Feedback Wanted on Proposed ACA Premium Tax Credit Reform: “Affordable Care Empowerment Act”

Hi everyone,

I’ve written a bill aimed at extending and restructuring the premium tax credits under the ACA. The core idea is to deliver credits through tiered flexible spending accounts (Tiered FSAs) with stricter means-testing, incentives for continuous coverage, and some offsets through Medicare reforms. Key highlights:

-Tiered FSAs: 80% of credits go toward premiums automatically; 20% go into a flexible bucket for medical expenses, including premiums, with rollover and interest. Access is phased based on continuous enrollment.

-Continuous Enrollment Incentives: Partial access to flexible funds after 6 months; full access after 12 months; $200/$400 renewal bonus.

-Means-Testing: Full credits for <300% of poverty line; gradual phase-out for 300–400%. Grandfathering for current enrollees.

-Offsets: Medicare Part D rebate reforms, site-neutral outpatient payments, and Medicare Advantage risk adjustment audits. Savings deposited into an “Affordable Care Extension Risk Pool Fund” to fund credits and cost-sharing reductions.

-Implementation & Oversight: AI-assisted audits, regulations to prevent fraud, and reporting requirements to Congress.

-Impact to the Deficit: Best-case scenario is a $50 billion surplus, worst-case is $250 billion added to the deficit; more likely it will cost $50-100 billion over ten years. It's still cheaper than a clean, 10-year extension of the current premium tax credits ($350 billion).

I’m looking for feedback from people who know healthcare policy or ACA implementation well. Does this approach seem practical, equitable, and likely to improve coverage and affordability?

Thanks in advance for your thoughts!

Here is the link to my bill: Affordable Care Empowerment Act