Tuesday, January 6, 2026

Legislative Summary: H.R. 6575, CommonGround for Affordable Health Care Act

Summary: The bill combines a one-year revival of now-expired enhanced Obamacare subsidies with 1) modifications to the enhanced subsidy regime, 2) provisions designed to reduce fraud, 3) transparency regarding pharmaceutical benefit managers, and 4) expedited procedures for Congress to consider additional reforms to the subsidy regime.

Obamacare Subsidies: Revives for one year (i.e., 2026) the enhanced system of premium subsidies first enacted by Democrats as part of the American Rescue Plan Act (P.L. 117-2), and extended until the end of 2025 in the Inflation Reduction Act (P.L. 117-169).

Modifies the enhanced subsidy regime in two ways:

  • Lowers subsidy levels for households with incomes above 600% of poverty.
  • Households with incomes above 1000% of poverty would become ineligible for subsidies. By contrast, the enhanced subsidy regime enacted under ARPA, and renewed under the IRA, had no income cap, allowing households at all income levels to receive subsidies whenever premiums for benchmark coverage exceeded 8.5% of household income.

The below table compares the subsidy regime of Obamacare as enacted (i.e., current law subsidy levels), the regime passed in ARPA and extended in the IRA, and the modified subsidy regime under the bill. All numbers are expressed as the maximum percentage of income a household would pay for benchmark coverage (i.e., the second-lowest cost silver plan), with the federal subsidy covering any difference.

Note that in 2025, the federal poverty level was $15,650 for a single individual, and $32,150 for a family of four. (Federal poverty levels for 2026 have not yet been released.) The Obamacare premium assistance percentages are adjusted every year, per a formula laid out in statute. The 2026 premium assistance percentages were published in IRS Revenue Procedure 2025-25.

Anti-Fraud Provisions: Creates a new category of penalty for agents and brokers who fail to provide correct information due to negligence or disregard for rules and regulations, of at least $10,000 and up to $50,000 for each individual for whom incorrect information is provided. (Current law provides a penalty for of up to $25,000 for any person providing incorrect information due to negligence or disregard.) Provides additional penalties for agents and brokers who knowingly provide false or fraudulent information, including monetary penalties of up to $200,000 for each individual for whom false information is provided, and imprisonment for up to 10 years.

Requires the Department of Health and Human Services (HHS) to establish no later than the 2029 plan year a verification process for enrollments by agents and brokers in qualified health plans. Such a process shall include:

  1. Establishing the consent of the individual for enrollment in the specified plan;
  2. Withholding any commission due the agent or broker until all inconsistencies are resolved;
  3. Creating a database tracking inconsistencies and their resolution, so insurers know when to pay brokers their commissions;
  4. Notifying individuals regarding changes in their coverage status, broker, etc.;
  5. Creating a consumer-facing website and/or telephone hotline, so individuals can track changes in their enrollment plan or status; and
  6. Requiring brokers to report the involvement of any third-party marketing organization involved in the chain of enrollment.

Requires the new process to “prioritize continuity of coverage and care for individuals, including by not disenrolling individuals from a qualified health plan” without consent, regardless of any potential violation by an agent or broker.

Requires HHS to develop procedures under which states may allow “field marketing organizations and third-party marketing organizations,” along with agents and brokers (included in current law), to participate in facilitating enrollment. Requires HHS to issue by January 1, 2029 revised criteria for states to determine whether to allow agents, brokers, and third-party marketing organizations to participate in the enrollment process.

The new criteria shall at minimum require that agents and brokers have a duty of care to enrollees, and that third-party marketing organizations report agent or broker terminations (and the reason for said termination) to the state and HHS. Agents, brokers, and third-party marketing organizations must also be licensed with the state and registered with HHS, meet marketing requirements, not employ misleading or confusing practices (as determined by HHS), submit all marketing materials for review and/or approval, as determined by HHS, and only compensate for referrals as provided for in the bill.

Requires HHS, in concert with the National Association of Insurance Commissioners, to by January 2029 develop a process for periodic audits (based on complaints, potentially fraudulent enrollment patterns, or other factors), and a process for sharing such audit results, including the referral of potential fraud cases to state insurance departments. Also requires HHS to regularly provide a list of suspended and terminated agents and brokers to plans, Exchanges, and states.

NOTE: The anti-fraud provisions above consist of the text of S. 976, the Insurance Fraud Accountability Act, introduced by Senate Finance Committee Ranking Member Ron Wyden (D-OR) and eight Democrats on March 12, 2025.

Beginning 90 days after enactment, and every quarter thereafter, requires HHS to check the Social Security Master Death List file to terminate enrollment of deceased individuals. Establishes a “preponderance of the evidence” standard for HHS to terminate agents or brokers operating in states with a federally-run Exchange. Adds requirement for Exchanges to notify individuals of the amount of subsidies they qualify for, beginning January 1, 2027.

Open Enrollment: Extends the Exchange open enrollment period for the 2026 plan year, currently scheduled to end on January 15, 2026, through March 19, 2026. Requires HHS to “perform such outreach activities as are necessary to inform qualified individuals…of the extended open enrollment period.”

Pharmaceutical Benefit Managers: Beginning in January 2029, prohibits pharmaceutical benefit managers (PBMs) running the Medicare Part D benefit for plans from receiving “any remuneration with respect to any services provided…other than bona fide service fees.” Such payments must be in a flat dollar amount consistent with fair market value and related to services provided. Any rebates provided by prescription drug manufacturers must be “fully passed through to a [plan] sponsor” and not retained by the PBM. Permits HHS (in consultation with the Office of the Inspector General) to review compensation arrangements, and requires PBMs to disgorge any remuneration in violation of the statute.

Imposes new transparency requirements on PBMs operating Part D and Medicare Advantage plans to identify and define standard terms, and submit an annual report every July 1, beginning in 2029. The report must include:

  • For each drug covered by the plan, the drug name, number of enrollees receiving the drug, total number of claims, and total units dispensed, broken out by prescription channel (e.g., mail order, retail pharmacy, etc.); the average wholesale acquisition cost and price, total out-of-pocket spending by plan enrollees, total rebates paid, all other direct and indirect remuneration, average pharmacy reimbursement, average national drug acquisition cost, and total manufacturer-derived revenue retained by the PBM.
  • Where a PBM has an affiliated pharmacy, the percentage of prescriptions filled by affiliated pharmacies, a breakout of costs paid by the plan (and plan enrollees) for drugs dispensed by pharmacies that are, and are not, affiliates of the PBM, and a list of drugs for which the PBM (or affiliate) has a contract with a covered entity participating in the 340B drug discount program.
  • For each covered brand name drug and biologic, a list of generic drugs and follow-on biologics that are NOT covered by the plan, or covered in a higher-cost formulary tier, estimated differences in beneficiary cost-sharing, and a justification “for providing more favorable coverage” of the brand name drug than the generic.
  • Total gross spending on Part D covered drugs, the total amount retained by the PBM, total spending on Part D covered drugs net of rebates, an explanation of all incentives for enrollees to fill prescriptions at affiliated pharmacies, a breakout of compensation provided to the PBM and/or its consultants and affiliates, and a list of all those affiliates.

Requires PBMs to submit to plan sponsors a written explanation within 30 days of any contract with a manufacturer that “makes rebates, discounts, payments, or other financial incentives…contingent upon coverage, formulary placement, or utilization management conditions on any other covered Part D drugs or other prescription drugs.” The explanation must be signed by the CEO, Chief Financial Officer, or General Counsel of the PBM.

Permits plans to audit PBMs’ compliance with their agreements and the accuracy of information. Plans may select the auditor, and conduct audits “not less than once per year.” Requires plans to disgorge to HHS any amounts disgorged to the plan from the PBM, and to ensure that PBMs reimburse plans for any penalties associated with violations. Requires HHS to make available a mechanism for entities to report violations confidentially, and prohibits plans from retaliating when violations are reported.

Directs HHS to develop via program guidance a standardized template for annual reports. Specifies that information in such reports shall remain confidential, subject to disclosure to the Government Accountability Office (GAO), Congressional Budget Office, Medicare Payment Advisory Commission (MedPAC), Justice Department, and HHS Inspector General, all of whom shall not disclose information that would identify a specific pharmacy or PBM or reveal contractual information.

Appropriates $113 million to the Centers for Medicare and Medicaid Services, and $20 million to the Office of Inspector General, for implementation. Mandates a GAO study on prescription drug pricing, business models, conflicts of interest, competition, and the effects on federal programs, to be issued within two years of enactment. Directs MedPAC to issue two separate reports, one approximately two years after enactment and a second two years later, examining PBM agreements with Medicare Part D and Medicare Advantage plans.

Expedited Consideration of Subsidy Reform Bill: Provides special procedures for Congress to consider a bill that “consists solely of legislative language with respect to continued health insurance premium savings, including more significant reforms, that has accumulated at least 10 co-sponsors from each of the majority party and the minority party at the time it is offered.”

Requires the relevant House and Senate Committees to discharge said legislation without amendment or revision within five legislative days of referral. Provides that a vote on House passage “shall occur” no later than three legislative days after the last relevant committee is discharged. While the bill specifies that any Senator may move to proceed to a subsidy reform bill after two days, and makes such motion non-debatable, it does NOT include a time limit on Senate floor consideration of the measure.

Outlines procedures for coordinating actions by each chamber. Specifies that a veto message shall be debatable in the Senate for 10 hours, equally divided between the majority and minority leaders or their designees. States that “the vote on final passage in the House of Representatives and the Senate of the enhanced premium tax credit reform bill shall occur not later than July 1, 2026.”

Cost: A formal Congressional Budget Office (CBO) cost estimate is not available. However, the one-year revival of enhanced subsidies would likely cost tens of billions of dollars, and an offset of such spending is not readily apparent from the bill text.

Possible Conservative Concerns: Conservatives may have significant concerns with the bill’s revival of enhanced subsidies, including but not limited to:

  • No Impact on Gross Premiums in 2026: CBO has admitted that the bill would have no effect on gross premiums for the current plan year, “because those premiums have already been set.”
  • Expands and Entrenches Obamacare: The bill would for the second time extend COVID-era enhanced subsidies that were designed to be temporary, amounting to a major entitlement expansion on the installment plan.
  • Funds Plans Covering Services Americans Find Morally Objectionable: Pro-life groups have consistently noted that Obamacare subsidizes plans that cover abortion—in recent months, Maryland has used Obamacare dollars to fund abortion tourism for out-of-state residents, and encouraged other blue states to follow suit. Moreover, Obamacare subsidy dollars have also been used to fund transgender procedures that many Americans find objectionable, and political indoctrination that violates the First Amendment.
  • Increases the Federal Deficit: With the federal government over $38 trillion in debt, many would question the wisdom of incurring tens of billions of dollars in deficit spending to subsidize health insurance companies.
  • Undermines Employer-Provided Health Coverage: CBO noted that under a separate subsidy revival bill, 2.1 million fewer Americans would have employer-sponsored coverage. Expanding and entrenching Obamacare will only encourage more businesses to stop offering insurance and dump their workers on to the Exchanges.
  • Increases Insurer Profits: The bill directs tens of billions in new taxpayer funds to insurance companies. Because Obamacare allows them to keep one-fifth of premium dollars for profit and administrative expenses, the bill could see insurance companies receiving billions of dollars in added profit—at taxpayer expense.
  • Costly “Free” Plans: The bill would revive the zero-dollar premiums for some enrollees that are anything but “free” for taxpayers—these plans have been a major source of fraud, and encourage individuals to retain their Exchange plan, even if they have other sources of insurance coverage.
  • Welfare for the Wealthy: While the bill does impose an income cap on eligibility, it would still allow households earning as much as ten times poverty, or over $325,000 for a family of four, to qualify for “low-income” insurance subsidies.
  • Raises, Rather than Lowers, Underlying Health Costs: While the bill contains some modest transparency reforms designed to lower costs, it retains and expands Obamacare’s subsidy mechanism, under which every additional premium dollar is subsidized by federal taxpayers, encouraging health insurers to raise premiums.