Puerto Rico Affordable Care Act introduced to establish ACA exchange in the territory

Representative Darren Soto (D) of Florida and Resident Commissioner Pablo José Hernández (PDP, D) of Puerto Rico introduced HR 6479, the Puerto Rico Affordable Care Act of 2025, legislation that would require the establishment of an Affordable Care Act (ACA) exchange in Puerto Rico and apply the same healthcare framework used in the 50 states and Washington, DC to the territory.

The bill seeks to amend the Patient Protection and Affordable Care Act to formally include Puerto Rico in the ACA exchange system, commonly referred to as Obamacare. Under the proposal, Puerto Rico would be treated as a state for purposes of operating an exchange, applying health insurance market reforms, and extending premium tax credits and cost-sharing reductions to eligible residents.

“For far too long, Puerto Ricans have been treated as second-class citizens—despite being part of the United States,” Soto said in a statement. He said the legislation aims to provide equal treatment in healthcare access and open the door to reforms that would allow residents to access tiered plans, tax premium credits, and cost-sharing reductions.

Resident Commissioner Hernández said that many families in Puerto Rico currently lack access to the same cost-saving tools available elsewhere in the United States. He said establishing an ACA exchange would provide federal support to expand coverage, lower costs, and strengthen the healthcare network on the islands.

Puerto Rico’s current healthcare exchange is not considered ACA-equivalent. It does not offer standardized bronze, silver, and gold plans, nor does it provide premium tax credits or cost-sharing reductions that reduce out-of-pocket costs for consumers. According to the sponsors, the absence of these features has limited access to affordable coverage, particularly for small business owners, their employees, and younger residents.

The bill also addresses the application of federal health insurance market reforms. It directs the Secretary of Health and Human Services to apply provisions of the Public Health Service Act to health insurance coverage offered in Puerto Rico beginning one year after enactment, notwithstanding prior federal guidance issued in 2014.

In addition, HR 6479 would amend the Internal Revenue Code to ensure that Puerto Rico is treated in the same manner as a state for purposes of calculating and applying ACA premium tax credits. These changes would also take effect one year after the bill’s enactment.

The legislators point to Puerto Rico’s economic conditions as a key factor. Approximately 43% of Puerto Ricans live below the poverty line, the highest poverty rate in the United States. The bill’s sponsors argue that extending full ACA benefits to Puerto Rico is critical to ensuring equitable access to healthcare for residents of the territory.

The Puerto Rico Affordable Care Act of 2025 has been introduced in the US House of Representatives and awaits further consideration.