Stopping Illegal Obamacare Subsidies Act - Prohibits American Health Benefit Exchanges from providing for automatic enrollment in health plans until the Inspector General (IG) of the Department of Health and Human Services (HHS) verifies that each state exchange and the federal exchange established under the Patient Protection and Affordable Care Act (PPACA) have resolved the inconsistencies outlined in the June 14 IG report.
Directs the Secretary of HHS to make public the steps that the Centers for Medicare and Medicaid Services (CMS) and the federal exchange will take to clear any inconsistencies that arose on or before the enactment of this Act and to ensure that the systems used by the CMS to determine or assess eligibility for premium tax credits, cost-sharing reductions, Medicaid, and the State Children's Health Insurance Program (CHIP) under title XXI of the Social Security Act can resolve such inconsistencies within 30 days after enactment of this Act.
Directs the Secretary to make public the methods that the CMS use to monitor, track, and measure the progress of the federal and state exchanges in resolving inconsistencies.
Suspends for plan year 2015 the availability of premium assistance tax credits and the reduced cost-sharing program under PPACA; and allows them to resume only after the Commissioner of the Social Security Administration declares affirmatively that all inconsistencies related to invalid Social Security numbers have been resolved, and the IG determines that this is so.
Directs the Secretary to request additional information from any applicant for a qualified health plan on a state or federal exchange whose information contains inconsistencies. Requires the applicant to: (1) be withdrawn from the premium assistance credit and reduced cost-sharing programs if the additional information is not provided within 90 days, and (2) re-enroll in a qualified health plan with appropriate and accurate information during the next open enrollment period.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2701 Introduced in Senate (IS)]
113th CONGRESS
2d Session
S. 2701
To require the Secretary of Health and Human Services to address
certain inconsistencies between the self-attested information provided
by an applicant in enrolling in a health plan on an Exchange and being
determined eligible for premium tax credits and cost-sharing reductions
or in being determined to be eligible for enrollment in a State
Medicaid plan or a State child health plan under the State Children's
Health Insurance Program and the data received through the Federal Data
Services Hub or from other data sources.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 30, 2014
Mr. Vitter introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To require the Secretary of Health and Human Services to address
certain inconsistencies between the self-attested information provided
by an applicant in enrolling in a health plan on an Exchange and being
determined eligible for premium tax credits and cost-sharing reductions
or in being determined to be eligible for enrollment in a State
Medicaid plan or a State child health plan under the State Children's
Health Insurance Program and the data received through the Federal Data
Services Hub or from other data sources.
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 ``Stopping Illegal Obamacare Subsidies
Act''.
SEC. 2. LIMITATION ON AUTO-ENROLLMENT.
Notwithstanding any other provision of law, American Health Benefit
Exchanges shall not provide for automatic enrollment in health plans
under such exchanges until the Inspector General of the Department of
Health and Human Services verifies that each State Exchange established
under section 1311 of the Patient Protection and Affordable Care Act
(42 U.S.C. 13031) and the Federal Exchange established under section
1321 of such Act (42 U.S.C. 18041) has resolved the inconsistencies (as
defined in section 3(a)) outlined in the June 2014 report of such
Inspector General.
SEC. 3. PROCESS FOR APPLICATIONS WITH INCONSISTENCIES.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall make public
the steps that the Centers for Medicare & Medicaid Services and the
Federal Exchange will take to clear any inconsistencies that arose on
or before the date of enactment of this Act and to ensure that the
systems used by the Centers for Medicare & Medicaid Services to
determine or assess eligibility for premium tax credits, cost-sharing
reductions, Medicaid, and the State Children's Health Insurance Program
(CHIP) can resolve such inconsistencies not later than 30 days after
the date of enactment of this Act.
(b) Methods To Monitor Progress.--Not later than 30 days after the
date of enactment of this Act, the Secretary shall make public the
methods that the Centers for Medicare & Medicaid Services use to
monitor, track, and measure the progress of the Federal Exchange and
State Exchanges in resolving inconsistencies.
(c) Suspension of Financial Assistance Programs.--Premium
assistance tax credits under section 36B of the Internal Revenue Code
of 1986 and the reduced cost-sharing program under section 1402 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18071) shall not
be available for plan year 2015. Such premium tax credit and cost-
sharing programs shall resume only after--
(1) the Commissioner of the Social Security Administration
affirmatively declares that all inconsistencies related to
invalid social security numbers have been resolved; and
(2) the Inspector General of the Department of Health and
Human Services determines that all inconsistencies, as defined
in section 4(1), have been resolved.
(d) Requests for Additional Information.--
(1) In general.--If applicant information provided by an
individual seeking to enroll in a qualified health plan on a
State or Federal Exchange contains inconsistencies, the
Secretary shall request additional information from the
individual, and the individual shall have 90 days to provide
such information.
(2) Restrictions during inconsistency period.--During the
inconsistency period, an individual may be enrolled in
qualified health plan, but may not participate in the premium
assistance credit program under section 36B of the Internal
Revenue Code of 1986 or the reduced cost-sharing program under
section 1402 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18071). An individual who cooperates with a request
for additional information and whom the Secretary later
determines to be eligible for such programs, shall
retroactively receive the benefits of such programs that such
individual was eligible to receive for the inconsistency
period.
(3) Failure to submit additional information.--If the
applicant does not submit additional information requested
under subparagraph (A)--
(A)(i) the applicant shall be withdrawn from the
premium assistance credit program under section 36B of
the Internal Revenue Code of 1986 and the reduced cost-
sharing program under section 1402 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18071),
as applicable, at the end of the inconsistency period;
and
(ii) the Secretary shall send notification of such
disenrollment to the applicable health insurance
issuer; and
(B) the applicant shall re-enroll in a qualified
health plan with appropriate and accurate information
during the next open enrollment period.
SEC. 4. DEFINITIONS.
In this Act--
(1) the term ``inconsistencies'' means differences between
the self-attested information provided by an applicant in
enrolling in a health plan on an Exchange and being determined
eligible for premium tax credits and cost-sharing reductions or
in being determined to be eligible for enrollment in a State
Medicaid plan or a State child health plan under the State
Children's Health Insurance Program (CHIP) and the data
received through the Federal Data Services Hub or from other
data sources, including differences with respect to--
(A) citizenship;
(B) income;
(C) coverage under an eligible employer-sponsored
plan;
(D) incarceration status; or
(E) any other issue that would impact individual's
eligibility for financial assistance programs under the
Patient Protection and Affordable Care Act (including
the amendments made by such Act); and
(2) the term ``inconsistency period'' means the 90-day
period beginning on the date the notice of an inconsistency is
sent to the applicant.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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