Bipartisan Health Insurance Affordability Act

This bill extends and modifies the enhanced premium tax credit for health insurance, adds fraud prevention measures for health insurance exchanges, extends the 2026 open enrollment period, imposes new requirements on pharmacy benefit managers (PBMs), requires full pass-through of drug rebates to group health plans, allows certain exchange enrollees to establish health savings accounts (HSAs), and permits prepayment of premiums and directing part of the premium tax credit into an HSA.

Sec. 2, Extension and modification of enhanced premium tax credit: For tax years 2026 and 2027, the bill creates new premium assistance amounts for taxpayers with household income up to 150% of the poverty line (premium capped at $5 per month), a sliding scale for those between 150% and 200% of poverty, and a new table of premium percentages for those between 200% and 700% of poverty. It also extends eligibility for the credit to taxpayers with household income up to 700% of the poverty line.

Sec. 3, Guardrails to prevent fraud in exchanges: The bill establishes civil penalties for agents or brokers who negligently or knowingly provide false information on enrollment applications, with fines ranging from $10,000 to $200,000 per individual, and criminal penalties of up to 10 years imprisonment for knowing and willful fraud. It also requires the Secretary to establish a verification process for new enrollments in federally operated exchanges.

Sec. 4, Extending annual open enrollment period for exchanges for plan year 2026: The Secretary of Health and Human Services must revise regulations so that the open enrollment period for plan year 2026 runs from November 1, 2025, to March 1, 2026.

Sec. 5, Modernizing and ensuring PBM accountability: For plan years beginning on or after January 1, 2029, contracts between prescription drug plan sponsors and PBMs must require that PBMs and their affiliates derive no income other than bona fide service fees, with certain exceptions for incentive payments and rebates passed through to the plan sponsor. The Secretary may review remuneration arrangements.

Sec. 6, Full rebate pass through to plan; exception for innocent plan fiduciaries: For plan years beginning 30 months after enactment, contracts for pharmacy benefit management services must require that 100% of rebates, fees, and other remuneration be remitted to the group health plan or issuer. A responsible plan fiduciary is not liable for a prohibited transaction if they did not know of a failure to remit, requested remittance, and notified the Secretary if the failure continues.

Sec. 7, Qualified exchange enrollees eligible to establish health savings accounts: For tax years beginning after 2025, an individual enrolled in the lowest cost bronze plan (or a lower-premium plan) through an exchange is treated as an eligible individual for HSA purposes, unless they elect to make an advance premium payment. Contribution limits are based on the qualified health plan, and HSA funds may be used to pay health insurance premiums.

Sec. 8, Option to prepay annual premium; option to direct partial advance payment of premium tax credit into HSA: Beginning in 2026, individuals eligible for the premium tax credit may prepay $5 per month of premium. Alternatively, they may elect to have 50% of the advance premium tax credit paid into their HSA, up to the annual HSA contribution limit.

Sec. 9, Report: Within one year of enactment, the Treasury and Health and Human Services Secretaries must jointly report to Congress on the implementation of sections 7 and 8 and any recommendations for expanding HSA accessibility.