No Subsidies Without Verification Act of 2014 - Disallows the health plan premium assistance tax credit or cost-sharing reduction under the Patient Protection and Affordable Care Act before the first date of the first coverage month beginning on or after the date on which the process to verify an individual's household income and coverage requirements of such individual for purposes of determining eligibility for, and the accurate amount of, the credit or reduction, respectively, has been completed.
Requires for such verification: (1) completion of a manual or electronic review of the information required of an applicant for enrollment in a plan, and (2) resolution of any inconsistency of such information with records of the Departments of the Treasury or Homeland Security (DHS) or the Social Security Administration.
Exempts individuals from the penalty for not maintaining minimum essential coverage for any month with respect to which a premium tax credit is being claimed and that begins before the date on which the verification process has been completed.
Suspends, until the coverage month beginning after eligibility verification has been completed, the premium tax credit and reduced cost-sharing in the case of individuals for whom the subsidy was allowed before enactment of this Act. Provides a special enrollment period for an individual who terminated enrollment in a qualified plan during the period of suspension.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4805 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4805
To delay the provision of the Affordable Care Act premium and cost-
sharing subsidies until the eligibility verification process for such
subsidies is completed, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 5, 2014
Mrs. Black (for herself, Mr. Griffin of Arkansas, Mr. Harris, Mr.
Tiberi, Mr. Fincher, Mr. Sam Johnson of Texas, Mr. Duncan of Tennessee,
Mr. Kelly of Pennsylvania, and Ms. Jenkins) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To delay the provision of the Affordable Care Act premium and cost-
sharing subsidies until the eligibility verification process for such
subsidies is completed, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``No Subsidies Without Verification
Act of 2014''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) On July 5, 2013, the Department of Health and Human
Services released more than 600 pages of a final rule to
implement the provisions of the Patient Protection and
Affordable Care Act and the health care provisions of the
Health Care and Education Reconciliation Act of 2010 (commonly
referred to as ``Obamacare'' or the ``ACA'').
(2) Such final rule included an announcement that the
Federal Government would no longer verify that each applicant
for premium tax credits or cost-sharing reductions for coverage
offered through an Exchange established under the Patient
Protection and Affordable Care Act are actually qualified for
such credits or reductions. Instead, the Administration would
rely on self-attestation and sample audits of a sample
population to ``protect'' the integrity of this new $1 trillion
entitlement program.
(3) The Department of Health and Human Services later
announced a change in such policy and stated it would extend
the sample population to 100 percent. This change, though
announced, was never made to the final rule, meaning there was
no guarantee to the American people that applicants would be
verified.
(4) It is estimated that not verifying eligibility for such
credits and reductions could likely equate to approximately
$250 billion in fraudulent payments through payments of such
Obamacare premium tax credits and cost-sharing reductions.
(5) The final rule provides that the Department of Health
and Human Services will offer to perform this verification
procedure for States that are establishing a State-based
Exchange, but will be unable to do so until 2015. As a result,
such States will not be required to randomly verify employer-
sponsored coverage until 2015.
(6) In order to protect taxpayers after the Department of
Health and Human Services failed to implement a new rule that
it would ensure Congress and taxpayers that verification of
eligibility would be performed, the House of Representatives
advanced legislation, H.R. 2775, the No Subsidies Without
Verification Act. This legislation would have provided the
force of law to ensure that verification would occur prior to
the issuance of any Obamacare premium tax credit or cost-
sharing reduction.
(7) On September 12, 2013, this legislation was passed in
the House of Representatives with bipartisan support by a 235
to 191 vote margin.
(8) On September 10, 2013, the Obama Administration issued
a Statement of Administration Policy to H.R. 2775 that stated
``the Administration strongly opposes House passage of H.R.
2775 because the goal of the bill is already being accomplished
while the text of the bill would create delays that could cost
millions of hard-working middle-class families the security of
affordable health coverage and care they deserve''.
(9) The Statement of Administration Policy also stated that
``H.R. 2775 is unnecessary because the Secretary of Health and
Human Services has already put in place an effective and
efficient system for verification of eligibility for premium
tax credits and cost sharing reductions.''.
(10) On October 16, 2013, the Senate removed the
verification mechanism of H.R. 2775 and replaced it with
language that required a report to Congress by the Secretary of
Health and Human Services no later than January 1, 2014.
(11) On January 1, 2014, the Department of Health and Human
Services submitted a mandated report to Congress entitled,
``Verification of Household Income and Other Qualifications for
the Provision of Affordable Care At Premium Tax Credits and
Cost-Sharing Reductions''.
(12) This report to Congress states, ``In accordance with
statute and applicable implementing regulations, when a
consumer submits an application for insurance affordability
programs (which include APTCs, CSRs, Medicaid, the Children's
Health Insurance Program (CHIP), and the Basic Health Program
(BHP)), the Exchange verifies information provided by the
consumer on the application as a component of making an
eligibility determination. The processes for verifying
information in order to determine eligibility for enrollment in
a qualified health plan (QHP) through the Exchange and for APTC
under section 36B of the Internal Revenue Code (the Code) and
CSRs under section 1402 of the ACA are specified in the ACA and
its implementing regulations. Pursuant to both statute and
applicable regulations, the Exchanges have implemented numerous
processes to carry out the verification of information provided
by applicants.''.
(13) Beginning in 2014, Federal subsidies have been made
available to help individuals purchase health insurance through
an Exchange through premium tax credits and cost-sharing
reductions. On April 2014, the Department of Health and Human
Services delayed implementation of income verification systems
in order to increase sign-ups for health care plans through the
healthcare.gov website.
(14) Various reports indicate that the internal portions of
the healthcare.gov website are yet to be finalized, thus
leaving the Department of Health and Human Services unable to
perform the verification it stated it was performing. The Obama
Administration is operating a new Federal entitlement program
that fails to prevent fraudulent subsidy claims before
administered. In doing so, the Department of Health and Human
Services has created a new ``pay and chase'' program that
places taxpayers at financial risk of fraudulent claims.
SEC. 3. DELAYING PROVISION OF ACA PREMIUM AND COST-SHARING SUBSIDIES
UNTIL ELIGIBILITY VERIFICATION PROCESS FOR SUCH SUBSIDIES
IS COMPLETE.
(a) In General.--Notwithstanding any other provision of law, in the
case of an individual with respect to whom a premium tax credit under
section 36B of the Internal Revenue Code of 1986 or reduced cost-
sharing under section 1402 of the Patient Protection and Affordable
Care Act (42 U.S.C. 18071) is being claimed, no such credit or
reduction shall be allowed before the first date of the first coverage
month beginning on or after the date on which the process to verify, in
accordance with section 1411 of the Patient Protection and Affordable
Care Act (42 U.S.C. 18081), the household income and coverage
requirements of such individual for purposes of determining eligibility
for, and the accurate amount of, such credit or reduction,
respectively, has been completed. For purposes of the previous
sentence, the verification process described in such sentence with
respect to an individual shall not be treated as complete unless a
manual or electronic review has been completed of applicable
information required to be submitted by such individual under section
1411(b) of such Act (42 U.S.C. 18081(b)) and any inconsistency of such
information with records of the Secretary of the Treasury, Secretary of
Homeland Security, or the Commissioner of Social Security has been
resolved.
(b) Treatment of Individual Mandate.--Notwithstanding any other
provision of law, no penalty shall be imposed under section 5000A of
the Internal Revenue Code of 1986 with respect to an individual for any
month--
(1) with respect to which a premium tax credit under
section 36B of the Internal Revenue Code of 1986 is being
claimed for such individual; and
(2) that begins before the date on which the verification
process described in subsection (a) has been completed, in
accordance with such subsection, with respect to such claim for
such individual.
(c) Application Provisions.--
(1) Effective date.--Subject to paragraph (2), the
provisions of this section shall apply to coverage months
beginning on or after the date of the enactment of this Act.
(2) Treatment of individuals currently receiving
subsidies.--
(A) Suspension of certain subsidies.--In the case
of an individual with respect to whom a premium tax
credit under section 36B of the Internal Revenue Code
of 1986 or reduced cost-sharing under section 1402 of
the Patient Protection and Affordable Care Act (42
U.S.C. 18071) has been claimed before the date of the
enactment of this Act and for whom such a credit or
reduction has been allowed before such date, such
allowance shall be suspended until the coverage month
described in subsection (a) with respect to such claim
for such individual.
(B) Special enrollment period.--
(i) In general.--The Secretary of Health
and Human Services shall take such steps as are
necessary to establish a special enrollment
period of 45 days, beginning on the date of
completion of the verification process
described in subsection (a), with respect to an
individual described in clause (ii), for such
individual to enroll in qualified health plans
offered through Exchanges established under
title I of the Patient Protection and
Affordable Care Act.
(ii) Individual described.--For purposes of
clause (i), an individual described in this
clause is an individual--
(I) who is enrolled in a qualified
health plan described in clause (i)
before the date of the enactment of
this Act;
(II) to whom the suspension under
subparagraph (A) applies;
(III) who terminated enrollment in
the qualified health plan during such
period of suspension; and
(IV) who, after the completion of
the verification process described in
subsection (a) with respect to such
individual, seeks to enroll in such a
qualified health plan.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Sponsor introductory remarks on measure. (CR H5251)
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