Health Bill Extends Subsidies Through 2026 and Imposes Strict New Penalties on PBMs and Insurance Agents

The newly introduced CommonGround for Affordable Health Care Act is a big one, touching on everything from your monthly insurance bill to how drug prices are negotiated in Medicare. The core of the bill is a dual focus: extending crucial financial help for health insurance and cracking down hard on fraud and opaque practices in the healthcare industry.

The 2026 Lifeline: Keeping Premiums Down

First, let’s talk insurance costs. If you buy health insurance through the marketplace (Affordable Care Act Exchanges), you know those enhanced premium tax credits (PTCs) have been a game-changer, keeping monthly premiums manageable. This bill extends those more generous subsidies through the 2026 tax year. That means the amount you’re expected to contribute toward your premium based on your income remains lower than it would be otherwise (Sec. 2).

Even more significantly, for 2026 only, the bill temporarily raises the upper income limit for eligibility from 400% of the federal poverty line (FPL) all the way up to 1000% of the FPL. What does that mean in real life? If you’re a family making significantly more than the current cap but still struggling with massive premium costs—maybe you’re a mid-career couple running a small business—you could suddenly qualify for substantial help next year. This is a major expansion of who gets financial assistance (Sec. 2).

To make sure people can actually use this extension, the bill also pushes the open enrollment period for 2026 all the way to March 19, 2026 (Sec. 4). If you’re busy juggling work and family, that extra time is a huge relief, ensuring you don’t miss the deadline for coverage.

New Guardrails: Hitting Agents and Brokers Where It Hurts

While expanding subsidies, the bill also targets fraud in the enrollment process. It introduces heavy-duty penalties for insurance agents and brokers who submit incorrect or fraudulent information in exchange applications. If an agent is found to be negligent, they face a civil penalty of $10,000 to $50,000 per application. If they knowingly submit false information, that fine jumps up to $200,000 per application, plus potential criminal penalties of up to 10 years in prison (Sec. 3).

For the consumer, this is a win: the bill requires new verification processes for enrollments submitted by agents, ensuring you are notified of any changes to your coverage or tax credits and giving you clear instructions on how to cancel unauthorized activity. The intent is to stop bad actors from signing people up for plans they didn't ask for (Sec. 3). However, this also puts immense pressure on legitimate agents and brokers, who now face massive financial risk if they make a simple error. This could raise compliance costs and potentially reduce the number of agents willing to help people navigate the marketplace.

PBMs: The Transparency Hammer Drops

The most significant restructuring in this bill focuses on Pharmacy Benefit Managers (PBMs)—the secretive middlemen who manage prescription drug benefits, especially in Medicare Part D. Effective in 2029, the bill fundamentally changes how PBMs can make money from Medicare plans (Sec. 5).

Currently, PBMs often profit from spread pricing and retaining rebates from drug manufacturers. This bill says PBMs can no longer receive any payment related to covered drugs except for “bona fide service fees,” which must be flat dollar amounts reflecting the fair market value of their services. Crucially, any rebates or discounts they get from manufacturers must be fully passed through to the plan sponsor (Sec. 5). The goal here is to stop the hidden incentives that critics say drive up drug costs.

To enforce this, PBMs will be required to submit incredibly detailed, standardized annual reports to the government and plan sponsors. These reports must disclose everything from total rebates and average pharmacy reimbursement amounts to how much revenue the PBM retained and comparative data if they own their own pharmacy (Sec. 5). This level of transparency is unprecedented and gives the government and plan sponsors the data needed to audit and enforce these new rules.

The Legislative Fast-Track

Finally, the bill includes a technical but powerful section that creates a special “fast-track” procedure for Congress to consider future bills aimed at continuing or reforming the enhanced premium tax credits. Any bill that meets specific bipartisan cosponsor requirements (10 from each party) and deals only with premium savings can bypass normal committee review and debate limits, including the Senate filibuster (Sec. 6).

While the stated goal is to ensure quick action on keeping healthcare affordable, this section is a significant procedural change. It creates a mechanism that limits deliberation and speeds up the legislative process for a specific policy area. It concentrates power to advance legislation quickly, which could be beneficial if Congress is deadlocked on subsidies, but it also means less public scrutiny and debate on potentially complex future reforms.