I 

118TH CONGRESS 

2D SESSION H. R. 10438 

To expand cost-sharing reductions with respect to qualified health plans 

offered through an Exchange, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 16, 2024 

Ms. SCHRIER (for herself and Ms. UNDERWOOD) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To expand cost-sharing reductions with respect to qualified 

health plans offered through an Exchange, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Capping Costs for Con5 sumers Act of 2024’’. 


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1 SEC. 2. EXPANDING COST-SHARING REDUCTIONS UNDER 

2 EXCHANGE PLANS. 

3 (a) IN GENERAL.—Section 1402 of the Patient Pro4 tection and Affordable Care Act (42 U.S.C. 18071) is 

5 amended— 

6 (1) in subsection (b)— 

7 (A) in paragraph (1), by striking ‘‘who en8 rolls’’ and inserting ‘‘subject to the last sen9 tence of this subsection, who enrolls’’; and 

10 (B) by adding at the end the following sen11 tence: ‘‘With respect to plan years beginning on 

12 or after January 1, 2026, paragraph (1) shall 

13 be applied as if the reference to the silver level 

14 of coverage were a reference to the gold level of 

15 coverage.’’; 

16 (2) in subsection (c)(1)(B)(i)— 

17 (A) in subclause (II), by striking ‘‘an eligi18 ble insured described in paragraph (2)(B)’’ and 

19 inserting ‘‘, with respect to plan years begin20 ning before January 1, 2026, an eligible in21 sured described in paragraph (2)(B)(i) and, 

22 with respect to plan years beginning on or after 

23 January 1, 2026, an eligible insured described 

24 in paragraph (2)(B)(ii)’’; and 

25 (B) by amending subclauses (III) and (IV) 

26 to read as follows: 


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1 ‘‘(III) with respect to plan years 

2 beginning before January 1, 2026— 

3 ‘‘(aa) 73 percent in the case 

4 of an eligible insured whose 

5 household income is more than 

6 200 percent but not more than 

7 250 percent of the poverty line 

8 for a family of the size involved; 

9 and 

10 ‘‘(bb) 70 percent in the case 

11 of an eligible insured whose 

12 household income is more than 

13 250 percent but not more than 

14 400 percent of the poverty line 

15 for a family of the size involved; 

16 and 

17 ‘‘(IV) with respect to plan years 

18 beginning on or after January 1, 

19 2026, 85 percent in the case of an eli20 gible insured described in paragraph 

21 (2)(C)(ii).’’; 

22 (3) in subsection (c)(2), by amending subpara23 graphs (B) and (C) to read as follows: 

24 ‘‘(B) in the case of— 


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1 ‘‘(i) with respect to plan years begin2 ning before January 1, 2026, an eligible 

3 insured whose household income is more 

4 than 150 percent but not more than 200 

5 percent of the poverty line for a family of 

6 the size involved, increase the plan’s share 

7 of the total allowed costs of benefits pro8 vided under the plan to 87 percent of such 

9 costs; and 

10 ‘‘(ii) with respect to plan years begin11 ning on or after January 1, 2026, an eligi12 ble insured whose household income is 

13 more than 150 percent but not more than 

14 300 percent of the poverty line for a family 

15 of the size involved, increase the plan’s 

16 share of the total allowed costs of benefits 

17 provided under the plan to 87 percent of 

18 such costs; and 

19 ‘‘(C) in the case of— 

20 ‘‘(i) with respect to plan years begin21 ning before January 1, 2026, an eligible 

22 insured whose household income is more 

23 than 200 percent but not more than 250 

24 percent of the poverty line for a family of 

25 the size involved, increase the plan’s share 


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1 of the total allowed costs of benefits pro2 vided under the plan to 73 percent of such 

3 costs; and 

4 ‘‘(ii) with respect to plan years begin5 ning on or after January 1, 2026, an eligi6 ble insured whose household income is 

7 more than 300 percent but not more than 

8 400 percent of the poverty line for a family 

9 of the size involved, increase the plan’s 

10 share of the total allowed costs of benefits 

11 provided under the plan to 85 percent of 

12 such costs.’’; and 

13 (4) by adding at the end the following new sub14 section: 

15 ‘‘(h) FUNDING.—Out of any funds in the Treasury 

16 not otherwise appropriated, there are appropriated to the 

17 Secretary such sums as may be necessary for payments 

18 under this section.’’. 

19 (b) CONFORMING AMENDMENTS TO STATE BASIC

20 HEALTH PROGRAMS FOR CERTAIN LOW-INCOME INDIVID21 UALS.—Section 1331(a)(2) of the Patient Protection and 

22 Affordable Care Act (42 U.S.C. 18051(a)(2)) is amend23 ed— 

24 (1) in subparagraph (A)(i), by striking ‘‘the ap25 plicable second lowest cost silver plan (as defined in 


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1 section 36B(b)(3)(B) of the Internal Revenue Code 

2 of 1986)’’ and inserting ‘‘, with respect to plan years 

3 beginning before January 1, 2026, the applicable 

4 second lowest cost silver plan (as defined in section 

5 36B(b)(3)(B) of the Internal Revenue Code of 1986) 

6 and, with respect to plans years beginning on or 

7 after January 1, 2026, the applicable second lowest 

8 cost gold plan (as defined in such section)’’; and 

9 (2) in the matter following subparagraph (B), 

10 by striking ‘‘or the applicable second lowest cost sil11 ver plan’’ and inserting ‘‘or, with respect to plan 

12 years beginning before January 1, 2026, the applica13 ble second lowest cost silver plan (or, with respect to 

14 plan years beginning on or after January 1, 2026, 

15 the applicable second lowest cost gold plan’’. 

16 SEC. 3. PREMIUM ASSISTANCE CREDIT AMOUNT DETER17 MINED USING APPLICABLE SECOND LOWEST 

18 COST GOLD PLAN. 

19 (a) IN GENERAL.—Section 36B of the Internal Rev20 enue Code of 1986 is amended— 

21 (1) by striking ‘‘silver’’ each place it appears 

22 and inserting ‘‘gold’’; and 

23 (2) in the header of subsection (b)(3)(B), by 

24 striking ‘‘SILVER’’ and inserting ‘‘GOLD’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to taxable years beginning after 

3 December 31, 2025. 

Æ 


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