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86–396 2014

PATIENT PROTECTION AND AFFORDABLE CARE 

ACT: IMPLEMENTATION IN THE WAKE OF 

ADMINISTRATIVE DELAY 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

JULY 18, 2013 

Serial No. 113–72 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

(II) 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

RALPH M. HALL, Texas 

JOE BARTON, Texas 

Chairman Emeritus 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

CORY GARDNER, Colorado 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Missouri 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

HENRY A. WAXMAN, California 

Ranking Member 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

EDWARD J. MARKEY, Massachusetts 

FRANK PALLONE, JR., New Jersey 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

JOHN BARROW, Georgia 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

BEN RAY LUJAN, New Mexico 

PAUL TONKO, New York 

(III) 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

TIM MURPHY, Pennsylvania 

Chairman 

MICHAEL C. BURGESS, Texas 

Vice Chairman 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

GREGG HARPER, Mississippi 

PETE OLSON, Texas 

CORY GARDNER, Colorado 

H. MORGAN GRIFFITH, Virginia 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

JOE BARTON, Texas 

FRED UPTON, Michigan (ex officio) 

DIANA DEGETTE, Colorado 

Ranking Member 

BRUCE L. BRALEY, Iowa 

BEN RAY LUJAN, New Mexico 

EDWARD J. MARKEY, Massachusetts 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

KATHY CASTOR, Florida 

PETER WELCH, Vermont 

PAUL TONKO, New York 

GENE GREEN, Texas 

JOHN D. DINGELL, Michigan 

HENRY A. WAXMAN, California (ex officio) 

(V) 

C O N T E N T S 

Page 

Hon. Tim Murphy, a Representative in Congress from the Commonwealth 

of Pennsylvania, opening statement ................................................................... 1 

Prepared statement .......................................................................................... 3 

Hon. Diana DeGette, a Representative in Congress from the state of Colorado, 

opening statement ................................................................................................ 4 

Hon. Fred Upton, a Representative in Congress from the state of Michigan, 

opening statement ................................................................................................ 6 

Prepared statement .......................................................................................... 7 

Hon. Michael C. Burgess, a Representative in Congress from the State of 

Texas, prepared statement .................................................................................. 8 

Hon. Henry A. Waxman, a Representative in Congress from the State of 

California, opening statement ............................................................................. 9 

Hon. Gregg Harper, a Representative in Congress from the State of Mississippi, opening statement ................................................................................. 54 

WITNESSES

J. Mark Iwry, Senior Advisor to the Secretary, Deputy Assistant Secretary 

for Retirement and Health Policy, U.S. Department of Treasury .................... 11 

Prepared statement .......................................................................................... 14 

Answers to submitted questions ...................................................................... 101 

SUBMITTED MATERIAL

Report, Majority staff, submitted by Mr. Murphy ................................................ 55 

Report, Urban Institute Analysis, submitted by Ms. DeGette ............................. 58 

Report, Democratic Staff of Committees on Energy and Commerce, Ways 

and Means, and Education and the Workforce, submitted by Mr. Waxman .. 64 

Report, Department of Health and Human Services, submitted by Mr. Waxman ........................................................................................................................ 89 

(1) 

PATIENT PROTECTION AND AFFORDABLE 

CARE ACT: IMPLEMENTATION IN THE WAKE 

OF ADMINISTRATIVE DELAY 

THURSDAY, JULY 18, 2013 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 2:34 p.m., in room 

2123 of the Rayburn House Office Building, Hon. Tim Murphy 

(chairman of the subcommittee) presiding. 

Members present: Representatives Murphy, Burgess, Blackburn, 

Gingrey, Scalise, Harper, Olson, Gardner, Griffith, Johnson, Long, 

Ellmers, Barton, Upton (ex officio), DeGette, Schakowsky, 

Butterfield, Castor, Tonko, Green, and Waxman (ex officio). 

Staff present: Mike Bloomquist, General Counsel; Sean Bonyun, 

Communications Director; Matt Bravo, Professional Staff Member; 

Karen Christian, Chief Counsel, Oversight; Noelle Clemente, Press 

Secretary; Andy Duberstein, Deputy Press Secretary; Paul Edattel, 

Professional Staff Member, Health; Julie Goon, Health Policy Advisor; Brad Grantz, Policy Coordinator, Oversight and Investigations; 

Sydne Harwick, Legislative Clerk; Brittany Havens, Legislative 

Clerk; Sean Hayes, Counsel, Oversight and Investigations; Andrew 

Powaleny, Deputy Press Secretary; John Stone, Counsel, Oversight; 

Tom Wilbur, Digital Media Advisor; Brian Cohen, Democratic Subcommittee Staff Director, Senior Policy Advisor; Hanna Green, 

Democratic Staff Assistant; Elizabeth Letter, Democratic Assistant 

Press Secretary; Stephen Salsbury, Democratic Special Assistant; 

and Matthew Siegler, Democratic Counsel. 

OPENING STATEMENT OF HON. TIM MURPHY, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA 

Mr. MURPHY. Good afternoon. I convene this hearing of the Subcommittee on Oversight and Investigations. 

We are here today to discuss the Administration’s recent decision 

to delay a substantial portion of the health care law, the requirement that businesses with over 50 employees provide coverage to 

their employees. This decision was announced quietly, just before 

the July 4 holiday, through a blog post. 

Valerie Jarrett, one of the President’s top advisors, stated that 

the Administration had delayed the employer mandate tax because 

2 

it was ‘‘listening’’ to employers who had complained about the law’s 

burdens and costs. 

In the 3 years since the President’s health care law was enacted, 

this committee has also been listening and we have heard this Administration repeatedly tell us that ‘‘all is well.’’ The exchanges 

would be ready to go live in October. Never once did the Administration officials suggest that a key underpinning of the law, the requirement that employers report offer federally-approved health 

benefits and pay extra taxes if they didn’t, would be delayed. 

As soon as the Treasury Department announced this decision in 

a blog post, the committee sent a letter asking for some basic information to understand how and why this decision was made. The 

Executive Branch, the President, has a constitutional duty to faithfully execute laws passed by Congress. 

Both the Treasury Department and White House have said the 

decision to delay the employer mandate was made after engaging 

in a discussion with employers. Yet, in a July 9 letter to our committee, the Treasury Department did not answer the committee’s 

questions about who they spoke with to reach this decision. Why 

did the Administration give businesses a waiver from the law for 

a full year, but force families to comply with the law now or pay 

a new tax? Where is the waiver for America’s families? 

This delay in the employer mandate tax is not the first clue that 

implementation of the Affordable Care Act is becoming a massive 

failure. In April 2011, more than 1,400 organizations and employers providing health insurance to 3.1 million Americans were 

granted waivers from the ACA’s mandates for one year. By January 2012, those 1,400 waivers were automatically extended for 2 

more years, and now, every employer in America gets a waiver 

from the employer mandate tax. The American people, however, get 

no waivers from the mandates, the taxes, and burdens of this law. 

It is interesting that the Treasury Department chose to explain 

that the employer mandate was delayed for two reasons: First, it 

will allow the Administration to find ways to simplify the reporting 

requirements in the law. Second, this provides time to adapt reporting systems. These same reasons support a delay for the individual mandate. 

Treasury’s position that a delay is necessary because additional 

time is needed to adapt reporting systems sends a troubling signal 

about how the Administration’s lack of progress is affecting implementation of the law. How the exchanges will operate next year appears now to be a far cry from what the law envisioned. It also 

raises questions about another recent delay by the Administration, 

also announced over the July 4 holiday: Health and Human Services’ decision to scrap the income and coverage verification requirements for 2014. 

I am sure today we will also hear a great deal about the news 

that New York’s premiums may be lower. This isn’t surprising: 

New York has the most heavily regulated and often the most expensive health care market in the country, so of course when you 

force every American to buy that expensive product, the cost may 

go down. I certainly am not going to be heading home to my district and saying congratulations, you now get to pay Manhattan 

prices in Pennsylvania. 

3 

Enrollment in the exchanges will begin in just over 70 days. It 

is important that every American understands how this system will 

work. So testifying before the committee today is J. Mark Iwry, 

Senior Advisor to the Secretary and Deputy Assistant Secretary for 

Retirement and Health Policy at the U.S. Department of the Treasury. So I welcome you, Mr. Iwry, and I hope that you can provide 

specific answers to the committee members’ questions about Treasury’s decision and whether we can expect additional delays. 

Now yesterday the House of Representatives voted to do two 

things. First, the House voted to codify the President’s ability to 

delay the employer mandate, and second, it voted to offer this same 

option, the one given to America’s businesses, to American families. 

Whether or not you agree on this policy, as an oversight subcommittee, we need to understand the basis for the Administration’s decisions to delay or postpone the Act’s requirements. As reports mount that the exchanges and states are not prepared to 

fully implement this law, it seems likely that the Administration 

will again find itself in the position of wanting to grant additional 

delays of the law’s requirements. Examining the basis for these decisions, and how they will be made, is the job of this subcommittee, 

and that is the reason for having this hearing today. 

I only have a few seconds left, but I yield to the vice chairman, 

if he has any—— 

[The prepared statement of Mr. Murphy follows:] 

PREPARED STATEMENT OF HON. TIM MURPHY

We are here today to discuss the administration’s recent decision to delay a substantial portion of the healthcare law—the requirement that businesses with over 

50 employees provide coverage to their employees. This decision was announced 

quietly, just before the July 4th holiday, through a blog post. Valerie Jarrett, one 

of the president’s top advisors, stated that the administration had delayed the employer mandate tax because it was ‘‘listening’’ to employers who had complained 

about the law’s burdens and costs. 

In the three years since the president’s health care law was enacted, this committee has also been listening and we’ve heard this administration repeatedly tell 

us that ‘‘all is well.’’ That exchanges would be ready to go live in October. 

Never once did administration officials suggest that a key underpinning of the 

law—the requirement that employers report offer federally-approved health benefits 

and pay extra taxes if they didn’t—would be delayed. 

As soon as the Treasury Department announced this decision in a blog post, the 

committee sent a letter asking for some basic information to understand how and 

why this decision was made. The executive branch—the president—has a constitutional duty to faithfully execute laws passed by Congress. 

Both the Treasury Department and White House have said the decision to delay 

the employer mandate was made after engaging in a discussion with employers. Yet, 

in a July 9th letter to our committee, the Treasury department did not answer the 

committee’s question about who officials spoke with to reach this decision. Why did 

the administration give businesses a waiver from the law for a full year, but force 

individual Americans to comply with the law NOW or pay a new tax? 

Where is the waiver for the American people? 

This delay in the employer mandate tax is not the first clue that implementation 

of the Affordable Care Act is becoming a massive failure. 

In April 2011, more than 1,400 organizations and employers providing health insurance to 3.1 million Americans were granted waivers from the ACA’s mandates 

for one year. 

By January 2012, those 1,400 waivers were automatically extended for two more 

years. 

And now, every employer in America gets a waiver from the employer mandate 

tax. 

4 

The American people, however, get no waiver from the mandates, the taxes, and 

burdens of this law. 

It is interesting that the Treasury Department chose to explain that the employer 

mandate was delayed for two reasons: First, it will allow the administration to find 

ways to simplify the reporting requirements in the law. Second, this provides time 

to adapt reporting systems. These same reasons support a delay in the individual 

mandate. 

Treasury’s position that a delay is necessary because additional time is needed to 

adapt reporting systems sends a troubling signal about the administration’s lack of 

progress in implementing the law. How the exchanges will operate next year appears now to be a far cry from what the law envisioned. It also raises questions 

about another recent delay by the administration, also announced over the July 4 

holiday: HHS’ decision to scrap the income and coverage verification requirements 

for 2014. 

I’m sure today we will also hear a great deal about the news that New York’s 

premiums may be lower. This isn’t surprising: New York has the most heavily regulated and often most expensive health care market in the country, so of course when 

you force every American to buy that expensive product, the cost may go down. I 

certainly am not going to be heading home to my district and saying: ‘‘Congratulations, you now get to pay Manhattan prices in Pennsylvania.’’ 

Enrollment in the exchanges will begin in just over 70 days. It is important that 

every American understands how this system will work. Testifying before the committee today is J. Mark Iwry, Senior Advisor to the Secretary and Deputy Assistant 

Secretary for Retirement and Health Policy at the U.S. Department of the Treasury. 

Welcome, Mr. Iwry. I hope that you can provide specific answers to the committee 

members’ questions about Treasury’s decision and whether we can expect additional 

delays. 

Yesterday the House of Representatives voted to do two things. First, the House 

voted to codify the President’s ability to delay the employer mandate, and second, 

it voted to offer this same option—the one given to America’s businesses—to American families. Whether or not you agree on this policy, as an oversight subcommittee, we need to understand the basis for the administration’s decisions to 

delay or postpone the Act’s requirements. As reports mount that the exchanges and 

states are not prepared to fully implement this law, it seems likely that the administration will again find itself in the position of wanting to grant additional delays 

of the law’s requirements. Examining the basis for these decisions, and how they 

were made, is the job of this subcommittee. That is the reason for having this hearing today. 

# # # 

Mr. BURGESS. I will submit them. 

Mr. MURPHY. He will submit them for the record. 

All right, I now recognize the ranking member for 5 minutes. 

OPENING STATEMENT OF HON. DIANA DEGETTE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF COLORADO 

Ms. DEGETTE. Thank you very much, Mr. Chairman. 

I am very pleased that we have started having oversight hearings on the implementation of the Affordable Care Act. I think it 

is an important role for the committee to play, and I also think as 

we go forward, it would be really constructive for us to begin having hearings on not just overall should we have the ACA or not, 

but rather, to drill down into some of the particular issues like we 

did a couple of weeks ago, when we did have small businesses come 

in here to this committee to talk to us about some of the challenges 

that they were facing. 

I wish, though, that we were pursuing some of this oversight in 

a less hyperbolic fashion, as we just heard. Frankly, when the Administration announced a couple of weeks ago that they were deVerDate Nov 24 2008 12:16 Feb 21, 2014 Jkt 037690 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-72 CHRIS
5 

laying the employer mandate, it took many of us on this side of the 

Aisle by surprise, as well as on your side of the Aisle. But frankly, 

thinking about that panel of small businesspeople that we had 

here, one might argue that the Administration was just listening 

to some businesses about some very real issues that they had. Not 

that I would expect anybody on your side of the Aisle to give the 

Administration any credit for that. 

I do think, though, that we should put all of this into context, 

because while this one particular part of the law has been delayed 

for a year, there is a lot more that is going to be going on in implementation and a lot that will help the American public. I would 

like to talk a little bit about that. 

First of all, the delay of the employer mandate does not impact 

the 95 percent of large employers that are already offering insurance to their employees. Let me say that again. Ninety-five percent 

of large employers are already offering coverage to their employees, 

and that will continue to happen. Also, the delay of the employer 

mandate does not impact the millions of low income, uninsured 

Americans who will be newly eligible for the Medicaid program, at 

least in the states where the governors have not turned down the 

opportunity to provide fully funded coverage to their citizens. And 

the delay won’t impact the state or federal exchanges, the heart of 

the health care law. Beginning in October, millions of Americans 

will be able to go to the exchanges, shop for the best insurance coverage for themselves and their family in a transparent, competitive 

market, and be protected from the worst abuses of the insurance 

industry. They won’t have to worry about rescissions or denial of 

coverage if they become ill or injured, or if they have a preexisting 

condition. 

And this is really key when you talk about should we delay this 

for a year for individuals. Those people, people who want insurance 

who can now go to the exchanges and get that insurance, will be 

eligible for billions of dollars in premium subsidies and tax credits 

to help make that health insurance affordable. So I would say, why 

would we delay that for people who really want to get affordable 

insurance, not just in New York, but in Pennsylvania and Colorado 

and all around this country? 

The benefits of the law will be real and significant. The reports 

released by the democratic staff show yesterday that in Colorado, 

for example—or I am sorry, in my district, in the 1st District of 

Colorado, over 120,000 people who don’t have health insurance now 

will have access to quality, affordable coverage without fear of discrimination or higher rates. And if it wasn’t so important, I would 

have almost had to laugh yesterday when the response to the Administration’s announcement was to vote yet again to repeal the 

Affordable Care Act. The main talking point seemed to be relief, 

but in fact, the public needs to get insurance and it needs to get 

it affordable. I don’t think that relief means taking health care coverage away from millions of Americans. I don’t think that it means 

eliminating billions of dollars in tax credits and subsidies. I don’t 

think that it means leaving millions of American children and 

adults with preexisting conditions at the tender mercies of the insurance companies. And I don’t think that it means eliminating or 

6 

delaying provisions of the law that are helping to keep costs under 

control. 

Now, you can pooh-pooh this article about the rates—the premium rates in New York State, and maybe you could if that was 

the only state in which the premiums were going down. But in fact, 

we have seen across the country that as these preliminary rates 

come in, they are lower, and in fact, in some cases, the insurance 

companies are actually asking to rebid in the exchanges. And so I 

think we need to continue to try to tune this up. I read an article 

today when the Republican majority passed the Part D Medicare 

provisions about 10 years ago, there was a lot of confusion. All of 

us worked together to make those work. It was rocky at first, but 

it worked, and now over 90 percent of seniors love those protections. That is what we should be striving for in a bipartisan way 

today. 

I want to thank you for having the hearing, but I think we need 

to move on from this, and I yield back. Thank you. 

Mr. MURPHY. Gentlelady yields back. Now recognize the chairman of the full committee, Mr. Upton, for 5 minutes. 

OPENING STATEMENT OF HON. FRED UPTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MICHIGAN 

Mr. UPTON. Thank you, Mr. Chairman. 

Yesterday the House voted to give to every American the same 

option the Administration gave to the business community: The 

ability to delay the impact of the health care law on their family 

for a year. 

It is the right thing to do. Individuals, like businesses, are subject to reporting requirements, costs, penalties under the Affordable 

Care Act. We believe that individuals left to suffer in the looming 

rate shock deserve the same treatment that the Administration 

awarded to businesses, and I am glad the House voted in a bipartisan manner to do it yesterday and I hope the Senate will follow. 

As a committee with jurisdiction over this law, and its implementation, we have a duty to hold the Administration accountable for 

its decisions and to make sure that they are transparent in the 

process which has sadly been missing throughout the writing, passage, and implementation of the health care law. 

A great deal of uncertainty surrounds the law. Americans don’t 

yet know how much their insurance will cost. Reports indicate that 

the exchanges are behind schedule. Deadlines have been delayed 

and missed entirely. 

Today we are going to hear from Mr. Mark Iwry of the Treasury 

Department on its decision to delay the mandate for employers. I 

hope we will hear the complete story from the witness today on 

how this decision was made, who made it, what the record was before Treasury that prompted it to take the action 2 weeks ago. Previous hearings before this committee, Administration witnesses 

have looked us square in the eye and assured us that the implementation of the Affordable Care Act was, in fact, on track. Treasury’s decision to delay the employer mandate confirms that this is 

not the case. And yesterday we learned the decision was made in 

June and the Administration had been considering the delay ‘‘for 

a while.’’ Why did the ‘‘most transparent Administration in history’’ 

7 

mislead Congress and try to deceive the public? Because it knew 

that the law perhaps is bad for business and also bad for jobs. 

We now know that the Administration shamelessly waited for 

July 4 fireworks to provide a smokescreen for their employer mandate bombshell. So we need to get a full accounting of this decision, 

in the full light of day, so we will be prepared for what comes our 

way once enrollment begins on October 1. 

One other point that I want to make. I see a lot of public reports 

about those that support the Affordable Care Act making the comparisons to Part D, the Prescription Drug Program, comparisons 

that show that it is now rated very favorable among those people 

that participate. I would remind my colleagues that Part D is still 

a voluntary, not mandatory, program where folks can change their 

plans literally every year, have dozens of choices to make, and yes, 

there is no financial penalty for failure to participate. 

I yield now to Dr. Burgess. 

[The prepared statement of Mr. Upton follows:] 

PREPARED STATEMENT OF HON. FRED UPTON

Yesterday the House voted to give to every American the same option the administration gave to the business community: The ability to delay the impact of the 

health care law on their family for one year. 

This is the right thing to do. Individuals, like businesses, are subject to reporting 

requirements, costs, and penalties under the Affordable Care Act. We believe individuals left to suffer the looming rate shock deserve the same treatment that the 

administration awarded to businesses. I’m glad the House voted in a bipartisan 

manner to do this yesterday and I hope the Senate follows suit. 

As a committee with jurisdiction over this law, and its implementation, we have 

a duty to hold the administration accountable for its decisions and to make sure 

they are transparent in the process which has sadly been missing throughout the 

writing, passage, and implementation of the health care law. 

A great deal of uncertainty surrounds this law. Americans don’t yet know how 

much their insurance will cost. Reports indicate that the exchanges are behind 

schedule. Deadlines have been delayed and missed entirely. 

Today we will hear from Mr. Mark Iwry of the Treasury Department on its decision to delay the mandate for employers. 

I hope we will hear the complete story from the witness today on how this decision was made, who made it, what the record was before Treasury that prompted 

it to take this action two weeks ago. In previous hearings before this committee, administration witnesses have looked us square in the eye and assured us that implementation of the Affordable Care Act was on track. Treasury’s decision to delay the 

employer mandate confirms that this is not the case. 

And yesterday we learned the decision was made in June and the administration 

had been considering the delay ‘‘for a while.’’ Why did the ‘‘most transparent administration in history’’ mislead Congress and try to deceive the public? Because it 

knew that the law is bad for business and bad for jobs. 

We now know the administration shamelessly waited for July 4th fireworks to 

provide a smokescreen for their employer mandate bombshell. 

We need to get a full accounting of this decision, in the full light of day, so we 

can all be prepared for what is coming our way once enrollment begins on October 

1—or for whatever rewrite the administration makes next. 

This is about fairness. 

### 

Mr. BURGESS. And I thank the gentleman for yielding. 

It is of concern that on the evening of July 2, this provision was 

suddenly repealed—or delayed. It became especially of concern to 

me after hearing from Administration officials here in this subVerDate Nov 24 2008 12:16 Feb 21, 2014 Jkt 037690 PO 00000 Frm 00013 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-72 CHRIS
8 

committee that they would definitely be ready to go with the Affordable Care Act on time and without delay. 

The questions are who discussed this delay? Were there memos 

circulating within the departments? Were there secret meetings 

with the White House? When did the Administration start thinking 

about delaying the reporting provisions? And what about the individuals that still must comply with the mandate to purchase their 

health care coverage? Do they get a delay as well? 

The White House, the Treasury, Health and Human Services 

continue to say all systems are go. No problems here, nothing to 

look at. Move on. But actually, their actions belie their words. And 

unfortunately, it is the American people who will be left hanging 

in the balance. 

If the gentleman from Texas would like time, I will yield to Mr. 

Barton. 

[The prepared statement of Mr. Burgess follows:] 

PREPARED STATEMENT OF HON. MICHAEL C. BURGESS

Thank you Mr. Chairman, 

Since ACA was signed into law 3 years ago, we have only seen the law’s failure 

to deliver on its promises. 

Two weeks ago, the Obama administration announced it would delay implementation and reporting requirements for the mandate in the Affordable Care Act which 

requires employers to provide insurance or pay a penalty. 

While the Administration attempted to bury their announcement in the midst of 

the July 4th holiday, they have only further proved that the President’s signature 

law is not ready for primetime. 

This announcement simply adds to a long list of provisions in the law that the 

Administration has delayed or postponed. Not to mention the provisions that have 

been so onerous and burdensome for business and consumers that Congress has already stepped in and repealed them altogether. 

Not only is the law filled with broken promises, but the July 4th announcement 

directly contradicts statements that Administration officials have made before this 

Committee. 

I have been told, time and time again, by officials from the agencies in charge 

of implementing the Affordable Care Act, that it would ‘‘definitely’’ be ready to go 

live on October 1, 2013. 

So—where was the disconnect? 

When did the Administration start thinking about delaying the reporting provisions? 

Who discussed this delay? Were memos circulated within the departments? Were 

there secret meetings with the White House? 

OR—is this just an attempt by the Administration to use perverse incentives to 

boost enrollment in their exchanges? 

Furthermore, within the Administration’s embarrassing admission of delay, they 

acknowledge the difficult of getting verification systems up and running. So instead, 

the administration will rely on an honor system for reporting. 

So what happens if they get it wrong? 

The Administration has given a break to big business—allowing them to delay reporting compliance with the law. 

What about the individuals that still must comply with the mandate to purchase 

health coverage? Do they get a delay? 

While the White House, Treasury, and HHS continue to report that ‘‘everything 

is working like it’s supposed to’’ and ‘‘they will definitely be ready’’, the American 

people are left hanging in the balance. 

Thank you and I yield back. 

Mr. BARTON. Well, I appreciate that. 

My concern is that we have an Obama—presidential administration and President Obama that is constitutionally required to implement all the laws, and in this case, apparently chose to not imVerDate Nov 24 2008 12:16 Feb 21, 2014 Jkt 037690 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-72 CHRIS
9 

plement a part of the very law that it was so strongly for. So I am 

going to be asking questions, where in the Constitution does it give 

the President and the Treasury Department the ability to choose 

to implement this part of a law but not that part of a law, and if 

you only going to implement part, how can you be expected to implement the rest of it? 

I have also got some questions and concerns about this decision 

to allow for self-attestation of income to comply with some of the 

subsidies. Is the Treasury Department now going to do away with 

the W-2 and W-4 forms and let the entire country self-attest what 

our income is for purposes of the income tax code? That is another 

question that I might have, Mr. Chairman, but I do appreciate the 

time and I appreciate the Treasury Department being here to participate in this hearing. 

Mr. MURPHY. I thank the gentleman. The gentleman’s time has 

expired, and now I will go to the ranking member of the full committee, Mr. Waxman, for 5 minutes. 

OPENING STATEMENT OF HON. HENRY A. WAXMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Mr. WAXMAN. Thank you, Mr. Chairman. 

The Constitution says a law is something that is passed by the 

Congress and signed by the President. And my colleague just 

talked about the constitutional responsibility of the President to 

uphold the law. What about the constitutional responsibility of the 

Congress to make sure that the laws work? 

I was shocked when we had the debate on the House Floor yesterday. A member stood up and said, ‘‘I despise the Affordable Care 

Act.’’ What passion. What passion. What is it they despise so 

much? It is the law. If they want to change some of it, let’s change 

it. But it just raises real concerns about—in my mind about where 

this Republican party is going. It is a state of mind that talks 

about taking things away from people that they desperately want 

for what purpose? Why should a state headed by a Republican governor want to deny their poor people 100 percent funding for Medicaid and leave them with no coverage at all? You know they have 

the hospitals and doctors say why not cover these people? I don’t 

care. We are going to punish them because we want to punish 

President Obama. But they are punishing a lot of people that did 

nothing to deserve this kind of treatment. 

Something has gone fundamentally wrong when a political party 

tries to deny health insurance to millions of American families just 

to advance its narrow partisan interest. 

This law is going to go fully into effect. Millions of Americans are 

already benefitting from its protections. Millions more will, for the 

first time, have access to quality, affordable health coverage. 

Yesterday, my staff released a series of reports on the benefits 

of this law in each congressional district in this country. I have 

these reports, Mr. Chairman, for each member of this subcommittee, and I would like to ask that they be made part of the 

hearing record. Mr. Chairman? 

10 

Mr. MURPHY. Without objection. I understand you have those 

things, I just want to add something, but I will mention it at the 

end of your time. 

Mr. WAXMAN. Well I have asked unanimous consent. 

Mr. MURPHY. Well let me just say I am not going to object to the 

unanimous consent. I do add that I will note that this report does 

not include information about expected costs and insurance price 

increases—— 

Mr. WAXMAN. You can put your critique of it in the record—— 

Mr. MURPHY. No, I just want to ask unanimous consent that we 

can put our Majority staff report from me on the expected premium 

increases. 

Mr. WAXMAN. I have no problem with that. 

Mr. MURPHY. Thank you. 

[The information appears at the conclusion of the hearing.] 

Mr. WAXMAN. Today, the Department of Health and Human 

Services released a new report finding that in contrast to the rate 

shock predictions from Republicans, health insurance plans under 

the Affordable Care Act will cost 18 percent less than predicted. 

Small businesses can almost save 20 percent over what they otherwise would have been paying for coverage. I would like to ask that 

this report also be made part of the hearing record. I will reserve 

that, because—— 

Mr. MURPHY. Thank you. No, we will give you time because I 

would like to find out what that report is. 

Mr. WAXMAN. OK. The fact sheets and the HHS report document 

that the incredible amount of good this law is already doing. But 

rather than acknowledging this and trying to improve on any 

flaws, Republicans on this committee and in the House have 

launched an unrelenting effort to destroy the Affordable Care Act. 

Political analyst Chuck Todd said House Republicans are ‘‘trying to 

sabotage the law.’’ Where does the Constitution say that members 

of Congress are supposed to sabotage a law that they didn’t vote 

for? 

USA Today described the actions of Republicans in the following 

way: ‘‘Having lost in Congress and in court, they are now using the 

most cynical of tactics: trying to make the law fail. Never mind the 

public inconvenience and human misery that will result.’’ 

Yesterday, Republicans voted for the 38th time to repeal or delay 

key parts of the health care law. Republican governors around the 

country are refusing to take 100 percent for their low income people for Medicaid. The same governors are making implementation 

more difficult by refusing to take the option of setting up health 

exchanges. Republicans in the Congress have refused to provide a 

dime for implementation of this law, and now they are attempting 

to intimidate those who had worked with the Administration or the 

non-profit group Enroll America to help educate the public about 

the new benefits for which they are eligible under the Obamacare. 

And I say that in a positive, not a pejorative, way. 

It does not have to be this way. When the Bush Administration 

passed and implemented Medicare Part D, Democrats and Republicans made sure the Administration had adequate funding to implement the law. I voted against Medicare Part D. We could have 

done a much better job to provide prescription drugs. I didn’t preVerDate Nov 24 2008 12:16 Feb 21, 2014 Jkt 037690 PO 00000 Frm 00016 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-72 CHRIS
11 

vail. The law was passed. We worked to spread the word about the 

new Medicare benefits that included a $300 million public relations 

campaign and a bus tour by Administration officials that stopped 

in 100 cities. 

The goal of this hearing is not to improve the law; the goal is 

to sabotage the law, regardless of the damage inflicted on the 

health care system or the millions of American people who, for the 

first time, will be able to receive affordable health insurance coverage. I think that is the wrong approach, Mr. Chairman. The Affordable Care Act is providing important benefits. I know Republicans said they want to repeal it, and then replace it. They have 

never given us a decent replacement. They are not talking about 

anything constructive—— 

Mr. MURPHY. I think the gentleman’s time is expired. 

Mr. WAXMAN [continuing]. It is all negative. 

Mr. MURPHY. Thank you. 

Mr. WAXMAN. I yield back the balance of my time. 

Mr. MURPHY. I would now like to introduce our witness for today’s hearing. The Honorable Mark Iwry is a senior advisor to the 

Secretary and Deputy Assistant Secretary for Retirement and 

Health Policy at The United States Department of Treasury. In 

this capacity, he is the reporting authority for the Office of the 

Benefits Tax Counsel and provides advice and counsel to the Secretary and the Assistant Secretary regarding tax issues related to 

retirement savings, health care, and employee benefits. 

I will now swear in Mr. Iwry. You are aware that this committee 

is holding an investigative hearing, and when doing so has had the 

practice of taking testimony under oath. Do you have any objections to testifying under oath? 

Mr. IWRY. No, Mr. Chairman. 

Mr. MURPHY. The chair then advises you that under the rules of 

the House and the rules of the committee, you are entitled to be 

advised by counsel. Do you desire to be advised by counsel during 

your testimony today? 

Mr. IWRY. No, sir. 

Mr. MURPHY. In that case, if you would please rise and raise 

your right hand? I will swear you in. 

[Witness sworn in.] 

Mr. MURPHY. You are now under oath and subject to the penalties set forth in Title 18, Section 1001 of the United States Code. 

You may now give a 5-minute summary of your written statement. 

TESTIMONY OF J. MARK IWRY, SENIOR ADVISOR TO THE SECRETARY, DEPUTY ASSISTANT SECRETARY FOR RETIREMENT 

AND HEALTH POLICY, U.S. DEPARTMENT OF TREASURY 

Mr. IWRY. Thank you, Chairman Murphy, Ranking Member 

DeGette, members of the subcommittee. Good afternoon. I am 

pleased to appear before you today. 

As you know, on July 2, the Treasury Department announced 

that it would provide a 1-year transition relief period for 2014 with 

respect to three provisions of the Affordable Care Act that the Act 

added to the internal revenue code. 

First, information reporting requirements for self-insuring employers, insurance companies, and other entities that provide 

12 

health coverage. Second, information reporting requirements for 

employers that are subject to the employer shared responsibility 

provisions, and third, the employer shared responsibility provisions. 

On July 9, we published formal guidance, Notice 2013–45, describing and providing this transition relief. Treasury is providing 

the transition relief after reviewing comments on reporting requirements and related discussions, and comments with employers and 

other stakeholders. Employers and their representatives requested 

transition relief for 2014 because of concerns about the difficulty or 

cost of complying with the reporting requirements, the desire that 

reporting be simplified, and the lead times necessary to adapt information gathering and reporting systems and implement reporting effectively. 

We recognize that the vast majority of employers that will need 

to do this reporting already provide health coverage to their workers, and we want to make sure employers will be able to comply 

with reporting effectively and efficiently. 

To address these concerns, Treasury announced that 2014, an additional year, would be provided before the reporting requirements 

began. This is designed to meet two primary concerns raised by 

stakeholders. First, it allows for an additional dialogue and consideration of ways to simplify the new reporting process, consistent 

with effective implementation of the law. Second, it gives employers more time, which many have requested, to adapt health coverage and reporting systems as they move toward making coverage 

affordable and accessible for their employees. Once reporting rules 

have been issued, employers, insurers, other reporting entities are 

encouraged to report voluntarily for 2014. Allowing time for real 

world testing of reporting systems for 2014 will contribute to a 

smoother transition to full implementation in 2015. 

Employer reporting is integral to administration of the employer 

shared responsibility provisions. Because of the 2014 transition relief, it generally will not be possible for the IRS to match up the 

information from employers with the information about individuals 

claiming a premium tax credit for 2014. As a result, as further explained in my written statement, the transition relief for reporting 

will make it impractical to determine which employers owe shared 

responsibility payments for 2014. Accordingly, we have extended 

the transition relief to the employer shared responsibility provisions so that no such payment will be assessed in 2014. 

In preparation, though, for the application of the reporting and 

employer responsibility provisions in 2015, employers and others 

are encouraged to report voluntarily for 2014 and maintain or expand health coverage in 2014. 

The transition relief provided in this notice is an exercise of the 

Treasury’s longstanding administrative authority under the tax 

code. This authority has been used to provide transition relief for 

taxpayers seeking to comply with new legislation and to provide a 

wide range of other guidance. In particular, on a number of prior 

occasions across administrations, this authority has been used to 

postpone the application of new legislation when immediate application would have subjected taxpayers to unreasonable administrative burdens or costs. 

13 

Finally, the transition relief does not affect employees or other 

individuals’ access to the premium tax credits available beginning 

in 2014; nor does this transition relief affect the effective date of 

other ACA provisions, including the individual responsibility provisions and the insurance market reforms. 

While the 2014 transition relief for employer reporting would 

make it impractical to implement the employer responsibility provisions, it would not have a comparable impact on implementation of 

the individual responsibility provisions, which as a practical matter, are necessary for implementing the ACA’s insurance market 

reforms that guarantee access to affordable insurance for individuals. 

As you know, the Affordable Care Act is projected to provide coverage for tens of millions of Americans. Together with the other departments involved, Treasury is implementing this Act to build on 

the progress already made toward better and more affordable coverage. We welcome the opportunity to further work with the committee to achieve these objectives, and I look forward to answering 

your questions. 

[The prepared statement of Mr. Iwry follows:] 

14 


86396.001

EMBARGOED UNTIL 10:00 A.M. July 18,2013 

Written Testimony of J. Mark Iwry 

Senior Advisor to the Secretary and 

Deputy Assistant Secretary for Retirement and Health Policy 

U.S. Department of the Treasury 

Before the House Energy and Commerce Subcommittee on Oversight and Investigations 

July 18,2013 

Chainnan Murphy, Ranking Member DeGette, and Members of the Subcommittee, I appreciate 

the opportunity to testify on the recent decision to provide transition relief with respect to certain 

requirements of the Affordable Care Act ("ACA"). 

On July 2, 2013, the Treasury Department announced that it would provide one-year transition 

relief(for 2014) with respect to three provisions of the ACA: (i) the infonnation reporting 

requirements that apply to insurance companies, self-insuring employers, and certain other 

entities that provide minimum essential health coverage under section 6055 of the Internal 

Revenue Code (the "Code"); (ii) the infonnation reporting requirements that apply to applicable 

large employers under section 6056 of the Code, and (iii) the employer shared responsibility 

provisions under section 4980H of the Code. On July 9,2013, we published fonnal guidance 

describing this transition relief. A copy ofthat guidance, Notice 2013-45, is attached. 

Background 

Section 6055 requires annual infonnation reporting by health insurers, self-insuring employers, 

government agencies, and other providers of health coverage. Section 6056 requires annual 
15 


86396.002

EMBARGOED UNTIL 10:00 A.M. July 18,2013 

infonnation reporting by applicable large employers relating to the health insurance that the 

employer offers (or does not offer) to its full-time employees. Section 4980H(a) imposes an 

assessable payment on an applicable large employer that fails to offer minimum essential 

coverage to its full-time employees (and their dependents) under an eligible employer-sponsored 

plan if at least one full-time employee enrolls in a qualified health plan for which a premium tax 

credit is paid with respect to the employee. Section 4980H(b) imposes an assessable payment on 

an applicable large employer that offers minimum essential coverage to its full-time employees 

(and their dependents) under an eligible employer-sponsored plan but has one or more full-time 

employees who enroll in a qualified health plan for which a premium tax credit is paid with 

respect to the employee (for example, if the coverage offered either does not provide minimum 

value or is not affordable to that full-time employee). 

Information Reporting 

The Treasury Department is providing this transition relief after reviewing written comments 

addressing the employer and insurer infonnation reporting requirements and discussions with 

stakeholders (including employers, governmental entities, and others) regarding the 

requirements. Employers and their representatives requested transition relief for 2014 because of 

concerns about the difficulty or cost of complying with the reporting requirements, the desire 

that reporting be simplified and the lead times necessary to adapt infonnation gathering and 

reporting systems and implement the reporting requirements effectively. We recognize that the 

vast majority of employers that will need to do this reporting already provide health coverage to 

their workers, and we want to make sure employers will be able to comply with the reporting 

requirements effectively and efficiently. 

2 
16 


86396.003

EMBARGOED UNTIL 10:00 A.M. July 18,2013 

To address these concerns, the Treasury Department announced that an additional year - 2014 -

will be provided before the ACA mandatory employer and insurer reporting requirements begin. 

This is designed to meet two primary concerns expressed in stakeholder comments and 

discussions. First, it allows for additional dialogue on and consideration of ways to simplify the 

new reporting requirements consistent with effective implementation of the law. Second, it gives 

employers additional time, which many have requested, to adapt health coverage and reporting 

systems as they move toward making health coverage affordable and accessible for their 

employees. Once reporting rules have been issued, employers, insurers, and other reporting 

entities are encouraged to voluntarily implement information reporting in 2014, in preparation 

for the application of the provisions in 2015. Real-world testing of reporting systems in 2014 

will contribute to a smoother transition to full implementation in 2015. 

Employer Shared Responsibility 

We recognize that this transition relieffor reporting will make it impractical to determine which 

employers owe shared responsibility payments for 2014. Accordingly, we have extended this 

transition relief to the employer shared responsibility payments. 

A brief explanation may be helpful in understanding how providing a transition year for 

employer reporting affects implementation of the employer shared responsibility provisions. 

Under those provisions, an applicable large employer generally must offer affordable, minimum 

value health coverage to its full-time employees or an "assessable payment" under the employer 

responsibility provisions may apply if one or more of its full-time employees qualifies for and 

receives a premium tax credit with respect to health insurance coverage purchased on a Health 

3 
17 


86396.004

EMBARGOED UNTIL 10:00 A.M. July 18.2013 

Insurance Marketplace (Marketplace). The employer infonnation reporting is integral to the 

administration ofthe employer shared responsibility provisions. 

Because an employer typically will not know whether a full-time employee received a premium 

tax credit, the employer generally will not have all of the infonnation needed to detennine 

whether it owes an assessable payment under the employer responsibility provisions. 

Recognizing that employers generally will not have all of the necessary information, the statute 

does not require the employer to calculate an assessable payment or file returns submitting such 

a payment. To implement these provisions, after receiving the infonnation returns filed by 

applicable large employers and the information about employees claiming the premium tax credit 

for any given calendar year, the Internal Revenue Service will determine whether any of the 

employer's full-time employees received the premium tax credit and, if so, whether an assessable 

payment may be due. If the IRS concludes that an employer may owe such an assessable 

payment, it will contact the employer, and the employer will have an opportunity to respond to 

the infonnation the IRS provides before a payment is assessed. 

Because of the transition relief for employer reporting for 2014, it generally will not be possible 

to match up the infonnation from employers with the infonnation about individuals claiming a 

premium tax credit for 2014. As a result, the 2014 transition relief for employer reporting will 

make it impractical to detennine which employers owe assessable payments for 2014. 

Accordingly, no such payments will be assessed for 2014. However, in preparation for the 

application of the reporting requirements and employer responsibility provisions beginning in 

2015, employers and other affected entities are encouraged to voluntarily comply with the 

4 
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86396.005

EMBARGOED UNTIL 10:00 A.M. July 18,2013 

reporting provisions for 2014, as noted earlier, and employers are encouraged to maintain or 

expand health coverage in 2014. 

Authority to Grant Transition Relief 

Notice 2013-45 is an exercise of the Treasury Department's longstanding administrative 

authority under section 7805(a) of the Internal Revenue Code. 

This administrative authority has been used to provide transition relief for taxpayers seeking to 

comply with new legislation, and to provide a wide range of other guidance. In particular, on a 

number of prior occasions across Administrations, this authority has been used to postpone the 

application of new legislation when immediate application would have subjected taxpayers to 

unreasonable administrative burdens or costs. For example, the Small Business and Work 

Opportunity Act of2007 made changes to the standards return preparers must follow to avoid 

penalties. The amendments were effective May 25, 2007. On June 11,2007, the Treasury 

Department released Notice 2007-54 providing that the IRS would follow the standards in prior 

law in determining whether to assert penalties for returns due on or before December 31, 2007. 

Similarly, the Airport and Airway Extension Act, Part IV (signed August 5, 2011) reinstated the 

air transportation and aviation fuels excise taxes retroactively to July 23, 2011, when they had 

expired. On September 9, 2011, the Treasury Department released Notice 2011-69 providing 

that the excise taxes would not be imposed on purchases of air transportation services made after 

July 22,2011 and before August 8, 2011. 1 

I See also, e.g., Notlee 2000-5 (waiving corporate penalties for certain estimated taxes due December IS, 1999, 

which were affected by the retroactive amendment of section 6655 by the Tax Relief Extension Act of 1999): 

Notices 2005-29, 2006-2, and 2007-4 (postponing the statutory effective date of the section 470 loss disallowance 

rules applicable to certain pass-through entities); Notices 2005-94, 2006-100, 2007-89, and 2008-115 (waiving 

5 
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86396.006

EMBARGOED UNTIL 10:00 A.M. July 18, 2013 

Effect on Other ACA Provisions 

Finally, it is important to note that this transition relief does not affect employees' or other 

individuals' access to the premium tax credits available under the ACA beginning in 2014. 

Individuals will continue to be eligible for a premium tax credit by enrolling in a qualified health 

plan through the Marketplaces iftheir household income is within a specified range and they are 

not eligible for other minimum essential coverage, including an eligible employer-sponsored 

plan that is affordable and provides minimum value. Nor does this transition relief affect the 

effective date of other ACA provisions, including the individual responsibility provisions, the 

insurance market reforms, and the various revenue provisions. While the 2014 transition relief 

for employer reporting would make it impractical, as noted earlier, to implement the employer 

responsibility provisions, it would not have a comparable impact on implementation ofthe 

individual responsibility provisions, which, as a practical matter, are necessary for implementing 

the ACA's insurance market reforms that guarantee access to affordable insurance for 

individuals. 

Conclusion 

As you know, the Affordable Care Act is projected to provide health coverage for nearly 30 

million additional Americans. Together with the other departments involved, we are 

implementing the ACA to build on the progress already made toward better and more affordable 

reporting of certain deferred compensation under section 409A for 2005 through 2008 and, subsequently, until the 

year after final regulations are published); Announcement 95-48, Notice 96-64, and Notice 99-40 (postponing the 

effective date of various statutory changes in qualification rules affecting governmental plans by deeming these 

plans to satisfy those requirements until a later date); Notice 2010-91 (postponing the statutory effective date for 3% 

withholding on contractors under section 3402(t)); Notice 2011-88 (postponing the effective date for required 

backup withholding payments made in settlement of payment card and third-party network transactions, as enacted 

by the Housing Assistance Tax Act of 2008); Notice 2012-34 (postponing the statutory effective date for 

amendments to the cost basis reporting regime enacted by the Energy Improvement and Extension Act of2008); and 

Notice 2013-14 (extending the statutory deadline for submitting a pre-screening notice to claim the Work 

Opportunity Tax Credit). 

6 
20 


86396.007

EMBARGOED UNTIL 10:00 A.M. July 18,2013 

coverage. We welcome the opportunity to further work with the Committee to achieve these 

objectives. Thank you, and I look forward to answering your questions. 

7 
21 

Mr. MURPHY. Thank you, Mr. Iwry. I will recognize myself now 

for 5 minutes. 

In your public posts in this law and in the information submitted 

to this committee, you claim that you have administrative authority to grant relief under the Internal Revenue Code. Do you have 

the ability to utilize this transition relief for the individual mandate? 

Mr. IWRY. Mr. Chairman, we have not—— 

Mr. MURPHY. It is a yes or no. 

Mr. IWRY. Mr. Chairman, we have given a lot of consideration to 

our authority—— 

Mr. MURPHY. You do have the authority or not? 

Mr. IWRY. We have not considered that question whether we 

would have the authority to provide similar transition relief with 

respect to the individual responsibility. 

Mr. MURPHY. Well wait, so is it your position that there are limits on the authority that prevent Treasury from delaying the individual mandate, and if so, I mean, is there any limits at all? Are 

you able to do anything with the individual mandate? 

Mr. IWRY. There certainly are limits, Mr. Chairman, to the 

Treasury’s authority to provide this kind of transition relief, and 

the limit—— 

Mr. MURPHY. Do you have information there about some of the 

burdens and costs involved with the individual mandate or the 

business mandate? Do you have information in front of you that 

you are referring to about some of those burdens and costs for businesses and individuals? 

Mr. IWRY. Mr. Chairman, we have considered the burdens—— 

Mr. MURPHY. Do you have information in front of you on the burdens and costs for individuals and businesses? That is a yes or no. 

Do you have information in front of you on the burdens and costs— 

I am going to yield myself more time, because you are not answering my question. Do you have information in front of you on the 

burdens and costs for individuals and businesses? That is a simple 

yes or no. I just want to know. 

Mr. IWRY. Yes, qualitative information. 

Mr. MURPHY. I would like you to submit that to the committee 

so that both sides have a chance to review that. I am going to order 

that. 

I am going to continue on here. So when you are looking at individual costs in business, who looked at this authority for Treasury 

to be able to make this decision that you can waive these things 

for the individual? Who in your department did that? 

Mr. IWRY. Mr. Chairman, the Office of Tax Policy—— 

Mr. MURPHY. Who? Were you involved in those discussions? 

Mr. IWRY. I was only tangentially involved, mainly. 

Mr. MURPHY. So communications were related to you about 

those? Communications were made to you about the content of 

those meetings, those discussions? 

Mr. IWRY. That is correct, Mr. Chairman. 

Mr. MURPHY. We would like to see the notes, emails, and things 

from those communications, because we would like to find out 

about how this decision was made. Can you provide that for the 

committee? 

22 

Mr. IWRY. I don’t recall, Mr. Chairman, that there were—whether there were written communications about that, but the Treasury 

Office of Tax Policy has for decades—— 

Mr. MURPHY. We will cover history another time, sir. I want you 

to focus on our questions. Things will go smooth if that happens. 

Before the announcement of the delay of the employer mandate, 

did you do an analysis of the constitutionality of the delay? 

Mr. IWRY. I did not. 

Mr. MURPHY. Did anyone that you communicated with do an 

analysis of constitutionality of the delay? For example, have you reviewed any memoranda or participated in any discussions at all 

about the authority to delay these provisions in the Affordable Care 

Act? 

Mr. IWRY. Yes, Mr. Chairman. The—— 

Mr. MURPHY. What I would like you to do is submit for the 

record information from those discussions. 

I want to ask you, too, as long as we are on the topic of waivers. 

I got a letter here from the International Brotherhood of Electrical 

Workers, the Electrical Workers Union, and it says that we cannot 

afford to sit on the sidelines as this law imposes increased benefit 

costs, fees, and new taxes. If these concerns are not addressed, it 

is likely that the majority of multi-employer health plans will dissolve and that 26 million covered individuals will lose their plans. 

They also managed to put a full-page ad—I think this was in roll 

call—also addressed these issues to Congress and to the President. 

This begs the question, do you agree that implementation of the Affordable Care Act is jeopardizing multi-employer plans and the individuals they cover? I might add, Mr. Jimmy Hoffa also published 

something in this, too. Do you agree that multi-employer plans are 

in jeopardy here too for these 26 million Americans? 

Mr. IWRY. Mr. Chairman, the multi-employer plans are going to 

be able, we believe, to comply with this law in a way that does not 

jeopardize coverage for—— 

Mr. MURPHY. Well, Jimmy Hoffa from the Teamsters and IBW 

and the National Electrical Contractors Association are saying it 

does not, so will you be reviewing about giving them a waiver as 

well? 

Mr. IWRY. Mr. Chairman, there have been requests—— 

Mr. MURPHY. Let me ask this. Do you have the authority to offer 

that waiver? 

Mr. IWRY. We have not—what sort of waiver are you referring to, 

Mr. Chairman, if I may ask? 

Mr. MURPHY. The kind of waivers you have been offering other 

people. The kind of waivers you are offering other people. I just 

want to know. I would like an answer to this question, without 

being desultory here. So if they like the coverage 26 million Americans have through the unions, can they keep it? Do you have the 

authority to waive that? 

Mr. IWRY. Mr. Chairman, the coverage that members of the plans 

sponsored by the multi-employer unions have is coverage that they 

can keep. 

Mr. MURPHY. Mr. Iwry, Jimmy Hoffa, the Teamsters, IBW, and 

other groups are saying they do not, and I would like you to submit 

an answer for the record of A) if you have the authority to offer 

23 

them waivers, and B) what they will be. I know I am over time 

here, but I am sure the members will follow up. I yield to Ms. 

DeGette for 5 minutes. 

Ms. DEGETTE. Now Mr. Iwry, the Treasury delayed the employer 

mandate, is that correct, by 1 year, correct? 

Mr. IWRY. Ms. DeGette, the Treasury provided transition relief 

with respect to the—— 

Ms. DEGETTE. And delayed the—— 

Mr. IWRY [continuing]. Employer responsibilities. 

Ms. DEGETTE. Correct? 

Mr. IWRY. Correct. 

Ms. DEGETTE. And what section of the Internal Revenue Code 

did they do that under? 

Mr. IWRY. The transition relief is an exercise of the Treasury Department’s administrative authority under Section 7805(a). 

Ms. DEGETTE. And what exactly does Section 7508—I am sorry, 

7805(a) say? 

Mr. IWRY. Section 7805(a) of the Internal Revenue Code provides 

that the Secretary shall prescribe all needful rules and regulations 

for the enforcement of this title, including all rules and regulations 

as may be necessary by reason of any alteration of law in relation 

to internal revenue. 

Now what that means in this context, Congresswoman, is not 

that it gives Treasury authority to ignore the statute or parts of 

the statute, but rather that it allows us to implement the law more 

effectively, specifically—— 

Ms. DEGETTE. OK, let me stop you right there, and let me ask 

you, to your knowledge, does Treasury intend to take any other 

steps under Section 7805(a) to delay any other provisions of the Affordable Healthcare Act? Are you contemplating using what you 

view your authority under the Act to delay any other provisions of 

the ACA? I think that is what the chairman was trying to get at. 

Mr. IWRY. Congresswoman, we do not have—first of all, let me 

make clear, this transition relief does not have any impact on any 

other—— 

Ms. DEGETTE. That is correct. 

Mr. IWRY [continuing]. Expected date—— 

Ms. DEGETTE. Is it the intention of the Agency—— 

Mr. IWRY [continuing]. Under the Act. 

Ms. DEGETTE [continuing]. To use Section 7805(a) to delay any 

other provisions of the ACA? That is a pretty easy question. 

Mr. IWRY. Right. Consistent with our normal process in implementing new legislation—— 

Ms. DEGETTE. Yes. 

Mr. IWRY [continuing]. We will evaluate the need for any other 

possible transition relief on a case-by-case basis if there is a reason 

sufficiently compelling circumstances to—— 

Ms. DEGETTE. To your knowledge, does the Agency intend—at 

this point, do you know of any other delays? 

Mr. IWRY. We don’t have any specific provision that we have 

identified for which we would—— 

Ms. DEGETTE. Thank you. And if further requests come in, you 

will evaluate those? That is what you are trying to tell me? 

Mr. IWRY. I am sorry? 

24 

Ms. DEGETTE. If further requests come in like came in from the 

business community, what you are saying is you will evaluate 

those within the Agency’s authority. Is that correct? 

Mr. IWRY. That is correct. 

Ms. DEGETTE. OK. Now has Treasury ever used this authority 

before to delay or modify other tax rules? 

Mr. IWRY. Yes, Congresswoman—— 

Ms. DEGETTE. Could you describe maybe one or two examples, 

very briefly? 

Mr. IWRY. Yes. Treasury has traditionally interpreted this authority to allow implementation of statutes in a manner that is 

best designed to give effect to their terms, including transition relief, as appropriate in connection with situations where the law has 

changed. 

Ms. DEGETTE. OK, do you have an example of that? 

Mr. IWRY. Right. My written testimony contains a whole series 

of specific examples, as you suggest, Congresswoman, in the tax 

law. Let me mention one or two of them here. 

Ms. DEGETTE. How about one? We have got 53 seconds left. 

Mr. IWRY. Sure. 

Ms. DEGETTE. Thank you. 

Mr. IWRY. Basis reporting rules for investment securities were 

enacted in 2008. Treasury and IRS issued proposed regulations on 

those for debt instruments and options. The statutory effective date 

was January 1, 2013, as reflected in the regulations, and after numerous comments from taxpayers that this proposed effective date 

did not give them enough time to program their information systems, Treasury and the IRS issued a notice postponing the effective 

date to January 1, 2014. 

Ms. DEGETTE. OK. Let me ask you a question, because I am running out of time. So I know you think the authority is clear. You 

are saying that you could do it here. You are going to look at any 

other situations that come up, but you know, we have institutional 

prerogatives, too, and when we write a law, we expect that it will 

go into effect. I can’t tell whether my friends on the other side of 

the Aisle object to this delay or think everything else should be delayed, but what I am hearing you say is it is not the intention of 

your agency to indefinitely delay this mandate or to ignore it completely or to do this wholesale with the rest of the ACA, is that correct? 

Mr. IWRY. That is—— 

Ms. DEGETTE. Yes or no would be good, since I am out of time. 

Mr. IWRY. That is correct. 

Ms. DEGETTE. Thank you very much. 

Mr. MURPHY. And the gentlelady’s time is expired. Now recognize 

the vice chair of the committee—full chair of the committee Mr. 

Upton is not here, so we will go to Ms. Blackburn, vice chair, for 

5 minutes. 

Mrs. BLACKBURN. Thank you, Mr. Chairman, and Mr. Iwry, 

thank you so much—I am over here—for your time to be with us. 

I want to go right back to what the chairman of the full committee—the subcommittee was talking with you about is where you 

got this authority and what you think gives you this authority. So 

this is a really simple yes or no. Does Treasury have the authority 

25 

to delay the individual mandate under the healthcare law? Yes or 

no? 

Mr. IWRY. Congresswoman, as I mentioned, Treasury has not yet 

had occasion to consider whether it would have authority to delay 

or to give transition relief with respect to individual—— 

Mrs. BLACKBURN. So your presumptiveness on the request from 

the business community that this thing is half-baked and not ready 

for primetime, you chose to delay the employer mandate. So what 

you are saying is you do not know if you do or do not have authority to delay the individual mandate? 

Mr. IWRY. Congresswoman, we have not had occasion because we 

have not found that the individual mandate presented the kinds of 

administrative difficulties for individuals—— 

Mrs. BLACKBURN. Well let me just interject right here, because 

we can show you plenty of surveys and evidence that it is causing 

tremendous disruption in the healthcare community and in the individual health insurance marketplace. 

I will try this another way. Why is it possible to delay the requirements on business but not on individuals? 

Mr. IWRY. Congresswoman, when we considered whether to provide this transition relief, we were motivated by the concerns that 

were raised with us and with Congress by those who would be providing coverage and continuing to provide coverage that the reporting requirements under the employer responsibility conditions—— 

Mrs. BLACKBURN. So then what you are telling me is that this 

is too cumbersome for our business community to comply with? 

Would that be a statement that matched what you found? It is too 

cumbersome? 

Mr. IWRY. Congresswoman, what we found was that the business 

concerns—— 

Mrs. BLACKBURN. OK, you are running the time—— 

Mr. IWRY. That they needed more time. 

Mrs. BLACKBURN. Yes, well, you are running my time out. You 

are running my time out by trying to talk as slow as I talk and 

I don’t appreciate it, quite frankly. 

Let me tell you what I am finding, and it shows that you have 

great sympathy for big business and that you are trying to cater 

to big business, but not to hardworking taxpayers and small business people that are fighting every single day against this law. Because it is redefining—I tell you, I agree with what the unions 

wrote to the Democrat leadership. This is redefining the 40-hour 

work week in this country, and I think you agree with that because 

of the actions that you took. It is redefining what benefits are for 

individuals. This is wrecking what employers are providing for individuals because you all want to put this out there that is going 

to destroy the healthcare marketplace and destroy the doctor-patient relationship. And you are saying—you are making this that 

you are motivated by concerns. Well let me tell you what concerns 

I am motivated by, and it is men and women who are going to 

work every single day and are seeking to do the best for their families. They want the ability to make these decisions. They do not 

trust bureaucrats in Washington, D.C. to make these decisions, and 

quite frankly, I don’t think they appreciate some of the attitudes 

when you come in and you are unprepared and unwilling to answer 

26 

a simple yes or no. What gives you the authority and do you have 

the authority, and if you do have the authority or think you do, and 

you think it was a constitutional act, then for heaven’s sake, why 

would you favor big business and then vote against hardworking 

men and women with the actions that you took? 

I yield back. 

Mr. MURPHY. Gentlelady yields back. Recognize the gentlelady 

from Florida, Ms. Castor, for 5 minutes. 

Ms. CASTOR. Well thank you, Mr. Chairman. 

Boy, I have a different view. I think the Affordable Care Act is 

working for families and it is certainly working for small businesses, and we have a ways to go. So I would hope that now that 

it is law, the Supreme Court has ruled. We are moving into significant areas of implementation. We can begin to all work together to 

ensure that it works for families across America and on all businesses, small and large. 

I would like to highlight what Chairman Waxman said early on. 

There are some new statistics out, and it is helpful because they 

are broken down by congressional district, that demonstrates how 

the law is helping families. And just a few great statistics from my 

own community—and keep in mind that a congressional district, 

the population now is estimated to be about 700,000. So what I 

learned yesterday is in my own congressional district, under the 

Affordable Care Act, almost 10,000 young adults in my district now 

have health insurance because they have been able to stay on their 

parents’ plan. Almost 6,000 seniors in my district have received 

prescription drug discounts worth $8.2 million. That is an average 

of $610 per person in 2011, $690 in 2012, and $840 in 2013. You 

better believe my seniors can use a few extra dollars in their pockets. My Medicare neighbors, they now have access to free preventative services that they didn’t have before without paying a co-pay. 

Children are no longer barred from getting insurance because they 

have a preexisting condition, like childhood cancer or asthma. 

These are very important consumer protections that the ACA has 

provided. And now the rebates are coming in. We expect another 

round of rebates. In the entire Tampa Bay area alone so far, my 

families have gotten $47 million back from insurance companies. 

And then the President announced that the White House says that 

there is another round coming this summer. We anticipate in the 

State of Florida alone we are—consumers, families are going to get 

back another $54 million, because under the law, we say most of 

the co-pays and premiums that people work hard to pay will go to 

actual healthcare and not to exorbitant salaries or profits. So this 

is good news and I hope we can all work together. 

Now Mr. Iwry, thank you for being here. I want to ask you about 

the extent to which the decision to implement a business transition 

relief period to those—some of those businesses is going to work. 

Now as of today, most large employers in America already offer 

coverage to their employees, correct? 

Mr. IWRY. Congresswoman, the vast majority of larger employers 

already offer coverage. 

Ms. CASTOR. In fact, it is about 160 million Americans today already receive health insurance through their employers. And when 

27 

we talk about the larger employers, we are talking about employers 

that have 50 or more employees, is that correct? 

Mr. IWRY. For this purpose, yes, Congresswoman. 

Ms. CASTOR. And I know this might not be your area of expertise, but why do employers, why do businesses provide health insurance to their employees? 

Mr. IWRY. Congresswoman—— 

Ms. CASTOR. Kind of the way the unique American health system 

has grown up over the decades. Your health insurance is tied to 

your job, but why do businesses provide health insurance? 

Mr. IWRY. Congresswoman, I think there are several reasons. 

One is that businesses find that offering important key benefits 

like health insurance makes it easier to recruit valuable employees. 

Ms. CASTOR. I think that is right. I think if you were—if you had 

two jobs in front of you and you had one that offered health coverage for you or your family, and the other that did not, that 

makes it more attractive to go work for that employer, and that is 

why over time most employers do that. It gives them an advantage. 

Now is there anything in your purview that changes the calculus 

here for the way that works? 

Mr. IWRY. Well that is, of course, still the case as well as to retain valued employees as they grow older, and—— 

Ms. CASTOR. Right. 

Mr. IWRY [continuing]. Prior to this—— 

Ms. CASTOR. And nothing changes that. Now there is another 

part of the ACA—and I take umbrage at what my colleague from 

Tennessee said—this law is going to provide substantial tax credits 

to our small businesses at home. In fact, over 360,000 small businesses across America have already taken advantage of those new 

tax credits. We anticipate this to grow. Mr. Iwry, did Treasury’s recent decision impact the small business tax credits provided under 

the ACA? 

Mr. IWRY. Congresswoman, it did not impact the small business 

tax credits or the premium tax credits worth several hundred billion dollars for individuals, which are central to the whole legislation here, nor did it affect the marketplaces. 

Mr. MURPHY. Thank you. Gentlelady’s time is expired. Now recognize the chairman emeritus of the committee, Mr. Barton, for 5 

minutes. 

Mr. BARTON. Thank you, Mr. Chairman. On July the 9th, the Assistant Secretary for Tax Policy, Mark Mazur, replied to a letter 

that myself and I think almost every Republican on this subcommittee had sent to the Treasury Secretary, asking for—why 

this particular part of the law was delayed and what the authority 

was from it. In that letter, on page two, it says that the legal authority to delay was based on the administrative authority under 

Section 7805(a) of the Internal Revenue Code. Well, I have Section 

7805(a) of the Code, and I am not an attorney, nor am I a tax expert, but what Section 7805 of the Revenue Code says is that unless explicitly authorized somewhere else so that some other official 

has the authority, the Secretary of the Treasury shall prescribe all 

needful rules and regulations for the enforcement of this title, including all rules and regulations as may be necessary by reason or 

any alteration of the law in relation to Internal Revenue. It says 

28 

nothing about giving authority to not implement, and in the Affordable Care Act, as Congresswoman Blackburn pointed out, there is 

not an opt-out clause. There is not a you shall do this unless you 

decide it can’t be implemented, in this case, you can delay. The law 

was passed on March 23 or signed into law on March 23, 2010. 

That is over 3 years ago. So we are now getting to the point where 

you actually have to implement it, and lo and behold, the Secretary 

of the Treasury has decided to pick and choose which parts of the 

law to implement. Other than this Section 7805, is there any other 

authority anywhere else that gives the Secretary of the Treasury, 

and I would assume in consultation with the President of the 

United States, to pick and choose which parts of which laws that 

he or she implements? 

Mr. IWRY. Mr. Chairman, Section 7805(a) is, in our view, sufficient authority and in the view of previous Treasury Departments 

across various administrations, to, in an appropriate case, implement statutes in a way that is best designed to give effect to their 

terms, including providing transition relief, as appropriate when 

there is what the provision refers to an alteration of the law—— 

Mr. BARTON. Well, 3 1⁄2 years from the law’s passage, it is pretty 

weak to say this is transition relief. And it is explicit in the law 

that it shall be implemented in the Affordable Care Act, and it is 

explicit in this Section 7805 that you are supposed to prescribe— 

the Secretary, that is—needful rules and regulations for the enforcement, not for the non-enforcement. I am not an attorney but 

I don’t believe you have got the legal authority, the Secretary of the 

Treasury, to do what you all just did. 

I do have a question. This decision to delay implementation, was 

it done in consultation with the White House, upon the direction 

of the White House, or without any input from the White House? 

Mr. IWRY. Mr. Chairman, it was—this decision to provide transition relief with respect to the reporting provisions for employers—— 

Mr. BARTON. To delay implementation, I don’t consider that transition relief. The decision to not implement one of the key components of the Affordable Care Act, did the Secretary of the Treasury, 

with advice from people like you who are senior advisors to the 

Secretary, did you all do this on your own or did you do it at the 

direction and consultation or with input from the White House? 

Mr. IWRY. Mr. Chairman, the Treasury Department did not do 

this without coordination with the White House. It was not at the 

direction, but it was with—— 

Mr. BARTON. So the President knew about this? 

Mr. IWRY [continuing]. Coordination and consultation—— 

Mr. BARTON. The President knew about this before it was announced? 

Mr. IWRY. Mr. Chairman, I don’t personally have a basis for 

knowing what the President knew at what point in time, but certainly to answer your question fairly, the White House was involved. The Treasury kept—— 

Mr. BARTON. Normally intelligent people can assume the President knew about this before the fact, was friendly towards it, probably, I would assume, directed it, but at least was strongly supportive of it. It wasn’t done against his opposition. 

29 

Mr. IWRY. Mr. Chairman, I have no reason to think that it was 

or would have been done had he been opposed to it. 

Mr. BARTON. My time is expired. I appreciate your candor. I will 

yield back. 

Mr. MURPHY. Gentleman’s time is expired. Now to the gentleman 

from North Carolina, Mr. Butterfield, for 5 minutes. 

Mr. BUTTERFIELD. Thank you very much, Mr. Chairman, and 

thank you for your testimony today. You know, Mr. Barton, I would 

stipulate that the President was aware of this change in policy, and 

he would be derelict if he was not aware of the change. And so I 

certainly believe that he was, and thank him for making this important administrative decision. 

The President’s decision to delay the employer mandate I think 

has gotten too much attention. I think we need to be using this energy and this time to try to find ways to make the Affordable Care 

Act work, and I am trying to listen very carefully at the debate 

today to try to figure out if my friends on the other side of the Aisle 

feel that the employer responsibility delay should be repealed or 

whether the individual mandate should be delayed. I can’t quite 

figure out where you are going with this. I have always looked at 

you as my friends over on the other side as being friends of business, and now today you seem to be really championing the rights 

of individuals. I am glad to see that progress. I wish you would join 

me in North Carolina to try to champion individuals who are poor 

people in North Carolina who are not going to be able to benefit 

from the Medicaid expansion. And so I just want to talk about the 

business aspect of this and try to get some answers on the record. 

Sir, correct me if I am wrong. Firms with fewer than 50 full-time 

equivalent employees are not subject to the employer responsibility 

provisions of the Act. Is that correct? 

Mr. IWRY. Congressman, firms with fewer than 50 full-time employees or full-time equivalent employees—— 

Mr. BUTTERFIELD. It doesn’t apply to them at all. 

Mr. IWRY [continuing]. Are not subject to the employer responsibility provisions of the Act. 

Mr. BUTTERFIELD. Now or in the future, the foreseeable future, 

is that right? 

Mr. IWRY. The statute, Congressman, does not provide at all for 

businesses smaller than 50 to be subject to that requirement. 

Mr. BUTTERFIELD. Am I correct, then, that the vast majority of 

U.S. businesses have fewer than 50 employees? That is the impression that I get. 

Mr. IWRY. Congressman, it is generally been estimated that 

roughly 95 percent of employers in the United States would be 

below that threshold. 

Mr. BUTTERFIELD. Well, am I correct that the vast majority of 

employers with more than 50 full-time employees already offer coverage to their employees? 

Mr. IWRY. Congressman, that is also correct. Roughly a similar 

percentage that is about 95 percent of employers above 50 in size 

have been estimated—it has been estimated that those employers 

do provide coverage currently to their employees. 

Mr. BUTTERFIELD. The number of businesses that we are talking 

about seems to be getting smaller and smaller and smaller. So 

30 

many of the employers that would have been affected by the employer mandate already offer coverage that meets the standards in 

the law. So what we are really talking about is a limited—a very 

limited number of companies that are affected by the mandate and 

the delay. And so for all the sound and fury over the mandate 

delay, the core of the law remains reform of the individual insurance market. That is what this thing is all about. Where people 

buy coverage when they do not get it through their jobs, and I can 

tell you, I represent a district in North Carolina. I don’t know 

about my friends who are in other seats in this committee, but the 

vast majority of the people that I represent are ready for implementation, full implementation of the Affordable Care Act. 

And so I want to thank you, sir, for your testimony today. I think 

my friend on the other side who criticized your method of speaking 

owes you an apology, because your response to my questions was 

equal in tone and pace and cadence as it was to the other members 

of this committee. I think without knowing your personality and 

knowing the way you express yourself that you are owed an apology. I yield back. 

Mr. MURPHY. Gentleman yields back. I now recognize the gentleman from Texas, Mr. Burgess, for 5 minutes. 

Mr. BURGESS. Thank you, Mr. Iwry. Thank you for being here. 

I want to pick up where Mr. Barton left off. I have got about 

three areas that I want to cover, so I apologize if it seems like we 

are going to go fast. And then I have got some other questions I 

am going to submit for a written response. 

When did you know that the mandate for the businesses was 

going to be delayed? That is not a yes or no question, but it is a 

calendar day. When did you know? 

Mr. IWRY. Mr. Burgess, I knew that this transition relief would 

be granted sometime last month, the month of June. 

Mr. BURGESS. June 25, June 27? Do you have a date? Would 

there be a meeting that took place? Would there be a phone call? 

Would there be a record of some type that you could provide to this 

committee? 

Mr. IWRY. Congressman, I don’t recall any specific meeting or 

phone call. 

Mr. BURGESS. May I ask that you look at your logs and your 

records and see if you can refresh your memory and provide that 

to the staff of this committee? 

Let’s move on, because I got a lot of stuff to do and we have already discussed how slow I talk. Who made the decision to delay 

the employer mandate? Was that made exclusively at Treasury, 

Health and Human Services? Did they have any role at all, or was 

it also the White House that was involved? You told Mr. Barton 

that the White House was aware. Were they actually involved, actively involved in the decision-making process? 

Mr. IWRY. Congressman, policy decisions under this legislation, 

in particular under the Affordable Care Act, policy decisions generally that are made by the Treasury Department are coordinated 

with the White House—— 

Mr. BURGESS. So who did you talk to? Who did you discuss this 

with? Who did you coordinate with in the White House? 

31 

Mr. IWRY. I was not—Congressman, I was not privy to all the 

conversations. 

Mr. BURGESS. Well let me just ask you a question. This was odd 

the way this happened at 6:00 p.m. Eastern time on July the 2nd. 

I think it caught a lot of us by surprise. Valerie Jarrett put it out 

in a blog post. Was there any discussion with you and Valerie 

Jarrett prior to her posting this on the blog site? 

Mr. IWRY. Congressman, I don’t recall having had any discussion 

with Ms. Jarrett about this, and indeed, I am a policy person, not 

someone who deals with communications or media relations, or 

congressional relations, so—— 

Mr. BURGESS. But sir, this was a big deal and it was rolled out 

at an odd time. Once again, will you review your logs and your 

email? Were you copied on any email or was Valerie Jarrett copied 

on any email to you? Can you provide that to this committee, because I think it is important to our understanding of this process. 

Mr. IWRY. Congressman, I am not the person at Treasury to respond to the question—— 

Mr. BURGESS. Well then who is that? 

Mr. IWRY [continuing]. What we can—sorry. 

Mr. BURGESS. Well fine. We can subpoena all of your records if 

that is what you would prefer. 

Mr. IWRY. Congressman, we are happy to cooperate with the 

committee. 

Mr. BURGESS. Thank you. 

Mr. IWRY. And I will refer this to the people at Treasury who 

would be dealing with this. 

Mr. BURGESS. Thank you. The reason this is important is we had 

Secretary Sebelius and Mr. Cohen from Center for Communications 

Insurance Oversight here at this committee at the very end of 

April. From them, no delay, we will be ready, it will be on time. 

I specifically asked Mr. Cohen about contingency plans. I specifically asked Mr. Cohen are you planning on any delay? Are you 

planning on narrowing the scope of what is provided, and even 

after I reminded him that he was under oath, he replied no. So 

somehow between April 30 and June 25, that all changed in a big 

way. And what we are trying to understand in this committee is 

how did that happen? What was the process? What was the trigger 

that occurred that caused such a massive change from no delay, we 

will be ready, to wait a year. Do you understand the concern? 

Mr. IWRY. Congressman, I understand your question, yes, and I 

would be happy to try to address that now, if I might. 

Mr. BURGESS. Well let me ask you this. What does a deadline 

mean? Are you aware of the phrase ‘‘deadline’’? 

Mr. IWRY. Congressman, we try our best at the Treasury Department to comply with the statutory timeframes and deadlines. We 

had a request here from—many requests from the plan sponsor 

committee—— 

Mr. BURGESS. Well let me ask you this. I mean, a lot of times 

we are accused of writing gobbledygook in our laws, but this is 

pretty straightforward. The amendments made in this section shall 

apply to the months beginning after December 31, 2013. That is 

pretty clear, isn’t it? 

Mr. MURPHY. Gentleman’s time is expired. 

32 

Mr. BURGESS. And it sounds like a deadline, and I would appreciate a response from your office in writing what deadline means 

to you and your office. I will yield back. 

Mr. MURPHY. Gentleman’s time is expired. Now recognize the 

gentleman from New York, Mr. Tonko, for 5 minutes. 

Mr. TONKO. Thank you, Mr. Chair. 

Mr. Iwry, before I ask you some questions, I just wanted to highlight some of the profile in my congressional district with the ACA. 

I have more than 12,000 seniors in the district receiving prescription drug discounts worth some $16 million, an average discount of 

$610 per person in 2011, and $650 in 2012, and some 124,000 seniors in the district now eligible for Medicare preventative services 

without paying any co-pays, co-insurance, or deductible. And up to 

27,000 children in the district with preexisting health conditions no 

longer being denied coverage by health insurers. And I just wanted 

to highlight that for the record, because it is part of the strength 

of the ACA. 

Again, Mr. Iwry, one concern raised by critics of the Treasury decision is that it will impact the verification process for individuals 

on the exchanges. I want to read you a quote from Uval Levin, a 

conservative critic of the law, and he says, and I quote, ‘‘The most 

serious problem for the Administration with this delay of the employer mandate is the effect on the liability of the exchanges. 

Under the law, eligibility for exchange subsidies depends on an individual not receiving an affordable offer of qualified insurance 

from an employer. If employers will now not be required to report 

on their insurance offerings in 2014, I don’t see how the government will be able to determine eligibility for subsidies and therefore how the exchanges will be able to function.’’ 

Mr. Iwry, is this a legitimate concern? 

Mr. IWRY. Congressman, the impact of the transition relief with 

respect to employer and insurer reporting on the functioning of the 

marketplaces and the ability to verify is something that was considered carefully as part of the decision-making process, together 

with many other factors, including the potential impacts of the decision on coverage and cost. And the conclusion was that the administration of the individual responsibility provisions could go forward without being unduly hampered by the lack of employer reporting partly for a year, except to the extent employers report voluntarily, which they are encouraged to do. Partly because the individual in going to the exchange would receive an employer form 

that provides information about their coverage, the individual 

would normally know during the open season with the employer 

through the summary of benefits and coverage that employers 

would be providing to employees, whether they had coverage or 

not, and therefore would be able to go to the exchange and know 

whether they are potentially entitled to apply for a premium tax 

credit at the exchange if their income otherwise permits. So the individual has the wherewithal to apply, determine whether he or 

she is entitled to apply for a premium tax credit to help them pay 

for this coverage, regardless of that employer report, and indeed, 

the employer report is something that the exchange provides to ultimately—information about employer coverage is something that 

the exchange also provides to the IRS when the IRS then does a 

33 

second check of the individual’s eligibility for the tax credit on reconciliation, after the individual files the return. The IRS gets information from the exchange about what the employer provided as a 

result of what the employer provides, information the employer reports to the individual. The individual can fill out their 1040, 

knowing whether they have coverage or not, knowing whether they 

are exempt from individual responsibility or not, and in the very 

few cases, the small percentage of cases where a person is expected 

to owe a payment, they will have the tools on their 1040 to make 

the payment. 

Mr. TONKO. Thank you. Thank you very much for the clarification, and with that, I yield back. 

Mr. MURPHY. Gentleman’s time is expired, and I now recognize 

the gentleman from Texas, Mr. Olson, for 5 minutes. 

Mr. OLSON. I thank the chair, and I thank Mr. Iwry for appearing to explain how the Administration decided to delay 

Obamacare’s employer mandate. 

I didn’t think it was possible, sir, but the Administration’s actions created more uncertainty back home in Texas 22 over 

Obamacare’s impacts on their families and businesses. The employer mandate was a low murmur compared to the full repeal war 

I heard after March 23 of 2010 when Obamacare was passed, but 

that changed when the employer mandate was delayed. That became a full-on war back home in Texas 22. And that war is locked 

on two questions. One, how can I plan for the future prosperity of 

my family? How can I plan for the future prosperity of my business? The second question, what change is coming next? 

Sir, under the Constitution of the United States, it is my job, my 

sacred duty to get answers to those questions for these 700,000 

people, Texans who live in Texas 22. Sir, I need, I demand the cooperation to get those answers. 

And now the facts. It seems this delay was ready for primetime 

by June 24 of this year. I say that because CMS Administrator 

Marilyn Tavenner testified yesterday that she was made aware of 

the delayed employer mandate that was being considered on June 

24 of this year. Yesterday. In your testimony in front of the Ways 

and Means Subcommittee and right here just about 10 minutes 

ago, you stated that Treasury’s final decision to postpone the Affordable Care Act’s employer mandate was made ‘‘sometime in 

June.’’ It was considered in a very careful way for a while. My 

question, sir, who in Treasury took part in the careful consideration in the month of June? I need names and positions, please. 

Mr. IWRY. Congressman, would you like me to start with your 

last question or your first one? 

Mr. OLSON. I need names and positions to my question. Who took 

part in this careful consideration in the month of June? Names and 

positions, please. 

Mr. IWRY. Congressman, the authority to make a tax policy regulatory decision resides in the Assistant Secretary—this is the position—the Assistant Secretary for Tax Policy within the Department—— 

Mr. OLSON. Names, please, sir. Names and positions, please. 

That is all I am asking. I worked in the Senate for 8 years. I know 

34 

what a filibuster looks like. Please, names and positions. Please 

help me. I have a duty to 700,000 people to get these answers. 

Mr. IWRY. Congressman, respectfully I am trying to answer your 

question fully. So the position is the Assistant Secretary for Tax 

Policy, and that authority is delegated to the Assistant Secretary 

by the Secretary of the Treasury. The name of the individual who 

is Assistant Secretary for Tax Policy is Mark Mazur. He is the author of that blog post. 

Mr. OLSON. OK, got that from Chairman Barton before, Chairman Emeritus Barton. 

One more question, sir. Your lack of details doesn’t support your 

repeated considerations that you had careful considerations, your 

repeated contentions. As you might have done some research on my 

life, I am a former Naval—U.S. Naval aviator. Careful, to me, 

means knowing that your plane, your route of flight, and the obstacles en route. If Treasury’s actions were applied to flying aircraft, 

you would have been on autopilot, asleep for over 3 years, only 

waking up when the collision avoidance system is going pull up, 

pull up, pull up. You pulled up, woke up, and avoided crashing the 

plane. 

I will give you one more chance to help me out, sir. Considering 

that at least seven components of the Affordable Care Act, the class 

act, the 1009, small business changes, mandate employers, data 

hub, income verification, employer insurance verification, have 

been repealed late in the past 3 years, what is coming in the future? Anything that Treasury is looking at that I can tell my people back home, get ready for this? 

Mr. IWRY. Congressman, we are continuing to implement the Affordable Care Act, and we have no specific provision at Treasury 

that I am aware of in mind that would call for, in our view, further 

transition relief. However, if it does develop that there is a legitimate need and one that is within our authority, which we take seriously, sir, and we very much begin with respect for the law and 

for the statute that Congress passed and the language of the statute, but if we need to exercise the longstanding authority which 

has been exercised across different Administrations under the 

7805(a) section of the Tax Code, with respect to another provision 

of the tax law, we would do that. There are many examples in the 

past where that has been done—— 

Mr. MURPHY. Gentleman’s time is expired. 

Mr. OLSON. My interpretation of your comments, sir, is we can 

expect a Labor Day, a Halloween, or Thanksgiving, or Christmas 

surprise again. I yield back the balance of my time. 

Mr. MURPHY. Gentleman’s time is expired. Now recognize Mr. 

Green of Texas for 5 minutes. 

Mr. GREEN. Thank you, Mr. Chairman. Welcome, Mr. Iwry. The 

issue of the delay of the employer mandate, I think, has been 

bogged down and whether the Department of Treasury had the authority to do so. Transitional relief is not objectionable. Has the authority to provide transition relief been used by other Administrations in the past? 

Mr. IWRY. Congressman, the authority that I have referred to 

under Section 7805(a) of the Tax Code to provide interpretations 

and in this case, transition relief, with respect to Tax Code proviVerDate Nov 24 2008 12:16 Feb 21, 2014 Jkt 037690 PO 00000 Frm 00040 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-72 CHRIS
35 

sions has been used in the past on a whole number of occasions. 

Information reporting is a particular area where transition relief 

has been found to be necessary on prior occasions, and the decisions to provide transition relief on occasion have been made, to my 

knowledge, in the exercise of the professional, legal judgment of the 

Treasury Department, without regard to political affiliation across 

different Administrations. There is a tradition at Treasury of very 

professional and serious dedication to the law and respect for the 

law and respect for tax policy, and there is an effort made consistently to keep that up, regardless of what Administration is in office. 

Mr. GREEN. OK, and so this has been used by other Administrations—— 

Mr. IWRY. Correct. 

Mr. GREEN [continuing]. In Department of Treasury and other 

Administrations. The bigger issue for me is what the future holds 

for the law that is so important to so many Americans. I know that 

we are how few people will be affected by this delay, however, I 

represent a very urban district in Houston. Currently our district 

has the highest percentage of people who have jobs, but no health 

insurance, either through their job or because they make too much 

to be qualified for Medicaid. And of course, our State of Texas unfortunately is not expanding Medicaid. So this delay deals my constituents a hard blow. 

The other issue, anyone who is employed and makes between 100 

and 130 percent of the federal poverty rate and doesn’t have insurance through their job still cannot afford it because their employers 

aren’t required to provide it, and they won’t receive the subsidies 

to purchase coverage through the exchange. Do you think there is 

some way that Treasury could look at that and maybe have a transition so those folks who are left waiting for that mandate for their 

employers, is there some way the Administration can deal with 

that, to where those people who are not qualified now because that 

would be able to have some type of transition purchase coverage 

with the subsidies through the exchange? That may not be your 

area. Probably not. Treasury is your jurisdiction, but that is one of 

the concerns. What are we going to do with these folks because of 

this decision their employers are not covering them? This delay creates significant uncertainty about the time and the implementation 

of the rest of the Affordable Care Act, and I have a number of questions that should require simply very short answers. Can you provide the necessary certainty to this committee, to the employers, 

and employees that in 2015 the employer mandate will not be delayed again? 

Mr. IWRY. Congressman, this transition relief is a 1-year grant 

of transition relief for 2014. There is every intention to have the 

implementation of these specific provisions go into effect at the beginning of 2015 of the expressed terms—— 

Mr. GREEN. OK. I only have about 40 seconds. Do you know if 

the Treasury is preparing to delay the implementation of any other 

provisions of the Affordable Care Act within its jurisdiction? 

Mr. IWRY. Congressman, as I have said, the administrative authority that we have used to provide transition relief for these employer provisions is authority that could, in appropriate cases, poVerDate Nov 24 2008 12:16 Feb 21, 2014 Jkt 037690 PO 00000 Frm 00041 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-72 CHRIS
36 

tentially be used as it has been in the past with respect to other 

provisions, but as we implement—continue to complete the implementation of the Affordable Care Act, we don’t currently have on 

our radar screen any particular provision—— 

Mr. GREEN. OK. Well one of my concerns—and I know my Republican colleagues might not share it, but I think I have been in 

every meeting we have had, not only on the committee but also 

through the Democratic caucus with Health and Human Services 

employees, Administration employees, granted, none from Treasury, and this was never even came up. Nobody knew about it until 

the day before the 4th of July. So I would hope some of us who 

really support this law and want it to work, that we will not give 

fodder to the folks who don’t want it to work. 

Thank you, Mr. Chairman, for your time—the time. 

Mr. MURPHY. Gentleman’s time is expired. Now to the gentleman 

from Virginia, Mr. Griffith, for 5 minutes. 

Mr. GRIFFITH. Thank you, Mr. Chairman. I appreciate it very 

much. 

Following up on that, you said that there was nothing on your 

radar screen at this time. We have heard the decision or some kind 

of decision was made sometime in June, but they wanted to contemplate it—and I know I may not be using the exact words you 

used—and that is why it didn’t come out until July 2. I would ask 

you, if there is nothing on your radar screen now, when did this 

one pop up on your radar screen, because as Congressman Green 

said, nobody ever heard anything about it in numerous hearings or 

meetings. 

Mr. IWRY. Congressman, the requests for transition relief from 

plan sponsors, which started the process of thinking about it, were 

ones that were made over the course of the past year or so. 

Mr. GRIFFITH. Past year or so, because here is what is really instructive. On July 1, as a result of part of this process, the Commonwealth of Virginia shifted its part-time employees from what 

they regularly would have to a 29-hour workweek because of what 

is going on. I am sure a lot of those folks would have liked transition relief, and if it has been talked about for some time, they 

would have liked to have had it before the law was changed back 

during the legislative session and it went into effect on July 1, your 

announcement not coming out until July 2. 

Further, I would submit to you that this creates a huge confusion 

and area of concern for the American people, because if something 

can be, you know percolating out there, there are all kinds of concerns—we have heard about union concerns and so forth—for a 

great deal of time and then all of a sudden it pops up and a decision is made, you know, late one month and 2 weeks later it is announced. That means anything can happen if you interpret the 

code this way before January 1 comes around or maybe even October 1. Do you believe you have the authority to delay the implementation of the exchanges? Yes or no? 

Mr. IWRY. Congressman, we—— 

Mr. GRIFFITH. Yes or no. I have got only limited time. Either you 

have the authority or you don’t. I am not asking you if you are 

doing it, I am asking you if you have the authority. 

37 

Mr. IWRY. That is—the exchanges are established pursuant to 

provisions which are—— 

Mr. GRIFFITH. Are not part of the Internal Revenue Code, but 

you don’t have authority. 

Mr. IWRY [continuing]. By and large—— 

Mr. GRIFFITH. Thank you. No answer. You know, that is real 

simple. Just no, we don’t have that authority. 

Mr. IWRY. Congressman—— 

Mr. GRIFFITH. In regard to that—hang on, I only have limited 

amount of time. You talk about this transition relief and you rely 

on the Section 7805(a). I have read 7805(a) and the rest of 7805. 

I don’t see the words transition relief anywhere in there, and in 

fact, I would point out to you that the section deals with regulations predominantly, although it does reference the Internal Revenue Code on three occasions, it references regulations 35 times 

and it is talking about, you know, delaying a regulation. This is not 

a regulation. This is a law that was put into effect by the United 

States Congress, and I would ask you, just because other Administrations have done it—you are a lawyer by training, I believe. 

Mr. IWRY. That is correct. 

Mr. GRIFFITH. That is correct. Just because other Administrations have done it doesn’t necessarily make it right, and am I not 

correct that there has been no court opinion that has ever said that 

changing the law by unelected bureaucrats under that particular 

code section is, in fact, lawful? I am correct, there is no court case 

saying that, yes or no? 

Mr. IWRY. Congressman, we have not exercised this authority because other Administrations have done it. We have exercised this 

authority because we believe in good conscience—— 

Mr. GRIFFITH. This law cannot be enforced the way it was written. I understand that, but the bottom line I am asking you is 

there is no court opinion. You have referenced other Administrations to say this is where we get our authority from, but there is 

no court opinion saying this is a lawful act. Isn’t that correct? Yes 

or no? 

Mr. IWRY. No court opinion addressing this transition—this 

branch of transition relief—— 

Mr. GRIFFITH. Any transition relief granted by this code section 

that you are referencing, 7805(a) of the Internal Revenue Code? I 

am correct, there is no opinion referencing that, am I not? No court 

opinion that says it is lawful, yes or no? It is real simple. You all 

are making a huge decision on the United States of America and 

you can’t answer the question? It is yes or no. It is simple. 

Mr. IWRY. Congressman, there are court opinions referencing 

Section 7805(a) of the Internal Revenue Code—— 

Mr. GRIFFITH. In changing a law passed by Congress? It is mostly regulation, am I not correct? Is there any case that references 

a time when the Treasury Department used this section to stop the 

implementation of a section of the law and a court has said oh yes, 

you got that authority? Can’t cite me one, can you? 

Mr. IWRY. Congressman, we will be happy to respond to you after 

the hearing. 

Mr. GRIFFITH. And I appreciate that, but I would think if you 

were coming to a hearing where you are going to testify under oath 

38 

and you are changing the law of the United States of America by— 

of the executive and by the administrative branch, I think you 

would have your court cases lined up. I don’t believe you got it, but 

I would be glad to see it if you do. 

Thank you. I yield back. 

Mr. MURPHY. Gentleman’s time is expired. Now recognize Mr. 

Johnson of Ohio for 5 minutes. 

Mr. JOHNSON. Thank you, Mr. Chairman. 

Mr. Iwry, I certainly am not happy that we are here today. I am 

sure you are not either. You know, the Administration has had 3 

years to work on this, and it is just now getting worried about the 

timeframe. Was there ever a comprehensive plan in place, or was 

too much of the 2,000 page healthcare law waiting to be written 

into 20,000 pages of regulations that have slowly leaked out of 

HHS and the IRS? Because oh, that is right, we had to pass the 

bill to find out what was in it. That was what we all heard. Turns 

out that deceiving the American people with a law largely written 

by bureaucrats after it was already signed into law wasn’t such a 

good thing for the President after all. Because now that we have 

got those 20,000 pages of regulations, the law supporters are finding out just how unworkable it is, something that we have been 

saying all along. 

Today, 78 percent of Americans lack awareness about the law, 

and four in ten don’t even know the law takes effect 5 months from 

now. We are 3 years in here, folks, and issues like this are exactly 

why the Administration should be delaying the individual mandate, too. And if things have gone the way they have and are going 

is any indication of what is to come, this law will never be workable. So it probably doesn’t come as a surprise to you, but let me 

ask you once again, does the IRS, does your department have the 

authority to delay the individual mandate? Because I thought I just 

heard you tell my colleague on the other side there that after analysis and under certain circumstances, you do have the authority. 

That is what you said, correct? 

Mr. IWRY. That is not, Congressman, what I—— 

Mr. JOHNSON. No, that is exactly what you said. 

Mr. IWRY [continuing]. Was saying with respect to—— 

Mr. JOHNSON. No, that is exactly what you said, Mr. Iwry. You 

said that under certain conditions, based on the analysis, that you 

would be able to apply the same section of the IRS code to waive 

this and other future law mandates under that provision in the IRS 

code. That is what you said to the colleague before, so are you now 

changing that answer? 

Mr. IWRY. Congressman—— 

Mr. JOHNSON. Do you have the authority? If you were to conduct 

the analysis, do you have the authority to change it? If the analysis 

were to give you the same level of concern that the employer mandate did, would you have the authority under the IRS code to 

change and give the transition relief? 

Mr. IWRY. Congressman, the individual responsibility provision 

does not present—— 

Mr. JOHNSON. No, I am asking you if you have the authority. I 

am not asking you will you; I am not asking you if you have conducted the analysis. I am asking you if the analysis were conVerDate Nov 24 2008 12:16 Feb 21, 2014 Jkt 037690 PO 00000 Frm 00044 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-72 CHRIS
39 

ducted, do you have the authority under the IRS code to provide 

that transition relief? That is a yes or no, Mr. Iwry. 

Mr. IWRY. Congressman, we have not performed—— 

Mr. JOHNSON. I know you haven’t. I know you haven’t. I am not 

asking you have you. You are not answering the question that I am 

asking you. You are very calm and poised. You have been very 

skilled at this, so I commend you on that. I have noticed. What is 

the IRS prepared to do if the analysis were to indicate the same 

level of concern over the individual mandate as the employer mandate? Does the code allow you to use this provision to delay the individual mandate? 

Mr. IWRY. Congressman, it is not based on the level of concern 

by stakeholders—— 

Mr. JOHNSON. But you just said it was. You said it was in an earlier statement—you are under oath. Do you remember what you 

said about 5 minutes ago, 10 minutes ago? 

Mr. IWRY. Respectfully, Congressman, what I am saying is—— 

Mr. JOHNSON. Well respectfully answer the question. If you want 

to be respectful, Mr. Iwry, to the voice of the American people, then 

answer the questions that you are being asked and stop dancing 

around the issue. Does the IRS have the authority to delay the individual mandate under the same IRS provision that they delayed 

the employer mandate? 

Mr. IWRY. Congressman, we have not considered—— 

Mr. JOHNSON. You are not going to answer the question. 

Mr. IWRY. We have not—— 

Mr. JOHNSON. You said earlier in your testimony—— 

Ms. DEGETTE. Mr. Chairman, I respectfully ask the witness be 

allowed to answer the question. 

Mr. MURPHY. Gentleman has the time. 

Mr. JOHNSON. This is my time, Mr. Chairman. 

You said in your testimony earlier that your decisions were based 

on concerns from stakeholders. Who were the stakeholders? Who 

did you talk—who did the IRS talk to before they made this decision? 

Mr. IWRY. Congressman, the stakeholders who expressed these 

concerns—— 

Mr. JOHNSON. Yes, who were they? Specifically, who were they? 

Mr. IWRY [continuing]. Included the National Restaurant Association, the National Retail Federation, the Retail Industry Leaders 

Association, the Employers for Flexibility in Healthcare. 

Mr. JOHNSON. Did you talk to any individual companies, the 

businesses that were going to be impacted? 

Mr. MURPHY. Gentleman’s time is expired. 

Mr. JOHNSON. I thank you, Mr. Chairman. I yield back. 

Mr. MURPHY. Chair recognizes the gentleman from Missouri, Mr. 

Long, for 5 minutes. 

Mr. LONG. Thank you, Mr. Chairman, and thank you, Mr. Iwry, 

for being here today on kind of a hot topic, I think as we all know. 

Mr. Johnson kind of took one of my questions. I guess he is over 

here looking at my notes, but these different companies that you 

talked to in making this decision or your agency made in delaying 

the employer mandate, can you name three companies? I mean, the 

top three companies that pop in your head, hey, we talked to John 

40 

Deere, we talked to General Motors, we talked to this one, we 

talked to that one. Can you name me three companies just real 

quickly that you talked to about it? 

Mr. IWRY. Congressman, we talked to many and heard from 

many company representatives, as well as various individual companies. What I am—— 

Mr. LONG. That, to me, is the company. If you talked to the representative, then—you are kind of representing Treasury here 

today so I think I am talking to Treasury. So if I was talking to 

somebody that represented John Deere, then I would think I was 

talking to John Deere, so can you just—three names that pop in 

your head of companies that you talked to about this, how onerous 

it was going to be on them or why you made this decision? 

Mr. IWRY. I am sorry, Congressman, I wasn’t being clear. What 

I meant was associations representing hundreds of companies. 

Mr. LONG. Right, well you named the National Restaurant, but 

that is not what I am looking for. I am looking for KFC. I am looking for Darden. I look for a lot of restaurants, if you haven’t noticed, but—— 

Mr. IWRY. Congressman, we spoke to Darden. We have spoken to 

the Gap. We have spoken to numerous companies, and I would be 

happy to think of them. What I am not coming up with right now 

and I would like to do that to be helpful and responsive to your 

question, is sorting out my recollection—— 

Mr. LONG. If you can, I would appreciate it. 

Mr. IWRY. Yes, sir. 

Mr. LONG. OK. Let me move on. I will tell you one company. I 

heard earlier one of the Congressmen said we each represent about 

700,000 people. I represent, I think, 751,000. We lost a Congressman due to the Census last time in Missouri, so I have 751,000 

constituents. But I don’t want to talk about 750,999 of them, I 

want to talk about two of them. One of them is an employer in my 

area that came to me, the CEO came to me and said I want to tell 

you how bad this Affordable Care Act is going to be on our company. This is a company that started out with one store in Springfield, Missouri. They now have 56,000 employees. Obviously, they 

have stores all around the country now. He said we provide a great 

healthcare insurance for our people. They loved it. It was affordable for our company. We cannot provide that insurance for them 

next year. The requirements of the Affordable Care Act are going 

to be so onerous on us that we cannot do that. We are going to tell 

our part-time employees—and I think they already have, at this 

point—that we are not going to provide healthcare for the parttime employee that they were providing for before, and the best we 

can figure, we are going to have to cut people down to 29 hours 

a week. Well that is not doable. That is not—people can’t go to 

work somewhere 29 hours a week and then pick up a few more 

hours somewhere else. So those are the types of people that I am 

concerned about. An employer in my area, again, started out—the 

great American success story. Started out with one company, now 

they have 56,000 employees. And this bill is so onerous on them 

that they cannot provide that coverage. 

So you stated earlier that the vast majority already receive this 

coverage, because they work for a company like this that has 

41 

56,000, but even when this 1-year mandate runs out, then they are 

not going to be able to provide the same healthcare at the same 

affordable cost that they are now. So they can’t keep it next year 

when this runs out. 

You said that the White House was involved. Were there any 

talks about the individual mandate? I mean, to me, you have done 

a good thing. I don’t know that it is constitutionally legal. I can’t 

imagine the President just willy-nilly arbitrarily saying I am going 

to change a law because we want to change the law. I don’t know 

that that is constitutional, but let’s say—let’s assume that it is. But 

I think you have done a good thing in shutting the barn door before 

the horse was out on the mandate on employers. The individual 

mandate, that horse is still in the barn. Did you talk about shutting the door before that horse gets out of the barn? Did you have 

those discussions about delaying the individual mandate? 

Mr. IWRY. Congressman, we collectively as a lot of people—I can 

just speak to you about the discussions I was in, which I assume 

is what you are asking me about. But in the discussions that I 

have been involved in, which are part of the total discussions, we 

did not consider delaying or giving transition relief with respect to 

the individual mandate because we did not identify similar reasons 

for doing so, a comparable impact. 

Mr. LONG. OK. So you didn’t think that the individuals would 

want and need this same relief that the employers would need, correct? 

Mr. IWRY. That is correct, Congressman. I would be happy to explain why. 

Mr. LONG. OK. I am about out of time here. For the record, I just 

want to state that we do things in Congress—I have a lot of friends 

on the other side of the Aisle. I have a few on this side, but I have 

a lot of friends that I really, really try and reach out and get along 

with people. I am kind of a people person, and I think that we need 

to work together. It just seems like on all of these issues—I don’t 

care what the topic is—that when we want to do something, the 

other side is violently opposed to it, and if they on our side and 

their side, too, once in a while could reach out with an olive branch 

and say hey, you know, the White House got in on this and we are 

not going to do the employer mandate, and we say hey, why not 

for the individuals, too? If they would come back and say that is 

fine on immigration reform, they want to—they don’t want to 

touch—we want the borders tightened. We can talk about immigration and get something done on immigration, but if they would 

once in a while come together, I think it would be better for all of 

us. Thank you. 

Mr. MURPHY. Gentleman would have more friends if he sticks to 

the time limit. I thank the gentleman. Now turn to the gentlelady 

from North Carolina, Ms. Ellmers, for 5 minutes. 

Mrs. ELLMERS. Thank you, Mr. Chairman. 

Mr. Iwry, I have a couple questions for you regarding the employer mandate. You know, the Affordable Care Act, or Obamacare, 

was put in place March 2010, is that correct? Yes or no? 

Mr. IWRY. That is correct, Congresswoman. 

42 

Mrs. ELLMERS. OK. When was the employer mandate actually 

put in place? When was the finalization of the actual language to 

what employers would have to adhere to put in place? 

Mr. IWRY. The language was part of the law that was enacted in 

March. 

Mrs. ELLMERS. So it was in the initial part of the law back in 

2010. OK. May I remind you it is now July 18, 2013. There have 

been businesses across this country and individuals and American 

families who have been dreading this terrible piece of legislation 

going into place. This is the worst piece of legislation that has ever 

affected American families. 

Now here we are, July 2, week of 4th of July, and we get this 

message put out that we are now going to delay the employer mandate, the employer mandate forcing businesses to have to give insurance and incur the cost. What was the tipping point at this 

point when we are so close to the implementation in 2014? What 

was it? Was it the cost to businesses? Was it the affordability? Was 

it the fact that jobs were going to be lost? Was it going to be the 

hours? What was it that you heard from these associations that 

changed your mind or urged you to make this decision? 

Mr. IWRY. Congresswoman, the associations and the individual 

companies—— 

Mrs. ELLMERS. What did they say the issue was? 

Mr. IWRY. The associations and the individual companies said 

that the issue was two-fold. 

Mrs. ELLMERS. And it was? 

Mr. IWRY. One, that they needed more time to implement the reporting requirements—— 

Mrs. ELLMERS. OK. 

Mr. IWRY [continuing]. But because their systems needed to be 

adapted, both for collecting—— 

Mrs. ELLMERS. OK, but this—so when did you start getting this 

information? When did you start sitting down with these associations? 

Mr. IWRY. We started sitting down with the associations and individual businesses shortly after enactment of the law. 

Mrs. ELLMERS. So that was back in 2010—— 

Mr. IWRY. 2010 or—— 

Mrs. ELLMERS. And you now, 3 years later, have made this decision. 

Mr. IWRY. Or 2011. 

Mrs. ELLMERS. OK. Well this is the issue. Do you have a business background? 

Mr. IWRY. Congresswoman, I have spent more years counseling 

businesses in the private sector—— 

Mrs. ELLMERS. OK, so you are very familiar with business. Time 

is money. When it costs a business to have to adhere to onerous 

regulations, that is money. So basically what you are telling me, 

yes or no, is that it really boils down to the cost and the fact that 

businesses would have to fire employees. Is that correct? 

Mr. IWRY. Congresswoman, that is not how the businesses that 

have expressed these concerns that the reporting be—— 

Mrs. ELLMERS. So what is going to change in a year? 

43 

Mr. IWRY. Congresswoman, businesses have asked us if we can 

simplify or streamline—— 

Mrs. ELLMERS. OK, so you are going to simplify the system. 

Three years later—knowing the requirements have always been 

there, now 3 years later we are going to simplify. OK, that is fine. 

That is fine. I don’t have a problem with that. It is totally inadequate, but I will accept it. 

Let me move on to the individual mandate. Now you say that you 

don’t see any problem with individuals being able to report? 

Mr. IWRY. Congresswoman, the impact of the reporting conditions—— 

Mrs. ELLMERS. Have you actually reached out to individuals to 

get comments, to find out what the individuals feel about this? Because I have, because I represent 700,000 of them and they are all 

very concerned about this. What input have you received? 

Mr. IWRY. The Administration has worked with many individuals—— 

Mrs. ELLMERS. The Administration or—OK. So what is your impact? So the individuals you are talking to are saying this is just 

perfect, it is wonderful, this is the best thing that has ever happened? 

Mr. IWRY. The individuals process for navigating—— 

Mrs. ELLMERS. OK. Let’s just move on, because see, interestingly 

enough, HHS put out a 606-page rule now saying that individuals 

who are going to the exchanges in the 16 States where they are up 

and running or will be that they won’t have to report any type of 

income verification or employer-based insurance for these exchanges. Now why would that happen at the same time? 

Mr. IWRY. I believe that is not correct, Congresswoman. 

Mrs. ELLMERS. What is your version, then, and has the Treasury 

had any input there? 

Mr. IWRY. My understanding from Ms. Tavenner—— 

Mrs. ELLMERS. I have 2 seconds. 

Mr. IWRY [continuing]. And from CMS HHS is that that 

verification change that they announced in that regulation—— 

Mrs. ELLMERS. Yes. 

Mr. IWRY [continuing]. Was much more limited in its application. 

Mrs. ELLMERS. Well, 606 pages. However, there is an issue here 

because there is no time limit on that. We are not just giving someone a year to learn how to report; we are just removing it. Am I 

not correct in that? We are just now saying that individuals do not 

have to report their asset verification, is that not correct? 

Mr. IWRY. That is not my understanding, Congresswoman. I am 

not an expert on the HHS requirements, but that is different from 

the myths and facts statement that they—that Ms. Tavenner at 

CMS posted—— 

Mrs. ELLMERS. Well my time has expired, but I find it amazingly 

coincidental. Thank you. 

Mr. MURPHY. Gentlelady’s time is expired. Now turn to the gentleman from Louisiana, Mr. Scalise, for 5 minutes. 

Mr. SCALISE. Thank you, Mr. Chairman. I appreciate you holding 

this hearing. It is very important that we have this hearing. Mr. 

Iwry, I appreciate you being here. 

44 

We have had a number of hearings in this committee exploring 

the ramifications of the President’s healthcare law, and when we 

have had Administration officials in the last few months come and 

testify, we have been hearing horror stories from people in our districts. You know, I represent southeast Louisiana. I hear from businesses all the time that have been talking about the devastating 

impacts this is having on their business, on their ability to hire 

new employees. Many businesses are being forced to reduce the 

number of hours that employees work because of the healthcare 

law. In fact, our State study had just come out that said our State, 

Louisiana, would see a 56 percent increase in individual healthcare 

premiums on families. Fifty-six percent increase because of the 

President’s healthcare law, so we are seeing all of this. And then 

when we have had hearings with Administration officials, they 

have all said everything is going fine. Everything is looking great. 

We have recently had hearings where those things were being said 

and we present them with this information, things that we are seeing and hearing on the ground in our districts back home. 

So I think when you come here and say that sometime in June 

you all made a decision that you could just ignore part of the law, 

there are a lot of real serious questions that come about. How long 

have you all known about this? How long has your agency known 

about it, and what other agencies within the Obama Administration have known? 

I want to first ask you, when you started coming up with this 

understanding as you are meeting with businesses and they are 

telling you we have got serious problems, and then ultimately you 

decided you think you can delay a part of the law, did you have 

any talks with HHS, to have the same conversation that you all 

had internally with HHS who was moving forward with implementation? 

Mr. IWRY. There is a lot of coordination between Treasury and 

HHS—— 

Mr. SCALISE. On this decision? On the decision to delay the employer mandate, did you have conversations with HHS about the 

decision that you made? It is a yes or no question. 

Mr. IWRY. Personally I did not have conversations, Congressman, 

with HHS that I can recall before the decision was made—— 

Mr. SCALISE. How about Mr. Mazur, the person that you said at 

Treasury made this decision? Do you know if he had any conversations with HHS about this? 

Mr. IWRY. Congressman, I do not know whether Mr. Mazur—— 

Mr. SCALISE. All right, then let me—he is not here, you are. I 

want to ask you, can you get the committee that information? Can 

you get the committee the names of anybody at Treasury that consulted with HHS, if those consultations happened along the way, 

that you all were going to delay this mandate, and when—because 

they were testifying that everything was fine, while you all were 

sitting in a room somewhere behind closed doors making a decision 

that it wasn’t going fine, so much so that you thought you can just 

ignore the law. And so can you get us that information? 

Mr. IWRY. Congressman, does that—does your request include— 

so I understand your request—— 

45 

Mr. SCALISE. I am asking you to get the names of people at 

Treasury that had any conversations with HHS about the delay of 

the employer mandate, and then the dates and times when those 

conversations occurred. Can you get that to us? It should be pretty 

easy. 

Mr. IWRY. The conversations that coordinate between Treasury 

and HHS—— 

Mr. SCALISE. Yes. Can you get that? 

Mr. IWRY [continuing]. Often go through—— 

Mr. SCALISE. Answers. Can you get us that? The clock is running. I don’t have all day. I appreciate your time and I hope you 

respect mine. Can you get us that information? 

Mr. IWRY. Congressman, the conversations are coordinated 

by—— 

Mr. SCALISE. Can you get us that information? 

Mr. IWRY [continuing]. OMB in many cases, or the White House. 

Mr. SCALISE. Can you get us that information, yes or no? 

Mr. IWRY. We will be happy to—I would be happy to ask the appropriate people at Treasury to pursue your question and—— 

Mr. SCALISE. And get us that. Because I am looking at the law 

here, and this is the law—I was on the committee. I just got on 

right when the President’s healthcare law was coming through. We 

had hearings for months and months, hours and hours at a time, 

and I had more concerns about this bill as it was going through. 

Every day they were worse. And unfortunately, they have all come 

to fruition and then some. 

But when I look at the section we are talking about, large employers, Section 605 says ‘‘large employers required to report on 

health insurance coverage effective date, the amendments made by 

this section shall apply to periods beginning after December 31, 

2013.’’ Now did the President get out some kind of magical pen and 

change this to 2014? Did the President change this law? This is the 

law right here. You are talking about something you all did on a 

blog post in a secret room behind closed doors. This is the law. Did 

this law change? Because yesterday we had a bill on the House 

Floor to actually change this law, to delay this by a year. I want 

to repeal the whole thing. Every American, the more they see about 

it—look, the unions, of all people, the labor unions who actually 

helped pass this law—James Hoffa wrote a letter saying ‘‘the law 

as it stands will hurt millions of Americans, including the members 

of our respective unions,’’ and actually went on to say it would not 

only harm their hard-earned health benefits, but destroy the foundation of the 40-hour workweek that is the backbone of the American middle class. That is the unions who helped pushed this bill 

through that are saying that. 

And so when the Secretary of HHS is out shaking down companies recently, trying to get them to give money, companies she 

oversees and regulates, I think it is corrupt for her to do it. She 

is shaking down companies, trying to get money, to get them to 

promote the law. She is going to the NFL and NBA trying to get 

them to promote the law, and then somebody else behind closed 

doors in the same Obama Administration is saying this thing is so 

unworkable we got to delay it. 

46 

And so what I am asking you is who is talking to who in the 

Obama Administration? It is Sebelius out there on one hand, shaking down companies, saying help us promote this lemon, while you 

all are out there in a room going you know, this thing is so unworkable we better delay the damn thing. Can you get us that information, those answers to those questions? 

Mr. IWRY. I would be happy to respond now. 

Mr. SCALISE. The floor is yours. 

Mr. MURPHY. Gentleman—the time has gone over so I am going 

to have to hold to that, but there are some questions we want— 

we will submit and you will respond in a timely fashion. 

Mr. SCALISE. Thank you. I yield back the balance of my time. 

Mr. MURPHY. I would now recognize Mr. Gardner from Colorado 

for 5 minutes. 

Mr. GARDNER. Thank you, Mr. Chairman, and thank you, Mr. 

Iwry, for your time before this committee. 

Just a couple of questions for you. You are the senior advisor to 

the Secretary, is that correct? 

Mr. IWRY. I am a senior advisor. 

Mr. GARDNER. A senior advisor, OK. So in terms of the advice 

you would give to the Secretary on the question that Mr. Johnson 

was asking you, do you have the authority under the same tax provision to provide a delay in the implementation for the individual? 

What would your advice be to the Secretary? 

Mr. IWRY. Congressman, I would have to participate with the appropriate people—— 

Mr. GARDNER. OK. 

Mr. IWRY [continuing]. At Treasury. 

Mr. GARDNER. So your answer is that you would look into it, and 

so the answer is not no. You would have the authority to do that. 

Mr. IWRY. Congressman, if that question were asked, I would 

have to research or—— 

Mr. GARDNER. And you haven’t researched that? 

Mr. IWRY [continuing]. Or participate with others or have—— 

Mr. GARDNER. Have you researched that point? 

Mr. IWRY [continuing]. Others research the question whether we 

would have authority to—— 

Mr. GARDNER. Have others researched that point? 

Mr. IWRY. Whether we would have authority to—— 

Mr. GARDNER. Correct, under the same provision of law. 

Mr. IWRY [continuing]. Provide transition relief with respect to 

individual—— 

Mr. GARDNER. To delay the mandate for individuals. Have you 

researched it, have others researched it? 

Mr. IWRY. We have not researched that particular request—— 

Mr. GARDNER. So you delayed the business mandate without understanding its full implication on what it would mean for individuals? 

Mr. IWRY. Congressman, no, that is not what we did. If I may 

explain—— 

Mr. GARDNER. You did—I have some other questions for you. 

How many—when was the President made aware of your decision 

to delay implementation of the business healthcare rules? 

47 

Mr. IWRY. Congressman, may I just finish my response to your 

prior question? 

Mr. GARDNER. If you would like to submit it for the record, that 

would be great. When was the President made aware of your decision to delay the business provisions? 

Mr. IWRY. I don’t know—— 

Mr. GARDNER. You don’t know when the President was made 

aware? 

Mr. IWRY. I don’t know what communications there were with 

the President on this matter. I was not involved. 

Mr. GARDNER. You weren’t a part of the decisions to inform the 

President of the United States about the decision to delay what is 

arguably a major provision of his marquee piece of legislation? 

Mr. IWRY. Congressman, we coordinate with the White House. 

The Treasury did coordinate with the White House—— 

Mr. GARDNER. Who spoke to the President about this? 

Mr. IWRY. Congressman, I don’t know who, whether at the White 

House or at Treasury, spoke to the President about this. If I assume you have—people here have assumed that the President was 

told, I don’t have—— 

Mr. GARDNER. Would you assume that the President was told? 

How are decisions made with this White House? 

Mr. IWRY. I would not be surprised at all if the President was 

advised of this, Congressman. 

Mr. GARDNER. Well I wouldn’t be surprised either. I would just 

like to know when. 

Mr. IWRY. I simply have no personal knowledge. 

Mr. GARDNER. Would you please get back to me on when the 

President was made aware of these decisions? 

How many IRS agents right now are working with you on implementation of the healthcare bill? 

Mr. IWRY. Congressman, I don’t know the exact number as I sit 

here of IRS personnel who are working on implementation, but we 

would be happy to check on that—— 

Mr. GARDNER. Could you get back and tell me how many IRS 

personnel are working on the healthcare bill at this moment? 

Would you please get back to me with that number? 

Mr. IWRY. We would be happy to—I assume that that is something that we would be able to do, so—— 

Mr. GARDNER. I will take that last question and if you could report it for the record, that would be great. 

How much money have businesses spent to this point, are you 

aware, to try to comply with the healthcare rules? 

Mr. IWRY. How much money businesses have spent to date? 

Mr. GARDNER. Yes, how much does it cost American businesses 

to try to comply with the healthcare law? 

Mr. IWRY. Congressman, I am not sure I know the—I don’t know 

the answer to that question. 

Mr. GARDNER. Could you get back to me with the estimate that 

Treasury has and what it will cost American businesses to comply 

with the healthcare law? 

Mr. IWRY. Congressman, businesses are benefitting as well from 

the healthcare provisions—— 

48 

Mr. GARDNER. Do you agree that it costs businesses to fill out 

their tax code, fill out their tax forms? It costs businesses to hire 

accountants? Do you agree with that? 

Mr. IWRY. Congressman, of course. 

Mr. GARDNER. So it will cost businesses to try to comply with a 

new regulation and new law. I would like to know Treasury’s estimation of how much it has cost American businesses to comply 

with the healthcare law. 

Mr. IWRY. I will be happy to inquire of my colleagues whether 

the economists at Treasury have that kind of information. 

Mr. GARDNER. Isn’t that something the Treasury Department 

should have, is how much it is costing the American businesses? 

Mr. IWRY. The cost issues with respect to the Affordable Care Act 

are certainly something that Treasury has been taking into account 

in a very serious way, and weighing them against the benefit—— 

Mr. GARDNER. Who advises the Treasury Secretary or the President on how much it will cost to comply with the regulation? 

Mr. IWRY. The Assistant Secretary for Tax Policy is the individual who would be delegated the authority to make those regulatory decisions, and therefore if the question was asked how much 

does this—would this cost—— 

Mr. GARDNER. Would you mind getting back to me with that information? 

Mr. IWRY. That would be at least one individual within Treasury, 

not necessarily the only official within Treasury who would be responsible for developing that. 

Mr. GARDNER. I think we would all be interested in that information. I have other questions for the record. Thank you. I yield back. 

Mr. MURPHY. Gentleman yields back. I now recognize the gentleman from Georgia, Mr. Gingrey—Dr. Gingrey, for 5 minutes. 

Mr. GINGREY. I thank the chairman, and I came in a little bit 

late, but I am looking at the witness’s bio and of course, in the 

name tag, Honorable Iwry, Senior Advisor to the Secretary of the 

Treasury, Deputy Assistant Secretary for Retirement and Health 

Policy of the United States Department of Treasury. Obviously 

haven’t earned that title of honorary, and I am just astounded at 

the lack of ability to answer the questions, Honorary Iwry. 

In your capacity at the Treasury Department, have you heard either in meetings or by public comments about concerns from businesses that the employer mandate will cause employers to reconsider or even halt plans to expand? Have you heard that concern? 

Mr. IWRY. Congressman, we have heard some people express that 

concern, as well as many who have said that it would not have that 

effect on their businesses. 

Mr. GINGREY. Well, I can tell you this, Honorary. I have certainly 

heard that concern in my district. When I talk to small businesses 

back home in Georgia, I often hear that the 50-employee threshold 

has repeatedly forced different hiring practices. I learned that 

Heatco, a company that specializes in the design and manufacture 

of world-class hearing solutions located in Bartow County, Georgia, 

has looked into expanding. The thing is, they currently have, you 

guessed it, 49 employees, and to expand by adding additional employees will cost more than automatizing some of their processes 

due to the added Obamacare costs. It seems to me that your delay 

49 

is directly influenced by examples such as this one, and not due to 

the purported reporting requirements, for God’s sake, that have 

had 3–1⁄4 years to figure that one out. 

In your response to the committee, you stated that the delay occurred after ‘‘having engaged in a dialogue with stakeholders and 

reviewing written comments about the employer and insurer reporting requirements.’’ Did any of these comments mention the effect the mandate could have on their expansion plans? 

Mr. IWRY. Congressman, I am confident that while I can’t recall 

specifics now, that at least some of those comments probably did. 

At least some probably did mention concerns such as those. Those 

were not what drove our decision, and indeed, the concerns that 

were expressed about the reporting and about the employer responsibilities were not ones that we gave credit to automatically or 

lightly. 

Mr. GINGREY. I want to interrupt you just for a second, because 

it seems to me you are kind of running out the clock, and that is— 

I thought that Harvard-educated lawyers could talk a little bit faster than Georgians. 

But look, would you please tell the committee some of these employer stakeholders who weighed in? Name two or three. 

Mr. IWRY. Well, the Business Roundtable representing numerous 

major companies—— 

Mr. GINGREY. That is a trade association. That is not a company. 

Mr. IWRY [continuing]. Weighed in. Oh, yes, sir. There were—we 

would be happy to get back to you with—— 

Mr. GINGREY. Well, I thank you for that. You should get back to 

me. That will be fine. 

Now it seems to me that this unconstitutional delay by the Executive Branch, by this President, was in direct response to the drag 

on the economy, higher unemployment, needing more time to develop reporting requirements was an economic political decision. I 

don’t deny that or have any particular problem with that. In that 

light, though, in that light, would you please answer the following 

questions as our distinguished chairman emeritus, Mr. Dingell, 

would often say with yes or no answers regarding the raw Senate 

politics of this decision that was dumped on us on the July the 2nd. 

Did you hear during the stakeholder process, Honorable Iwry, 

did you hear either directly or indirectly from Senator Mark Pryor? 

Mr. IWRY. From Senator—— 

Mr. GINGREY. Mark Pryor of Arkansas. 

Mr. IWRY. I don’t recall having heard from Senator Pryor. 

Mr. GINGREY. How about Senator Mary Landrieu from Louisiana? 

Mr. IWRY. Congressman, I don’t recall having heard from—— 

Mr. GINGREY. Struggling a little bit, Honorable. How about Senator Mark Begich from Alaska? How about Senator Kay Hagan 

from North Carolina? 

Mr. IWRY. Congressman, what I am referring to by stakeholders 

are companies, associations of companies, other organizations in 

the private sector—— 

Mr. GINGREY. Yes, what you are referring to as stakeholders and 

what I am referring to as stakeholders are two different animals, 

and I am trying to ask you if these Senators up for reelection in 

50 

2014 in States that Mitt Romney carried overwhelmingly came to 

you, Honorable, and I am sure you were in the room if they did, 

if you had heard any concerns that they have about their reelection 

potential process in regard to this bill, which is a train wreck, as 

retiring Senator Baucus described to the Secretary of Health and 

Human Services—— 

Mr. MURPHY. Gentleman’s time is expired. 

Mr. IWRY. Congressman—— 

Mr. MURPHY. Gentleman’s time is expired. Here is how we are 

going to handle this in talking with the Minority here. So what we 

are going to do is give each side 5 additional minutes to ask some 

questions. I have a question or two, and if members from my side 

want to ask a question, let me know. 

All right, Ms. DeGette, 5 minutes. 

Ms. DEGETTE. Thank you very much, Mr. Chairman. 

I really appreciate you coming over here, Mr. Iwry. I know it is 

sometimes frustrating and difficult to answer questions to which 

you have no answer, but I do think it is important for us to understand the decision that was made, and also to understand the scope 

of Treasury’s ability to make these decisions regarding implementation of the Affordable Care Act. So thank you for coming. Some 

of the questions where folks asked you to submit written responses, 

you may not be able to respond to those questions because they 

were, you know, they were big, but if that is the case, please let 

us know that, too, so that we can help make sure that we get the 

information we need. 

Mr. Chairman, I just—I think finally Mr. Johnson’s question did 

get answered and I appreciate my colleague from Colorado, Mr. 

Gardner, for getting that answer because I thought it was very useful about the agency’s scope of ability to be able to delay the individual mandate. And I believe what you had said, Mr. Iwry, is the 

agency has not really considered delaying the individual mandate, 

and therefore, the agency has not done an analysis to determine 

whether or not they do have that ability under Section 7805(a). Is 

that correct? Yes or no would be—— 

Mr. IWRY. Congresswoman, that is correct. 

Ms. DEGETTE. OK, thank you. I just want to point one last thing 

out, Mr. Chairman, which is we keep talking about this Administration decision to delay the reporting requirements under Section 

7805(a) for the employers, and then we keep talking about delaying 

the individual mandate as if it were a comparable decision, but in 

fact, it is really apples and oranges because the employer reporting 

is simply an IRS reporting that the employers have to make. And 

in fact, the Urban Institute did an analysis—and I will submit this 

for the record. They did an analysis after the Administration’s decision figuring out how many more people would be uninsured if you 

had the ACA, even without the employer mandate, not just the 1- 

year delay, but without it, and it turned out to be very minimal. 

The reason is because over 90 percent of Americans who work for 

companies already have insurance, and that is not going to change 

with just the 1-year delay. 

But the Urban Institute analysis also showed, though, if you delayed the individual mandate by a year, that is a totally different 

thing and the reason is the individual mandate encourages people 

51 

to go out and buy insurance. It is not simply a tax reporting, but 

when they go out and buy this insurance then, they get the subsidies, they get the tax relief, they get all of the other benefits that 

people are going to get. And what the Urban Institute analysis 

found out was that if you did not have the individual mandate, the 

Affordable Care Act without the individual mandate, then 13 million people would be without coverage. So in fact—and you know, 

it is just two ways of looking at different sides of the coin is you 

delay the business mandate for a year, which is something that all 

the businesses sat in this room and said they wanted and everybody on both sides of the Aisle seemed to think might be a good 

idea. You delay that for a year, well swell, but then if you delay 

the individual mandate for a year, what will happen is many, many 

millions of Americans, people with preexisting conditions and others, won’t be able to get affordable health insurance through these 

exchanges. 

So I think it is kind of a little different, and I myself intend to 

continue to try to help all of my constituents in the 1st Congressional District of Colorado get enrolled so that they can get these 

benefits and so that we can bend the cost curve. And those are my 

two cents, Mr. Chairman. I would ask unanimous consent to put 

this Urban Institute analysis into the record. 

Mr. MURPHY. Without objection. 

[The information appears at the conclusion of the hearing.] 

Ms. DEGETTE. Thank you very much, Mr. Chairman. 

Mr. MURPHY. Gentlelady yields back? 

Ms. DEGETTE. I yield back. 

Mr. MURPHY. Thank you. I am just going to ask a couple questions here, and then yield to Dr. Burgess. 

What are the costs to American businesses of complying with the 

reporting requirements? Do you have this number, the cost to 

American businesses of complying with the reporting requirements? I am assuming that is part of the record the Treasury is 

considering as a basis for your decision, their costs. 

Mr. IWRY. Mr. Chairman, the fact that there are costs is certainly something that is relevant. 

Mr. MURPHY. I know it is relevant. Is it—do we have a number 

of how much it is going to cost American businesses to comply? 

Mr. IWRY. I would be happy to take that back and see whether 

we—— 

Mr. MURPHY. Is there a memorandum or any other information 

that was reviewed by you or other people with regard to the costs? 

Mr. IWRY. Businesses and their representatives provided information about the fact that it was costly. If I—— 

Mr. MURPHY. So you will provide us with those memorandums 

or communications regarding the costs? 

Mr. IWRY. I am sorry, sir? 

Mr. MURPHY. You will provide us with information regarding the 

costs? 

Mr. IWRY. We will be happy to look back and see whether they 

provided information—— 

Mr. MURPHY. It was only a week ago you decided this, so I was 

hoping you would remember. It was only 2 weeks ago that you deVerDate Nov 24 2008 12:16 Feb 21, 2014 Jkt 037690 PO 00000 Frm 00057 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-72 CHRIS
52 

cided to delay this, so I was hoping you would remember how much 

the costs were. 

Mr. IWRY. Mr. Chairman, I don’t remember a particular figure 

that—— 

Mr. MURPHY. Did Treasury do an analysis of the costs? 

Mr. IWRY. Treasury considered the cost as part of the analysis—— 

Mr. MURPHY. And the number is? 

Mr. IWRY [continuing]. Taking it into account, but I don’t know 

whether there is a separate number that was broken out. I will be 

happy—— 

Mr. MURPHY. Add that up and please get that to us. 

You also mentioned that Treasury carefully considered the rule. 

Do you know what other agencies reviewed the announcement with 

regard to delay? Did other departments, other than Treasury, review this before the announcement came out? For example, did you 

ask HHS to review? 

Mr. IWRY. Mr. Chairman, OMB or other White House offices coordinate typically between the various departments that are involved in implementing—— 

Mr. MURPHY. Did you seek review from anyone else? Did Treasury seek review from any other agencies? 

Mr. IWRY. I personally did not, don’t recall talking to the 

other—— 

Mr. MURPHY. Did you see any memos or hear of any communications where other people within Treasury were reviewing this with 

any other agencies, any other departments? 

Mr. IWRY. I do recall discussions in which this was reviewed by 

and there were consultations—— 

Mr. MURPHY. Other agencies, other departments? 

Mr. IWRY [continuing]. With other organizations within the government, but I don’t recall such with respect to the other departments, as opposed to OMB or—— 

Mr. MURPHY. Let me broaden that. Any government agency, entity, department, division, person, desk, cubicle, group where two or 

more are gathered, we would like to know, all right? 

Is there any evidence or data before Treasury about the burdens 

of costs on the individual? You had mentioned before that you reviewed this for businesses but not necessarily for individuals. Did 

you hear from any individual groups? Did you seek information or 

do you plan to seek any information from individuals with regard 

to individual concerns and burdens? 

Mr. IWRY. I think the Administration has heard from individuals, 

Mr. Chairman—— 

Mr. MURPHY. Treasury. I am pausing the clock. 

Mr. IWRY. I would have to check. Certainly Treasury has weighed 

the impact on—— 

Mr. MURPHY. Let me ask this. If Americans want to let you know 

what their concerns are as individuals, what address can they send 

their concerns to? 

Mr. IWRY. There are—— 

Mr. MURPHY. Just yours. I want them to write to you. Do you 

have an address at Department of Treasury? 

53 

Mr. IWRY. Mr. Chairman, yes, there are specific addresses that 

have been provided for the public. 

Mr. MURPHY. We are asking you because you are involved with 

this decision and implementation, and you said you haven’t heard 

from individuals. So I would like—if there are some people that 

have concerns out there, I would like them to be able to write to 

you. So we can have them write to you at Department of Treasury, 

care of the Department of Treasury? 

Mr. IWRY. Mr. Chairman, I would be happy to hear from them. 

Mr. MURPHY. Thank you. I am now going to yield to Dr. Burgess 

for a question. 

Mr. BURGESS. Thank you, Mr. Chairman. 

Let me just ask, did you get any feedback from the Department 

of Health and Human Services as to making this announcement on 

July 2? 

Mr. IWRY. I don’t recall, Mr. Burgess, hearing any feedback from 

HHS regarding this July 2 announcement. 

Mr. BURGESS. Did they provide you an analysis of what this 

delay meant? 

Mr. IWRY. Whether they provided an analysis to the White House 

or to OMB or to someone else at Treasury, some other office at 

Treasury, I don’t know. I had not—I don’t recall receiving any analysis from HHS. 

Mr. BURGESS. I just find that extremely odd that a department 

that had worked on this so diligently and then you provide this 

delay, and there is no consultation. 

Did Treasury consult CMS directly on the question of whether a 

delay would harm the integrity of the employer verification system, 

and shouldn’t this question have been discussed, given that the Exchange Subsidy Program will cost taxpayers a trillion dollars over 

the next decade? 

Mr. IWRY. Congressman, there are discussions which I am not 

privy to between CMS and IRS personnel about verification and reporting coordination between the marketplaces or exchanges and 

the tax system that go on on a, I believe, a continual basis and I 

am not involved generally in those conversations, so I don’t know. 

Mr. BURGESS. Mr. Chairman, it is apparent that the witness does 

not want to answer the question. I am going to respectfully request 

that this committee follow up with an aggressive document request 

from the Department of Treasury and the Department of Health 

and Human Services, and I expect a document request to be fulfilled. I will yield back to the chairman. 

Mr. MURPHY. Thank you. We are—our time is expired. I just 

want to—with regard to your welcoming comments from individual 

citizens across the country, so I am assuming if they write to you, 

Mr. Iwry, at Office of the Deputy Assistant Secretary for Retirement Health Policy at the U.S. Treasury Department, letters 

should get to you. Am I correct? 

Mr. IWRY. Mr. Chairman, we would be happy to provide an appropriate address or a recipient for those letters. 

Mr. MURPHY. Can you tell me—I am just asking your address. 

You have got to be able to answer that question. You told us you 

haven’t heard from people. I am just trying to help America. I am 

just trying to clear this up. So is it OK if people write to you at 

54 

Deputy Assistant Secretary for Retirement Health Policy at the 

U.S. Department of Treasury? 

Mr. IWRY. Mr. Chairman, we have heard from individuals, but on 

this particular issue—— 

Mr. MURPHY. On this issue. This is what we would like to know. 

Mr. IWRY. I am not aware that whether we have heard from individuals on this particular issue. 

Mr. MURPHY. OK, thank you. Well with regard to this, I ask 

unanimous consent that the written opening statements of other 

members be introduced into the record, and so without objection, 

documents will be entered into the record. 

And in conclusion, I would like to thank you for being here today 

and participating in this hearing. I remind members that they have 

10 business days to submit the questions for the record. Mr. Iwry, 

I ask that you respond to them promptly with answers. 

Thank you very much. This hearing is adjourned. 

[Whereupon, at 5:03 p.m., the subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 

PREPARED STATEMENT OF HON. GREGG HARPER

Mister Chairman, 

Thank you, Mr. Chairman, for facilitating today’s discussion on two issues that 

are of major concern to Mississippians. 

Once again, we see that the ‘‘Affordable Care Act’’ is nothing short of politics 

above economics. 

I’ve argued that this law was bad for employers from the start. And it seems now 

that the administration would agree. But if the federal government is going to exempt billion-dollar corporations from this burdensome law, why wouldn’t we give average citizens the same relief? 

This law is broken. And it can’t be fixed by handpicking some provisions to enforce and others to conveniently ignore. 

Let’s repeal all of this health care law. 

Let’s consider fair health care reforms. 

And only then will Americans receive the care that they need, from the doctors 

that they choose, at a cost that they can afford. 

Thank you, and I yield back. 

55 


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•• u Prifrnillmjarlrn/Mduf1lbooA:Qjbusirn!$$i:J;notdiM:!rlyrornparoble«>premiumjor5mallt$nwpbaokofbllsiMS5/ntlliserQfflpledilttodijfererltirltlenrtt 

benefitfeve/$,.gttQ9roph/cmil(.f1IIdOMer/adM 

MateriltlproducedtoIheU.S.HouaeQf~CommItteeonEnergyal'\dCommen:eirl~1003l141j31't!q111!1St, 

The analyses are note compret\eIlsive summary of III! PPA~ pmmium impacI$ There may be othef fac:tol'$lhatimpaet 

premiumsthalarenotfeflectedil!!hematenal 
56 


86396.009

__ .. """"_ .. _~ .. _ ... ~~_ .. WW>~_ 

.... ----_.'-- ---~--., ... ------.. ----
57 


86396.010

Examples of actual premium increases projected in the individual and small group markets 

One national insurer predicts a :1"1 ; ',') 't average increase fur new customers in the individual market; 

Another predicts that small businesses in ' c:,t'~ <' in the small group market 

F10rldre In the indiviuuall1'ull'kt-'i:, 

('lQlmpleofil·year.okl 

milk andf",m<\k· currently 

enrolled in k>ss l'Ompl'f'hoo,'.;i>.-e 

pluru;rouid>lt)l'illCJ.'Ca..'4l'lBof 

I~\': 
58 


86396.011

There will be a one-year delay in the implementation of employer penalties for large employers (50 or more workers) who do not 

offer affordable coverage to their full-time workers (30 or more hours per week) under the Affordable Care Act (ACA). Some viewed 

the employer responsibility requirement as a key part of the ACA and the penalties as being an important tool for securing employer 

based insurance coverage once other reforms to the nongroup market are implemented. However, our analysis shows otherwise. 

In addition, some have suggested that it IS unfair to leave the individual mandate in place while delaying the employer mandate. 

Our analysis shows that the different requirements have dramatically different implications for cost and coverage under reform. 

We use the Urban Institute's Health Insurance Policy Simulation Model (HIPSM), a state-of-the-art microsimulation model for 

estimating the cost and coverage implications of an array of changes to the health care system. The analysis compares the distribution 

of coverage under the full ACAj the ACA without an employer mandate, and the ACA without an individual mandate. We show 

that the employer mandate delay has almost no effect on overall coverage under the ACA or the distribution of that coverage across 

public and private sources of coverage. Eliminating the individual mandate, however, would significantly increase the number of 

uninsured compared to full implementation of the ACA, decreasing employer coverage as well. These findings are consistent with 

the evidence in Massachusetts, where coverage reforms were implemented beginning in 2006. The delay of the employer mandate 

also has little effect on government spending on subsidies or Medicaid, but does result in a slight reduction in government revenue. 

While a delay of one year in the implementation of the employer mandate will not have a discernible efiect on coverage or 

government spending on insurance, delaying the individual mandate would undermine a critical component of the coverage 

expansion in the ACA. Combined with the Medicaid expansion, insurance market refOrms, and subsidies to assist those with 

modest incomes to purchase private insurance through the health insurance exchanges, the ACNs individual responsibility 

requirement provides stability to insurance pools and financial access to adequate coverage for a broad swath of the population 

disadvantaged by the prior system. 

Introduction 

On July 2, the Obama administration 

announced a one-year delay in the 

implementation of employer penalties 

for large employers (50 or more workers) 

who do not offer affordable coverage to 

their full-time workers (30 or more hours 

per week) under the Affordable Care 

Act (ACA).' Under the law, a penalty 

is imposed on larger employers if at 

least one of their full*t1me employees 

purchases coverage through one of the new 

nongroup health insurance exchanges (or 

marketplaces) and uses a federal subsidy to 

do so. The announcement of the delay was 

met with some suggesting that the employer 

penalties amounted to a key component 

of the ACA and, as such, inferring that 

the delay was further evidence that the 

law was unworkable.2 Some members of 

Congress and some health policy analysts 

expressed their feelings that it was "unfair" 

to delay the penalty on employers but to 

leave the penalty on individuals in place, 

indicating that the individual responsibility 

requirement ought to be delayed as welL3 

In contrast, our analysis compares the 

effectiveness of the two policies and 

shows that the employer responsibility 

requirement is not central to expanding 

insurance coverage and does not have 

substantial effects on the public and 

Support tor this report was provided by a grant from the Robert Wood Johnson Foundation. 

private costs associated with the coverage 

expansion. That is. the ACA can achieve 

aU its major objectives without the 

employer responsibility provisions. On 

the other hand, the individual mandate 

is clearly a central component of the law 

and its anticipated coverage expansion. 

Using the Urban Institute's Health 

Insurance Policy Simulation Model 

(HIPSM), we show that the employer 

mandate delay has almost no effect 

on overall coverage under the ACA or 

the distribution of that coverage across 

public and private sources of coverage. 

Eliminating the individual mandate, 

II Urban Institute 
59 


86396.012

Table 1: Health Insurance Coverage Distribution of the Nonelderly, With and 

Without Reform 

_d 

Employer (Non-E.xthal'lge) 

Employe.r(ExChaflge) 

EmpIoyerTotal 

Nongroup(No!1-Excllal1ge) 15,218,000 

Nongroup(Exchafl{le) 0 

NongroupTotaJ 15,218,000 

Souree: Urban InsttIuteanal}'Sis.HlPSM 2013 

Note: TtleACA simulated as if fully Implemented in 2013, 

however, would significantly increase the 

number of uninsured compared to full 

implementation of the ACA. decreasing 

employer coverage as welL These findings 

are consistent with the evidence in 

Massachusetts, where coverage reforms 

were implemented beginning in 2006. The 

delay of the employer mandate also has 

little effect on government spending on 

subsidies or Medicaid. but does result in a 

slight reduction in government revenue. 

Approach 

We use the Urban Institute's HIPSM 

to estimate the effects of health reform 

among the nonelderly population.4 The 

Urban Institute has mOTe than 10 years of 

experience using detailed microsimulation 

models to simulate the effects of changes 

in health policy, including analysis of 

Massachusetts' landmark health refonn 

law. HIPSM is our latest model. and it has 

been used in more than 40 publications 

and research reports since its launch in 

2009. National ACA results using HIPSM 

are generally comparable to those of other 

commonly used models, such as that used 

by the Congressional Budget Office (CBO), 

HIPSM simulates the decisions of 

businesses and individuals in response 

to policy changes, such as Medicaid 

expansions, new health insurance 

options, subsidies for the purchase of 

health insurance, and insurance market 

reforms, The model estimates changes 

% ». %' 'SO .... ' ~,541,OOO ,.84. .... , 

55.5% 148,203,000 51.5% 

0.0% 10,112,000 3.2% 

55.5% 158,315,000 57.1% 57.0% 151,848,000 54.7% 

5.5% 2,660,000 1.0% 2,658,000 1.0% 2,043,000 0.7% 

0.0% 15,881,000 5.7% 15,671,000 5.6% 11,483,000 4.1% 

5,5% 18,541,000 6.7% 18,329,000 6,6% 13,526,000 4.9% 

16.7% 63,879,000 23,0% 63,843,00() 61,320,000 22.1% 

3.2% 8,807,000 ~2% 8,807,000 8,807,000 ,;,. 

a,.92a,D® ,\1Q;.1%': ._,00'(" '41 

m,~ooo, ,"'0% 2n.~OOO 27,7,~ 

Figure 1: Share of the Non-Elderly Who are Uninsured 

Today Compared with Reform 

25 

21) 

15 

10 

ACA 

Source: UrbaI1 InstItuteanalysis,H1PSM 2013 

Note: The ACA simulated as if fully Implemented in 2013, 

in government and private spending, 

premiums, rates of employer offers of 

coverage, and health insurance coverage 

resulting from specific refonns. We simulate 

the main coverage provisions of the ACA as 

if they were fully phased in today (2013).' 

Individuals age 65 and over eligible for 

Medicare are excluded from the analysis, 

Results are simulated as if each state 

eventually chooses to participate in the 

Medicaid expansion; this assumption has 

no effect on the rdative differences across 

the policy options examined here. 

ACAWHhout 

Employer Mandab! 

ACAWltllout IndivllluaiMarn:tate 

We provide coverage and spending 

simulation results under four scenarios: 

• NoACA; 

• Full implementation of all the 

ACN.s policies; 

• ACA with no employer mandate 

(individual mandate and all other 

coverage-related reforms in place); and 

• ACA with no individual mandate 

(employer mandate and all other 

coverage~related reforms in place). 

Timely Analysis of Immediate Heatth Policy Issues 
60 


86396.013

Table 2: Health Care Spending of Government and Employers, With and Without 

Reform (in millions) 

lklvernmBnt,Sj)elyJrnQ' 

Medicaid/SCHIP' $284,253 

Federal Share $162,9a4 

StateSlmre $121,269 

Premium Subsidies $0 

Cost-Shating:Subsidies $0 

EmployarSubsidies $0 

imllvitillaiMandatePenalties $0 

Employef Mandate Pena!tles $0 

....... _~ii!I $284 .... 

$ource: Urban Institute analySls, HIPSM 2013 

Note: TheACA simulated as if fully implemented in 2013. 

'Spe!1ding on acute care costs for the lloneldel1y. 

Results 

Coverage. Table 1 shows the distribution 

of insurance coverage for each of the four 

policy scenarios: no ACA, full ACA, ACA 

without the employer mandate, and ACA 

without the individual mandate. The share 

of the population uninsured under each 

policy scenario is also shown graphically 

in Figure L Under the full implementation 

of the ACA, the share of the nonelderly 

population uninsured is estimated to 

decline from 19.2 percent absent any 

reform to 10.1 percent. Nongroup and 

employer coverage both increase, but the 

reason for more than half of the decline in 

the uninsured is the increase in Medicaid 

covemge, under our assumption that all 

states participate.6 This impact on overall 

coverage is essentially unchanged if the 

employer mandate is removed ITom the rest 

of the AC/ts reforms; the share uninsured 

falls to 10.2 percent instead of 10.1 percent 

under the full refoan. 

Eliminating the employer mandate has 

very little effect on the distribution of 

coverage; it remains virtually identical to 

the case when the full ACA is in effect.7 1n 

particular, there is no large movement from 

employer~based coverage to the nongroup 

exchanges. Most employers offer coverage 

today, when they face no penalty, and they 

S344.105 

$224,464 

$119,642 

$37,473 

$4,166 

$4,368 

-$3,540 

-$3,717 

$382,&1& 

will, by and large, continue to do so under 

the ACA. 8 The bottom line: most workers' 

firms will be dominated by workers who 

will receive better benefits and, through the 

tax system, better subsidies through the tax 

exclusion for employer-provided coverage 

than for coverage purchased through newly 

created insurance exchanges. If employers 

were to drop coverage, over time they 

inevitably would make their most valued 

workers worse off. If those workers sought 

employment elsewhere as a result, then 

the firm would be worse off as well, Thus, 

under the ACA, the employer penalty is not 

what keeps employers offering coverage; it 

is the preferences of their workers, the same 

reason large employers are very likely to 

offer coverage even before implementation 

of health care reform. ~ 

Eliminating the individual mandate has 

a much greater impact, with insurance 

coverage declining significantly; Without 

the individual mandate, the share of 

the nonelderly population uninsured 

would only fall to 15.1 percent of the 

population. In contrast, under the full 

ACA, the uninsured fulls to 10.1 percent 

of the population. This difference in 

coverage means that an extra 13.7 million 

people would be uninsured under the 

ACA without an individual mandate 

compared to the situation with no 

I,,': , <:: : 

$344,276 $337,955 

$224,694 5220,325 

S119,582 $117,£3{I 

$37,036 $31,808 

$4,161 $3,328 

$4,343 $4,035 

-$3,552 $() 

$() -$6,108 

$381\263 ml,ow 

employer mandate. Even without an 

individual mandate. insurance coverage 

remains above the levels with no reform 

at all, since some individuals will take 

advantage of increased eligibility for 

Medicaid and subsidized insurance 

coverage in the nongroup exchange even 

without a requirement to do so. 10 

In the absence of an individual mandate, 

the rate of employer~sponsored insurance 

coverage (exchange and nonexchange 

combined) would be lower than under the 

full ACA: 54.7 percent of the none1derly 

compared to 57.1 percent of the nonelderly. 

Nongroup coverage and Medicaid/CH1P 

coverage would be lower as welL 

Our earlier analysis!! showed that the 

individual mandate combined with 

income-related financial assistance for 

the purchase of nongroup coverage, even 

in the absence of an employer mandate, 

increases employer-based insurance 

coverage. This microsimulation finding was 

since confirmed by survey results following 

implementation of comprehensive health 

reform in Massachusetts.!2,t3 Once the 

individual requirement to have coverage 

is in place, uninsured individuals identify 

the best source for obtaining that coverage, 

For a significant number of them, their best 

option will be to purchase coverage through 

Timely Analysis of Immediate Health Policy Issues 3 
61 


86396.014

their employer. As a result, some workers 

will take up offers they had previously 

declined, and Some employers will begin to 

offer coverage for the first time, knowing 

that their employees are newly willing to 

trade off some of their wages in order to 

receive some of their compensation as 

health insurance. 

Government and Employer Spending. 

Eliminating the employer mandate 

fiom the ACA has very little effect on 

government spending (table 2). Medicaid 

and spending on exchange*based premium 

and cost-sharing subsidies remain largely 

unchanged between the full-ACA and 

no-employer~mandate scenarios. There is 

about a 1 percent decrease in premium 

and cost~sharing subsidies paid through 

the exchanges, which parallels a roughly 

1 percent decline in exchange-based 

coverage. Overall, these findings reflect 

the results discussed previously that there 

is almost no difference in the distribution 

of insurance coverage. 

The only noticeable difference when 

the employer mandate is dropped is that 

the federal government loses the $3.7 

billion in revenue that it would otherwise 

recelve from employer penalties, a finding 

comparable to that ofeBo.l') Likewise, 

there is virtually no change in employer 

spending on premiums, since employer 

coverage stays quite constant. IS Employers 

do save, however. by not paying penalties. 

By contrast, eliminating the individual 

mandate but leaving the employer mandate 

in place does lead to significant difterences 

in spending. Medicaid spending is $6.2 

biltion lower due to fewer individuals 

enrolling in the program absent the 

individual mandate. As has been seen 

in Massachusetts, even those groups 

who would not be directly subject to an 

individual mandate penalty-due, for 

example, to exemptions for being low 

income-increase their take-up of Medicaid 

in the presence of an individual mandate. 

This may stem from misunderstanding their 

exempt status or from changes in social 

expectations of coverage in the presence of 

a general requirement affecting others. As 

a result, without the individual mandate. 

even the number of individuals covered by 

Medicaid will be lower, as will spending on 

the program. 

As a consequence of lower demand 

for employer-based coverage absent an 

individual mandate, small employers 

are less likely to offer coverage to their 

workers, lowering federal spending 

on small employer subsidies by about 

$300 million. Individual mandate 

penalties are eliminated in this scenario, 

decreasing federal revenue by about $3.5 

billion relative to the full ACA case. 

If the individual mandate is eliminated 

but the employer mandate is kept in pJace, 

employer penalties are significantly higher; 

federal revenues mount to $6.1 billion 

compared to $3.7 billion under the full 

ACA implementation. This results from a 

smaller number of workers in finns of 50 

or more being offered coverage without an 

individual mandate. Some of these workers 

purchase insurance through exchanges 

and receive subsidies, leading to their 

finns being assessed penalties. Without 

the individual mandate, the demand for 

health insurance among some workers falls, 

and some employers no longer offer it. We 

estimate that about 2 million fewer workers 

in large firms would receive offers without 

an individual mandate (data not shown), 

and thus more large employers are subject 

to employer mandate penalties. 16 

Employer premium spending in the 

absence of the individual mandate is 

lower than under the full ACA, as fewer 

workers and dependents are covered. Large 

employers' spending on penalties is higher 

and small employer subsidies are modestly 

lower, as was already discussed. 

Discussion 

Microsimulation results using HIPSM show 

that the ACRs individual mandate has a 

significant effect on health insurance coverage 

and spending by government and employers, 

but the employer mandate does not. Delaying 

or eliminating the individual mandate would 

significantly decrease insurance coverage 

relative to the full ACNs implementation, 

whereas delaying or eliminating the 

employer mandate will have essentially 

no effect on coverage or program costs. 

The employer mandate is not central to the 

coverage goals of the ACA, though it does 

playa very modest financing role. Some 

have argued that the employer mandate 

will dissuade employers that currently offer 

coverage to their workers from stopping 

doing so once the rest of the reforms are in 

place. However, the analytic evidence and 

the experience in Massachusetts does not 

support the need for employer penalties 

for that purpose. Thus, a delay of one 

year in its implementation will not have a 

discernible effect in that regard. 

The individual mandate, in contrast, is a 

critical component of the coverage expansion 

in the ACA Combined with the Medicaid 

expansion, insurance market refonns, 

and subsidies to assist those with modest 

incomes to purchase private insurance 

through the health insurance exchanges, 

the ACNs individual responsibility 

requirement provides stability to insurance 

pools and financial access to adequate 

coverage for a broad swath of the population 

disadvantaged by the prior system. The 

principal objectives of the law can be 

met without the employer requirement, 

and implementation of the law should 

be made considerably easier without it. 

Timely Analysis of Immediate Health Policy Issues 4 
62 


86396.015

Endnotes 

1 Mazur MJ. ~Continuing to Implement the ACA 

in a Careful, Thoughtful Manner." Treasury Notl's. 

July 2, 2013. http://www.treasury,gov/connect/ 

~~Qillllmllng~tQ·iml2!ement"the-aca·in-il: 

Cilreful·thoughtful-manner-.• lspx. On July 5, 2013, 

the Department of Health and Human Services 

(HHS) announced a new rule, which induded 

changes to the subsidy eligibility verification 

process for state-based exchanges. This rule 

includes a narrow exception for 2014 related 

to verification of affordable offers of employer 

insurance. The federa! government had originally 

intended to conduct random sample checks of 

cases ofindividual-s reporting whether they have 

job-based insurance, but that federal assistance 

will not be available until 2015, HHS is aHowing 

the 16 states running their o\\'n exchanges 

to accept individuals' reports without doing 

sampling until HHS can begin doing it in 2015. 

Workers are still required, however, to provide 

information from their employers on coverage 

offered in the workplace. Judy Solomon provides 

a clear explanation of the verification delays at her 

blog, http://\\,'ww.offthecbartsblQg.ocg/autbor/ 

£\2l.Qm.QflL. 

\ Ideally, we would simulate reform in a future year, 

such as 2017, when the ACAand the associated 

behavioral changes of employers and individuals 

would be fully phased-in. Doing so requires an 

array of assumptions about the growth in health 

care expenditures, changes in employment and 

incomes, and other factors. For simplicity, here 

we simulate the reforms fully phased-in in the 

current year, and the comparisons across policy 

options are not affected by the choice of year, 

7 One noticeable exception is that a slightly Jarger 

share of employer coverage is expected to be 

purchased through the small group exchanges 

without the employer mandate. This occurs due to 

changes in source of coverage for a small number 

of families with one working spouse in a large firm 

and one in a small firm. In the absence of the 

employer mandate, a slightly smaller share of 

large-finn workers will have offers of coverage from 

their employer; consequently, if their spouse has an 

offer through a small employer, the family is more 

likely to obtain their coverage that war There is 

also a very slight decrease in nongroup coverage 

through the exchange of about 1 percent, When 

the number of workers offered declines by even a 

very small number, families change CO\'er<lge 

decisions in both the group and nongroup 

markets, which have very small secondary effects 

on premiums in those markets, which lead small 

numbers of other individuals and families to 

change their coverage decisions. Microsimulation 

models capture these interactions and secondary 

effects. but they are very small and not meaningful. 

B Blumberg L, Buettgens M, Feder J and Holahan 

J. ~Why Employers Will Continue to Provide 

Health Insurance: The Impact of the Affordable 

Care Act," Time!}' Analysis tif Immedial( Health 

Polity b!lles. Washington: The Urban Institute, 

2011, available at htt.g;Liwv;,\ .... urba~ 

~rt~m42B.Jlt!Dl. 

? The ACA with employer penalties in place may, 

however, provide incentives for employers to 

reduce premium contributions ror their lowest 

income workers if that is nec~ssary to avoid 

penalties. If so, some employers could decrease 

overall premiums by modifying the plans they 

offer by increasing deductiM-!s or other costsharing responsibilities. We do not model such 

potential changes to employer/worker premium 

divisions and cost-sharing structure of plans, 

to Absent an individual mandate, some individuals 

otherwise excluded from the nongroup market will 

enter it, and others wi!lleave t1at market due to the 

broader sharing of health care risk through modified 

community rating and other changes to insurance 

market rules, ultimately leavin;:; nongroup coverage 

at a lower level than the case ~ithout any reforms. 

11 Blumberg L}, Holahan}, We I A, et aL "ToVlc'ard 

Universal Cover<lge in Massachusetts." Inquiry, 

43(2); 102-21,]une 2006. 

1.1 Long SK, Stockley K and No ·dahl KW "'Coverage, 

Access, and Affordability under Health Reform: 

Learning from the Massachmetts Model." Inquiry, 

49(4); 303-16, Winter 201212013. 

)3 Employers of 11 or morewo~kers who do not 

make a "fair and reasonable contribution~ 

toward their workers' health Ulsurance can be 

assessed a penalty of up to $,!95 per worker 

per year. This nominal assessment is small 

enough to be roughly equivalent to an example 

of comprehensive reform wilh an individual 

mandate but not an employer mandate. Our 

microsimulation analysis pri')f to the passage 

of the state's 2006 reforms compared a scenario 

with an individual mandate ,md a "play or pay" 

employer mandate to an identical reform that 

excluded the employer man(:ate. 

14 Reports indicate that the CBa estimates lost 

revenue from elimination of the em.ployer 

penalties at $4 billion in 2014, See Kennedy K, 

"Delay of Employer Penaltie; Could Have 

Unintended Effects," USA 1?d<ry,}uly 7, 2013, 

http;//w\l:w.usatQday.("Qm/stf1n:ilt~<m: 

PQlitiq.!2Q13/Q7/03!hQw"hc~t: 

budget!248649.2L 

II Our results show aggregate employer spending on 

premiums of roughly .06 percent higher without 

the employer mandate than ·,vith it. This aggregate 

increase is a result of average employer premiums 

increasing by less than 1 percent without the 

employer mandate, due to very modest changes 

in the risk poo! of insured w)rkers. That premium 

increase is barely noticeable, hut in aggregate it 

leads to slightly higher overall employer spending 

on premiums as shown in taale 2. 

lb Without an employer manclllte, roughJy 1 million 

fewer workers in large firms 'vouJd have an 

employer offer of coverage through their own job 

(data not .ho\\'Il). 

Timely Analysis of Immediate Health PoliCY Issues 5 
63 


86396.016

The views expressed are those of the authors a:nd should not be attributed to the Robert WoodJohnson Foundation or the Urblln Institute. 

its trustees. or its funders. 

About the Authors and Acknowledgments 

Linda Blumberg is a Senior Fellow, John Holahan is an Institute Fellow, and Matthew Buettgens is a Senior Research Associate in the 

Urban Institute's Health Policy Center. This research was funded by the Robert Wood Johnson Foundation. The authors are grateful for 

research assistance by Chris Hildebrand and the comments and suggestions made by Steve Zuckennan and Katherine B<!icker. 

About the Urban Institute 

The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, ewnomic, 

and governance problems facing the nation. For more infurmation. visit h.....ttp;L~.urbatL.Qrg. Follow the Urban Institute on 

Twitter \\'WW.urban.or~.twitter or Facebook ~~.urban.org;facebook. The work of the Institute's Health Policy Center is highlighted on 

www.healthpoliC;YCCDtt.r..mg. 

" Timely Analysis of Immediate Health Policy Issues 6 
64 


86396.017

July 2013 

Benefits of the Health Care Reform Law in the 

33rd Congressional District of California 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October 1,2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable. and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care refonn law in Rep. 

Waxman's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

7,500 young adults in the district now have health insurance through their parents' plan. 

More than 12,000 seniors in the district received prescription drug discounts worth $17.5 

million, an average discount of $650 per person in 2011, 5740 in 2012, and 5550 thus far in 

2013. 

126,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

236,000 individuals in the district - including 48,000 children and 99,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

324,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 48,400 consumers in the district 

received approximately $3.6 million in insurance company rebates in 2012 and 2011 - an 

average rebate of 571 per family in 2012 and $65 per family in 2011. 

Up to 31,000 children in the district with preexisting healtb conditions can no longer be denied 

coverage by health insurers. 

329,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

63,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting healtb 

condition. In addition, tbe 128,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for fmaneial assistance. 
65 


86396.018

July 2013 

Benefits of the Health Care Reform Law in the 

1 sf Congressional District of Colo.rado 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October 1,2013, when 

health insurance marketplaces open in all SO states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

DeGette's district. It also provides the first picture ofth" impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

8,000 young adults in the district now have health insurance through their parents' plan. 

More than 6,900 seniors in the district received prescription drug discounts worth $9.3 million, 

an average discount of $570 per person in 2011, $660 in 2012, and 51,120 thus far in 2013. 

110,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

192,000 individuals in the district - including 36,000 children and 80,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

201,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 27,900 consumers in the district 

received approximately $5.2 million in insurance company rebates in 2012 and 2011- an 

average rebate of $134 per family in 2012 and $227 per family in 2011. 

Up to 37,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurerS. 

247,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

121,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition. In addition, the 55,000 individuals who currently purchase private health insurance 

on the individual or small group market will bave access to mQre secure, higher quality coverage 

and many will be eligible for financial assistance. 
66 


86396.019

July 2013 

Benefits of the Health Care Reform Law in the 

1 sf Congressional District of Iowa 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Ohama. But the largest benefits of the law will become available to consumers on October 1, 2013, when 

bealth insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quaJity, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Braley's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

5,100 young adults in the district now have health insurance through their parents' plan. 

More than 9,100 seniors in the district received prescription drug discounts worth $12.5 million, 

an average discount of$610 per person in 2011, $680 in 2012, and $790 thus far in 2013. 

129,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

238,000 individuals in the district - including 51,000 children and 95,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

179,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums On profits and 

administrative overhead. Because of these protections, over 7,100 consumers in the district 

received approximately $400,000 in insurance company rebates in 2012 and 20 II - an average 

rebate of $111 per family in 2012 and $100 per family in 2011. 

Up to 43,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

278,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

61,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition. In addition, the 50,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 
67 


86396.020

July 2013 

Benefits of the Health Care Reform law in the 

3rd Congressional District of New Mexico 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law wiD become available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals. families, 

and small businesses an efficient, transparent, one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage, 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Lujan's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 20 I 0 Census. As a result of the law: 

7,700 young adults in the district now have health insurance through their parents plan. 

More tban 5,600 seulors in the district received preserlption drug discounts worth $7.3 million, 

an average discount ofS480 per person in 2011, $810 in 2012, and $880 tbus far in 2013. 

105,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

147,000 individuals in the district - including 32,000 children and 60,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

122,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead, 

Up to 43,000 cbildren in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

163,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

147,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition. In addition, the 33,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 
68 


86396.021

July 2013 

Benefits of the Health Care Reform Law in the 

9th Congressional District of Illinois Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Schakowsky's district It also provides the first pictore of the impacts of the law in districts redrawn or 

newly created following the 2010 Census. As a result of the law: 

6,600 young adults in the district now have health insurance through their parents' plan. 

More than 8,700 seniors in the district received prescription drug discounts worth $13.8 million, 

an average discount of $730 per person in 2011, $800 in 2012, and $750 thus far in 2013. 

102,000 seniors in the district are now eligible fot Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

201,000 individuals in the district - including 39,000 children and 84,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

188,000 Individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 17,300 consumers in the district 

received approximately $3.9 million in insurance company rebates in 2012 and 201 I - an 

average rebate of $52 per family in 2012 and$3S0 per family in 2011. 

Up to 36,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

251,000 individuals in the district now have insurance that canoot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

99,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition. To addition, the 42,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for fmancial assistance. 
69 


86396.022

July 2013 

Benefits of the Health Care Reform Law in the 

1 st Congressional District of North Carolina 

Committees on Energy and Commerce, Ways and Means, and 

Education and tbe Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care refonn law in Rep. 

Butterfield's district. It also provides the first picture of the impacts oftbe law in districts redrawn or 

newly created following the 2010 Census. As a result of the law: 

8,200 young adults in the district now have health insurance through their parents' plan. 

More than 7,300 seniors in the district received prescription drug discounts worth $9.7 million, 

an average discount ofS600 per person in 2011, S680 in 2012, and SI,110 tbus far in 2013. 

130,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, Or deductible. 

150,000 individuals in the district - including 25,000 cbildren and 71,000 women - now have 

health insurance that covers preventive services 'without any co-pays, coinsurance, or deductible. 

138,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 13,200 consumers in the district 

received approximately SI.7 million in insurance company rebates in 2012 and 2011 - an 

average rebate of$87 per family in 2012 and $158 per family in 2011. 

Up to 41,000 cbildren in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

155,000 individuals in the district now have insurance that cannot place liferime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

• Up to 137,000 individual. in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.' In addition, the 33,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

, Presently. coverage for many of these individuals - those with incomes below 100% of the federal poverty levelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision tD take these funds and pro\ide this covernge is at the discretion of the 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
70 


86396.023

July 2013 

Benefits of the Health Care Reform Law In the 

14th Congressional District of Florida Committees on Energy and Commerce, Ways and Means, and Education and 

the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obarna. Bnt the largest benefits of the law will become available to consumers on October 1, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

fmancial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Castor's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the20lO Census. As a result of the law: 

9,800 young adults in lhe district now have health insurance through lheir parents' plan. 

More than 5,900 seniors in lhe district received prescription drug discounts worth $8.2 million, 

an average discount of$610 per person in 2011, $690 in 2012, and $840 thus far in 2013. 

87,000 seniors in lhe district are now eligible for Medicare preventive services wilhout paying 

any co-pays, coinsurance, or deductible. 

152,000 indhiduals in lhe district - including 29,000 children and 65,000 women - now have 

heallh insurance lhat covers preventive services without any co-pays, coinsurance, or deductible. 

134,000 individuals in lhe district are saving money due to ACA provisions lhat prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of lhese protections, over 43,000 consumers in the district 

received approximately $6.1 million in insurance company rebates in 2012 and 2011 - an 

average rebate ofS132 per family in 2012 and $168 per family in 2011. 

Up to 39,000 children in the district wilh preexisting health conditions can no longer be denied 

coverage by health insurers. 

181,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 156,000 individuals in the district who lack heallh insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition. I In addition, lhe 31,000 individuals who currently purchase private heallh insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

J Presently, coverage for many ofthese individuals .- those with incomes below J 00% of the federal poverty Jevelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion of the 

Governor and the Legislature, To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
71 


86396.024

July 2013 

Benefits of the Health Care Reform Law in 

Vermont 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October 1, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in the State 

of Vermont, which Rep. Welch represents. As a result of the law: 

5,000 young adults in state now have health insurance through their parents' plan. 

More than 6,100 seniors in the state received prescription drug discounts worth $9.4 million, an 

average discount of $720 per person in 2011, $780 in 2012, and $1,000 thus far in 2013. 

118,000 seniors in the state are now eligible for Medicare preventive services without paying any 

co-pays, coinsurance, or deductible. 

175,000 individuals in the state - including 30,000 children and 75,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

163,000 individuals in the state are saving money due to ACA provisions that prevent insurance 

companies from spending more than 20% of their premiums on profits and administrative 

overhead. Because of these protections, over 5,200 consumers in the state received 

approximately $2.5 million in insurance company rebates in 2012 and 201 I-an average rebate 

of$S8 per family in 2012 and $807 per family in 2011. 

Up to 31,000 children in the state with preexisting health conditions can no longer be denied 

coverage by health insurers. 

201,000 individuals in the state now have insurance that cannot place lifetime I imits on their 

coverage and will not face annual limits on coverage starting in 2014. 

41,000 individuals in the state who lack health insurance will have access to quality, affordable 

coverage without fear of discrimination or higher rates because of a preexisting health condition. 

Tn addition, the 32,000 individuals who currently purchase private health insurance on the 

individual or small group market will have access to more secure, higher quality coverage and 

many will be eligible for financial assistance. 
72 


86396.025

July 2013 

Benefits of the Health Care Reform Law in the 

20th Congressional District of New York 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October 1, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secore insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Tonko's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

6,500 young adults in the district now have health insnrance through their parents' plan. 

More than 12,100 seniors in the district received prescription drug disconnts worth $16 million, 

an average discount of$610 per person in 2011, $650 in 2012, and $290 thus far in 2013. 

124,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

223,000 individuals in the district - including 42,000 children and 95,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

227,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 43,600 consumers in the district 

received approximately $5.1 million in insurance company rebates in 2012 and 20 II - an 

average rebate of$92 per family in 2012 and $138 per family in 2011. 

Up to 37,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

262,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

49,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimioation or higher rates because of a preexisting health 

condition. In addition, the 31,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 
73 


86396.026

July 2013 

Benefits of the Health Care Reform Law In the 

29th Congressional District of Texas 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic StaHReport 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost inunediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October 1, 2013, when 

health insurance marl<etplaces open in aliSO states. These marl<etplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Green's district. It also provides the first picture of the impacts oftbe law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

11,000 young adults in the district now have health insurance through their parents' plan. 

More than 3,000 seniors in the district received prescription drug discounts worth $3.6 miUion, 

an average discount of $530 per person in 2011, $570 in 2012, and $1,090 thus far in 2013. 

58,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

96,000 individuals in the district - including 22,000 children and 36,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

89,000 individuals in the district are saving money due to ACA provisions that prevent insurance 

companies from spending more than 20% of their premiums on profits and administrative 

overhead. Because of these protections, over 24,600 consumers in the district received 

approximately $3.5 miUion in Insurance company rebates in 2011 and 2012 - an average rehate 

0[$95 per family in 2012 and $187 per family in 2011. 

Up to 55,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

121,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 261,000 indMduals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition. [ In addition, the 12,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

1 Presently, coverage for many of these individuals - those with ineo",", below 1 00% of the federal poverty levelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion oflhe 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
74 


86396.027

July 2013 

Benefits of the Health Care Reform Law in the 

12th Congressional District of Michigan 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October 1, 2013, when 

health insurance marketplaces open in aliSO states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent, one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Dingell's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result ofthe law: 

8,500 young adults in the district now have health insurance through their parents' plan. 

More than 6,200 seniors in the district received preseription drug discounts worth $7.9 million, 

an average discount of$580 per person in 2011, $750 in 2012, and $540 thus rar in 2013. 

107,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, Or deductible. 

206,000 individuals in the district - including 40,000 children and 86,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

183,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 2()% of their premiums on profits and 

administrative overhead. Because of these protections, over 16,700 consumers in the district 

received approximately :SZ.5 million in insurance company rebates in 2012 and 2011- an 

average rebate of $138 per family in 2012 and $214 per family in 2011. 

Up to 39,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

252,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 75,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.! in addition, the 40,000 Individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

I Presently, covemge for many of these individuals - those with incomes below 100% of the federal poverty level -

is in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the deei.ion to take these funds and provide this coverage is at the discretion of the 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
75 


86396.028

July 2013 

Benefits of the Health Care Reform Law in the 

6th Congressional District of Michigan 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October 1,2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent, one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care refonn law in Rep. 

Upton's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 20lO Census. As a result of the law: 

6,700 young adults in the district now have health insurance through their parents' plan. 

More than 9,100 seniors in the district received prescription drug discounts worth $11.4 million, 

an average discount of $590 per person in 2011, $740 in 2012, and $850 thus far in 2013. 

131,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

197,000 individuals in the district - including 43,000 children and 80,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

163,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 16,000 consumers in the district 

received approximately $2.3 million in insnrance company rebates in 2012 and 201 I - an 

average rebate oUl38 perfamily in 2012 and $214 per family in 2011. 

Up to 41,000 ehildren in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

223,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 84,000 individuals in the district who lack health insurance will bave access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.' in addition, the 36,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

, Presently, coverage for many of these individuals - those with incomes below 100% of the federal poverty levelis in doubt. The ACA provides for tbe fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion ofthe 

Governor a.."d the Legislature. To date~ the Governor and Legislature have Dot approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
76 


86396.029

July 2013 

Benefits of the Health Care Reform Law in the 

18th Congressional District of Pennsylvania 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately aftet it was signed into law by President 

Obama. But the largest benefits of the law will become available to consurnetS on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for higb-quality, affordable, and secure insurance covetage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Murphy's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

3,800 young adults in the district now have health insurance througb tbeir parents' plan. 

More than 15,300 seniors in the district received prescription drug discounts worth $23.1 

milUon, an average discount of $620 per person in 2011, $800 in 2012, and $730 thus rar in 

2013. 

133,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

• 230,000 individuals in the district - including 45,000 children and 97,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

181,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 35,800 consumers in the district 

received approximately $3.6 million in insurance company rebates in2012 and 201l-an 

avetage rebate of$77 per family in 2012 and $165 per family in 2011. 

Up to 35,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insuretS. 

266,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 49,000 individuals in the district who lack health insurance will have access to quality, 

affordable covetage without fear of discrimination or higbet rates because of a preexisting health 

condition.' In addition, the 40,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higbet quality coverage 

and many will be eligible for financial assistance. 

, Presently, coverage for many of these individuals - those with incomes below 100% of the federal poverty levelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion of the 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
77 


86396.030

July 2013 

Benefits of the Health Care Reform Law In the 

26th Congressional District of Texas 

Committees on Energy and Commerce, Ways and Means, and 

Edncation and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost irrunediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October 1, 2013, when 

health insurance maticetplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care refonn law in Rep. 

Burgess's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

• 9,500 yonng adults in the district now have health insurance through their parents' plan. 

More than 4,900 seniors in the district received prescription drug discounts worth $7 minion, an 

average discount of $650 per person in 2011, $720 in 2012, and $850 thns far in 2013. 

• 55,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

232,000 individuals in the district - including 66,000 children and 86,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

230,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums On profits and 

administrative overhead. Because of these protections, over 59,300 consnmers in the district 

received approximately $8.3 minion in insurance company rebates in 2012 and 2011 - an 

average rebate of$95 per family in 2012 and $187 per family in 2011. 

• Up to 48,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

• 305,000 individuals in the district now have insurance thai cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 90,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition. I in addition, the 44,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

I Presently, coverage for many of these indi;iduals - those with incomes below 100% of the federal poverty levelis in doubt. The ACA pro;ides for the fully funded expansion of Medicaid to cover these indi;iduals. However, the 

Supreme Court has ruled that the decision to take these funds and pro;ide this coverage is at the discretion of the 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these indi;iduals, putting their access to affordable co verage in doubt. 
78 


86396.031

July 2013 

Benefits of the Health Care Reform Law in the 

7th Congressional District of Tennessee 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama But the largest benefits of the law will become available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for hlgh-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new d!lta on the significant benefits of the health care reform law in Rep. 

Blackburn's district. It also provides the first picture of the impacts of the law in districts redrawn or 

newly created following the 2010 Census. As a result of the law: 

5,900 young adults in the district now have health insurance through their parents' plan. 

More than 8,000 seniors in the district received prescription drug discounts worth $10 million, 

an average discountofS580 per person in 2011, $610 in 2012, and $960 thus far in 2013. 

116,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

191,000 individuals in the district - including 50,000 children and 75,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

181,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 27,900 consumers in the district 

received approximately $4 million in insurance company rebates in 2012 and 2011 - an 

average rebate of $69 per family in 2012 and $201 per family in 2011. 

• Up to 44,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

208,000 individuals in the district now have insurance that canoot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 91,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or bigher rates because of a preexisting health 

condition.' In addition, the 39,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

I Presently, coverage for many of these individuals- those with incomes below 100% of the federal poverty levelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion of the 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
79 


86396.032

July 2013 

Benefits of the Health Care Reform Law in the 

11 th Congressional District of Georgia 

Committees on Energy and Commerce, Ways and Means, and Education and 

the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Gingrey's district It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

8,300 young adults in the district now have health insurance through their parents' plan. 

More than 8,800 seniors in the district received prescription drug discounts worth $12.6 million, 

an average discount of $620 per person in 2011, $760 in 2012, and $900 thus far in 2013. 

86,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

195,000 individuals in the district - including 47,000 children and 78,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

169,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 19,900 consumers in the district 

received approximately $2.8 million in insurance company rebates in 2012 and 2011 - an 

average rebate of $82 per family in 2012 and $134 per family in 2011. 

Up to 43,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

248,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not mce annual limits on coverage starting in 2014. 

Up to 129,000 indhiduals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.' in addition, the 45,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

, Presently, coverage for many of these individuals - those with incomes below J 00% of the federal poverty level 

is in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion of the 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
80 


86396.033

July 2013 

Benefits of the Health Care Reform Law in the 

1 st Congressional District of Louisiana Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent, one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Scalise's district. It also provides the first picture of the impacts oflhe law in districts redrawn or newly 

created follOwing the 2010 Census. As a result of the law; 

8,200 young adults in the district now have health insurance through their parents' plan. 

More than 13,600 seniors in the district received prescription drug discounts worth $17 million, 

an average discount of $570 per person in 2011, $650 in 2012, and $740 thus far in 2013. 

125,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

200,000 individuals in the district - including 43,000 children and 82,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

175,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 15,100 consumers in the district 

received approximately $1.2 million in insurance company rebates in 2012 and 2011 - an 

average rebate of $50 per family in 2012 and $94 per family in 2011. 

Up to 42,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

239,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not tace annual limits on coverage starting in 2014. 

Up to 112,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.' In addition, the 51,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

J Presently, coverage for many cfthese individuals - those with incomes below 100% of the federal poverty levelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion oflhe 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
81 


86396.034

July 2013 

Benefits of the Health Care Reform Law In the 

3rd Congressional District of Mississippi Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October 1,2013, when 

health insurance marketplaces open in alISO states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent, one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits ofthe health care reform law in Rep. 

Harper's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

9,100 young adults in the district now have health insurance through their parents' plan. 

More than 9,000 seniors in the district received prescription drug discounts worth $11.7 million, 

an average discount of $610 per person in 2011, $650 in 2012, and $890 thus rar in 2013. 

132,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

184,000 individuals in the distriet- including 40,000 children and 77,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

153,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 16,400 consumers in the district 

received approximately $4.4 million in insurance company rebates in 2012 and 2011 - an 

average rebate of $140 per family In 2012 and $329 per family In 2011. 

Up to 44,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

217,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 114,000 indl~iduals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.' In addition, the 44,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

I Presently, coverage for many of these individuals - those with incomes below J 00% of the federal poverty levelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion ofth. 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
82 


86396.035

July 2013 

Benefits of the Health Care Reform Law in the 

22nd Congressional District of Texas 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost itrunediately after it was signed into law by President 

Obama. But the largest benefits oflhe law will become available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care refonn law in Rep. 

Olson's district It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

7,500 young adults in the district now have health insurance through their parents' plan. 

More than 5,500 seniors in the district received prescription drug discounts worth $8 million, an 

average discount of$680 per person in 2011, $730 in 2012, and $660 thus far in 2013. 

65,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

212,000 individuals in the district - including 61,000 children and 77,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

• 208,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 54,100 consumers in the district 

received approximately $7.6 million in insurance company rebates in 2012 and 20 II - an 

average rebate of$95 per family in 2012 and $187 per family in 2011. 

Up to 49,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

279,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 127,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.' In addition, the 35,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

I Presently, coverage for many of these individuals - those with incom:s below 100% of the federal poverty levelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion of the 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals) putting their access to affordable coverage in doubt. 
83 


86396.036

July 2013 

Benefits of the Health Care Reform Law in the 

4th Congressional District of Colorado 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will beoome available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Gardner's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result oftbe law: 

6,000 young adults in the district now have health insurance through their parents' plan. 

More than 4,700 seniors in the district received prescription drug discounts worth $6.3 million, 

an average discount 0£$600 per person in 2011, $660 in 2012, and $990 thns far in 2013. 

81,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

206,000 individuals in the district - including 53,000 children and 79,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductihle. 

215,000 individnals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 30,000 consumers in the district 

received approximately $5.6 million in insnrance company rebates in 2012 and 2011 - an 

average rebate of$134 per family in 2012 and $227 per family in 2011. 

Up to 47,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

265,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

100,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition. In addition, the 58,000 individnals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligihle for financial assistance. 
84 


86396.037

July 2013 

Benefits of the Health Care Reform Law in the 

9th Congressional District of Virginia Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October 1, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care refonn law in Rep. 

Griffith's district. It also provides the first pictnre of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

6,800 yonng adults in the district now have health insurance through their parents' plan. 

• More than 12,200 seniors in the district received prescription drug discounts worth $17.7 

million, an average discount 0[$620 per person in 2011, $770 in 2012, and $840 thns far in 

2013. 

162,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

189,000 individuals in the district - including 32,000 children and 81,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

168,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 18,600 OR 54,000 consumers in the 

district received approximately $4.3 million in insurance company rebates in 2012 and 2011 

an average rebate oU88 per family in 2012 and $115 per family in 2011. 

Up to 34,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

214,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 93,000 Individuals in the district who lack health insurance will bave access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.' In addition, the 41,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for fInancial assistance. 

1 Presently, coverage for many of these individuals - those with incomes below 100% of the federal poverty levelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion of the 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
85 


86396.038

July 2013 

Benefits of the Health Care Reform Law in the 

6th Congressional District of Ohio 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care refonn law in Rep. 

Johnson's district It also provides the first picture ofthe impacts ofthe law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

• 5,100 young adults in the district now have health insurance through their parents' plan. 

More than 15,200 senion; in the district received prescription drug discounts worth S20.8 

million, an average discount ofS510 per pen;on in 2011, S810 in 2012, and $860 thus far in 

2013. 

"162,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

• 186,000 individuals in the district - including 38,000 children and 76,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

149,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 8,300 consumen; in the district 

received approximately S7oo,000 in insurance company rebates in 2012 and 2011- an average 

rebate ofS133 per family in 2012 and $139 per family in 2011. 

Up to 38,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

206,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 88,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.' In addition, the 22,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

I Presently, coverage for many of these individuals -those with incomes below 100% of the federal poverty levelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion of the 

Governor and the Legislature. To date, the Govemor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
86 


86396.039

July 2013 

Benefits of the Health Care Reform Law in the 

7th Congressional District of Missouri 

Committees on Energy and Commerce, Ways and ~ans, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections In 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent, one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care refonn law in Rep. 

Long's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created follOwing the 2010 Census. As a result of the law: 

7,500 young adults in the district now have health insurance through their parents' plan. 

More than 10,100 seniors in the district received prescription drug discounts worth $13.7 

million, an average discount of $600 per person in 2011, $680 in 2012, and $770 thns far in 

2013. 

141,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

194,000 individuals in the district - including 40,000 children and 79,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

139,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 68,900 consumers in the district 

received approximately $9.4 miIllon in insurance company rebates in 2012 and 2011 - an 

average rebate of $72 per family in 2012 and $173 per family in 2011. 

Up to 43,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

225,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up In 126,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.' In addition. the 40,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

J Presently, coverage for many ofthese individuals - those with incomes below 100% of the federal poverty levelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However. the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion ofthe 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
87 


86396.040

July 2013 

Benefits of the Health Care Reform Law in the 

2nd Congressional District of North Carolina 

Committees on Energy and Commerce, Ways and Means, and 

Education and tbe Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure insurance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care refonn law in Rep. 

Ellmers's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

6,600 young adults in the district now have health insurance through their parents' plan. 

More than 8,400 seniors in the district received prescription drug discounts worth $11.3 million, 

an average discount of $600 per person in 2011, $670 in 2012, and $990 thus far in 2013. 

119,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

197,000 individuals in the district - including 52,000 children and 77,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

142,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 17,300 consumers in the district 

received approximately $2.3 million in insurance company rebates in 2012 and 2011 - an 

average rebate of$87 per family in 2012 and $158 per family in 2011. 

Up to 47,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

207,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 109,000 individnals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.' In addition, the 38,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

1 Presently, coverage for many of these individuals - those with incomes below 100% of the federal poverty levelis in doubt. The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion of the 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
88 


86396.041

July 2013 

Benefits of the Health Care Reform Law In the 

6th Congressional District of Texas 

Committees on Energy and Commerce, Ways and Means, and 

Education and the Workforce 

Democratic Staff Report 

The landmark Affordable Care Act (ACA) began delivering important new benefits and protections to 

tens of millions of American families almost immediately after it was signed into law by President 

Obama. But the largest benefits of the law will become available to consumers on October I, 2013, when 

health insurance marketplaces open in all 50 states. These marketplaces will offer individuals, families, 

and small businesses an efficient, transparent one-stop shop to compare health insurance policies, receive 

financial assistance, and sign up for high-quality, affordable, and secure ins11rance coverage. 

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. 

Barton's district. It also provides the first picture of the impacts of the law in districts redrawn or newly 

created following the 2010 Census. As a result of the law: 

9,100 young adults in the district now have health insurance through their parents' plan. 

More than 6,400 seniors in the district received prescription drug discounts worth $8.7 million, 

an average discount of $610 per person in 2011, $680 in 2012, and $890 thus far in 2013. 

85,000 seniors in the district are now eligible for Medicare preventive services without paying 

any co-pays, coinsurance, or deductible. 

188,000 individuals in the district - including 46,000 children and 72,000 women - now have 

health insurance that covers preventive services without any co-pays, coinsurance, or deductible. 

183,000 individuals in the district are saving money due to ACA provisions that prevent 

insurance companies from spending more than 20% of their premiums on profits and 

administrative overhead. Because of these protections, over 48,100 consumers in the district 

received approximately $6.8 million in insurance company rebates in 2012 and 2011 - an 

average rebate ofS95 per family in 2012 and S187 per family in 2011. 

Up to 47,000 children in the district with preexisting health conditions can no longer be denied 

coverage by health insurers. 

241,000 individuals in the district now have insurance that cannot place lifetime limits on their 

coverage and will not face annual limits on coverage starting in 2014. 

Up to 142,000 individuals in the district who lack health insurance will have access to quality, 

affordable coverage without fear of discrimination or higher rates because of a preexisting health 

condition.' In addition, the 40,000 individuals who currently purchase private health insurance 

on the individual or small group market will have access to more secure, higher quality coverage 

and many will be eligible for financial assistance. 

I Presently, coverage for many of these individuals - tbose with incomes below 100% of the federal poverty levelis in doubt The ACA provides for the fully funded expansion of Medicaid to cover these individuals. However, the 

Supreme Court has ruled that the decision to take these funds and provide this coverage is at the discretion of the 

Governor and the Legislature. To date, the Governor and Legislature have not approved the expansion of Medicaid 

to these individuals, putting their access to affordable coverage in doubt. 
89 


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ASPE 

[sSUEBRIEF 

Market Competition Works: Proposed Silver Premiums in the 2014 Individual and Small 

Group Markets Are Nearly 20% Lower than Expected 

By: Laura Skopec and Richard Kronick, ASPE 

A goal of the Affordable Care Act is to increase competition and transparency in the markets for 

individual and small group insurance, leading to higher quality, more affordable products, To 

date, this proposition has largely been based on theory. The early market reforms, such as 

requirements for a minimum Medical Loss Ratio and for review of proposed rate increases of 

10% or greater, have clearly created value for consumers. 1 Further, data from the Medical 

Expenditure Panel Survey Insurance Component (MEPS-IC) shows that the average premiums 

for employer sponsored insurance increased by only 3% from 2011 to 2012, the lowest rate of 

increase observed since the data series started in 1996, However, the major changes in the rules 

for individual and small group insurance will begin in plan year 2014. 

Information on proposed premiums in the individual and small group markets has recently been 

made available by selected states, and it is now possible to move from theoretical arguments to 

data-driven analysis. This research brief analyzes proposed rates in the individual market for 

2014 in the eleven states that have made information available, and compares these rates to those 

estimated by the Congressional Budget Office (CBO). Further, for six states, we compare the 

rates that will be charged to small employers under the Affordable Care Act with the average 

amount that small employers would have been expected to pay in 2014 for comparable coverage 

and a comparable population, Details about our methodology and assumptions are available in 

the methods section. 

As shown below, we find that: 

In the eleven states for which data are available, the lowest cost silver plan in the 

individual market in 2014 is, on average, 18% less expensive than ASPE's estimate of 

2014 individual market premiums derived from CBO publications,2 

1 See Health Insurance Premium Increases in the Individual Market Since the Passage of the Affordable Care Act, 

Chu R, Kronick R, Februruy 2013, Available at: http://aspe,hhs,gov/healthirenorts/2013Irateincreaseindvmktlrb,cfm; 

and 80120 Rule Delivers More Value to Consumers in 2012 Centers for Medicare and Medicaid Services, June 2013, 

Available at: http'!lwww,cms,gov/CClIO/ResourceslForrns-Reports-and-Other-ResonrceSiDownloadsl2012-

medical-loss-ratio-report,pdf 

2 Throughout this document, we refer to the ASPE-derived CBO estimate, This is an estimate derived from CBO's 

March 2012 estimate that the average premium for a family enrolled in the second lowest cost silver plan will be 

$15,400 in 2016. See the methods section for details on how we derived a 2014 single premium from CBO's 2016 

fS'iIDfte 

Department of Health and Human Services 

Office of the Assistant Secretary for Planning and Evaluation 

http://aspe.hhs,gov 
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ASPE Research Brief Page 2 

• Further, the lowest cost silver plan available to small employers in 2014 in the six states 

with available data is estimated to be 18% less expensive, on average, than the average 

premium that small employers would be paying for a pre-Affordable Care Act silver plan 

trended forward. 

These preliminary rates may be further lowered before health plans are offered in 

Marketplaces3 this fall. Already, in a number of states (DC, OR, RI, VT), the rate review 

process and competition are resulting in final rates that are significantly below rates 

proposed earlier this spring. 

Preliminary premiums appear to be affordable even for young men - a group about which 

there has been concern about "rate shock." There are approximately 750,000 young men 

(ages 18-34) who will not qualify for a premium tax credit who are currently enrolled in 

the individual market. In Los Angeles County (the county with the largest number of 

uninsured Americans in the nation), the lowest cost silver plan in 2014 for a 25-year-old 

individual costs $174 per month without a tax credit, $34 per month for an individual 

whose income is $17,235 (or 150% of the Federal Poverty Level), and a catastrophic plan 

can be purchased for $117 per month for an individua1.4 

While further work is needed to better understand 2014 rates, the results strongly suggest that 

greater competition and transparency are leading to substantial benefits for both consumers and 

employers in these markets. 

Individual Market Results 

From the premiums released by eleven states, the lowest cost silver premium in the individual 

market is 18% lower than the ASPE-derived CBO estimate of 20 14 individual market premiums 

(Figure 1), and premium from the second lowest cost issuer is 10% lower than the ASPE-derived 

CBO estimate (Figure 2). As noted in the methods section, we make some assumptions about 

medical trend and about reinsurance parameters for the Affordable Care Act reinsurance progranJ 

in order to infer a 2014 premium consistent with the 2016 CBO premium estimates, and we 

make assumptions about the age distribution of individual market enrollees in order to compare 

the proposed premiums by age group for 2014 with the average premium estimated by CBO. 

With that caveat, we are quite confident that the average premiums proposed by the lowest cost 

and second lowest cost issuers in the eleven states where data are available are substantially 

below the second lowest cost plan that was inferred from the CBO in its modeling. 

It is theoretically possible that the eleven states for which we have data are not representative of 

the rest of the nation, and that when data are available from all fifty states and the District of 

Columbia that the national averages will be much closer to the ASPE-derived CBO estimates. 

However, we note that the weighted average small group premiums from MEPS-IC data in these 

3 "Marketplaces" are also known as "American Health Benefit Exchanges" or "Exchanges" as defined by and 

established in Section 1311 of the Affordable Care Act. In addition, Marketplaces may be established and operated 

by a state (State-based Marketplaces or "SBMs"), by the federal government (Federally-facilitated Marketplaces or 

"FFMs"), or by the federal government with state participation (State Partnership Marketplaces or "SPMs''). 

4 Tax credits can not be used for the purchase of catastrophic plans. 

ASPE Office of Health Policy July 2013 
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eleven states is close to the national avemge, and that data on per capita health spending in these 

eleven states from the CMS Office of the ActuaI)"s National Health Accounts also shows the 

weighted avemge per capita spending in these states are close to the national avemge. Thus, it 

seems unlikely that data from all states will be much different. For individual states, however, it 

is possible that the state-level premiums could be closer to ASPE-derived CBO estimates, while 

national or multi-state averages remain below ASPE-derived CBO estimates. 

Although there are many hypotheses that might account for the fmding that actual premiums 

appear to be substantially below ASPE-derived CBO estimates, a likely explanation is that 

greater competition and greater tmnsparency are driving down prices in the Marketplace. 

We note that, although the ASPE-derived CBO estimate of 20 14 premiums is higher than the 

actual 2014 premium costs seen to date, the ASPE-derived CBO estimate was still much closer 

to actual 2014 premiums than those of many other analysts. For example, in a 2009 report, 

Oliver Wyman estimated that the average premium for an individual purchasing coverage in the 

individual market would be $4,561(or $380 per month) in 2009 dollars due to the Affordable 

Care Act reforms, and that this would represent a 54% premium increase over the status quo.s It 

is not clear from the report what actuarial value (A V) level the Oliver Wyman analysis assumed, 

but it seems likely that the assumption was for an A V no greater than a silver level, and, 

probably, less. We trended forward the 2009 estimate to 2014 dollars using CMS Office of the 

ActuaI)' trends in private health insurance per person, which is almost certainly a substantial 

underestimate of the rate of increase in individual market premiums. This yields a 2014 

estimated premium of $5,400 annually, or $450 per month. 6 Even using this low estimate of 

trend, and assuming the average individual market actuarial value is in the silver range (which is 

likely an overestimate), the Oliver Wyman predictions are clearly far above the reality of2014 

premiums. In the eleven states with available data 2014 premiums average $321 per month for 

the lowest cost silver plan, and $352 per month for the second lowest cost issuer. 

5 Impaci of Ihe Palien! Protection and Affordable Care Act on Costs in Ihe Individual and Small Employer Health 

Insurance Markets. Oliver Wyman. December 2009. Available at http://www.oliverwyman.comimediafYBS009-11-

28 PPACA120309.pdf 

6 We trended forward to 2()14 using estimates of per enrollee private health insurance spending increases from 2012 

to 2013 and 2013 to 2014 from the Office of the Actuary described in footnote 8, as well as 2009-2010 and 2010-

2011 estimates from https:liwww.cms,govlResearch-Statistics-Data-and-Systems/Statistics-Trends-andReportslNationalHealthExpendDatalDownloads/tables.pdf. The 2011-2012 estimate, also from the Office of the 

Actuary, was 2.9%. Many people would expect that actual trend will be higher than these estimates, particularly for 

individual market premium growtb. To tbe extent that actual trend is bigber, our analysis is conservative - that is, 

true savings are likely higber than those estimated here. 

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Figure I: Comparison of ASPE-Derived CBO 2014 Premium Estimate to Individual 

Market Lowest Cost Silver Premium, Weighted by Expected 2014 Individual Market Age 

Distribution 

$450 

$400 

$350 

$300 

$250 

$200 

$150 

$100 

$50 

$-

Note: Ohio and Virginia have not yet posted premiums for oil issuers; the numbers presented here may be higher 

than the {owest cost 2014 silver premiums when all filings are posted. 

Sources: Congressional Budget Office estimate derived as described infoo/note 19, State datafrom publicly 

a>,ailahle sources, weighted by RAND COMPARE estimate of enrollment by age in the individual market in 2014. 

US average constructed by weighting each state according to its proportion of individual market enrollees per the 

201 J Medical Loss Ratio filings. 

e; 

ASPE Office of Health Policy July 2013 

M 
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ASPE Research Brief PageS 

Figure 2: Comparison of ASPE-Derived CBO 2014 Premium Estimate to Individual 

Market Second Lowest Cost Issuer's Silver Premium, Weighted by Expected 2014 

Individual Market Age Distribution 

$500 

$450 

$400 

$350 

$300 

$250 

$200 

$150 

$100 

$50 

$-

$392 

to" <:":lI::SI 

C:::I' I I:: 

::>":::11 ~l~~ 

$440 

$384 .~-

::>,jq::l e::l1r::: ::>,j:lU 

5280 

Note: Ohio and Virginia have not yet posted premiums for all issuers; the numbers presented here may be higher 

than the lowest cost 2014 silver premiums when alljilings are posted. 

Sources: Congressional Budget Office estimate derived as described infOOlnote 19. State datafrom publicly 

available sources, weighted by RAND COMPARE estimate of enrollment by age in the individual market in 2014. 

US average constructed by weighting each state according to its proportion of individual market enrollees per the 

2011 Medical Loss Ratio jilings. 

Small Group Market Results 

In the six states for which small group data is readily accessible, the lowest small group silver 

premium for single coverage, weighted by small group age distribution, is 8% to 36% lower than 

the estimated pre-Affordable Care Act 2014 small group average premium for single coverage/ 

averaging 18% lower across these six states when weighted by total small group market size. 

Similarly, the small group premium from the second lowest cost issuer for 2014 is 6% to 36% 

lower than the estimated pre-Affordable Care Act 2014 small group premium (Table 1), 

averaging 15% lower across these six states. 

7 The pre-Affordable Care Act average premium is based on MEPS-IC survey data. In the pre-Affordable Care Act 

market, most states allowed health status rating in the small group market, often restricted to a "rate band" of +1-

35% of the base rate. As of January 1,2014, this practice is no longer allowed for new or renewing small group 

health plans. 

ASPE Office of Health Policy July 2013 
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In addition, the State of New York has reported that its 2014 small group silver premiums are 

nearly 32% below CBO projections. 8 

As noted in the methods section, the data available for 2014 is different in kind from the preAffordable Care Act data. For pre-Affordable Care Act, we have reported average premiums in 

2011. We assume, based on data from two independent sources, that the average small group 

enrollee with single coverage is enrolled in a silver plan, but there is some uncertainty about this 

assumption. In addition, there may be variations in the average actuarial value of small employer 

plans by state, which we do not account for here. We use the Current Population Survey to 

estimate the age distribution of employees covered by single policies by small employers, and 

the uniform age curve specified by CMS to estimate the average amount that small employers 

would pay in 2014. 

Part of the reason that we estimate such substantial savings for small employers in 2014 is that 

we are comparing average premiums in the pre-Affordable Care Act environment to lowest cost 

and second lowest cost issuer premiums in 2014. Some employers offering silver plans in 2014 

may choose more expensive silver plans than the lowest cost or second lowest cost issuer 

options, in part because they or their employees value the wider networks that the more 

expensive plans may offer. But it is clear that all small employers have the option of choosing 

the lower price offerings, and for small employers, on average, these lower price offerings 

appear to offer substantial savings below the status quo for a comparable benefit package and a 

comparable population. 

8 Governor Cuomo Announces Approval of 2014 Health Insurance Plan rates for New York Health Benefit 

Exchange, July 2013, Available at: http://www,healthbenefitexchange.ny.gov!newslpress-release-govemor-cuomoannounces-approval-20 14-health-insurance-plan-rates-new-york 

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Table 1: Comparison of Pre-Affordable Care Act Small Group Average Premiums for 

S' In gl e C overage to 2014S m anG roup S'l I ver PI ans 

% 

Average Difference, 

Monthly % 2014 Small 

Small Difference, Group 

Group Pre- 2014 Small Second 

Affordable Second Group Lowest Cost 

Care Act Lowest Lowest Silver Issuer 

Premium, Lowest Cost Weighted Weighted 

Single Cost Silver Issuer's Averagevs Averagevs 

Coverage, Plan, Silver Plan, Status Quo Status Quo 

Inflated to Weighted Weighted Trended to Trended to 

2014 average average 2014 2014 

Colorado $474 $391 $412 -18% -13% 

District of 

Columbia $538 $343 $343 -36% -36% 

New Mexico $494 $323 $410 -35% -17% 

Oregon $458 $362 $369 -21% -20% 

Vermont $507 $400 $440 -21% -13% 

Washington $438 $404 $413 -8% -6% 

Sources: For average small group premIums, 2008-2011 MEPS IC trendedforward to 2014. See 

http://www.irs.govlpublirs-pdfli8941.pdC For 2014 small group market, publicly available premium data, weighted 

using CPS age distribution of small group employees with Single coverage described infootnote 24. 

Note: For pre-Affordable Care Act data, analysis assumes that the average Actuarial Value for small group plans 

was approximately 70"/0. It seems likely that there is state-level variation in average A V. but reliable state-level 

data on average AV in the small group market is nol available. 

Recent Reports on Rate Review 

As described above, most of the rates that have been published to date are preliminary and 

proposed. States typically review their rationale and basis, and rates may be lowered before they 

are fmalized. The 2012 Annual Rate Review Report issued by HHS found that, when issuers 

requested rate increases of 10% or more, the rate increase approved was lower than requested 

more than half of the time.9 In 2014, examples of issuers lowering rates include: 

• In Oregon, two issuers lowered their proposed 2014 individual market premiums within 

days of the State of Oregon's public release of2014 premium information.lO In addition, 

through the state's rate review process, the Oregon Insurance Division lowered proposed 

9 2012 Annual Rate Review Report: Rate Review Saves Estimated $1 Billion for Consumers. Centers for Medicare 

and Medicaid Services. September 2012. Available at: http://www.cms.govICCIlO/ResourcesIForms-Reports-andOther-Resources/rate-review091120 12a.html. 

to Two Oregon Insurers Rethink 2014 Premiums as Slate Posts First-Ever Rate Comparison. The Oregonian. May 9, 

2013. Available at: 

http://www.oregonlive.comihealthiindex.ssf/2013/0S/twooregoninsurersreconsider.html 

ASPE Office of Health Policy Juiy2013 
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rates for individual plans by between a few percentage points to 30 percentage points. For 

small employers, the Oregon Insurance Division lowered rates from a few percentage 

points to 12 percentage points.ll 

In the District of Columbia, United Healthcare submitted a 10% rate reduction for small 

businesses after rates were posted publicly. 12 

The Green Mountain Care Board, which runs the Health Insurance Marketplace in 

Vermont, lowered proposed rates from Blue Cross Blue Shield of Vermont and MVP 

Health Care by 4.3% and 5.3%, respectively.13 

Through its rate review process, the Rhode Island Office of the Health Insurance 

Commissioner lowered proposed rates in the individual market by 5.2% for Blue Cross 

Blue Shield of Rhode Island, and by 9.6% for Neighborhood Health Plan of Rhode 

Island. The Office of the Health Insurance Commissioner also lowered proposed rates in 

the small group market by between 1% and 8.2%.14 

In addition to these examples in which effective rate review caused approved rates to be below 

those initially proposed by insurers, it is clear that the requirement that all rate proposals of 10 

percent or greater be reviewed for reasonableness created a strong sentinel effect, and reduced 

the number of proposals with increases above 10%. In the individual market in 2010, 75% of all 

rate proposals were for increases greater than 10%, a statistic that declined sharply to 34% of all 

rate proposals in 2012, and to 14% in partial data for 2013. 15 The average increase approved in 

2012 and the first part of 2013 was 30% lower than the average increase approved in 2010. 

Rates for Young Men 

Evidence is also emerging that the concerns expressed that millions of young men will be priced 

out of coverage due to the new rating reforms may be unfounded. 

First, an analysis of the individual market today shows that young men with income above tax 

credit eligibility (400% of FPL) comprise a small fraction of enrollees: 7 percent of the 10.8 

II Oregon Department afConsumer & Business Services press release. July 10,2013. Available at; 

http://www.oregon.govIDCBS/docsnews releasesl20 131july J Oratedecisions.pdf. 

12 UnitedHealthcare Lowers RGlClI for the District of Columbia's Health-Insurance Exchange -A Sign Competition 

Is Already CUlling Ihe Cost of Buying Insurance. DC Department of Insurance, Securities, and Banking. June 26. 

2013. Available at: http://disb.dc.govlnode.567902. 

"Care Board Trims Ratesfor Vermont Health Exchange. Burlington Free Press. July 8, 2013. Available at: 

ht!p:llwww.burlingtonfreepress.comlarticle/20 130708INEWS03/307080022iCare-Board-mms-rates-Verrnonthealth-exchange. 

,4 OHIC Approves Commercial Health Insurance Contracts, Rates and Rate Factors. State of Rhode Island Office 

of the Health Insurance Commissioner. June 28, 2013. Available at 

http://www.ohic.ri.gov/documentsl20J3%20Rate%20Review%20Process/2013%20Rate%20Review%20Final%20D 

.cisionll 2013%20Rate%20Review%20Process%20Final%20Decision%20Press%20Release FlNAL.pdf. 

IS Health Insurance Premium Increases in the Individual Market Since the Passage of Ihe Affordable Care Act. Chu 

R, Kronick R. February 2013. Available at ht!p:llaspe.hhs.govlhealthireportsI2013/ratelncreaselndvMkt/rb.cfm. 

H 

ASPE Qlfice of Health Policy Jllly 2013 
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million total individual market enrollees, or about 750,000 in 2011 (See Table 2 be1ow).16 

Overall, nearly 60 percent of young men ages 18-34 currently enrolled in the individual market 

may be eligible for tax credits or Medicaid if their state implements the Affordable Care Act's 

Medicaid eligibility expansion. 

Second, preliminary information suggests that premiums will be affordable for this group, even 

without eligibility for a premium tax credit. In Los Angeles for example, for a 25 year old 

individual the lowest cost silver plan is $174 per month, and the lowest cost bronze plan is $147 

per month. Premiums in Portland are very similar-$174 per month for the lowest cost silver 

plan for a 25 year old individual and $133 per month for the lowest cost bronze plan. In 

Albuquerque, a 25 year old could pay as little as $143 for a silver plan. 17 Individuals under the 

age of 30 will also be eligible for catastrophic coverage, and those under the age of 26 may be 

eligible for coverage on parent's policy. In Los Angeles, California, the lowest cost catastrophic 

plan is $117 per month for a 25-year-old individual. In Albuquerque, New Mexico, the lowest 

cost catastrophic plan is $109 per month for a 25-year-old individual. In Portland, Oregon, a 25-

year-old individual could pay as little as $89 for a catastrophic plan. 

Third, tax credits will help many young men in this market. To illustrate the impact, a 25 year 

old in California with income of$17,235 (150% of poverty) could pay as little as $34 per month 

for a silver plan in North Los Angeles, and could purchase a bronze plan for as little as $7 per 

month. 

16 From the 2011 submissions of Medica! Loss Ratio data to the Centers for Medicare and Medicaid Services, there 

are lO.S million enrollees in the individual market. 

"New Mexico has 001 yet posted bronze rates for 2014. 

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Table 2: Individual Market Enrollmeut by -re Gender and Income 2011 18 

< 138% of the 138-249% of 250-399% of 400% of the 

FPL theFPL the FPL FPL 

Totals 

Men Women Men Women Men Women Men Women bvAge 

Age 18- 2.5% 1.9% 1.8% 1.5% 1.8% 1.9% 3.8% 2.2% 17.3% 25 

Age 26- 0.4% 0.6% 0.8% 0.7% 1.2% 0.8% 1.5% 1.6% 7.6% 29 

Age 30- 0.4% 0.5% 0.7% 0.9% 0.8% 0.7% 1.7% 1.6% 7.3% 34 

Age 35- 0.3% 0.3% 0.4% 0.6% 0.8% 0.8% 2.4% 1.8% 7.3% 39 

Age 40- 0.2% 0.2% 0.9% 0.9% 1.1% 1.5% 2.2% 2.7% 9.8% 44 

Age 45- 0.6% 0.9% 0.9% 0.8% 1.3% 1.1% 3.3% 2.6% 11.5% 49 

Age 50- 0.3% 0.5% 0.8% 0.8% 1.5% 1.3% 3.3% 3.6% 12.1% 54 

Age 55- 0.5% 0.6% 0.5% i 1.0% 0.9% 1.8% 3.6% 3.7% 12.5% 59 

Age 60- 0.3% 1.1% 0.8% 1.9% 1.5% 2.2% 3.3% 3.6% 14.6% 64 

Totals 

by 11.9% 16.8% 22.9% 48.3% 100.0% 

Income 

Notes: FPL ~ Federal Poverty Level 

Source: ASPE analysis of the 201 I National Health Interview Survey. 

Methods 

Eight states have posted health insurance premiums for their state-based Marketplace, and an 

additional three states have posted health insurance premiums for their Federally-facilitated 

Marketplaces or State Partnership Marketplaces. 19 In each of these states, information is 

available on the proposed premium payments, by age, for each of the issuers that is proposing to 

sell plans in the individual market. In addition, information on proposed rates in the small group 

market is readily available for all issuers in six of these states.20 

is Table 2 Was developed based on internal analysis of the 201 I National Health Interview Survey. This analysis 

used adults only, and defined individual market coverage as those with private insurance who indicated coverage 

was "purchased directly," excluding those who also reported Medicare, Medicaid, military, or other public coverage. 

19 The states are: California, Colorado, District of Columbia, New Mexico, New York, Ohio, Oregon, Rhode Island, 

Vermont, Virginia, and Washington. 

20 These states are: Colorado, District of Columbia, New Mexico, Oregon, Vermont, and Washington. Three of the 

remaining five states had some small group filings available, but we do not analyze those filings due to missing 

premium data in some filings, inability to find filings for large issuers in the state, or lack of clarity on how to 

develop accurate rates by age from the filed rating factors. In New York, while small group premiums for silver 

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The ASPE·derived CBO premium estimate was derived from the March 2012 CBO estimate that 

the average family would pay $15,400 in 2016 for coverage in the second lowest cost silver 

plan.21 This estimate was adjusted to reflect single individual market coverage in 2014 by using a 

single coverage to family coverage ratio of 1:2.7, trending backward at 5.5% per year to 2014, 

and adjusting for higher levels of reinsurance payments in 2014, yielding an estimated 2014 

single premium of $4,700.22 For comparison to proposed 2014 individual market premiums, we 

weighted by the expected age distribution of individual market enrollees in 2014 from the RAND 

COMPARE microsimulation model. To arrive at a national estimate, we weighted state·level 

premiums by the number of current individual market enrollees in each state from the 2011 

Medical Loss Ratio data collection. 

Due to data limitations, we are unable to directly compare the ASPE-derived CBO estimates to 

the price of the second lowest cost silver plan in 2014. Therefore, we have presented a 

comparison to the lowest cost silver plan as well as a comparison to the second lowest cost silver 

issuer. It is likely that the second lowest cost silver plan will differ very little in price from the 

lowest cost silver plan, as both plans will often be from the same issuer. Our estimates here can 

be thought of as a range that captures the second lowest cost silver plan in each state. 

Data on premiums in the pre-Affordable Care Act small group market come from the Insurance 

Component of the Medical Expenditure Panel Survey (MEPS-IC), conducted by the Agency for 

Healthcare Research and Quality (AHRQ). MEPS·IC surveys approximately 38,000 employers 

each year, and gathers information on the average premium paid. In order to increase sample 

size in each state, we average data from the 2008 to 2011 MEPS-IC, and trend the estimates 

forward to 20 14 usin~ estimates from the CMS Office of the Actuary of trends in private health 

insurance per person. 3 

plans are available, the State notes that they are not comparable to pre-Affordable Care Act premiums. See press 

release referenced in footnote 6. 

2l CBO and JeT's Estimates of the Effects of the Affordable Care Act all the Number of People Obtaining 

Employment.Based Health Insurance. March 2()l2. Available at: 

http://cbo. gov!sites!defaultifilesicbofiles/attachments/03.I 5·ACA and Insurance 2.pdf. 

22 Single coverage to family coverage ratio derived from: Letter to the Honorable Evan Bayh providing an analysis 

of health insurance premiums under the Patient Protection and Affordable Care Act. Congressional Budget Office. 

November 30, 2009. Available at: http://cbo.gov/sites/defaultlfileslcbofiles/ftodocs/l 07xx1docl078 11 !I·30. 

premiums.pdf. Annual increase in premiums of 5.5% from the Congressional Budget Office's March 2013 Baseline. 

Our inference about CBO's assumptions about reinsurance recoveries as a percentage of premium is 2% in 2016 and 

10% iu 2014. The reinsurance inference was derived using the following assumptions. From the March 2013 CBO 

baseline, we estimate there will be approximately 20 million individual market enrollees in 2014 (7 million 

Exchange enrollees, 13 million other individual market enrollees). This lead~ to a very approximate market size of 

$100 billion based on an approximate average premium of $5000, which would yield a 10% reduction in premiums 

due to reinsurance (10 billionilOO billion). Also from the March 2013 CBO baseline, we estimate there will be 

roughly 35 million individual market enrollees in 2016. This leads to a very approximate market size of roughly 

S200 billion including trend, which would yield a roughly 2% reduction in premiums due to reinsurance (4 

billionl200 billion). 

23 Data on average small group premiums used for comparison comes from tables publisbed by the Internal Revenue 

Service for 2012 average premiums by state. See http://www.irs.gov/pub/irs·pdfli894l.pdf. The IRS tables are based 

on 2008·2011 MEPS·IC data, trended forward to 2012. For comparison to the 2014 individual market premiums, we 

trended the IRS estimates forward to 2014 using estimates of per enrollee private health insurance spending 

increases from 2012 to 2013 and 2013 to 2014 from the CMS Office of the Actuary. These estimates are 3.7% for 

2012-2013 and 3.4% for 2013·2014. Many people would expect that actual trend will be higher than these 

ASPE Office of Health Policy July 2013 
100 


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ASPE Research Brief Page 12 

Analysis of data from the Health Intelligence Company, LLC (HIC) database that was used by 

HHS in the development of the Actuarial Value Calculator estimates that average A V for single 

coverage in the small group market is very close, on average, to silver coverage, with an average 

AV of69% for single coverage in 2010.24 Analysis of data from the 2012 Employer Health 

Benefits Survey finds that the average deductible for single coverage in small group plans is 

about $1,900, the average maximum out-of-pocket is $3,300, and the average coinsurance rate is 

approximately 20%.25 Taking into account that about 30% of small group plans in the sample 

only cover generic prescription drugs, and nearly two thirds do not apply prescription drugs to 

the maximum out-of-pocket limit, the KFFIHRET data also supports an average small group A V 

in the silver range. Thus, it is appropriate to compare pre-Affordable Care Act small group 

premiums trended forward to proposed silver premiums in 2014. 

We collected 2014 small group market silver premiums by age from the following six states: 

Colorado, the District of Columbia, New Mexico, Oregon, Vermont, and Washington. To create 

weighted average premiums that are comparable to pre-Affordable Care Act small group market 

average premiums, we weighted posted small group market premiums in 2014 by the age 

distribution of workers in small firms who have single employer-sponsored insurance coverage?6 

Given the changes in pricing practices and information available due to the Affordable Care Act, 

our comparison of pre-Affordable Care Act average small group premiums to proposed 2014 

small group premiums inevitably uses different data for pre- and post-Affordable Care Act. For 

the 2014 proposed small group premiums, we have actual prices by age and metal level. For the 

pre-Affordable Care Act data, we have an average premium paid by small employers in each 

state. To compare these, we estimated the average A V in the current small group market, as well 

as the age distribution. We note that there is uncertainty about each of these assumptions, as well 

as variation in average small group actuarial value by state, which we have not taken into 

account here. 

estimates. To the extent that actual trend is higher. our analysis is conservative - that is. true savings are likely 

higher than those estimated here. 

14 From the Health Intelligence Company, LLC (HIC) database. Actuarial values are imputed based on plan 

characteristics. 

2S Estimates derived from the Kaiser Family FoundatiOn/Health Research and Educational Trust 2012 Employer 

Health Benefits Survey microdata. Estimates limited to employers with fewer than 50 employees that reponed a 

deductible. maximum-out-of-pocket, and whether the maximum-out-of-pocket was inclusive of the deductible. 

26 The age distribution for the current small group market was estimated using the 20]2 Current Population Survey. 

We analyzed the average age and age distribution for individuals with ESI in their own name who report working 

for a small employer and have no dependents in their household with dependent ESI. The average age of small 

group employees covered by single coverage is approximately 45. However, the standard age curve rises steeply 

after age 45. As a result, the weighted average standard age factor that we use in the analysis is close to 50 - that is, 

we compare status quo small employer average premiums, trended forward, to the premium that would be paid by a 

50 year old purchasing silver coverage in 2014. 

ASPE Office of Health Policy July 2013 
101 


86396.054

THIRTEENTH CONGRESS 

of tbt ~nittb ~tattS 

of l\tprtli'rntatii.le5 

COMMITTEE ON ENERGY AND COMMERCE 

The Honorable Mark Iwrv 

Senior Advisor to the Secretary 

August 2, 2013 

Deputy Assistant Secretary for Retirement and Health Policy 

U.S. Department of Treasury 

1500 Pennsylvania Avenue, N.W. 

Washington. D.C. 20220 

Dear Mr. Iwry: 

Thank you rbr appearing before the Subcommittee on Oversight and Investigations on Thursday, 

July 18,2013, to testilY at the hearing entitled "Patient Protection and Affordable Care Act: 

Implmentation in the Wake of Administrative Delay." 

Pursuant to the Rules of the Committee on Energy and Commerce, the hearing record remains 

open for ten business days to pennit Members to submit additional questions for the record, which arc 

attached. The funnat ofyaur responses to these questions should be as follows: (I) the name oflbe 

Member whose question you are addressing, (2) the complete text of lIle question you are addressing in 

bold, and (3) your answer to that question in plain text. 

Also attached are Member requests made during lIle hearing. The fonnat afyaur responses ta 

these requests should follow the same fonnat as your respenses to the additional questions for the record. 

To facilitate tbe printing of the hearing record, please respond to these questions and requests by 

the close of business on Friday, August 16, 2013. Your respenses should be mailed to Brittany Havens, 

Legislative Clerk, Committee on Energy and Commerce, 2125 Rayburn House Office Building. 

Washington, D.C. 20515 and .-mailed in Word fonnat to brittanv.havens@majl.house.gov. 

Thank you again for your time and effort preparing and delivering testimony before the 

Subeommillee. 

~~ Tim Murpl;· ..... (/ U 

Chainnan 

Subcommittee on Oversight and Investigations 

ce: Diana DeGette, Ranking Member, Subeommittee on Ovel'$ighl and Investigations 

Attachments 
102 


86396.055

House Committee on Energy and Commerce, sic on Oversight and Investigations 

"Patient Protection and Affordable Care Act: Implementation in the Wake of Administrative Delay" 

Questions for the Record for J Mark Iwry 

Hearing held July 18, 2013 

The Honorable G.K Butterfield ro-NC) 

Question I: 

Thank you, Deputy Assistant Secretary Iwry, for your testimony. At the June 26th hearing 

of this Subcommittee, we heard from business owners who unanimously agreed during 

questioning that they embrace the goal of the Affordable Care Act to make affordable 

insurance available to every single American. Those business leaders also agreed during 

questioning that good corporate citizens should look for responsible ways to comply with 

the law. What I took from that hearing is that businesses have accepted this is the law of 

the land and are committed to working with us to ensure that implementation ofthe 

Marketplaces and other aspects of the law go smoothly 

The Treasury Department Appears to be working closely with many of these stakeholders 

to find the best way to ensure the law of the land is implemented effectively. The 

Administration's decision to provide transition relief preserves the ability of business 

employees and individuals to access tax credits offered by the ACA starting in 2014. And 

there will still be safeguards in place to prevent access to premium tax credits in error. 

Once the Marketplaces are up and running, more than 30 million additional Americans, 

including 137,000 of my constitnents in eastern North Carolina who currently lack health 

insurance, will be able to benefit from more comprehensive and more affordable health 

insurance under the ACA. 

The Treasury's decision to delay implementation of certain requirements under the 

Affordable Care Act is designed to help businesses come in compliance with the law, while 

enabling people to be able to participate in the Marketplaces set to begin in 2014. If I am 

an employee of a business in Goldsboro, North Carolina who wishes to purchase a qualified 

health plan from the Marketplaces and I qualify under the law for a credit, will I still be 

able to receive that credit regardless of transition relief? Will transition relief impact in 

any way the ability of individuals to access the Marketplaces and receive affordable health 

insurance? 

The decision to provide transition relief with respect to the reporting and employer responsibility 

requirements under the Affordable Care Act is designed to help businesses come into compliance 

(as well as provide more time to develop simplified, streamlined reporting rules), without 

delaying people's ability to participate in the Marketplaces and obtain a premium tax credit. 

Individuals who wish to purchase coverage under a qualified health plan in the Marketplaces and 

who qualify for a premium tax credit will still be able to receive the credit starting in 2014. The 

transition relief provided by the Treasury Department and Internal Revenue Service in Notice 

2013-45 will not impair anyone's eligibility for a premium tax credit under the Affordable Care 

Act. Likewise, this transition relief generally will have no impact on the ability of individuals to 

access the Marketplaces and receive affordable health coverage. 
103 


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House Committee on Energy and Commerce, sic on Oversight and Investigations 

"Patient Protection and Affordable Care Act: Implementation in the Wake 0/ Administrative Delay" 

Questions/or the Record/or J Mark Iwry 

Hearing held July 18, 2013 

Questiou 2: 

Can you describe tbe safeguards and income verification steps in place tbat ensure an 

employee from a company in, for instance, Elizabetb City, Nortb Carolina will not receive 

a premium credit in error? What type of penalties will be in place for individuals who try 

to receive credits they do not qualify for? 

Both the Marketplaces and the IRS have safeguards in place to prevent those who are not eligible 

for these benefits from receiving them. The Marketplaces are required by the statute and HHS 

regulations to verify eligibility criteria. The IRS is building systems to collect, match, and 

leverage available data to verify premium tax credit claims on individuals' income tax returns. 

The Affordable Care Act includes penalties to address false claims for benefits by 

applicants. For example, individuals applying at a Marketplace submit their application under 

the penalty of perjury. Where appropriate, the IRS may also apply existing tax penalties and 

sanctions. 

Question 3: 

Tbe decision to move forward with transition relief for 2014 came with a great deal of 

outreacb and communication with stakeholders. As I mentioned earlier, we recently beard 

from a panel of businesses before this committee who embraced the goal of the law to 

provide affordable health insurance to all Americans and believed good corporate citizens 

should make efforts to comply with the law. In Treasury's communications witb these 

stakeholders, have you found that most businesses have accepted this law, aim to comply 

with it, and are interested in finding ways to provide affordable health care to their 

employees? Would you say that transition assistance will make it easier for businesses tbat 

embrace the goals of the ACA to comply with the law? 

Most of the stakeholders that have communicated with the Treasury Department about the 

Affordable Care Act have contacted us about specific issues that are of particular interest to them 

and have not expressed their views on the Affordable Care Act as a whole. Most of those 

communications and interactions, however, seem to reflect a desire to comply with the 

Affordable Care Act and provide affordable health care to employees. 

2 
104 


86396.057

House Committee on Energy and Commerce, sic on Oversight and Investigations 

"Patient Protection and Affordable Care Act: Implementation in the Wake of Administrative Delay" 

Questions for the Record for J Mark Iwry 

Hearing held July 18, 2013 

Question 4: 

You mentioued that employers aud affected entities may voluntarily comply with reporting 

provisions from 2014. It is encouraging that employer who embrace the ACA are 

preparing to assist with the implementations ofthis law, even though they will not be 

required to for another year. Can you provide some examples of employers who are 

preparing to report voluntarily in 2014? Will employers who voluntarily report 

information in 2014 be responsible for "assessable payments"? Will employers who do 

voluntarily report in 2014 be rewarded for doing so? 

Reporting entities will be encouraged to voluntarily implement infonnation reporting in 2014 

(when reporting will be optional), in preparation for the full application of the reporting 

provisions in 2015. Real-world testing of reporting systems in 2014 will contribute to a 

smoother transition to full implementation in 2015. Notice 2013-45 provides that no employers 

will be responsible for assessable payments under Code section 4980H for 2014, including 

employers that voluntarily implement infonnation reporting for that year. 

The Honorable Tim Murphy {R-PAl 

Question 1: 

Please snbmit the information you have on the bnrdens and costs for individuals and 

businesses. 

To minimize costs and administrative tasks for businesses and individuals, and to provide greater 

flexibility, Treasury and the IRS have sought to develop, among other things, simplified 

infonnation reporting methods. For example, the preamble to the proposed regulations 

implementing Section 6056 infonnation reporting states that stakeholders provided comments 

suggesting that, "at least for some employers, the collection, assembling and processing of the 

necessary data into an appropriate fonnat for filing may not be necessary if the employer offers 

sufficient coverage to make it unlikely that the employer will be subject to an assessable 

payment under section 4980H because the employee will be ineligible for a premium tax credit. 

Treasury and the IRS have considered these comments in fonnulating the potential simplified 

reporting methods described in this section. If Treasury and the IRS adopt one or more of these 

simplified reporting methods, they would be optional alternatives to the general reporting 

method set forth in the proposed regulations, which could substantially reduce the data elements 

reported using the general method." The preamble also invites comments on "potential 

simplified reporting methods and on other possible simplified approaches that would benefit 

employers while providing sufficient and timely infonnation to individual taxpayers and the 

IRS." 

3 
105 


86396.058

House Committee on Energy and Commerce, sic on Oversight and Investigations 

"Patient Protection and Affordable Care Act: Implementation in the Wake of Administrative Delay" 

Questions for the Record for J Mark Iwry 

Hearing held July 18, 2013 

Question 2: 

Please provide all notes, emails, and other related documents with respect to the 

communication ofthe Treasury Department's authority to be able to make the decision to 

delay the employer mandate. 

The Treasury Department's authority to be able to make the decision to provide transition relief 

derives from section 7805(a) of the Internal Revenue Code. This authority has been used to 

postpone the application of new legislation on a number of prior occasions across 

Administrations, including Notice 2011-69 regarding the Airport and Airway Extension Act, Part 

IV (signed August 5, 2011); Notice 2007-54 regarding the Small Business and Work 

Opportunity Act of2007; and Notice 2000-5 regarding the Tax Relief Extension Act of 1999. 

Question 3: 

Please submit all documents related to the discussious regarding the Treasury 

Department's analysis of the constitutionality of the delay. 

The authorities Congress provided under section 7805(a) of the Internal Revenue Code allowed 

the Treasury Department to make the decision to provide transition relief, This authority has 

been used to postpone the application of new legislation on a number of prior occasions across 

Administrations. 

Question 4: 

Do you have the authority to offer mUlti-employers waivers? If so, what will they be? 

Certain multiemployer health plans have asked the Treasury Department whether the premium 

(ax credit under the Affordable Care Act would be available to individuals who are covered by a 

multiemployer health plan. Under the Affordable Care Act, an individual who is covered by an 

eligible employer-sponsored plan is not eligible to receive a premium tax credit. The conclusion 

that an individual cannot benefit from both the exclusion from taxable income for employerprovided health coverage under an eligible employer-sponsored plan and the premium tax credit 

provided by the Affordable Care Act applies whether the individual is covered by a singleemployer plan or a multi employer plan. Similarly, the statute also would not allow an employee 

who was offered minimum essential coverage under an eligible employer-sponsored plan that 

provided minimum value and was deemed "affordable" for the employee to receive a premium 

tax credit, even ifthe employee declined the coverage. 

The Administration is committed to implementing the Affordable Care Act in a manner that 

makes health care more effective and affordable for all Americans, including those covered by 

multiemployer plans. We intend to continue working with employers, labor organizations, and 

all other stakeholders who have ideas on how best to preserve high-quality existing coverage 

while new coverage is extended to those who do not have it - in all cases in accordance with the 

statutory terms of the Affordable Care Act. 

4 
106 


86396.059

House Committee on Energy and Commerce, sic on Oversight and Investigations 

"Patient Protection and Affordable Care Act: Implementation in the Wake of Administrative Delay" 

Questions for the Recordfor J Mark Iwry 

Hearing held July 18, 2013 

Question 5: 

Was there any communication between people within the Treasury Department and any 

other government agency regarding the delay of the employer mandate? If so, please 

provide any communication. 

Treasury decided to provide transition relief after receiving feedback over the course of 20 12 and 

2013. Treasury has been engaged in a dialogue with stakeholders, including employers, insurers, 

and governmental entities. Stakeholders submitted comments on the information reporting 

provisions of both section 6055 and section 6056. At various points in the process, Treasury has 

discussed the reporting provisions with others, including government offices that help coordinate 

the efforts of the multiple federal agencies involved in implementing the Affordable Care Act. 

Ultimately, Treasury decided to provide an additional year as a transition period before the 

Affordable Care Act employer and insurer reporting requirements would first apply. We also 

extended this transition relief to the employer responsibility provisions under section 4980H, 

which would have been impractical to implement without the reporting information. 

Question 6: 

What are the costs to American businesses of complying with the reporting requirements? 

a. Please provide all communication regarding the costs to American businesses. 

Treasury decided to provide transition relief after receiving feedback over the course of2012 and 

2013. Stakeholders - including the u.S. Chamber of Commerce, the Business Roundtable, the 

Blue Cross Blue Shield Association, Aetna, the National Association of Health Underwriters, 

and the American Benefits Council - submitted comments on the information reporting 

provisions of both section 6055 and section 6056. Particular comments expressed concern about 

the anticipated difficulty or cost of complying with the reporting requirements, the desire that the 

reporting process be made as simple as possible, and the need for adequate lead time to adapt 

information gathering and reporting systems to implement the reporting requirements effectively. 

Treasury and the IRS have sought to develop simplified information reporting methods to 

minimize costs and administrative tasks for businesses. The preamble to the proposed 

regulations implementing Section 6056 information reporting states that stakeholders have 

provided comments suggesting that, "at least for some employers, the collection, assembling and 

processing of the necessary data into an appropriate format for filing may not be necessary if the 

employer offers sufficient coverage to make it unlikely that the employer will be subject to an 

assessable payment under section 4980H because the employee will be ineligible for a premium 

tax credit. Treasury and the IRS have considered these comments in formulating the potential 

simplified reporting methods described in this section. If Treasury and the IRS adopt one or 

more of these simplified reporting methods, they would be optional alternatives to the general 

reporting method set forth in the proposed regulations, which could substantially reduce the data 

elements reported using the general method." The preamble also invites comments on "potential 

simplified reporting methods and on other possible simplified approaches that would benefit 

5 
107 


86396.060

House Committee on Energy and Commerce, sic on Oversight and Investigations 

"Patient Protection and Affordable Care Act: Implementation in the Wake of Administrative Delay" 

Questions for the Recordfor J Mark Iwry 

Hearing held July 18, 2013 

employers while providing sufficient and timely information to individual taxpayers and the 

IRS," 

The Honorable Michael C. Burgess (R-TX): 

Question 1: 

Please provide any records related to the date you found out that the mandate for 

businesses was going to be delayed. 

The transcript of my July testimony before the Committee documents that I knew sometime in 

June 2013 that transition relief would be granted with respect to the employer shared 

responsibility provisions, 

Question 2: 

Please provide any documents related to communications with Valarie Jarrett related to 

the delay of the mandate. 

Consistent with my testimony before this committee in July, I do not recall communicating with 

Ms. Jarrett about Treasury's decision to provide transition relief. 

The Honorable Phil Gingrey (R-GA): 

Question 1: 

Please provide a list of employer stakeholders that weighed in and helped you make this 

decision to delay the employer mandate. 

Treasury decided to provide transition relief after receiving feedback and reviewing statements 

and comments from stakeholders, including employers, insurers, governmental entities and 

others. Particular comments expressed concern about the anticipated difficulty or cost of 

complying with the reporting requirements, the desire that the reporting process be made as 

simple as possible, and the need for adequate lead time to adapt information gathering and 

reporting systems to implement the reporting requirements effectively. Treasury recognized that 

transition relief for reporting would make it impractical to determine which employers owed 

employer shared responsibility payments and therefore provided transition relief with respect to 

the employer responsibility provisions as well. Among the entities that weighed in were the 

following: 

• American Benefits Council 

• Aetna 

• America's Health Insurance Plans 

• Aon Hewitt 

• BlueCross BlueShield Association 

• Business Roundtable 

6 
108 


86396.061

House Committee on Energy and Commerce, sic on Oversight and Investigations 

"Patient Protection and Affordable Care Act: Implementation in the Wake of Administrative Delay" 

Questions for the Record for J Mark Iwry 

Hearing held July 18, 2013 

• Cigna 

• Corporate Health Care Coalition 

• Employers for Flexibility in Health Care 

• Families USA 

• HR Policy Association 

• Information Reporting Program Advisory Committee 

• National Association of Health Underwriters 

• National Business Group on Health 

• National Coordinating Committee for Multiemployer Plans 

• National Immigration Law Center 

• National Payroll Reporting Consortium 

• Retail Industry Leaders Association 

• State of Tennessee, Department of Finance and Administration 

• UPMC Insurance Services Division 

• U.S. Chamber of Commerce 

• World at Work 

The Honorable Steve Scalise (R-LA): 

Question 1: 

Did you or Mark Mazur have any conversations with HHS about the decision to delay the 

employer mandate? If so, please provide any documents related to communications. 

Treasury decided to provide transition relief after receiving feedback over the course of2012 and 

2013. Treasury has been engaged in a dialogue with stakeholders, including employers, insurers, 

and governmental entities. Such stakeholders including the U.S. Chamber of Commerce, the 

Business Roundtable, the Blue Cross Blue Shield Association, Aetna, the National Association 

of Health Underwriters, and the American Benefits Council- submitted comments on the 

information reporting provisions of both section 6055 and section 6056. At various points in the 

process, Treasury has discussed the reporting provisions with others, including government 

offices that help coordinate the efforts of the multiple federal agencies involved in implementing 

the Affordable Care Act. Ultimately, Treasury decided to provide an additional year as a 

transition period before the Affordable Care Act employer and insurer reporting requirements 

would first apply. We also extended this transition relief to the employer responsibility 

provisions under section 4980H, which would have been impractical to implement without the 

reporting information. 

7 
109 


86396.062

House Committee on Energy and Commerce, sic on Oversight and Investigations 

"Patient Protection and Affordable Care Act: Implementation in the Wake of Administrative Delay" 

Questions for the Record for J Mark lwry 

Hearing held July 18, 2013 

Question 2: 

Please provide the names of all individuals who communicated with HHS and the dates and 

times that they communicated with HHS about delaying the employer mandate. 

Treasury decided to provide transition relief after receiving feedback over the course of2012 and 

2013. Treasury has been engaged in a dialogue with stakeholders, including employers, insurers, 

and governmental entities. Such stakeholders - including the U.S. Chamber of Commerce, the 

Business Roundtable, the Blue Cross Blue Shield Association, Aetna, the National Association 

of Health Underwriters, and the American Benefits Council- submitted comments on the 

information reporting provisions of both section 6055 and section 6056. At various points in the 

process, Treasury has discussed the reporting provisions with others, including government 

offices that help coordinate the efforts of the multiple federal agencies involved in implementing 

the Affordable Care Act. Ultimately, Treasury decided to provide an additional year as a 

transition period before the Affordable Care Act employer and insurer reporting requirements 

would first apply. We also extended this transition relief to the employer responsibility 

provisions under section 4980H, which would have been impractical to implement without the 

reporting information. 

The Honorable Cory Gardner (R-CO): 

Question 1: 

When was the President made aware of the Treasury Department's decision to delay the 

employer mandate? 

The President addressed the decision to provide transition relief in his remarks at an August 9, 

2013 press conference. I do not have personal knowledge of when the President was made 

aware of the transition relief. 

Question 2: 

How many IRS personnel are currently working with you on the implementation ofthis 

law? 

It is our understanding, based on recent information provided to us by the IRS, that the IRS has 

just under 700 full-time equivalent staff working on the tax law changes included in the 

Affordable Care Act. 

8 
110 


86396.063

House Committee on Energy and Commerce, sic on Oversight and investigations 

"Patient Protection and Affordable Care Act: Implementation in the Wake of Administrative Delay" 

Questions for the Record for .J Mark Iwry 

Hearing held .July 18, 2013 

Question 3: 

Please provide the Treasury Department's cost estimate on how much money it will cost 

American businesses to comply with this law? 

To minimize costs and administrative tasks for businesses and individuals, and to provide greater 

flexibility, Treasury and the IRS have sought to develop, among other things, simplified 

information reporting methods, For example, the preamble to the proposed regulations 

implementing section 6056 information reporting states that stakeholders provided comments 

suggesting that, "at least for some employers, the collection, assembling and processing of the 

necessary data into an appropriate format for filing may not be necessary if the employer offers 

sufficient coverage to make it unlikely that the employer will be subject to an assessable 

payment under section 4980H because the employee will be ineligible for a premium tax credit. 

Treasury and the IRS have considered these comments in formulating the potential simplified 

reporting methods described in this section. If Treasury and the IRS adopt one or more of these 

simplified reporting methods, they would be optional alternatives to the general reporting 

method set forth in the proposed regulations, which could substantially reduce the data elements 

reported using the general method." The preamble also invites comments on "potential 

simplified reporting methods and on other possible simplified approaches that would benefit 

employers while providing sufficient and timely information to individual taxpayers and the 

IRS." 

The Honorable Morgan Griffith (R-VA): 

Question 1: 

Is there any case that references a time when the Treasury Department used Section 

7805(a) to stop the implementation of a section ofthe law and a court has said they have 

authority? 

The Treasury Department has exercised its administrative authority to postpone the application 

of new legislation on a number of prior occasions across Administrations of both parties. 

For example, the Small Business and Work Opportunity Act 0[2007 made changes to the 

standards return preparers must follow to avoid penalties. The amendments were effective May 

25,2007. On June 11, 2007, the Treasury Department released Notice 2007-54 providing that 

the IRS would follow the standards in prior law in determining whether to assert penalties for 

returns due on or before December 31,2007. 

Similarly, the Airport and Airway Extension Act, part IV (signed August 5, 2011) reinstated the 

air transportation and aviation fuels taxes retroactively to July 23, 2011, when they had expired. 

On September 9, 2011, the Treasury Department released Notice 2011-69 providing that the 

excise taxes would not be imposed on purchases of air transportation services made after July, 

2011 and before August 8, 2011. See also, e.g., Notice 2000-5 (waiving corporate penalties for 

certain estimated taxes due December 15, 1999, which were affected by the retroactive 

amendment of section 6655 by the Tax Relief Extension Act of 1999); Notices 2005-29,2006-2, 

9 
111 


86396.064

House Committee on Energy and Commerce, sic on Oversight and Investigations 

"Patient Protection and Affordable Care Act: Implementation in the Wake of Administrative Delay" 

Questions for the Recordfor J Mark Iwry 

Hearing held July 18, 2013 

and 2007-4 (postponing the statutory effective date ofthe section 470 loss disallowance rules 

applicable to certain pass-through entities); Notices 2005-94, 2006-)00, 2007-89, and 2008-115 

(waiving reporting of certain deferred compensation under section 409A for 2005 through 2008 

and, subsequently, until the year after final regulations are published); Announcement 95-48, 

Notice 96-64, and Notice 99-40 (postponing the effective date of various statutory changes in 

qualification rules affecting governmental plans by deeming these plans to satisfy those 

requirements until a later date); Notice 2010-91 (postponing the statutory effective date for 3% 

withholding on contractors under section 3402(t»; Notice 2011-88 (postponing the effective date 

for required backup withholding payments made in settlement of payment card and third-party 

network transactions, as enacted by the Housing Assistance Tax Act of2008); Notice 2012-34 

(postponing the statutory effective date for amendments to the cost basis reporting regime 

enacted by the Energy Improvement and Extension Act of 2008); and Notice 2013-14 (extending 

the statutory deadline for submitting a pre-screening notice to claim the Work Opportunity Tax 

Credit). 

The Honorable Bill Johnson (R-OH): 

Ouestion 1: 

If an analysis conducted by the Treasury Department revealed that there was a need to 

delay the individual mandate, do you have the authority to delay the individual mandate? 

While the 2014 transition relief for employer reporting would make it impractical for the IRS to 

administer the employer responsibility provisions of the Affordable Care Act, the IRS has 

determined that that transition relief will not have a comparable impact on implementation of the 

individual responsibility provisions. Accordingly, it is unnecessary to delay the individual 

responsibility provisions. Moreover, as a practical matter, the individual responsibility 

provisions are necessary to implement the Affordable Care Act's insurance market reforms that 

guarantee health security for Americans, such as prohibiting discrimination against people with 

preexisting conditions. 

The Honorable Billy Long ill-MOl: 

Question 1: 

Please name companies that you have talked to that helped the Treasury Department make 

the decision to delay the employer mandate. 

Treasury decided to provide transition relief after receiving feedback and reviewing statements 

and comments from stakeholders, including employers, insurers, governmental entities and 

others. Particular comments expressed concern about the anticipated difficulty or cost of 

complying with the reporting requirements, the desire that the reporting process be made as 

simple as possible, and the need for adequate lead time to adapt information gathering and 

reporting systems to implement the reporting requirements effectively. Treasury recognized that 

10 
112 

Æ 


86396.065

House Committee on Energy and Commerce, sic on Oversight and Investigations 

"Patient Protection and Affordable Care Act: Implementation in the Wake of Administrative Delay" 

Questions for the Record for J Mark Iwry 

Hearing held July 18, 2013 

transition relieffor reporting would make it impractical to determine which employers owed 

shared responsibility payments and therefore provided transition relief with respect to the 

employer responsibility provisions as well. 

Among the entities that weighed in were the following: 

• American Benefits Council 

• Aetna 

• America's Health Insurance Plans 

• Aon Hewitt 

• B1ueCross B1ueShield Association 

• Business Roundtable 

• Cigna 

• Corporate Health Care Coalition 

• Employers for Flexibility in Health Care 

• Families USA 

• HR Policy Association 

• Information Reporting Program Advisory Committee 

• National Association of Health Underwriters 

• National Business Group on Health 

• National Coordinating Committee for Multiemployer Plans 

• National Immigration Law Center 

• National Payroll Reporting Consortium 

• Retail Industry Leaders Association 

• State of Tennessee, Department of Finance and Administration 

• UPMC Insurance Services Division 

• U's.ChamberofCommerce 

• WorldatWork 

11