subclause (II) and inserting the 
following: ``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'';
(C) 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 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
(D) in clause (iv) (as so redesignated), by 
inserting ``or (ii)'' after ``clause (i)'';
(2) in subparagraph (B)--
(A) by inserting ``including subparagraph (C),'' 
after ``law,'';
(B) by striking ``Any person'' and inserting the 
following:
``(i) In general.--Any person''; and
(C) by adding at the end the following:
``(ii) Civil penalties for knowing 
violations by agents or brokers.--
``(I) In general.--Any agent or 
broker who knowingly 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
(3) 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.''.
(b) Consumer Protections.--
(1) 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:
``(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, 2028, 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.''.
(2) Required reporting.--Section 1311(c)(1) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18031(c)(1)) is 
amended--
(A) in subparagraph (H), by striking ``and'' at the 
end;
(B) in subparagraph (I), by striking the period at 
the end and inserting ``; and''; and
(C) by adding at the end the following:
``(J) report to the Secretary the termination (as 
defined in section 1312(e)(4)(C)) of an issuer.''.
(c) 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--
(1) by redesignating paragraphs (1) and (2) as subclauses 
(I) and (II), respectively, and adjusting the margins 
accordingly;
(2) in subclause (II) (as so redesignated), by striking the 
period at the end and inserting ``; and'';
(3) 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
(4) 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, 2028, 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 from marketing to such individual, to 
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.''.
(d) Transparency.--Section 1312(e) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18032(e)) (as amended by subsection (c)) 
is amended by adding at the end the following:
``(2) Audits.--
``(A) In general.--For plan years beginning on or 
after such date specified by the Secretary, but not 
later than January 1, 2028, 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.''.
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