S. 46 (119th)Bill Overview

Health Care Affordability Act of 2025

Taxation|Health care costs and insuranceIncome tax credits
Cosponsors
Support
Democratic
Introduced
Jan 9, 2025
Discussions
Bill Text
Current stageCommittee

Read twice and referred to the Committee on Finance.

Introduced
Committee
Floor
President
Law
Congressional Activities
01 · The brief
Plain-English summaryWhat this bill actually does

The bill amends Internal Revenue Code section 36B to change the premium-contribution (applicable) percentages used to calculate the refundable premium tax credit for Marketplace coverage. It creates a new sliding scale of taxpayer contribution percentages across income tiers (0% up to 150% FPL; 0–2% for 150–200% FPL; 2–4% for 200–250% FPL; 4–6% for 250–300% FPL; 6–8.5% for 300–400% FPL; a flat 8.5% for 400%+ FPL).

Why people may split

Liberal emphasizes expanded affordability and equity benefits

Watch point

Relative to its intended legislative type, this bill is a straightforward substantive amendment to the Internal Revenue Code that specifies numeric changes to the applicable percentage table for the premium tax credit and lists conforming deletions; it sets an explicit effective date.

The bill amends Internal Revenue Code section 36B to change the premium-contribution (applicable) percentages used to calculate the refundable premium tax credit for Marketplace coverage.

It creates a new sliding scale of taxpayer contribution percentages across income tiers (0% up to 150% FPL; 0–2% for 150–200% FPL; 2–4% for 200–250% FPL; 4–6% for 250–300% FPL; 6–8.5% for 300–400% FPL; a flat 8.5% for 400%+ FPL).

The bill removes several existing affordability-related subparagraphs in section 36B(c) and takes effect for taxable years beginning after December 31, 2025.

Passage40/100

Clear, administrable change that helps many, but substantial fiscal impact and lack of offsets reduce prospects absent a legislative vehicle or compromise.

CredibilityPartially aligned

Relative to its intended legislative type, this bill is a straightforward substantive amendment to the Internal Revenue Code that specifies numeric changes to the applicable percentage table for the premium tax credit and lists conforming deletions; it sets an explicit effective date. The bill is clear in purpose and specifies the principal legal mechanism, but contains drafting deficiencies and omits fiscal, implementation, oversight, and edge-case detail.

Contention72/100

Liberal emphasizes expanded affordability and equity benefits

02 · What it does

Who stands to gain, and who may push back.

Likely benefits vs burdens50% / 50%
Likely helpedFederal agencies · Employers

These are examples from the analysis, not a ranked list of the most-affected groups.

Likely helped
  • Potential benefitMakes marketplace coverage more affordable for middle-income households previously facing high premium costs.
  • Potential benefitExtends premium tax credit eligibility to households above 400% of the poverty line.
  • Potential benefitLikely increases marketplace enrollment and reduces the number of uninsured individuals.
Likely burdened
  • Federal agenciesIncreases federal spending and likely raises budget deficits absent offsetting revenue or cuts.
  • Potential burdenProvides subsidies to higher-income households above 400% FPL who were previously ineligible.
  • EmployersCould reduce incentives for some employers to offer comprehensive employer-sponsored coverage.
03 · Why people split

Why the argument around this bill splits.

Liberal emphasizes expanded affordability and equity benefits
Progressive95%

This persona will view the bill positively as expanding financial help for people buying Marketplace coverage and lowering premium burden for lower- and middle-income households.

They will see the extension of subsidy rules beyond 400% FPL and the 0% contribution for the lowest tier as improvements to affordability and equity.

Leans supportive
Centrist70%

This persona will generally favor the bill's goal of reducing out-of-pocket premiums while seeking caution on fiscal and market effects.

They will support affordability improvements if accompanied by fiscal transparency and evidence that the change won't destabilize insurance markets.

Leans supportive
Conservative20%

This persona will likely oppose the bill as an unnecessary expansion of federal subsidy and spending that risks market distortion.

They will be especially concerned about extending credits above 400% FPL and removing affordability-related provisions.

Likely resistant
04 · Can it pass?

The path through Congress.

Introduced

Reached or meaningfully advanced

Committee

Reached or meaningfully advanced

Floor

Still ahead

President

Still ahead

Law

Still ahead

Passage likelihood40/100

Clear, administrable change that helps many, but substantial fiscal impact and lack of offsets reduce prospects absent a legislative vehicle or compromise.

Scope and complexity
52%
Scopemoderate
24%
Complexitylow
Why this could stall
  • Magnitude of fiscal cost and CBO scoring
  • Interaction with any existing temporary subsidy law provisions
05 · Recent votes

Recent votes on the bill.

No vote history yet

The bill has not accumulated any surfaced votes yet.

06 · Go deeper

Go deeper than the headline read.

Included on this page

Liberal emphasizes expanded affordability and equity benefits

Clear, administrable change that helps many, but substantial fiscal impact and lack of offsets reduce prospects absent a legislative vehicl…

Unlocked analysis

Relative to its intended legislative type, this bill is a straightforward substantive amendment to the Internal Revenue Code that specifies numeric changes to the applicable percentage table for the premium tax credit a…

Go beyond the headline summary with full stakeholder mapping, legislative design analysis, passage barriers, and lens-by-lens tradeoff breakdowns.

Perspective breakdownsPassage barriersLegislative design reviewStakeholder impact map
Open full analysis