Bipartisan Bill Extends ACA Premium Tax Credits, Targets Fraud and PBM Reform

The Bipartisan Health Insurance Affordability Act, introduced by Congresswoman Nicole Malliotakis and several co-sponsors, aims to extend and reform the Enhanced Premium Tax Credit beyond its scheduled expiration in 2025. This extension seeks to prevent premium spikes that could impact millions of Affordable Care Act (ACA) marketplace enrollees by maintaining affordability of health insurance coverage. The bill sets an income cap for eligibility at 700% of the Federal Poverty Level, impacting individuals earning up to $109,000 and families up to $225,000 annually, and introduces a minimum premium requirement for lower-income enrollees to mitigate zero-dollar premium issues.\n\nThe legislation also targets waste, fraud, and abuse within the ACA marketplace, particularly addressing concerns over improper enrollments and unused coverage. It proposes criminal accountability for insurance brokers who knowingly submit false information and mandates regular audits to detect suspicious enrollment activities. These measures align with ongoing regulatory efforts to enhance compliance and program integrity in the health insurance sector.\n\nAdditional provisions in the bill include an opt-in Health Savings Account feature that directs 50% of tax credits into HSAs, offering greater consumer flexibility in managing health expenses. The bill also features reforms to Pharmacy Benefit Managers (PBMs) intended to control drug pricing and reduce costs passed on to consumers.\n\nRegionally, the legislation has significant implications for districts like New York's 11th, where nearly 80,000 ACA enrollees could face premium increases of up to 95% if tax credits expire. By maintaining these subsidies, over 80% of households in that district would continue to afford marketplace plans, highlighting the bill's role in preserving access to affordable coverage for middle-income Americans.\n\nThis bipartisan approach underscores a balanced effort to address affordability challenges while enforcing stricter oversight on fraudulent practices and the roles of brokers and PBMs. It reflects ongoing policymaker focus on reforming the ACA to curb rising premium costs and enhance the sustainability of the health insurance marketplace.