This legislation, titled the "CommonGround for Affordable Health Care Act," aims to extend and modify the enhanced premium tax credit, bolster fraud prevention in health insurance Exchanges, and enhance accountability for Pharmacy Benefit Managers (PBMs).

For taxable year 2026, the bill extends the enhanced premium tax credit rules, setting new premium percentage tables across various income tiers. Crucially, it removes the previous 400% of poverty line income cap, making individuals with household incomes up to 1000% of the poverty line eligible for these credits.

To combat fraud within health insurance Exchanges, the bill establishes new penalties for agents and brokers. These include civil penalties for negligent or knowing provision of incorrect information, and criminal penalties for willful fraudulent conduct, with fines and potential imprisonment.

The bill mandates enhanced consumer protections, requiring a verification process for agent- or broker-assisted enrollments in federally-operated Exchanges by January 1, 2029, including documented consent and timely notifications. It also grants the Secretary authority to regulate Field Marketing Organizations (FMOs) and Third-Party Marketing Organizations (TPMOs) participating in the "chain of enrollment," establishing criteria for their conduct and marketing practices.

Further fraud prevention measures include periodic audits of agents and brokers, sharing results with State insurance departments, and maintaining a list of suspended or terminated agents. The bill also mandates quarterly checks of the Death Master File to remove deceased individuals from Exchange plans and requires Exchanges to notify individuals of their premium tax credit amount before enrollment, starting January 1, 2027.

For plan year 2026, the bill extends the annual open enrollment period for Exchanges from November 1, 2025, to March 19, 2026, with required outreach to inform eligible individuals.

A significant portion of the bill focuses on modernizing and ensuring accountability for Pharmacy Benefit Managers (PBMs) in Medicare Part D, effective for plan years beginning January 1, 2029. It stipulates that PBMs and their affiliates may only derive income from bona fide service fees, with specific provisions for incentive payments and the full pass-through of rebates and discounts to plan sponsors.

PBMs will be required to provide extensive annual reports to PDP sponsors and the Secretary, detailing drug-specific information such as dispensing channels, acquisition costs, out-of-pocket spending, rebates, and all direct and indirect remuneration. This includes specific reporting on affiliated pharmacies and written explanations of drug manufacturer contracts that link rebates or incentives to formulary placement.

To ensure compliance, PDP sponsors gain annual audit rights over PBMs, and the bill establishes enforcement mechanisms including the disgorgement of non-compliant PBM funds to the Secretary, alongside anti-retaliation protections for whistleblowers. Additionally, the Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) are tasked with conducting studies and reports on PBM compensation structures and their impact.

Finally, the legislation establishes an expedited legislative process for an "enhanced premium tax credit reform bill," provided it has bipartisan cosponsorship. This special procedure sets strict timelines for committee action and floor consideration in both the House and Senate, aiming for a final passage vote by July 1, 2026.