H.R. 10730 – Healthy Communities Act of 2026

119th CONGRESS

2d Session

H. R. 10730

IN THE HOUSE OF REPRESENTATIVES

October 5, 2026

Ms. Davids of Kansas introduced the following bill; which was 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 BILL

To amend the Internal Revenue Code of 1986 to modify the premium tax credit, and for other purposes.

Short title

This Act may be cited as the Healthy Communities Act of 2026.

Modification of premium tax credit

(a)

Increase in eligibility for credit

Subparagraph (A) of section 36B(c)(1) of the Internal Revenue Code of 1986 is amended by striking but does not exceed 400 percent.

(b)

Applicable percentages

(1)

In general

Subparagraph (A) of section 36B(b)(3) of such Code is amended to read as follows:

(A)

Applicable percentage

The applicable percentage for any taxable year shall be the percentage such that 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:

In the case of household income (expressed as a percent of poverty line) within the following income tier:	The initial premium percentage is—	The final premium percentage is—
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.

(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).

(c)

Repeal of certain amendments made by Public Law 119–21

Section 36B(c) of such Code, as amended by sections 71303 and 71304 of Public Law 119–21, is amended—

(1)

by amending paragraph (3)(A) to read as follows:

(A)

Qualified health plan

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.

, and

(2)

by striking paragraphs (5) and (6).

(d)

Effective date

The amendments made by this section shall apply to taxable years and plan years beginning after December 31, 2025.

Application of premium tax credit in case of Medicaid coverage gap individuals

(a)

In general

Section 36B of the Internal Revenue Code of 1986 is amended by redesignating subsection (h) as subsection (i) and by inserting after subsection (g) the following new subsection:

(h)

Special rule for Medicaid coverage gap individuals

(1)

In general

For purposes of this section, 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.

(2)

Medicaid coverage gap individual defined

For purposes of this subsection, the term Medicaid coverage gap individual means an individual—

(A)

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.

(3)

Application of joint return requirement

Paragraph (1)(A) shall not affect the application of subsection (c)(1)(C).

(b)

Effective date

The amendment made by this section shall apply to taxable years beginning after December 31, 2026.

Restoring and expanding temporary FMAP increase to certain State plans under Medicaid

(a)

In general

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..

(b)

Effective date

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.

Repeal of certain reconciliation health provisions

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.

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.

Guardrails to prevent fraud in Exchanges

(a)

Reduction of fraudulent enrollment in qualified health plans

(1)

Penalties for agents and brokers

Section 1411(h)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18081(h)(1)) is amended—

(A)

in subparagraph (A)—

(i)

by redesignating clause (ii) as clause (iv);

(ii)

in clause (i)—

(I)

by striking If— and all that follows through the such person and inserting If any person (other than an agent or broker) fails to provide correct information under subsection (b) and such failure is attributable to negligence or disregard of any rules or regulations of the Secretary, such person; and

(II)

in the second sentence, by striking For purposes and inserting the following:

(iii)

Definitions of negligence, disregard

For purposes

;

(iii)

by inserting after clause (i) the following:

(ii)

Civil penalties for certain violations by agents or brokers

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.

; and

(iv)

in clause (iv) (as so redesignated), by inserting or (ii) after clause (i);

(B)

in subparagraph (B)—

(i)

by inserting including subparagraph (C), after law,;

(ii)

by striking Any person and inserting the following:

(i)

In general

Any person

; and

(iii)

by adding at the end the following:

(ii)

Civil penalties for knowing and willful violations by agents or brokers

(I)

In general

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.

(II)

Procedure

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) in the same manner as such provisions apply to a penalty or proceeding under section 1128A of the Social Security Act.

; and

(C)

by adding at the end the following:

(C)

Criminal penalties

(2)

Consumer protections

(A)

In general

Section 1311(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)) is amended by adding at the end the following new paragraph:

(8)

Agent- or broker-assisted enrollment in qualified health plans in certain exchanges

(A)

In general

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.

(B)

Requirements

The enrollment verification process under subparagraph (A) shall include—

(i)

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;

(ii)

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);

(iii)

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;

(iv)

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;

(v)

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; and

(vi)

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.

(C)

Consumer protection

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.

(B)

Required reporting

Section 1311(c)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(1)) is amended—

(i)

in subparagraph (H), by striking and at the end;

(ii)

in subparagraph (I), by striking the period at the end and inserting ; and; and

(iii)

by adding at the end the following:

(J)

report to the Secretary the termination (as defined in section 1312(e)(1)(C)) of an issuer.

(3)

Authority to regulate field marketing organizations and third-party marketing organizations

Section 1312(e) of the Patient Protection and Affordable Care Act (42 U.S.C. 18032(e)) is amended—

(A)

by redesignating paragraphs (1) and (2) as subclauses (I) and (II), respectively, and adjusting the margins accordingly;

(B)

in subclause (II) (as so redesignated), by striking the period at the end and inserting ; and;

(C)

by striking the subsection designation and heading and all that follows through brokers— and inserting the following:

(e)

Regulation of agents, brokers, and certain marketing organizations

(1)

Agents, brokers, and certain marketing organizations

(A)

In general

The Secretary shall establish procedures under which a State may allow—

(i)

agents or brokers—

; and

(D)

by adding at the end the following:

(ii)

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.

(B)

Criteria

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 as described in subclause (I) of subparagraph (A)(i) and to assist individuals as described in subclause (II) of such subparagraph and field marketing organizations and third-party marketing organizations to participate in the chain of enrollment as described in subparagraph (A)(ii). Such criteria shall, at a minimum, require that—

(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; and

(iii)

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)

(VII)

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).

(C)

Definitions

In this paragraph:

(i)

Chain of enrollment

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.

(ii)

Field marketing organization

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.

(iii)

Marketing

The term marketing means the use of marketing materials to provide information to current and prospective enrollees in a qualified health plan offered through an Exchange.

(iv)

Marketing materials

The term marketing materials means materials relating to a qualified health plan offered through an Exchange or benefits offered through an Exchange that—

(I)

are intended—

(aa)

to draw an individual’s attention to such plan or the premium tax credits or cost-sharing reductions for such plan or plans offered through an Exchange;

(bb)

to influence an individual’s decision-making process when selecting a qualified health plan in which to enroll; or

(cc)

to influence an enrollee’s decision to stay enrolled in such plan; and

(II)

include or address content regarding the benefits, benefit structure, premiums, or cost sharing of such plan.

(v)

Termination

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.

(vi)

Third-party marketing organization

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.

(4)

Transparency

Section 1312(e) of the Patient Protection and Affordable Care Act (42 U.S.C. 18032(e)), as amended by paragraph (3), is further amended by adding at the end the following new paragraphs:

(2)

Audits

(A)

In general

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) that shall include—

(i)

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.

(B)

Effect

Nothing in this paragraph limits or restricts any referrals made under section 1311(i)(3) or any enforcement actions under section 1411(h).

(3)

List

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.

(b)

Removal of deceased individuals from Exchange plans

Section 1311(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)), as amended by subsection (a), is further amended by adding at the end the following new paragraph:

(9)

Removal of deceased individuals from Exchange plans

(A)

In general

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.

(B)

Process

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.

(c)

Standard of proof for terminating agents and brokers

Section 1312(e) of the Patient Protection and Affordable Care Act (42 U.S.C. 18032(e)), as amended by subsection (a), is further amended by adding at the end the following new paragraph:

(4)

Standard for termination for certain Exchanges

In the case of an agent or broker with an agreement in effect with an Exchange operated by the Secretary pursuant to section 1321(c) to perform activities described in paragraph (1)(A)(i) with respect to such Exchange, 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.

(d)

Requirement for Exchange To notify individuals of value of premium tax credits

Section 1412(c)(2) of the Patient Protection and Affordable Care Act (42 U.S.C. 18082(c)(2)) is amended by adding at the end the following new subparagraph:

(C)

Exchange responsibilities

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.

(e)

Effective date

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.

Healthy Communities Act of 2026

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