PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
No official summary is available in the imported record yet.
People & committees
Rep. Davids, Sharice [D-KS-3] · D–KS
Legislative record
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Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
Source last updated: Oct 15, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-10-05 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed Healthy Communities Act of 2026 would expand access to tax credits that help pay health insurance premiums, including for certain people below the poverty line who cannot get Medicaid because their state has not expanded coverage. It would also change temporary federal Medicaid funding, set annual insurance enrollment dates, and add safeguards for people enrolling through insurance agents or brokers. These are proposed changes; the supplied record does not establish enactment.
This Act may be cited as the Healthy Communities Act of 2026.
Subparagraph (A) of section 36B(c)(1) of the Internal Revenue Code of 1986 is amended by striking but does not exceed 400 percent.
such taxpayer shall be treated for the taxable year as an applicable taxpayer whose household income for the taxable year is equal to 100 percent of the poverty line for a family of the size involved
Restoring and expanding temporary FMAP increase to certain State plans under Medicaid
for calendar years beginning with 2026, that begin on November 1 of each such year and end on the following January 15
the Secretary shall establish a verification process for new enrollments of individuals in, and changes in coverage for individuals under, a qualified health plan offered through such Exchange
Section 2 would remove the 400-percent-of-poverty income ceiling from the cited premium tax credit eligibility provision. This change alone would not remove other eligibility requirements.
Subparagraph (A) of section 36B(c)(1) of the Internal Revenue Code of 1986 is amended by striking but does not exceed 400 percent.
The bill would replace the income-based percentages used in the premium tax credit calculation. The table specifies 0 percent through 150 percent of poverty; sliding percentages of 0–2, 2–4, 4–6, and 6–8.5 across the next four income bands; and 8.5 percent at 400 percent of poverty and above. These calculation percentages do not establish the price of every insurance plan.
the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier
Up to 150 percent 0 0 150 percent up to 200 percent 0 2.0 200 percent up to 250 percent 2.0 4.0 250 percent up to 300 percent 4.0 6.0 300 percent up to 400 percent 6.0 8.5 400 percent and higher 8.5 8.5.
Section 2 would delete three specified affordability-related provisions and paragraphs (5) and (6) of section 36B(c). The deleted language is not reproduced, so the bundle does not establish the full practical effect of these deletions.
(2) Conforming amendments relating to affordability of coverage (A) Paragraph (1) of section 36B(c) of such Code is amended by striking subparagraph (E). (B) Subparagraph (C) of section 36B(c)(2) of such Code is amended by striking clause (iv). (C) Paragraph (4) of section 36B(c) of such Code is amended by striking subparagraph (F).
(2) by striking paragraphs (5) and (6).
For premium tax credit purposes, the bill would use the Affordable Care Act's definition of a qualified health plan but exclude the category called a catastrophic plan. The referenced definitions are not reproduced.
The term qualified health plan has the meaning given such term by section 1301(a) of the Patient Protection and Affordable Care Act, except that such term shall not include a qualified health plan which is a catastrophic plan described in section 1302(e) of such Act.
All section 2 amendments would apply to tax years and insurance plan years beginning after December 31, 2025.
The amendments made by this section shall apply to taxable years and plan years beginning after December 31, 2025.
Beginning with tax years after December 31, 2026, a taxpayer who meets the Medicaid coverage gap definition for any month would be treated for premium tax credit purposes as having annual income equal to 100 percent of poverty, with a 0-percent applicable percentage. The definition requires income below poverty and lack of qualifying coverage because the state has not extended Medicaid to the entire specified expansion group.
in the case of a taxpayer who is a Medicaid coverage gap individual for any month of a taxable year— (A) such taxpayer shall be treated for the taxable year as an applicable taxpayer whose household income for the taxable year is equal to 100 percent of the poverty line for a family of the size involved, and (B) the applicable percentage for such taxpayer for the taxable year shall be 0 percent.
who would be eligible for minimum essential coverage (as defined in section 5000A(f), determined without regard to paragraph (1)(C) thereof) but for the fact that the State in which such individual resides has not elected to provide medical assistance under the State Medicaid plan under title XIX of the Social Security Act (or a waiver of such plan) to all individuals described in section 1902(a)(10)(A)(i)(VIII) of such Act, and (B) whose household income for the taxable year is less than 100 percent of the poverty line for a family of the size involved.
The amendment made by this section shall apply to taxable years beginning after December 31, 2026.
The special Medicaid coverage gap eligibility rule would preserve the application of the existing joint tax return requirement. The bill does not reproduce that requirement.
(3) Application of joint return requirement Paragraph (1)(A) shall not affect the application of subsection (c)(1)(C).
Section 4 would change an existing temporary federal Medicaid matching provision from an 8-quarter period to a 24-quarter period and replace the number 5 with 10. It would also replace a state eligibility clause with a condition that the state had not spent amounts for all members of the referenced Medicaid group before January 1, 2026. The duration and numerical changes would apply to quarters within qualifying periods beginning on or after that date; the full matching formula is not supplied.
Section 1905(ii) of the Social Security Act (42 U.S.C. 1396d(ii)) is amended— (1) in paragraph (1)— (A) by striking 8-quarter and inserting 24-quarter; and (B) by striking 5 and inserting 10; and (2) in paragraph (3), by striking which and all that follows through the end and inserting which did not expend amounts for all individuals described in section 1902(a)(10)(A)(i)(VIII) before January 1, 2026.
The amendments made by subsection (a)(1) shall apply with respect to quarters occurring during a period described in section 1905(ii)(1) of the Social Security Act (42 U.S.C. 1396d(ii)(1)) that begins on or after January 1, 2026.
Section 5 would repeal sections 71107, 71112, 71119, and 71120 of Public Law 119–21 and direct that affected laws and regulations operate as if those sections and their amendments had not been enacted. Their contents are not supplied, so their specific policies cannot be described from this bundle.
Sections 71107, 71112, 71119, and 71120 of the Act titled An Act to provide for reconciliation pursuant to title II of H. Con. Res. 14 (Public Law 119–21) are hereby repealed, and any law or regulation referred to in such sections shall be applied as if such sections and the amendments made by such sections had not been enacted.
Beginning in calendar year 2026, the bill would set the annual Affordable Care Act open enrollment period—the regular window to enroll in coverage—from November 1 through the following January 15.
Codifying open enrollment period dates under the Affordable Care Act Section 1311(c)(6)(B) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)(B)) is amended by inserting and before 2026, and, for calendar years beginning with 2026, that begin on November 1 of each such year and end on the following January 15 after initial enrollment period.
Agents and brokers who provide incorrect covered enrollment information through negligence or disregard of the Secretary's rules would face civil penalties of $10,000 to $50,000 for each affected individual, in addition to other legally available penalties.
If any agent or broker fails to provide correct information under subsection (b) or section 1311(c)(8), or other information as part of an application for enrollment in a qualified health plan offered through an Exchange, as specified by the Secretary, and such failure is attributable to negligence or disregard of any rules or regulations of the Secretary, such agent or broker shall be subject, in addition to any other penalties that may be prescribed by law, including subparagraph (C), to a civil penalty of not less than $10,000 and not more than $50,000 with respect to each individual who is the subject of an application for which such incorrect information is provided.
Agents and brokers who knowingly and willfully provide false or fraudulent covered enrollment information would face civil penalties of up to $200,000 for each affected individual, in addition to other penalties. Specified Social Security Act procedures would govern these civil penalties.
Any agent or broker who knowingly and willfully provides false or fraudulent information under subsection (b) or section 1311(c)(8), or other false or fraudulent information as part of an application for enrollment in a qualified health plan offered through an Exchange, as specified by the Secretary, shall be subject, in addition to any other penalties that may be prescribed by law, including subparagraph (C), to a civil penalty of not more than $200,000 with respect to each individual who is the subject of an application for which such false or fraudulent information is provided.
The provisions of section 1128A of the Social Security Act (other than subsections (a) and (b) of such section) shall apply to a civil monetary penalty under subclause (I)
Knowingly and willfully providing false or fraudulent covered enrollment information could also expose an agent or broker to a criminal fine, imprisonment for up to 10 years, or both. The penalty amendments would apply to enrollment applications for plan years beginning on or after January 1, 2027.
Any agent or broker who knowingly and willfully provides false or fraudulent information under subsection (b) or section 1311(c)(8), or other false or fraudulent information as part of an application for enrollment in a qualified health plan offered through an Exchange, as specified by the Secretary, shall be fined under title 18, United States Code, imprisoned for not more than 10 years, or both.
The amendments made by subsection (a)(1) shall apply with respect to applications for enrollment in a qualified health plan offered through an Exchange for plan years beginning on or after January 1, 2027.
For federally operated insurance marketplaces, the Secretary would establish verification of new enrollments and coverage changes submitted by agents or brokers eligible for commissions. It would require evidence of the individual's consent and start with plan years beginning on a date the Secretary selects, no later than January 1, 2029.
For plan years beginning on or after such date specified by the Secretary, but not later than January 1, 2029, in the case of an Exchange that the Secretary operates pursuant to section 1321(c)(1), the Secretary shall establish a verification process for new enrollments of individuals in, and changes in coverage for individuals under, a qualified health plan offered through such Exchange, which are submitted by an agent or broker in accordance with section 1312(e) and for which the agent or broker is eligible to receive a commission.
a requirement that the agent or broker provide with the new enrollment or coverage change such documentation or evidence (such as a standardized consent form) or other sources as the Secretary determines necessary to establish that the agent or broker has the consent of the individual for the new enrollment or coverage change
Under that verification process, commissions would be paid only after the enrollee resolves all inconsistencies under the cited verification provisions. Health plans would receive access to consent information and, where applicable, the date inconsistencies were resolved so commissions could be paid at the appropriate time.
a requirement that any commissions due to a broker or agent for such new enrollment or coverage change are paid after the enrollee has resolved all inconsistencies in accordance with paragraphs (3) and (4) of section 1411(e)
a requirement that the information required under clause (i) and, as applicable, the date on which inconsistencies are resolved as described in clause (ii), is accessible to the applicable qualified health plan through a database or other resource, as determined by the Secretary, so that any commissions due to a broker or agent for such enrollment can be effectuated at the appropriate time
The verification process would require timely notices about changes to enrollment, coverage, the assigned agent, or premium tax credits, with plain-language instructions for canceling unauthorized activity. People using an alternative enrollment platform would also have access to account information, including their plan, assigned agent, and changes, through a consumer website or toll-free hotline.
a requirement that individuals are notified of any changes to enrollment, coverage, the agent of record, or premium tax credits in a timely manner and that such notice provides plain language instructions on how individuals can cancel unauthorized activity
a requirement that individuals be able to access their account information on a website or other technology platform, as defined by the Secretary, when used to submit an enrollment or plan change, in lieu of the Exchange website described in subsection (d)(4)(C), including information on the agent of record, the qualified health plan, and when any changes are made to the agent of record or the qualified health plan, on a consumer-facing website or through a toll-free telephone hotline
Agents and brokers subject to the verification process would have to identify marketing organizations involved in an enrollment or coverage change. The process would have to prioritize continued coverage and care, including keeping people enrolled without their consent to removal even when an agent, broker, or plan violates these verification requirements.
a requirement that the agent or broker report to the Secretary any third-party marketing organization or field marketing organization (as such terms are defined in section 1312(e)) involved in the chain of enrollment (as so defined) with respect to such new enrollment or coverage change.
The Secretary shall ensure that the enrollment verification process under subparagraph (A) prioritizes continuity of coverage and care for individuals, including by not disenrolling individuals from a qualified health plan without the consent of the individual, regardless of whether the broker, agent, or qualified health plan is in violation of any requirement under this paragraph.
The bill would add a requirement to report an insurer's “termination” to the Secretary. Its cross-referenced definition covers the ending of an agent or broker's business arrangement, including expiration without a substantially similar replacement. The wording leaves uncertainty about precisely which insurer-related terminations must be reported.
(J) report to the Secretary the termination (as defined in section 1312(e)(1)(C)) of an issuer.
The term termination, with respect to a contract or business arrangement between an agent or broker and a field marketing organization, third-party marketing organization, or health insurance issuer, means— (I) the ending of such contract or business arrangement, either unilaterally by one of the parties or on mutual agreement; or (II) the expiration of such contract or business arrangement that is not replaced by a substantially similar agreement.
The Secretary would set procedures under which states may allow marketing organizations to participate in marketplace enrollment. By a selected plan-year start no later than January 1, 2029, federal regulations would establish criteria states must use for agents, brokers, and these organizations. Agents and brokers would owe enrollees a duty to act in their best interests; marketing organizations would have to report agent or broker terminations and reasons to the state and Secretary.
The Secretary shall establish procedures under which a State may allow
field marketing organizations and third-party marketing organizations to participate in the chain of enrollment for an individual with respect to qualified health plans offered through an Exchange.
For plan years beginning on or after such date specified by the Secretary, but not later than January 1, 2029, the Secretary, by regulation, shall establish criteria for States to use in determining whether to allow agents and brokers to enroll individuals and employers in qualified health plans
(i) an agent or broker act in accordance with a standard of conduct that includes a duty of such agent or broker to act in the best interests of the enrollee; (ii) a field marketing organization or third-party marketing organization agree to report the termination of an agent or broker to the applicable State and the Secretary, including the reason for termination
Agents, brokers, and covered marketing organizations would have to follow federal and state marketing rules, avoid confusing or misleading practices, submit all marketing materials for federal review and approval as the Secretary considers appropriate, satisfy state licensing requirements, and register with the Secretary.
an agent, broker, field marketing organization, or third-party marketing organization— (I) meet such marketing requirements as are required by the Secretary; (II) meet marketing requirements in accordance with other applicable Federal or State law; (III) does not employ practices that are confusing or misleading, as determined by the Secretary; (IV) submit all marketing materials to the Secretary for, as determined appropriate by the Secretary, review and approval; (V) is a licensed agent or broker or meets other licensure requirements, as required by the State; (VI) register with the Secretary
Covered agents, brokers, and marketing organizations could not pay people or organizations for referrals or other services related to marketplace plan sales, marketing, or enrollment unless the recipients also meet the specified marketing, licensing, and registration criteria.
does not compensate any individual or organization for referrals or any other service relating to the sale of, marketing for, or enrollment in qualified health plans unless such individual or organization meets the criteria described in subclauses (I) through (VI).
The marketing rules would cover the process from initial marketing through an individual's enrollment decision. Covered organizations include those employing or contracting with agents, brokers, or insurers for enrollment functions, and those paid to generate potential customers, market, or sell marketplace coverage.
The term chain of enrollment, with respect to enrollment of an individual in a qualified health plan offered through an Exchange, means any steps taken during the period beginning with marketing to such individual and ending with such individual making an enrollment decision with respect to such a plan.
The term field marketing organization means an organization or individual that directly employs or contracts with agents and brokers, or contracts with carriers, to provide functions relating to enrollment of individuals in qualified health plans offered through an Exchange as part of the chain of enrollment.
The term third-party marketing organization means an organization or individual that is compensated to perform lead generation, marketing, or sales relating to enrollment of individuals in qualified health plans offered through an Exchange as part of the chain of enrollment.
By a selected plan-year start no later than January 1, 2029, the Secretary would implement agent and broker oversight with states and consultation with the National Association of Insurance Commissioners. Periodic audits would consider enrollee complaints, patterns suggesting fraud, and other selected factors. Audit results would be shared and potential fraud referred to state insurance departments without restricting the specified existing referral or enforcement powers.
For plan years beginning on or after such date specified by the Secretary, but not later than January 1, 2029, the Secretary, in coordination with the States and in consultation with the National Association of Insurance Commissioners, shall implement a process for the oversight and enforcement of agent and broker compliance with this section and other applicable Federal and State law (including regulations)
periodic audits of agents and brokers based on— (I) complaints filed with the Secretary by individuals enrolled by such an agent or broker in a qualified health plan offered through an Exchange; (II) an incident or enrollment pattern that suggests fraud; and (III) other factors determined by the Secretary; and (ii) a process under which the Secretary shall share audit results and refer potential cases of fraud to the relevant State department of insurance.
Nothing in this paragraph limits or restricts any referrals made under section 1311(i)(3) or any enforcement actions under section 1411(h).
The Secretary would develop a process to regularly give health plans, marketplaces, and states a list of suspended and terminated agents and brokers.
The Secretary shall develop a process to regularly provide to qualified health plans, Exchanges, and States a list of suspended and terminated agents and brokers.
Within 90 days after enactment and quarterly afterward, the Secretary would check the Death Master File, a death-record source, for deceased marketplace enrollees. The Secretary would have to establish a process to verify deaths and require marketplaces to terminate those individuals' coverage.
Not later than 90 days after the date of the enactment of this paragraph, and on a quarterly basis thereafter, the Secretary shall conduct a check of the Death Master File (as such term is defined in section 203(d) of the Bipartisan Budget Act of 2013) for purposes of identifying individuals enrolled in a qualified health plan through an Exchange who are deceased.
The Secretary shall— (i) establish a process to verify that an individual identified pursuant to a check described in subparagraph (A) is deceased; and (ii) require an Exchange to terminate such individual’s enrollment under a qualified health plan.
The Secretary could terminate an agent's or broker's agreement with a federally operated marketplace for cause upon finding a violation of the agreement, applicable law, or another applicable requirement. The standard would be a preponderance of the evidence—meaning the violation is more likely than not.
the Secretary may terminate such agreement for cause if the Secretary finds, based on a preponderance of the evidence, that such agent or broker has violated such agreement, otherwise applicable law, or any other requirement applicable to such agent or broker.
Beginning January 1, 2027, a marketplace notified of an advance premium tax credit eligibility determination would have to clearly tell the individual the credit amount before enrolling them in a plan.
Beginning January 1, 2027, if an Exchange is notified under paragraph (1) of an advance determination under section 1411 with respect to the eligibility of an individual for a premium tax credit under section 36B of the Internal Revenue Code of 1986, the Exchange shall, prior to enrolling such individual in a qualified health plan, clearly notify such individual of the amount of such tax credit.
The supplied official-actions snapshot, updated October 15, 2026, records House introduction on October 5, 2026, and referral that day to the Energy and Commerce and Ways and Means committees. This snapshot does not establish subsequent advancement or enactment.
Source snapshot updated 2026-10-15T20:43:00Z.
2026-10-05: Introduced in House
2026-10-05: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
A closer look
Reviewed version: Introduced in House · 2026-10-05. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated rider was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish the contents or attachment history of other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for a particular recipient or place outside a general statutory allocation was identified in the complete supplied introduced text. This does not establish absence in other versions or accompanying disclosure materials.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
Findings to examine
The supplied introduced text contains a selective state funding benefit tied to a historical eligibility condition. Its identification does not imply improper purpose.
Section 4 would extend and increase a temporary federal Medicaid matching benefit for a selected class of states, with the replacement eligibility clause requiring that they had not spent amounts for all members of the referenced Medicaid group before January 1, 2026. This preferential funding treatment relates directly to the bill's Medicaid policy. The complete underlying statute is needed to determine the full eligibility rules and payment calculation.
Restoring and expanding temporary FMAP increase to certain State plans under Medicaid
(1) in paragraph (1)— (A) by striking 8-quarter and inserting 24-quarter; and (B) by striking 5 and inserting 10; and (2) in paragraph (3), by striking which and all that follows through the end and inserting which did not expend amounts for all individuals described in section 1902(a)(10)(A)(i)(VIII) before January 1, 2026.
The amendments made by subsection (a)(1) shall apply with respect to quarters occurring during a period described in section 1905(ii)(1) of the Social Security Act (42 U.S.C. 1396d(ii)(1)) that begins on or after January 1, 2026.
Full text preserved for this analysis. Legislative record snapshot: Oct 15, 2026. How PlainBill uses AI