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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 3368 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 3368
To improve patient protections and affordability under the Patient
Protection and Affordable Care Act, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 4, 2025
Ms. Blunt Rochester (for herself, Mr. Wyden, Mr. Booker, Mr. Merkley,
and Ms. Smith) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To improve patient protections and affordability under the Patient
Protection and Affordable Care Act, 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Restoring Patient
Protections and Affordability Act of 2025''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--CONSUMER PROTECTIONS
Sec. 101. Extension of temporary enhanced premium credits.
Sec. 102. Extending annual open enrollment period for plan year 2026.
Sec. 103. Restoring navigator program.
Sec. 104. Repeal of disallowance of premium tax credit in case of
certain coverage enrolled in during special
enrollment period.
TITLE II--HEALTH PLAN ACCOUNTABILITY
Sec. 201. Minimum notice requirements for plan year 2025 enrollees.
Sec. 202. Minimum notice requirements for plan year 2026 enrollees.
Sec. 203. Health insurance issuer reporting requirements.
Sec. 204. Enforcement.
TITLE III--ELIMINATING RED TAPE
Sec. 301. Applying commercial market policy to reenrollment process.
Sec. 302. Protection against bureaucratic coverage denials.
Sec. 303. Automatic enrollment from bronze to silver level qualified
health plans offered on Exchanges.
TITLE IV--MARKET STABILIZATION
Sec. 401. Restoring marketplace flexibility.
Sec. 402. No health plan gouging.
Sec. 403. Protecting continuity of coverage.
Sec. 404. Protecting enrollees from surprise premium bills.
Sec. 405. No ACA and employer coverage premium spikes.
TITLE I--CONSUMER PROTECTIONS
SEC. 101. EXTENSION OF TEMPORARY ENHANCED PREMIUM CREDITS.
(a) In General.--Clause (iii) of section 36B(b)(3)(A) of the
Internal Revenue Code of 1986 is amended--
(1) by striking ``January 1, 2026'' and inserting ``January
1, 2029'', and
(2) by striking ``2025'' in the heading and inserting
``2028''.
(b) Taxpayers Whose Household Income Exceeds 400 Percent of the
Poverty Line.--Section 36B(c)(1)(E) of the Internal Revenue Code of
1986 is amended--
(1) by striking ``January 1, 2026'' and inserting ``January
1, 2029'', and
(2) by striking ``2025'' in the heading and inserting
``2028''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2025.
SEC. 102. EXTENDING ANNUAL OPEN ENROLLMENT PERIOD FOR PLAN YEAR 2026.
With respect to plan year 2026, the annual open enrollment period
required to be provided by Exchanges under section 1311(c)(6) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6))
shall extend through May 1, 2026.
SEC. 103. RESTORING NAVIGATOR PROGRAM.
(a) Funding.--Section 1311(i)(6) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031(i)(6)) is amended--
(1) by striking ``Grants under'' and inserting the
following:
``(A) State exchanges.--In the case of an Exchange
established and operated by a State pursuant to
subsection (b), grants under''; and
(2) by adding at the end the following:
``(B) Federal exchanges.--For purposes of carrying
out this subsection with respect to an Exchange
established and operated by the Secretary pursuant to
section 1321(c), the Secretary shall obligate
$100,000,000 out of amounts collected through the user
fees on participating health insurance issuers pursuant
to section 156.50 of title 45, Code of Federal
Regulations (or any successor regulations) for fiscal
year 2026. Such amount so obligated for a fiscal year
shall remain available until expended.''.
(b) Standards.--Section 1311(i)(4)(A) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031(i)(4)(A)) is amended--
(1) in clause (i), by striking ``or'' at the end;
(2) in clause (ii), by striking the period and inserting a
semicolon; and
(3) by adding at the end the following:
``(iii) charge any fees to applicants or
enrollees; or
``(iv) request any form of remuneration
from or on behalf of any applicant or
enrollee.''.
SEC. 104. REPEAL OF DISALLOWANCE OF PREMIUM TAX CREDIT IN CASE OF
CERTAIN COVERAGE ENROLLED IN DURING SPECIAL ENROLLMENT
PERIOD.
(a) In General.--Section 36B(c)(3)(A) of the Internal Revenue Code
of 1986, as amended by Public Law 119-21, is amended by striking clause
(iii).
(b) Effective Date.--The amendment made by this section shall apply
with respect to plan years beginning after December 31, 2025.
TITLE II--HEALTH PLAN ACCOUNTABILITY
SEC. 201. MINIMUM NOTICE REQUIREMENTS FOR PLAN YEAR 2025 ENROLLEES.
The Secretary of Health and Human Services shall require each
health insurance issuer that offered a qualified health plan through a
Federal or State Exchange for plan year 2025 to notify, not later than
15 days after the date of enactment of this Act, all individuals
enrolled in such plan for any month during plan year 2025 of--
(1) changes to eligibility for premium assistance credits,
and to the premium assistance credit amounts, under section 36B
of the Internal Revenue Code of 1986 that first take effect
with respect to plan year 2026;
(2) the extended open enrollment period for plan year 2026
pursuant to section 101; and
(3) any additional information relating to such eligibility
and enrollment, as the Secretary determines appropriate,
including the website and phone number for the applicable
Federal or State Exchange.
SEC. 202. MINIMUM NOTICE REQUIREMENTS FOR PLAN YEAR 2026 ENROLLEES.
(a) In General.--The Secretary of Health and Human Services shall
require each health insurance issuer that offers a qualified health
plan through a Federal or State Exchange for plan year 2026 to notify
all individuals enrolled in such plan for plan year 2026 of--
(1) changes to eligibility for premium assistance credits,
and to the premium assistance credit amounts, under section 36B
of the Internal Revenue Code of 1986 that first take effect
with respect to plan year 2026;
(2) the extended open enrollment period for plan year 2026
pursuant to section 101; and
(3) any additional information relating to such eligibility
and enrollment, as the Secretary determines appropriate,
including the website and phone number for the applicable
Federal or State Exchange.
(b) Timing.--The notification by a health insurance issuer under
subsection (a) shall be made--
(1) not later than 15 days after the date of enactment of
this Act, with respect to individuals enrolled in such plan as
of the date of enactment of this Act; and
(2) not later than 15 days after an individual's
enrollment, with respect to individuals enrolling, after such
date of enactment, in the plan during the open enrollment
period for plan year 2026.
SEC. 203. HEALTH INSURANCE ISSUER REPORTING REQUIREMENTS.
(a) Report From Issuer.--Not later than 90 days after the date of
enactment of this Act, each health insurance issuer that is subject to
the reporting requirements under sections 201 and 202 shall submit to
the Secretary of Health and Human Services a report attesting to
compliance with the requirements under sections 201 and 202.
(b) Consolidated Report to Congress.--Not later than 120 days after
the date of enactment of this Act, the Secretary of Health and Human
Services shall submit to the Committee on Finance and the Committee on
Health, Education, Labor, and Pensions of the Senate and the Committee
on Ways and Means, the Committee on Energy and Commerce, and the
Committee on Education and Workforce of the House of Representatives a
report that consolidates the reports submitted by issuers under
subsection (a).
SEC. 204. ENFORCEMENT.
(a) In General.--Consistent with the process set forth in
subsections (d) and (e) of section 156.805 of title 45, Code of Federal
Regulations (or successor regulations), the Secretary of Health and
Human Services may impose a civil monetary penalty upon any health
insurance issuer who fails to comply with the notification requirements
under section 201 or 202 or the reporting requirements under section
203.
(b) Penalty Amounts.--
(1) Violations regarding notice to enrollees.--In the case
of a violation of section 201 or 202, such penalty shall be in
the amount equal to $1,000 for each individual enrolled in a
plan for plan year 2025 or 2026 who did not receive a notice as
required under section 201 or 202, as applicable, for each day
between the date on which such notice was due and the date on
which the notice is provided.
(2) Reporting violations.--In the case of a violation of
section 203, such penalty shall be in the amount of $1,000 per
day for each individual enrolled in health insurance coverage
with respect to which the report is required, for each day
between the date on which the report under section 302 was due
and the date on which the report is submitted.
TITLE III--ELIMINATING RED TAPE
SEC. 301. APPLYING COMMERCIAL MARKET POLICY TO REENROLLMENT PROCESS.
(a) In General.--Section 36B(c)(5)(A) of the Internal Revenue Code
of 1986, as added by Public Law 119-21, is amended by striking ``,
using applicable enrollment information that shall be provided or
verified by the applicant,''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after December 31, 2027.
SEC. 302. PROTECTION AGAINST BUREAUCRATIC COVERAGE DENIALS.
(a) In General.--Section 1311(c)(6) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031(c)(6)) is amended--
(1) in subparagraph (C), by striking ``; and'' and
inserting a semicolon; and
(2) by adding at the end the following:
``(E) special enrollment periods for any individual
denied the advance payment for which the individual
applies for one or more months pending the verification
prescribed by section 36B(c)(5)(A) of the Internal
Revenue Code of 1986, to permit enrollment of any such
individual following such verification; and''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to plan years beginning on or after January 1, 2028.
SEC. 303. AUTOMATIC ENROLLMENT FROM BRONZE TO SILVER LEVEL QUALIFIED
HEALTH PLANS OFFERED ON EXCHANGES.
The Secretary of Health and Human Services shall revise section
155.335(j) of title 45, Code of Federal Regulations (or any successor
regulation) to ensure that, with respect to reenrollments for plan
years beginning on or after January 1, 2026, a Federal or State
Exchange established under subtitle D of title I of the Patient
Protection and Affordable Care Act (42 U.S.C. 18021 et seq.) may
reenroll an individual who was enrolled in a bronze level qualified
health plan in a silver level qualified health plan (as such terms are
defined in section 1301(a) and described in 1302(d) of such Act (42
U.S.C. 18021(a); 18022(d))).
TITLE IV--MARKET STABILIZATION
SEC. 401. RESTORING MARKETPLACE FLEXIBILITY.
(a) In General.--Section 1311(c)(6) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031(c)(6)), as amended by section
302(a), is further amended by adding at the end the following:
``(F) a special enrollment period once per month
for any individual who is eligible for the advance
payment of premium tax credits under section 1412 and
whose household income is not expected to exceed 150
percent of the poverty line for a family of the size
involved.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to plan years beginning on or after January 1, 2026.
SEC. 402. NO HEALTH PLAN GOUGING.
The Secretary of Health and Human Services shall--
(1) revise section 156.140(c) of title 45, Code of Federal
Regulations (or a successor regulation), to provide that, for
plan years beginning on or after January 1, 2026, the allowable
variation in the actuarial value of a health plan applicable
under such section shall be the allowable variation for such
plan applicable under such section for plan year 2025; and
(2) revise section 156.400 of title 45, Code of Federal
Regulations (or a successor regulation), to provide that, for
plan years beginning on or after January 1, 2026, the term ``de
minimis variation for a silver plan variation'' means a minus 0
percentage point and plus 2 percentage point allowable
actuarial value variation.
SEC. 403. PROTECTING CONTINUITY OF COVERAGE.
(a) In General.--The Secretary of Health and Human Services shall
revise section 155.305(f)(4) of title 45, Code of Federal Regulations
(or a successor regulation) to provide that an Exchange may determine
an enrollee ineligible for an advance premium tax credit under section
36B of the Internal Revenue Code of 1986 as described in such section
155.305(f)(4) only after a taxpayer (or a taxpayer's spouse, if
married) has failed to file a Federal income tax return and reconcile
their past advance premium tax credit for 2 consecutive years for which
tax data will be utilized for verification of household income and
family size.
(b) Effective Date.--The requirement described in subsection (a)
shall apply with respect to plan years beginning on or after January 1,
2026.
SEC. 404. PROTECTING ENROLLEES FROM SURPRISE PREMIUM BILLS.
(a) In General.--Section 36B(f)(2) of the Internal Revenue Code of
1986, as amended by Public Law 119-21, is amended--
(1) by striking ``If the advanced payments'' and inserting
the following:
``(A) In general.--If the advanced payments'', and
(2) by adding at the end the following new subparagraph:
``(B) Limitation on increase.--
``(i) In general.--In the case of a
taxpayer whose household income is less than
400 percent of the poverty line for the size of
the family involved for the taxable year, the
amount of the increase under subparagraph (A)
shall in no event exceed the applicable dollar
amount determined in accordance with the
following table (one-half of such amount in the
case of a taxpayer whose tax is determined
under section 1(c) for the taxable year):
------------------------------------------------------------------------
The
``If the household income (expressed as a percentage of the applicable
poverty line) is: dollar
amount is:
------------------------------------------------------------------------
Less than 200%............................................. $600
At least 200% but less than 300%........................... $1,500
At least 300% but less than 400%........................... $2,500.
------------------------------------------------------------------------
``(ii) Indexing of amount.--In the case of
any calendar year beginning after 2014, each of
the dollar amounts in the table contained under
clause (i) shall be increased by an amount
equal to--
``(I) such dollar amount,
multiplied by
``(II) the cost-of-living
adjustment determined under section
1(f)(3) for the calendar year,
determined by substituting `calendar
year 2013' for `calendar year 2016' in
subparagraph (A)(ii) thereof.
If the amount of any increase under clause (i)
is not a multiple of $50, such increase shall
be rounded to the next lowest multiple of
$50.''.
(b) Conforming Amendment.--Section 35(g)(12)(B)(ii) of such Code is
amended by striking ``the amount determined under clause (i) shall be
substituted for the amount determined under section 36B(f)(2)'' and
inserting ``then section 36B(f)(2)(B) shall be applied by substituting
the amount determined under clause (i) for the amount determined under
section 36(f)(2)(A)''.
(c) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after December 31, 2025.
SEC. 405. NO ACA AND EMPLOYER COVERAGE PREMIUM SPIKES.
Section 1302(c)(4) of the Patient Protection and Affordable Care
Act (42 U.S.C. 18022(c)(4)) is amended by adding at the end the
following: ``For calendar year 2026 and each subsequent calendar year,
the lower bound of the allowable premium adjustment percentage for
purposes of paragraph (1)(B)(i) is the lower bound of the premium
adjustment percentage that applied under this paragraph for plan year
2022 using National Health Expenditure Accounts projections of average
per enrollee employer-sponsored insurance premiums.''.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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