Medicare shifts financial risk to doctors, reshaping care for seniors.

What it does

This bill creates a permanent federal program allowing groups of doctors, hospitals, and other healthcare providers to take on financial risk for Medicare patients' total care costs, moving away from traditional fee-for-service billing. Providers who join these 'full risk ACOs' receive capitated (fixed monthly) payments per patient and keep savings if they reduce costs, but absorb losses if costs exceed benchmarks. The program has two tracks: a standard track for general Medicare patients (minimum 2,500 patients) and a complex-care track for patients with multiple chronic conditions (starting at 250 patients). Participating providers gain flexibility in how they deliver and pay for care, including nontraditional services like telehealth and in-home care, but must meet quality standards and allow beneficiaries to opt out.

Why we flagged it

The bill's core function is to establish a new permanent payment and care-delivery model for Medicare, moving from fee-for-service to capitated risk-bearing arrangements. It is not a tax measure, appropriation, or commemorative act, but a structural reform of how Medicare compensates providers.

What the text implies

• Providers bearing full financial risk may reduce referrals to specialists or high-cost services to protect margins, potentially limiting beneficiary access to necessary care even if clinically appropriate.
• Concurrent risk adjustment for complex-care ACOs uses current-year diagnoses to set payment benchmarks, creating incentives to code diagnoses aggressively upfront to inflate benchmarks and secure higher capitation payments.
• Beneficiaries assigned via 'signed voluntary alignment' may face pressure to enroll in ACOs through provider marketing, and monthly opt-out windows may not provide sufficient protection against lock-in.
• The program exempts ACO participants from MIPS (Merit-Based Incentive Payment System) reporting, reducing transparency and accountability for quality performance compared to traditional Medicare providers.
• Regional blending of benchmarks (especially for complex-care ACOs with 'at least half' regional component) may disadvantage rural and underserved ACOs that serve sicker populations, as regional benchmarks may not reflect local cost structures.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Medicare beneficiaries gain access to coordinated care, nontraditional services, and care tailored to complex conditions, with opt-out rights preserved. However, the program shifts financial risk to providers, creating incentives to limit costly services or restrict access; beneficiaries assigned to ACOs may experience reduced choice of providers and potential undertreatment if providers prioritize cost control over care intensity.

Who stands to gain

• Healthcare provider organizations (hospitals, physician groups, CAHs, RHCs, FQHCs)
• Integrated delivery systems and large health systems with capital to absorb financial risk
• Health IT vendors providing data analytics and population management platforms

Named in the bill

Centers for Medicare & Medicaid Services (CMS), Medicare fee-for-service beneficiaries, Accountable Care Organizations (ACOs), Hospitals, Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Teaching hospitals, Medicare Shared Savings Program, Medicare Advantage, Merit-Based Incentive Payment System (MIPS), Medicare Access and CHIP Reauthorization Act (MACRA)

Where it stands

2 cosponsors: 2 Democrats.

• Mar 26, 2026 — Introduced · Congress.gov: “Introduced in House”
• Mar 26, 2026 — Referred to House Committee on Energy and Commerce and House Committee on Ways and Means · Congress.gov: “Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

5 lobbying clients named this bill on 5 disclosure filings across 1 quarter, Jun 2026 to Jun 2026. Those filings disclosed $622,230 in lobbying spend. A filing names 1 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 78% of bills with at least one filing.

Claudia Tenney, the sponsor, reported $1,179,908 in PAC receipts in the 2026 cycle.

• Accountable for Health, Inc. — $250,000 on 1 filing
• National Association of Accountable Care Organizations — $142,230 on 1 filing
• Agilon Health, Inc. — $100,000 on 1 filing
• Accountable for Health — $70,000 on 1 filing
• Agilon Health, Inc. — $60,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.