Restoring Patient Protections and Affordability Act of 2025

This Act may be cited as the Restoring Patient Protections and Affordability Act of 2025.

The table of contents for this Act is as follows:

Clause (iii) of section 36B(b)(3)(A) of the Internal Revenue Code of 1986 is amended—

(1) by striking January 1, 2026 and inserting January 1, 2029, and

(2) by striking 2025 in the heading and inserting 2028.

Section 36B(c)(1)(E) of the Internal Revenue Code of 1986 is amended—

(1) by striking January 1, 2026 and inserting January 1, 2029, and

(2) by striking 2025 in the heading and inserting 2028.

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

With respect to plan year 2026, the annual open enrollment period required to be provided by Exchanges under section 1311(c)(6) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)) shall extend through May 1, 2026.

Section 1311(i)(6) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(i)(6)) is amended—

(1) by striking Grants under and inserting the following:

In the case of an Exchange established and operated by a State pursuant to subsection (b), grants under

(1) ; and

(2) by adding at the end the following:

For purposes of carrying out this subsection with respect to an Exchange established and operated by the Secretary pursuant to section 1321(c), the Secretary shall obligate $100,000,000 out of amounts collected through the user fees on participating health insurance issuers pursuant to section 156.50 of title 45, Code of Federal Regulations (or any successor regulations) for fiscal year 2026. Such amount so obligated for a fiscal year shall remain available until expended.

Section 1311(i)(4)(A) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(i)(4)(A)) is amended—

(1) in clause (i), by striking or at the end;

(2) in clause (ii), by striking the period and inserting a semicolon; and

(3) by adding at the end the following:

(iii) charge any fees to applicants or enrollees; or

(iv) request any form of remuneration from or on behalf of any applicant or enrollee.

Section 36B(c)(3)(A) of the Internal Revenue Code of 1986, as amended by Public Law 119–21, is amended by striking clause (iii).

The amendment made by this section shall apply with respect to plan years beginning after December 31, 2025.

The Secretary of Health and Human Services shall require each health insurance issuer that offered a qualified health plan through a Federal or State Exchange for plan year 2025 to notify, not later than 15 days after the date of enactment of this Act, all individuals enrolled in such plan for any month during plan year 2025 of—

(1) changes to eligibility for premium assistance credits, and to the premium assistance credit amounts, under section 36B of the Internal Revenue Code of 1986 that first take effect with respect to plan year 2026;

(2) the extended open enrollment period for plan year 2026 pursuant to section 101; and

(3) any additional information relating to such eligibility and enrollment, as the Secretary determines appropriate, including the website and phone number for the applicable Federal or State Exchange.

The Secretary of Health and Human Services shall require each health insurance issuer that offers a qualified health plan through a Federal or State Exchange for plan year 2026 to notify all individuals enrolled in such plan for plan year 2026 of—

(1) changes to eligibility for premium assistance credits, and to the premium assistance credit amounts, under section 36B of the Internal Revenue Code of 1986 that first take effect with respect to plan year 2026;

(2) the extended open enrollment period for plan year 2026 pursuant to section 101; and

(3) any additional information relating to such eligibility and enrollment, as the Secretary determines appropriate, including the website and phone number for the applicable Federal or State Exchange.

The notification by a health insurance issuer under subsection (a) shall be made—

(1) not later than 15 days after the date of enactment of this Act, with respect to individuals enrolled in such plan as of the date of enactment of this Act; and

(2) not later than 15 days after an individual's enrollment, with respect to individuals enrolling, after such date of enactment, in the plan during the open enrollment period for plan year 2026.

Not later than 90 days after the date of enactment of this Act, each health insurance issuer that is subject to the reporting requirements under sections 201 and 202 shall submit to the Secretary of Health and Human Services a report attesting to compliance with the requirements under sections 201 and 202.

Not later than 120 days after the date of enactment of this Act, the Secretary of Health and Human Services shall submit to the Committee on Finance and the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Ways and Means, the Committee on Energy and Commerce, and the Committee on Education and Workforce of the House of Representatives a report that consolidates the reports submitted by issuers under subsection (a).

Consistent with the process set forth in subsections (d) and (e) of section 156.805 of title 45, Code of Federal Regulations (or successor regulations), the Secretary of Health and Human Services may impose a civil monetary penalty upon any health insurance issuer who fails to comply with the notification requirements under section 201 or 202 or the reporting requirements under section 203.

In the case of a violation of section 201 or 202, such penalty shall be in the amount equal to $1,000 for each individual enrolled in a plan for plan year 2025 or 2026 who did not receive a notice as required under section 201 or 202, as applicable, for each day between the date on which such notice was due and the date on which the notice is provided.

In the case of a violation of section 203, such penalty shall be in the amount of $1,000 per day for each individual enrolled in health insurance coverage with respect to which the report is required, for each day between the date on which the report under section 302 was due and the date on which the report is submitted.

Section 36B(c)(5)(A) of the Internal Revenue Code of 1986, as added by Public Law 119–21, is amended by striking, using applicable enrollment information that shall be provided or verified by the applicant,.

The amendment made by this section shall apply to taxable years beginning after December 31, 2027.

Section 1311(c)(6) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)) is amended—

(1) in subparagraph (C), by striking; and and inserting a semicolon; and

(2) by adding at the end the following:

(E) special enrollment periods for any individual denied the advance payment for which the individual applies for one or more months pending the verification prescribed by section 36B(c)(5)(A) of the Internal Revenue Code of 1986, to permit enrollment of any such individual following such verification; and

The amendment made by this section shall apply with respect to plan years beginning on or after January 1, 2028.

The Secretary of Health and Human Services shall revise section 155.335(j) of title 45, Code of Federal Regulations (or any successor regulation) to ensure that, with respect to reenrollments for plan years beginning on or after January 1, 2026, a Federal or State Exchange established under subtitle D of title I of the Patient Protection and Affordable Care Act (42 U.S.C. 18021 et seq.) may reenroll an individual who was enrolled in a bronze level qualified health plan in a silver level qualified health plan (as such terms are defined in section 1301(a) and described in 1302(d) of such Act (42 U.S.C. 18021(a); 18022(d))).

Section 1311(c)(6) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)), as amended by section 302(a), is further amended by adding at the end the following:

(F) a special enrollment period once per month for any individual who is eligible for the advance payment of premium tax credits under section 1412 and whose household income is not expected to exceed 150 percent of the poverty line for a family of the size involved.

The amendment made by subsection (a) shall apply with respect to plan years beginning on or after January 1, 2026.

The Secretary of Health and Human Services shall—

(1) revise section 156.140(c) of title 45, Code of Federal Regulations (or a successor regulation), to provide that, for plan years beginning on or after January 1, 2026, the allowable variation in the actuarial value of a health plan applicable under such section shall be the allowable variation for such plan applicable under such section for plan year 2025; and

(2) revise section 156.400 of title 45, Code of Federal Regulations (or a successor regulation), to provide that, for plan years beginning on or after January 1, 2026, the term de minimis variation for a silver plan variation means a minus 0 percentage point and plus 2 percentage point allowable actuarial value variation.

The Secretary of Health and Human Services shall revise section 155.305(f)(4) of title 45, Code of Federal Regulations (or a successor regulation) to provide that an Exchange may determine an enrollee ineligible for an advance premium tax credit under section 36B of the Internal Revenue Code of 1986 as described in such section 155.305(f)(4) only after a taxpayer (or a taxpayer's spouse, if married) has failed to file a Federal income tax return and reconcile their past advance premium tax credit for 2 consecutive years for which tax data will be utilized for verification of household income and family size.

The requirement described in subsection (a) shall apply with respect to plan years beginning on or after January 1, 2026.

Section 36B(f)(2) of the Internal Revenue Code of 1986, as amended by Public Law 119–21, is amended—

(1) by striking If the advanced payments and inserting the following:

If the advanced payments

(1) , and

(2) by adding at the end the following new subparagraph:

In the case of a taxpayer whose household income is less than 400 percent of the poverty line for the size of the family involved for the taxable year, the amount of the increase under subparagraph (A) shall in no event exceed the applicable dollar amount determined in accordance with the following table (one-half of such amount in the case of a taxpayer whose tax is determined under section 1(c) for the taxable year):

If the household income (expressed as a percentage of the poverty line) is: The applicable dollar amount is: Less than 200% $600 At least 200% but less than 300% $1,500 At least 300% but less than 400% $2,500.

In the case of any calendar year beginning after 2014, each of the dollar amounts in the table contained under clause (i) shall be increased by an amount equal to—

(I) such dollar amount, multiplied by

(II) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year, determined by substituting calendar year 2013 for calendar year 2016 in subparagraph (A)(ii) thereof.

If the amount of any increase under clause (i) is not a multiple of $50, such increase shall be rounded to the next lowest multiple of $50.

Section 35(g)(12)(B)(ii) of such Code is amended by striking the amount determined under clause (i) shall be substituted for the amount determined under section 36B(f)(2) and inserting then section 36B(f)(2)(B) shall be applied by substituting the amount determined under clause (i) for the amount determined under section 36(f)(2)(A).

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

Section 1302(c)(4) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(c)(4)) is amended by adding at the end the following: For calendar year 2026 and each subsequent calendar year, the lower bound of the allowable premium adjustment percentage for purposes of paragraph (1)(B)(i) is the lower bound of the premium adjustment percentage that applied under this paragraph for plan year 2022 using National Health Expenditure Accounts projections of average per enrollee employer-sponsored insurance premiums..