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