HR-6421-119
Referred to the House Committee on Energy and Commerce.
Sponsored by Max Miller (R-OH)
What it does
This bill would amend the Affordable Care Act to allow individuals who are ineligible for — or who reasonably expect to be ineligible for — ACA premium tax credits or cost-sharing reductions to purchase catastrophic health plans, regardless of age. Currently, catastrophic plans are only available to people under 30 or those who qualify for a hardship or affordability exemption. The change would take effect for plan years beginning at least six months after enactment.
Who benefits
Middle- and higher-income adults over 30 who earn too much to qualify for ACA subsidies but find standard bronze, silver, gold, or platinum plans unaffordable. Self-employed individuals and small business owners who pay full premiums without employer contributions. Younger adults over 30 who prefer lower monthly premiums and are willing to accept higher out-of-pocket costs. Health insurers that could expand their catastrophic plan offerings to a larger market. Hospitals and providers, who may see a reduction in uncompensated care if previously uninsured individuals opt into catastrophic coverage.
Who is hurt
Individuals who enroll in catastrophic plans and then face a serious medical event may encounter very high out-of-pocket costs before the deductible is met, potentially leading to medical debt. Insurers offering comprehensive plans could see adverse selection if healthier, higher-income enrollees migrate to catastrophic plans, potentially raising premiums for those remaining in fuller-coverage plans. Lower-income enrollees in ACA marketplaces who depend on a stable risk pool could face higher premiums if the pool skews sicker. State insurance regulators may face added complexity in overseeing a broader catastrophic plan market.
Supporters argue
Supporters argue that millions of middle-income Americans — particularly those earning just above the subsidy cliff — are effectively priced out of the ACA marketplace because they receive no financial assistance yet face premiums that can exceed $500–$1,000 per month for a family. They contend that expanding access to catastrophic plans gives these individuals a meaningful, lower-cost option over going entirely uninsured, which reduces uncompensated care burdens on hospitals and improves overall coverage rates. They further argue the bill aligns with the ACA's original goal of expanding coverage by removing an arbitrary age restriction that leaves a large segment of the population without affordable options.
Opponents argue
Opponents argue that catastrophic plans, with their very high deductibles (over $9,000 for an individual in 2024), provide limited real-world financial protection and may give enrollees a false sense of security while leaving them exposed to significant medical debt. They contend that allowing healthier, higher-income adults to exit the standard risk pool could destabilize ACA marketplaces by concentrating sicker enrollees in comprehensive plans, driving up premiums for those who need robust coverage most — a dynamic documented in pre-ACA markets. They further argue the bill does not address the underlying cost drivers that make comprehensive coverage unaffordable in the first place.
Constitutional context
Congress has broad authority to regulate health insurance markets under the Commerce Clause (Art. I, §8, cl. 3) and the Taxing and Spending Clause (Art. I, §8, cl. 1), as affirmed in NFIB v. Sebelius (2012). This bill modifies an existing ACA provision rather than creating a new mandate or funding condition, so it does not raise the coercion or compulsion concerns identified in NFIB. No clear active constitutional tension applies.
Checks and balances
Congress would expand eligibility through a statutory amendment to the ACA; HHS would implement and enforce the change through rulemaking, subject to post-Loper Bright independent judicial review of any agency interpretations.
Historical precedent
The ACA's original catastrophic plan provisions (2010) established age and hardship-based eligibility limits; subsequent regulatory guidance and state waiver experiments have tested modest expansions of catastrophic plan access, though no prior federal statute has extended eligibility on the basis of subsidy ineligibility alone.