Section 1 Short title
This Act may be cited as the “Care Over Profits Act of 2026”.
Care Over Profits Act of 2026
A BILL
To amend title XXVII of the Public Health Service Act and the Patient Protection and Affordable Care Act to provide for certain reforms with respect to medical loss ratios and reducing fraudulent enrollment in qualified health plans.
Sec. 2 Increasing medical loss ratio for health insurance coverage offered in small group and individual markets
In general— Section 2718(b)(1)(A)(ii) of the Public Health Service Act (42 U.S.C. 300gg–18(b)(1)(A)(ii)) is amended by striking “80” each place it appears and inserting “85”.
Effective date— The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2026.
Sec. 3 Imposing penalties on agents and brokers for certain violations with respect to enrollment in a qualified health plan offered through an Exchange
In general— Section 1411(h)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18081(h)(1)) is amended—
in subparagraph (A)—
by redesignating clause (ii) as clause (iv);
in clause (i)—
by striking “If—” and all that follows through “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
in the second sentence, by striking “For purposes” and inserting the following:
“(iii) Definitions of negligence, disregard—For purposes”
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 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.”
in clause (iv) (as so redesignated), by inserting “or (ii)” after “clause (i)”;
in subparagraph (B)—
by inserting “including subparagraph (C),” after “law,”;
by striking “Any person” and inserting the following:
“(i) In general—Any person”
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 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 monetary 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.”
by adding at the end the following:
“(C) Criminal penalties—Any agent or broker who knowingly and willfully provides false or fraudulent information under subsection (b), 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 fined under title 18, United States Code, imprisoned for not more than 10 years, or both.”
Effective date— The amendments made by this section 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.