Bill · H.R. 7861· House(119-HR-7861)
Care Over Profits Act of 2026
- Introduced
- 3/9/2026
- Last activity
- 3/9/2026 — Referred to the House Committee on Energy and Commerce.
- Sponsored by
- Tom Barrett
- Cosponsors
- - 0 - 1
- Introduced
- In Committee
What this bill would do
This bill is known as the Care Over Profits Act of 2026. It makes changes to the Public Health Service Act and the Patient Protection and Affordable Care Act. The main goals are to update medical loss ratios and reduce fraudulent enrollment in health plans. It changes the medical loss ratio percentage for small group and individual health insurance markets. It also adds new civil and criminal penalties for agents and brokers who give incorrect, false, or fraudulent information on health plan applications.
Yes· 3 of 9
Does this give people more protection from unfair business practices?+8
The bill enhances consumer protection by cracking down on fraudulent enrollment practices by agents and brokers.
Does this strengthen the Affordable Care Act?+7
The bill strengthens the Affordable Care Act by increasing the medical loss ratio to 85 percent and penalizing fraudulent enrollment.
Would households on low incomes be better off under this?+6
Low-income individuals relying on ACA exchange plans are better protected from fraudulent broker enrollments.
The opposite
Would business owners be better off under this?-2
Small business health insurance offerings are subject to stricter medical loss ratio requirements.
Who it would affect, and how
Potential Positive Impacts for People
-
Higher Medical Loss Ratios: Under Section 2, the bill changes the medical loss ratio from 80 percent to 85 percent for health insurance coverage offered in small group and individual markets. This means insurance companies are required to spend a larger portion of their revenue on patient care and quality improvements.
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Penalties for Fraudulent Agents and Brokers: Under Section 3, the bill imposes strict civil penalties ranging from $10,000 to $50,000 for negligence, civil monetary penalties of up to $200,000 for knowing and willful violations, and criminal penalties including fines and up to 10 years in prison for agents or brokers who provide false or fraudulent information on health plan applications. This holds bad actors accountable and helps protect people from fraudulent enrollment in qualified health plans.
Potential Negative Impacts for People
- Potential Burdens on Agents and Brokers: Under Section 3, agents and brokers face severe financial penalties and potential imprisonment of up to 10 years for providing incorrect or false information on applications. While this targets fraud, it places a heavy legal and financial burden on insurance intermediaries, which could potentially impact the availability of assistance for people trying to enroll in plans.
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Demographic And Interest Groups
- Good For Low Income Households+6Good For Middle Class Households+6Good For Children+5Good For Middle Aged+5Good For Seniors+5Good For Young Adults+5Good For Business Owners-2
- Healthcare
- Increases Affordable Care Act Support+7Improves Healthcare Access+6
- Economy And Finance
- Improves Consumer Protection+8
- 3/9/2026
- Referred to the House Committee on Energy and Commerce.
- 1 Cosponsor added.
- Introduced in House
Josh RileyDemocrat · New York