H.R. 7164 — Capping Costs for Consumers Act of 2026

This section expands cost-sharing reductions (CSRs) available through Affordable Care Act (ACA) Exchanges by revising actuarial value requirements and income eligibility bands for plan years beginning on or after January 1, 2028, as follows: (1) increasing a participating plan's share of total allowed costs to 87% for enrollees with household incomes between 150% and 300% of the federal poverty level (FPL) (from 150%-200% FPL) and to 85% for enrollees with incomes between 300% and 400% FPL (from 73% for 200%-250% FPL and 70% for 250%-400% FPL); and (2) applying CSRs as if referencing gold-level plans rather than silver-level plans. (CSRs reduce out-of-pocket costs such as deductibles and copayments for eligible low- and moderate-income enrollees.) The section also appropriates from the Treasury such sums as necessary for CSR payments and makes conforming amendments to the state Basic Health Program—under which states may offer standard health plans meeting essential health benefits to individuals eligible for Medicaid expansion but with incomes between 133% and 150% FPL in lieu of Exchange coverage—to cap enrollee premiums at the amount payable for the second lowest cost gold plan (from silver plan) in the enrollee's rating area after premium tax credits, for plan years beginning on or after January 1, 2028.

This section revises the premium assistance credit—refundable tax credits available to eligible individuals and families with incomes up to 400% of the federal poverty level to purchase qualified health plans through Affordable Care Act Exchanges—to determine the credit amount using the applicable second lowest cost gold plan (from silver plan) for taxable years beginning after December 31, 2027. (Thus, the benchmark premium generally increases because gold plans cover a higher share of expected costs—80% on average, versus 70% for silver plans.)