Legislative Summary: Comparison of Subsidy Revival Bills
The table below compares legislation that would revive and modify the now-expired enhanced subsidy regime, along with the subsidy regime of Obamacare as enacted (i.e., current law subsidy levels) and the regime passed in the American Rescue Plan Act and extended in the Inflation Reduction Act (i.e., prior law subsidy levels). All numbers are expressed as the maximum amount (dollar figure or 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.
NOTES:
- The parameters in the Kiggans bill would apply for 2026 only, and the parameters in the Fitzpatrick bill and Collins amendment would apply for 2026 and 2027. The Marshall bill would 1) revive the ARPA and IRA subsidy regime without alteration in 2026, 2) impose an income cap at 700% of poverty beginning in 2027, 3) deliver premium subsidies via a new HSA-like mechanism, the Health Care Affordability Account, for 2027 through 2031, and 4) phase out the ARPA/IRA subsidy regime over four years (i.e., 2028 through 2031), transitioning down to the underlying Obamacare subsidy regime for the 2032 plan year.
- In 2025, the federal poverty level is $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.
- The two percentages in each box are expressed on a sliding scale, with households at the bottom end of the income range paying the lower percentage of income (e.g., families earning 200% of poverty paying 6.60% of income under current law in 2026), households at the top end of the income range paying the higher percentage (e.g., families earning 250% of poverty paying 8.44% of income under current law), and households with incomes in between paying a sliding-scale percentage between 6.60% and 8.44%.
Other Components of Subsidy Revival Bills
The Fitzpatrick and Kiggans bills include several common elements:
- Both bills include Sen. Wyden’s bill regarding fraud by agents and brokers, the Insurance Fraud Accountability Act (S. 976), in its entirety
- Both bills also include identical provisions 1) adding language regarding the removal of deceased individuals from Exchange plans, 2) adding a standard of proof for terminating agents and brokers, and 3) requiring Exchanges to report to households the value of the premium subsidies they receive in a given year
- Both bills would extend the 2026 open enrollment period—the Fitzpatrick bill to March 1, 2026, and the Kiggans bill to March 19, 2026
- Both bills include the same new requirements regarding transparency and reporting requirements for pharmaceutical benefit managers running Medicare Part D plans for seniors
In contrast, the Fitzpatrick bill only amends ERISA to require PBMs to remit “100 percent of rebates, fees, alternative discounts, and other remuneration…related to the utilization of drugs or drug spending” back to the plan sponsor on a quarterly basis.
In addition, the Kiggans bill only includes a process of expedited procedures to allow Congress to consider an “enhanced premium tax credit reform bill” by July 1, 2026.
The Marshall bill contains other insurance reform provisions, including:
- A photo identification requirement for all adults over age 18
- Distribution of premium subsidy amounts for 2027 through 2031 via a new HSA-like mechanism, the Health Care Affordability Account
- Language regarding federal funding of abortion, and a prohibition on all qualified health plans covering gender transition procedures
- A permanent appropriation for cost-sharing reductions, effective January 1, 2026, for plans that do not cover elective abortions; this spending will be paid directly to insurers, and not included in the Health Care Affordability Account mechanism discussed above
- Amendments to the State Innovation Waiver program created by Section 1332 of Obamacare
- The full text of the Patients Deserve Price Tags Act, S. 2355, sponsored by Sen. Marshall and Sen. Hickenlooper