This bill expands cost-sharing reductions and shifts the benchmark for premium assistance tax credits under the Affordable Care Act from silver to gold level health plans starting in 2028.
Kim Schrier
Representative
WA-8
The Capping Costs for Consumers Act of 2026 aims to lower healthcare costs for consumers purchasing insurance through the Exchange. It achieves this by changing the benchmark used to calculate both cost-sharing reductions and premium assistance tax credits from a silver-level plan to a gold-level plan, effective starting in 2028. The bill also permanently funds these expanded cost-sharing reductions.
New Healthcare Bill Upgrades Benchmark to Gold: Lower Deductibles and Higher Tax Credits Set for 2028.
The Capping Costs for Consumers Act of 2026 is essentially a major software update for the Affordable Care Act (ACA), designed to lower the bill when you visit the doctor. Starting January 1, 2028, the bill shifts the math for health insurance subsidies from the current 'Silver' plan standard to the more robust 'Gold' plan. By using a more expensive plan as the baseline for calculating financial help, the government effectively increases the size of the tax credits and discounts available to people buying insurance on the Exchange. This isn't just a technical tweak; it’s a shift that aims to make high-quality coverage the standard rather than the exception for millions of workers.
The Gold Standard Upgrade
Currently, if you buy insurance on the Exchange, your tax credits and out-of-pocket discounts are tied to the second-lowest-cost Silver plan in your area. This bill (Sec. 3) swaps that 'Silver' label for 'Gold' across the board. For a freelance graphic designer or a construction contractor making between 150% and 400% of the federal poverty line, this change means their monthly premium tax credits will likely grow because they are now being calculated against a more expensive plan. Additionally, for those in the 150% to 300% income bracket, the law mandates that insurance plans cover 87% of total allowed costs (Sec. 2). In plain English: your insurance pays more, and you pay less in deductibles and copays when you actually go to the clinic.
More Coverage, Less Out-of-Pocket
The bill specifically targets the 'hidden costs' of healthcare—the money you spend after you’ve already paid your monthly premium. For individuals earning between 300% and 400% of the federal poverty line, the plan’s share of costs will jump to 85% starting in 2028. Imagine a retail manager who previously avoided a necessary physical because their deductible was too high; under these new percentages, the out-of-pocket barrier drops significantly. To make sure these promises aren't empty, the bill includes a provision that automatically appropriates the necessary funds from the Treasury (Sec. 2), ensuring the government can cover these increased costs without needing a new budget vote every year.
Long-Term Planning and Stability
While the main changes don't kick in until 2028, the bill provides a clear runway for the healthcare market to adjust. It also ensures that State Basic Health Programs—which some states use to cover lower-income residents—stay in sync with these federal changes (Sec. 2). By locking in these gold-level benchmarks, the legislation attempts to stabilize the 'cost-sharing' system that has often been a point of financial stress for middle-income families who earn too much for Medicaid but struggle with the high out-of-pocket costs of mid-tier private plans. It’s a move toward making 'Gold' coverage the new baseline for the American workforce.