To amend title XXVII of the Public Health Service Act and the Patient Protection and Affordable Care Act to provide for certain reforms with respect to medical loss ratios and reducing fraudulent enrollment in qualified health plans.

The "Care Over Profits Act of 2026" (HR7861) mandates a direct reduction in health insurers' profitability by increasing the minimum medical loss ratio (MLR) from 80% to 85% for plans in the small group and individual markets. This means insurers must spend 85 cents of every premium dollar on medical care and quality improvement, leaving only 15 cents for administrative costs and profit. This change applies to plan years beginning on or after January 1, 2026. Additionally, the bill introduces substantial civil penalties, ranging from $10,000 to $50,000 per individual, for agents and brokers who fail to provide correct information during enrollment, attributable to negligence or disregard of regulations. This provision increases compliance burdens and costs for health plans, as they must enhance oversight and potentially absorb penalties or incur higher costs from agents and brokers to mitigate this risk. Historically, changes to MLR requirements have directly impacted insurer profitability. When the Affordable Care Act (ACA) first implemented MLR requirements in 2010, health insurers adjusted their business models, leading to a period of consolidation and a focus on administrative efficiency to maintain margins. For example, following the ACA's implementation, major insurers like UnitedHealth Group ($UNH) and Anthem (now Elevance Health, $ELV) saw their administrative expenses scrutinized, and their stock performance reflected the market's adjustment to these new regulatory constraints. While specific stock movements tied solely to MLR changes are difficult to isolate due to broader market factors, the general trend was a tightening of margins for the sector. Specific companies that stand to lose directly from this legislation include major health insurers with significant exposure to the small group and individual markets. UnitedHealth Group ($UNH), Elevance Health ($ELV), Cigna ($CI), Humana ($HUM), and CVS Health ($CVS) through its Aetna subsidiary, all operate substantial health insurance segments that will be affected by the increased MLR. These companies will experience a direct reduction in their gross profit margins from these segments. The increased compliance costs associated with agent and broker oversight will further erode net profitability. There are no clear winners from this bill among publicly traded companies; the financial impact is uniformly negative for health insurers. This bill has been introduced by Rep. Barrett (R-MI-7) with one cosponsor and has been referred to the Committee on Energy and Commerce. The referral to a committee indicates the initial stage of the legislative process. The next step is for the committee to consider the bill, potentially hold hearings, and vote on whether to advance it. Given the effective date of January 1, 2026, if enacted, the market will price in these changes well in advance of that date as the bill progresses through Congress. The current legislative momentum is low, given only two sponsors, but the direct financial impact on a major sector warrants attention.