H.R. 6575 — CommonGround for Affordable Health Care Act

This section extends and modifies the temporary enhanced premium tax credit—available through 2025 to reduce required household contributions for Affordable Care Act (ACA) Marketplace coverage—for taxable year 2026 (i.e., after December 31, 2025). Specifically, it (1) replaces the premium percentage table with a new table that maintains 0% contributions up to 150% of the federal poverty level (FPL), ramps up to 8.5% at 300%-400% FPL, holds 8.5% flat through 600% FPL, and increases to 10% at 900%-1000% FPL (previously capped at 8.5% above 400% FPL); and (2) expands eligibility to households with income up to 1000% FPL (from 400% FPL). (Thus, the credit remains available without a contribution cap above 400% FPL for 2026 only.)

This section imposes new civil and criminal penalties on agents and brokers who provide incorrect, false, or fraudulent information in applications for enrollment in qualified health plans through Exchanges and requires the Secretary to establish a verification process for agent- or broker-assisted enrollments and coverage changes in federally-facilitated Exchanges (i.e., those operated by the Secretary under ACA §1321(c)(1)) for plan years beginning no later than January 1, 2029. (1) Penalties.—Amends ACA §1411(h)(1) (42 U.S.C. 18081(h)(1)) to impose on agents or brokers, in addition to existing penalties, a civil penalty of $10,000–$50,000 per individual for failures attributable to negligence or disregard of rules (with procedures from SSA §1128A for knowing violations up to $200,000 per individual) and criminal penalties (fine under 18 U.S.C., imprisonment up to 10 years, or both) for knowing and willful violations. (2) Verification process.—Adds ACA §1311(c)(8) (42 U.S.C. 18031(c)) to require, for applicable enrollments eligible for agent/broker commissions, documentation of enrollee consent (e.g., standardized form); delayed commission payments until inconsistencies are resolved; issuer access to required information via database; timely notices to individuals of changes (with cancellation instructions); and enrollee access to account details (including agent of record and plan changes) via website or hotline. (Thus, these measures aim to reduce fraudulent enrollments in ACA Exchanges, which facilitate purchase of qualified health plans by individuals and small businesses.)

This section directs the Secretary of Health and Human Services to revise regulations to extend the annual open enrollment period for American Health Benefit Exchanges for plan year 2026 to end on March 19, 2026 (from January 15, 2026), and to conduct outreach notifying qualified individuals of the extension. (Thus, individuals may enroll in or change qualified health plans through mid-March 2026.)

This section establishes requirements for pharmacy benefit managers (PBMs) under Medicare Part D prescription drug plans (PDPs), effective for plan years beginning on or after January 1, 2029, by adding a new subsection (h) to Section 1860D–12 of the Social Security Act (42 U.S.C. 1395w–112). PDP sponsor contracts with PBMs must require that PBMs and their affiliates (1) derive remuneration only from bona fide service fees for services related to covered Part D drugs (with exceptions for certain incentive payments deemed bona fide if flat, fair market value-based, service-related, and Secretary-approved; full pass-through of manufacturer rebates, discounts, or price concessions; Secretary review of arrangements for fair market value consistency; and disgorgement of improper remuneration to the PDP sponsor); (2) apply transparent, consistent definitions (e.g., generic drug, brand name drug per 42 C.F.R. § 423.4) to pricing guarantees or cost performance measures, clearly identify exclusions, and provide wholesale acquisition cost equivalents where applicable; and (3) submit annual reports by July 1 (beginning in 2029) to the PDP sponsor and Secretary on specified information. (As background, PBMs negotiate drug prices and manage pharmacy networks for Part D plans, which provide outpatient prescription drug coverage to approximately 50 million Medicare beneficiaries.)

This section establishes expedited consideration procedures in the House of Representatives and Senate for an "enhanced premium tax credit reform bill," defined as a bill or joint resolution consisting solely of legislative language with respect to continued health insurance premium savings, including more significant reforms, that has at least 10 cosponsors from each of the majority party and the minority party at the time it is offered. In the House, the section (1) requires committees to report the bill without amendment within 5 legislative days or be automatically discharged; (2) makes a non-debatable motion to proceed in order after the last committee reports or is discharged, with no motion to reconsider; and (3) requires a vote on passage within 3 legislative days thereafter. In the Senate, the section (1) requires committees to report the bill within 5 session days or be automatically discharged; and (2) allows the majority leader (or designee) to make a non-debatable motion to proceed within 2 session days after reporting or discharge (or any senator thereafter), waiving all points of order against the motion, the bill, and its consideration, with the bill becoming unfinished business if the motion is agreed to. The section further coordinates bicameral action by (1) directing that a bill received from the other house is not referred to committee and supplants the receiving house's bill at the passage vote (except for Senate revenue measures in the House); and (2) providing that a House-passed bill receives the same Senate procedures if the Senate does not introduce or consider one under this section.