H.R. 7164

119 HR 7164 IH: Capping Costs for Consumers Act of 2026
 U.S. House of Representatives
 2026-01-20
 text/xml
 EN
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 I  119th CONGRESS  2d Session  H. R. 7164  IN THE HOUSE OF REPRESENTATIVES   January 20, 2026   Ms. Schrier  (for herself and  Ms. Budzinski ) 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 expand cost-sharing reductions with respect to qualified health plans offered through an Exchange, and for other purposes.
1.
Short title
This Act may be cited as the   Capping Costs for Consumers Act of 2026  .
2.
Expanding cost-sharing reductions under Exchange plans
(a)
In general
Section 1402 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18071 ) is amended—
(1)
in subsection (b)—
(A)
in paragraph (1), by striking  who enrolls  and inserting  subject to the last sentence of this subsection, who enrolls ; and
(B)
by adding at the end the following sentence:  With respect to plan years beginning on or after January 1, 2028, paragraph (1) shall be applied as if the reference to the silver level of coverage were a reference to the gold level of coverage. ;
(2)
in subsection (c)(1)(B)(i)—
(A)
in subclause (II), by striking  an eligible insured described in paragraph (2)(B)  and inserting  , with respect to plan years beginning before January 1, 2028, an eligible insured described in paragraph (2)(B)(i) and, with respect to plan years beginning on or after January 1, 2028, an eligible insured described in paragraph (2)(B)(ii) ; and
(B)
by amending subclauses (III) and (IV) to read as follows:
(III)
with respect to plan years beginning before January 1, 2028—
(aa)
73 percent in the case of an eligible insured whose household income is more than 200 percent but not more than 250 percent of the poverty line for a family of the size involved; and
(bb)
70 percent in the case of an eligible insured whose household income is more than 250 percent but not more than 400 percent of the poverty line for a family of the size involved; and
(IV)
with respect to plan years beginning on or after January 1, 2028, 85 percent in the case of an eligible insured described in paragraph (2)(C)(ii).
  ;
(3)
in subsection (c)(2), by amending subparagraphs (B) and (C) to read as follows:
(B)
in the case of—
(i)
with respect to plan years beginning before January 1, 2028, an eligible insured whose household income is more than 150 percent but not more than 200 percent of the poverty line for a family of the size involved, increase the plan’s share of the total allowed costs of benefits provided under the plan to 87 percent of such costs; and
(ii)
with respect to plan years beginning on or after January 1, 2028, an eligible insured whose household income is more than 150 percent but not more than 300 percent of the poverty line for a family of the size involved, increase the plan’s share of the total allowed costs of benefits provided under the plan to 87 percent of such costs; and
(C)
in the case of—
(i)
with respect to plan years beginning before January 1, 2028, an eligible insured whose household income is more than 200 percent but not more than 250 percent of the poverty line for a family of the size involved, increase the plan’s share of the total allowed costs of benefits provided under the plan to 73 percent of such costs; and
(ii)
with respect to plan years beginning on or after January 1, 2028, an eligible insured whose household income is more than 300 percent but not more than 400 percent of the poverty line for a family of the size involved, increase the plan’s share of the total allowed costs of benefits provided under the plan to 85 percent of such costs.
 ; and
(4)
by adding at the end the following new subsection:
(h)
Funding
Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary such sums as may be necessary for payments under this section.
 .
(b)
Conforming amendments to State basic health programs for certain low-Income individuals
Section 1331(a)(2) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18051(a)(2) ) is amended—
(1)
in subparagraph (A)(i), by striking  the applicable second lowest cost silver plan (as defined in  section 36B(b)(3)(B)  of the Internal Revenue Code of 1986)  and inserting  , with respect to plan years beginning before January 1, 2028, the applicable second lowest cost silver plan (as defined in  section 36B(b)(3)(B)  of the Internal Revenue Code of 1986) and, with respect to plans years beginning on or after January 1, 2028, the applicable second lowest cost gold plan (as defined in such section) ; and
(2)
in the matter following subparagraph (B), by striking  or the applicable second lowest cost silver plan  and inserting  or, with respect to plan years beginning before January 1, 2028, the applicable second lowest cost silver plan (or, with respect to plan years beginning on or after January 1, 2028, the applicable second lowest cost gold plan .
3.
Premium assistance credit amount determined using applicable second lowest cost gold plan
(a)
In general
 Section 36B  of the Internal Revenue Code of 1986 is amended—
(1)
by striking  silver  each place it appears and inserting  gold ; and
(2)
in the header of subsection (b)(3)(B), by striking
silver   and inserting
gold  .
(b)
Effective date
The amendments made by this section shall apply to taxable years beginning after December 31, 2027.