WeVote
Log In

Bill

TB

Bill

HR 7861

Care Over Profits Act of 2026

119th Congress Introduced by Tom Barrett and 1 co-sponsor

Bill reforms ACA health insurance loss ratio standards and adds enrollment fraud safeguards to improve marketplace integrity and consumer premium fairness.

Introduced in House
0
WeVote Research Nonpartisan
Bill Summary · HR 7861

Legislative bill overview

HR 7861 proposes amendments to healthcare law regarding medical loss ratios (MLRs)—the percentage of premium revenues insurers must spend on actual medical care—and measures to combat fraudulent enrollment in Affordable Care Act qualified health plans. The bill aims to reform how insurers calculate and report MLR compliance while implementing stricter verification procedures for plan enrollment eligibility.

Why is this important

Medical loss ratio requirements directly affect insurance premiums and insurer profitability, influencing healthcare affordability for consumers. Fraudulent enrollment drains resources from legitimate plans and can destabilize risk pools, potentially increasing costs for honest enrollees. These reforms could impact both insurer operations and the stability of the ACA marketplace.

Potential points of contention

  • MLR calculation changes: Depending on specifics, stricter MLR requirements could reduce insurer profits, potentially leading to higher premiums, reduced plan options, or insurers exiting markets entirely
  • Enrollment verification burden: Enhanced fraud-prevention measures may create administrative costs and friction for legitimate applicants attempting to enroll, potentially reducing overall plan participation
  • Definitional ambiguity: The bill's language on what constitutes "fraudulent enrollment" and reformed MLR calculations could be interpreted differently, creating implementation challenges and legal disputes

Compiled from official sources — confirm details with the bill’s official record.

Sign in to ask a question.