H.R. 7860: Stop ACA Enrollment Fraud Act of 2026

This bill, known as the Stop ACA Enrollment Fraud Act of 2026, seeks to amend certain aspects of the Patient Protection and Affordable Care Act (ACA) to address issues related to fraudulent enrollments in health insurance exchanges. It proposes two main changes aimed at preventing fraud in enrolling individuals for healthcare coverage through these exchanges.

Preventing Duplicate Enrollments

The bill requires the Secretary of Health and Human Services to establish a system within 60 days after the bill's enactment. This system will:

• Identify Duplicate Social Security Numbers: It will check if the Social Security number (SSN) of a new individual applying for coverage matches that of anyone already enrolled in an exchange for the same coverage period.
• Prevent Duplicate Payments: If a duplicate SSN is found, the Secretary will take necessary actions to ensure no duplicate advance payments of premium tax credits are made for the same individual.

Ensuring Consent for Agent and Broker Enrollments

The bill also modifies how enrollments through agents and brokers are handled to ensure proper consent. Key points include:

• Requirement for Consent: For enrollments beginning on or after January 1, 2027, individuals or employers must give explicit consent before any enrollment made by an agent or broker becomes effective.
• Consent Mechanism: The Secretary will create and manage a mechanism through which this consent is obtained. The consent must be given directly and cannot rely on any attestation of consent provided by the agent or broker themselves.

In summary, the bill aims to tighten controls on enrollment processes in the ACA exchanges by reducing the potential for fraudulent enrollments and ensuring individuals consent to their enrollment when assisted by agents or brokers.

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