CommonGround for Affordable Health Care Act

Increased Premium Assistance: The bill modifies rules to increase premium assistance amounts for certain income tiers for the 2026 tax year (Section 2(a)).

Expanded Tax Credit Eligibility: The bill allows the premium tax credit to be applied to taxpayers whose household income exceeds 400 percent of the poverty line, up to 1000 percent (Section 2(b)).

Enhanced Fraud Prevention: The bill establishes civil penalties of up to $50,000 for agents or brokers who negligently provide incorrect information, and civil penalties of up to $200,000 for those who knowingly provide false or fraudulent information (Section 3(a)(1)).

Consumer Protections during Enrollment: The bill requires the Secretary to establish a verification process for enrollments to ensure individuals consent to coverage changes and provides for timely notifications regarding changes to coverage or premiums (Section 3(a)(2)).

Continuity of Care: The enrollment verification process is required to prioritize continuity of coverage and care, ensuring individuals are not disenrolled without consent (Section 3(a)(2)).

Increased Pharmacy Benefit Manager Accountability: The bill requires pharmacy benefit managers to operate under written agreements that include bona fide service fees and mandates the disgorgement of any unlawful remuneration (Section 5(a)(1)).

Drug Pricing Transparency: The bill requires pharmacy benefit managers to submit detailed annual reports regarding drug costs, dispensing channels, and manufacturer-derived revenue (Section 5(a)(1)(C)(i)).

Financial Penalties for Agents and Brokers: Agents or brokers may face significant civil penalties for negligence or significant criminal penalties, including fines and up to 10 years in prison, for knowing and willful violations (Section 3(a)(1)).

Increased Regulation for Marketing Organizations: Field marketing and third-party marketing organizations must meet specific criteria, including the requirement to register with the Secretary and submit marketing materials for review (Section 3(a)(3)).

Strict Requirements for Pharmacy Benefit Managers: Pharmacy benefit managers must comply with rigorous reporting requirements, undergo annual audits, and enter into specific written agreements, which may impact their business operations (Section 5(a)(1)).