To amend the Internal Revenue Code of 1986 to limit eligibility for the premium tax credit to individuals enrolled in qualified health plans offered by health insurance issuers that offer at least one qualified health plan which provides the option to make monthly cost-sharing payments, and for other purposes.

119th Congress Introduced by Mark Alford and 1 co-sponsor

The bill narrows premium tax credit eligibility to enrollees in plans that offer at least one monthly cost-sharing option.

Introduced in House

Overview

HR 9455, introduced in the 119th Congress, seeks to make changes to the premium tax credit (PTC) under the Internal Revenue Code of 1986. The bill narrows eligibility for the PTC by tying eligibility to enrollment in qualified health plans (QHPs) offered by issuers that provide at least one QHP option with the ability to make monthly cost-sharing payments. The measure is designed to influence the types of health plans that are eligible for PTC subsidies.

Main purpose and intent

Limit eligibility for the premium tax credit to individuals who enroll in QHPs offered by health insurance issuers that offer at least one QHP with a monthly cost-sharing payment option.

Align PTC eligibility with plan designs that support consistent monthly cost-sharing arrangements for enrollees.

Key provisions and changes

Eligibility criterion for PTC: An individual must be enrolled in a qualified health plan that is offered by a health insurance issuer and that provides at least one QHP option allowing monthly cost-sharing payments.

Scope of “cost-sharing payments”: The bill specifies that the QHP must provide the option to make monthly cost-sharing payments, which may include deductibles, co-pays, and other cost-sharing amounts as structured in the plan.

Structural linkage: The PTC would be limited to enrollees in plans meeting the above condition, effectively excluding PTC eligibility for enrollees in QHPs without a monthly cost-sharing payment option (as defined by the bill).

Affected parties and stakeholders

Individuals enrolling in health insurance through the ACA marketplace who rely on the PTC for financial assistance.

Health insurance issuers offering QHPs that make monthly cost-sharing payment options available.

Policyholders and potential enrollees who prefer or rely on QHPs without monthly cost-sharing options (these plans would become ineligible for PTC subsidies under the bill’s framework).

The Internal Revenue Service (IRS) and Department of Health and Human Services (HHS) for implementation and administration, given their roles in subsidy administerability and QHP oversight.

Procedural and timeline aspects

Action history: The bill was introduced in the House and referred to the House Committee on Ways and Means on June 25, 2026.

Next steps: Likely committee consideration, potential markups, and eventual floor debate and voting in the House. If advanced, similar actions would be needed in the Senate and possible negotiation during conference if companion legislation exists.

Potential impact and considerations

Subsidy eligibility shift: A portion of current PTC recipients may become ineligible if their QHPs do not include a monthly cost-sharing option.

Market effects on issuers: Plans with monthly cost-sharing options may become more favored within the subsidy framework, possibly affecting plan design and enrollment patterns.

Access and affordability: For individuals who prefer or require plans without monthly cost-sharing options, affordability may be affected due to reduced subsidy support.

Administrative implications: Agencies would need to verify plan features related to monthly cost-sharing options to determine PTC eligibility, potentially increasing compliance and oversight requirements.

Bill