H.R. 9877

Health Equity and Accountability Act of 2026

Sponsor: Raul Ruiz

26 cosponsors
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I Data collection and reporting

II Culturally and linguistically appropriate health and health care

III Health workforce diversity

A Diversifying the health care workplace

B Substance Use Disorder Treatment and Behavioral and Mental Health Workforce

C ACCESS in Mental Health Act

D Developing the Community Health Workforce Act

IV Improving Health Care Access and Quality

A Reducing Barriers to Accessing Care

B Improvement of Coverage

C Expansion of Access

1 General Provisions

2 Rural

3 Indian Communities

4 Providers

5 Dental

D Advancing Health Equity Through Payment and Delivery Reform

E Health Empowerment Zones

F Equitable Health Care for All

G Investing in Equity

H Miscellaneous

I Territories Health Equity

1 Medicare

A Part A

B Part B

C Medicare Advantage (Part C)

D Part D

2 Miscellaneous

Sec. 4843. Access to coverage for individuals in certain areas without any available exchange plans

Part 2 of subtitle D of title I of the Patient Protection and Affordable Care Act (42 U.S.C. 18031 et seq.) is amended by adding at the end the following:

Text this section adds to the law

1314. Access to coverage for individuals in certain areas without any available exchange plans

(a) In general

(1) Coverage through dc exchange. Not later than 3 months after the date of enactment of this section, the Secretary, in consultation with the Secretary of the Treasury and the Director of the Office of Personnel Management, shall establish a mechanism to ensure that, for any plan year beginning on or after the date described in subsection (c), any individual described in paragraph (2) has access to health insurance coverage which is at least as broad as the coverage available to Members of Congress and congressional staff (as defined in section 1312(d)(3)(D)) through the Exchange operating in the District of Columbia. Such individuals shall be eligible for any premium tax credit under section 36B of the Internal Revenue Code of 1986, reduced cost sharing under section 1402, and advance determination and payment of such credits or such reductions under section 1412 to be administered by the Secretary, in consultation with the Secretary of the Treasury and the Director of the Office of Personnel Management. The District of Columbia, its residents, and small businesses shall be held harmless from any increased costs resulting from the enactment of this section.

(2) Individual described. An individual described in this paragraph is any individual who—

(A) is not eligible to enroll in an employer-sponsored health plan (excluding such a plan that would not be considered minimum essential coverage due to the application of subparagraph (C) of section 36B(c)(2) of the Internal Revenue Code of 1986 if such subparagraph applied to such plan); and

(B) is a bona fide resident of any possession of the United States (as determined under section 937(a) of such Code) in which the Secretary certifies that no qualified health plan is offered through an Exchange established under this title.

(3) Possession of the united states. For purposes of this section, the term possession of the United States shall include such possessions as are specified in section 937(a)(1) of the Internal Revenue Code of 1986.

(b) Treatment of possessions

(1) Payments to possessions

(A) Mirror code possession. The Secretary of the Treasury shall periodically (but not less frequently than annually) pay to each possession of the United States with a mirror code tax system amounts equal to the loss to that possession by reason of the application of this section (determined without regard to paragraph (2)) with respect to taxable years beginning after the date described in subsection (c). Such amounts shall be determined by the Secretary of the Treasury based on information provided by the government of the respective possession.

(B) Other possessions. The Secretary of the Treasury shall periodically (but not less frequently than annually) pay to each possession of the United States which does not have a mirror code tax system amounts estimated by the Secretary of the Treasury as being equal to the aggregate benefits that would have been provided to residents of such possession by reason of the application of this section for any taxable years beginning after the date described in subsection (c) if a mirror code tax system had been in effect in such possession. The preceding sentence shall not apply with respect to any possession of the United States unless such possession has a plan, which has been approved by the Secretary of the Treasury, under which such possession will promptly distribute such payments to the residents of such possession.

(2) Coordination with credit allowed against united states income taxes. No credit shall be allowed against United States income taxes for any taxable year under section 36B of the Internal Revenue Code of 1986 to any person—

(A) to whom a credit is allowed against taxes imposed by the possession by reason of this section (determined without regard to this paragraph) for such taxable year, or

(B) who is eligible for a payment under a plan described in paragraph (1)(B) with respect to such taxable year.

(3) Mirror code tax system. For purposes of this subsection, the term mirror code tax system means, with respect to any possession of the United States, the income tax system of such possession if the income tax liability of the residents of such possession under such system is determined by reference to the income tax laws of the United States as if such possession were the United States.

(4) Treatment of payments. For purposes of section 1324(b)(2) of title 31, United States Code, or any similar rule of law, the payments under this subsection shall be treated in the same manner as a refund due from the credit allowed under section 36B of the Internal Revenue Code of 1986.

(c) Date described. The date described in this subsection is the date on which the Secretary establishes the mechanism described in subsection (a)(1).

V Improving health outcomes for women, gender-diverse people, children, and families

A Underserved communities

B Pregnancy screening

C Pregnancy-Related care

D Federal agency coordination on maternal health

E Reproductive and Sexual Health

F Children’s Health

G Elder Care

H Miscellaneous provisions

VI Mental health and substance use disorders

A Access to care and funding streams

B Interprofessional care

C Workforce development

D Children’s mental health

E Community-Based care

F Reports

G Miscellaneous provisions

VII Addressing high-impact minority diseases

A Cancer

B Viral hepatitis and liver cancer control and prevention

C Acquired bone marrow failure diseases

D Cardiovascular disease, chronic disease, obesity, and other disease issues

E HIV/AIDS

F Diabetes

G Lung disease

H Tuberculosis

I Osteoarthritis and Musculoskeletal Diseases

J Sleep and circadian rhythm disorders

K Kidney disease research, surveillance, prevention, and treatment

L Diversity in clinical trials

M Additional provisions addressing high-impact minority diseases

N Health Equity and Rare Disease Act

O Asunción Valdivia Heat Illness, Injury, and Fatality Prevention

P New Era of Preventing End-Stage Kidney Disease

VIII Health Information Technology

A Reducing Health Disparities Through Health IT

B Modifications To Achieve Parity in Existing Programs

C Additional Research and Studies

D Closing Gaps in Funding To Adopt Certified EHRs

E Expanding Access to Telehealth Services

IX Accountability and Evaluation

X Addressing Social Determinants and Improving Environmental Justice

A In General

B Gun Violence

C Nutrition for women, children, families

1 Senior hunger prevention

2 Closing the meal gap

D Universal school meals

1 School breakfast program

2 School lunch program

3 Elementary and secondary education data

4 Amendments to other programs and laws

XI Protections to combat regulatory harm to health equity