H.R. 7861

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7861 Introduced in House (IH)]

<DOC>

119th CONGRESS
2d Session
H. R. 7861

To amend title XXVII of the Public Health Service Act and the Patient 
Protection and Affordable Care Act to provide for certain reforms with 
respect to medical loss ratios and reducing fraudulent enrollment in 
qualified health plans.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

March 9, 2026

Mr. Barrett (for himself and Mr. Riley of New York) introduced the 
following bill; which was referred to the Committee on Energy and 
Commerce

_______________________________________________________________________

A BILL

To amend title XXVII of the Public Health Service Act and the Patient 
Protection and Affordable Care Act to provide for certain reforms with 
respect to medical loss ratios and reducing fraudulent enrollment in 
qualified health plans.

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 ``Care Over Profits Act of 2026''.

SEC. 2. INCREASING MEDICAL LOSS RATIO FOR HEALTH INSURANCE COVERAGE 
OFFERED IN SMALL GROUP AND INDIVIDUAL MARKETS.

(a) In General.--Section 2718(b)(1)(A)(ii) of the Public Health 
Service Act (42 U.S.C. 300gg-18(b)(1)(A)(ii)) is amended by striking 
``80'' each place it appears and inserting ``85''.
(b) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2026.

SEC. 3. IMPOSING PENALTIES ON AGENTS AND BROKERS FOR CERTAIN VIOLATIONS 
WITH RESPECT TO ENROLLMENT IN A QUALIFIED HEALTH PLAN 
OFFERED THROUGH AN EXCHANGE.

(a) In General.--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) by striking ``If--'' and all that 
follows through ``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'';
(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 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
(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 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 
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 monetary 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 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) Effective Date.--The amendments made by this section 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>