H.R. 6232: Bipartisan Healthcare Optimization, Protection, and Extension Act

The Bipartisan Healthcare Optimization, Protection, and Extension Act aims to make several modifications to healthcare and insurance provisions, primarily focusing on extending and modifying premium assistance through tax credits, enhancing consumer protections, and improving the management of health coverage exchanges. Here’s a summary of what the bill proposes:

1. Extension and Modification of Enhanced Premium Tax Credit

• The bill seeks to extend and revise the rules for the enhanced premium tax credit under the Internal Revenue Code.
• Premium assistance amounts will be increased for households with incomes exceeding 400% of the federal poverty level, allowing these households to access more affordable healthcare coverage.
• Specific changes will apply for taxable years starting after December 31, 2025, with new income tiers established for determining premium percentages that will be gradually phased in through 2028.

2. Guardrails to Prevent Fraud in Health Exchanges

• The bill includes measures to reduce fraudulent enrollments in the health insurance exchanges, implementing stricter penalties for agents and brokers who fail to provide accurate information.
• New civil penalties ranging from $10,000 to $50,000 will be established for negligent agents and brokers, while knowingly providing false information could lead to penalties up to $200,000.
• It also introduces criminal penalties for fraudulent activities, including potential imprisonment for up to 10 years.

3. Consumer Protections

• It mandates a new verification process for enrollments submitted by agents or brokers to ensure consumer protection and maintain continuity of coverage.
• Agents and brokers must provide clear evidence of consent from individuals for any enrollment or coverage change, and commissions will be contingent upon resolution of any inconsistencies in enrollment.
• The legislation aims to ensure that consumers are notified of any enrollment changes in a timely manner and that they have access to their account information efficiently.

4. Removing Deceased Individuals from Coverage

• The Secretary of Health and Human Services will conduct regular checks against a Death Master File to identify and terminate coverage for deceased individuals who are enrolled in the exchanges.

5. Standard of Proof for Agents and Brokers

• The Secretary will have the authority to terminate the agreements of agents or brokers with exchanges if they are found in violation of applicable laws or their agreement terms.

6. Revising the Open Enrollment Period

• The annual open enrollment period for the year 2026 will be extended, allowing individuals to enroll or make changes to their coverage from November 1, 2025, to May 15, 2026.

Relevant Companies

• None found