```

[House Report 114-268]
[From the U.S. Government Publishing Office]

114th Congress   }                                       {      Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                       {     114-268

======================================================================

 
                EQUITABLE ACCESS TO CARE AND HEALTH ACT

                                _______
                                

 September 28, 2015.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

Mr. Ryan of Wisconsin, from the Committee on Ways and Means, submitted 
                             the following

                              R E P O R T

                             together with

                            ADDITIONAL VIEWS

                        [To accompany H.R. 2061]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 2061) to amend section 5000A of the Internal Revenue 
Code of 1986 to provide an additional religious exemption from 
the individual health coverage mandate, and for other purposes, 
having considered the same, report favorably thereon with an 
amendment and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
  I. SUMMARY AND BACKGROUND...........................................2
          A. Purpose and Summary.................................     2
          B. Background and Need for Legislation.................     3
          C. Legislative History.................................     3
 II. EXPLANATION OF THE BILL..........................................3
          A. Additional Religious Exemption From Health Coverage 
              Responsibility Requirement (sec. 2 of the bill and 
              sec. 5000A of the Code)............................     3
III. VOTES OF THE COMMITTEE...........................................6
 IV. BUDGET EFFECTS OF THE BILL.......................................6
          A. Committee Estimate of Budgetary Effects.............     6
          B. Statement Regarding New Budget Authority and Tax 
              Expenditures Budget Authority......................     7
          C. Cost Estimate Prepared by the Congressional Budget 
              Office.............................................     7
  V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE......13
          A. Committee Oversight Findings and Recommendations....    13
          B. Statement of General Performance Goals and 
              Objectives.........................................    13
          C. Information Relating to Unfunded Mandates...........    13
          D. Applicability of House Rule XXI 5(b)................    13
          E. Tax Complexity Analysis.............................    14
          F. Congressional Earmarks, Limited Tax Benefits, and 
              Limited Tariff Benefits............................    14
          G. Duplication of Federal Programs.....................    14
          H. Disclosure of Directed Rule Makings.................    14
 VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED...........15
VII. ADDITIONAL VIEWS................................................29
    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Equitable Access to Care and Health 
Act'' or the ``EACH Act''.

SEC. 2. ADDITIONAL RELIGIOUS EXEMPTION FROM HEALTH COVERAGE 
                    RESPONSIBILITY REQUIREMENT.

  (a) In General.--Section 5000A(d)(2)(A) of the Internal Revenue Code 
of 1986 is amended to read as follows:
                  ``(A) Religious conscience exemptions.--
                          ``(i) In general.--Such term shall not 
                        include any individual for any month if such 
                        individual has in effect an exemption under 
                        section 1311(d)(4)(H) of the Patient Protection 
                        and Affordable Care Act which certifies that--
                                  ``(I) such individual is a member of 
                                a recognized religious sect or division 
                                thereof which is described in section 
                                1402(g)(1), and is adherent of 
                                established tenets or teachings of such 
                                sect or division as described in such 
                                section, or
                                  ``(II) such individual is a member of 
                                a religious sect or division thereof 
                                which is not described in section 
                                1402(g)(1), who relies solely on a 
                                religious method of healing, and for 
                                whom the acceptance of medical health 
                                services would be inconsistent with the 
                                religious beliefs of the individual.
                          ``(ii) Special rules.--
                                  ``(I) Medical health services 
                                defined.--For purposes of this 
                                subparagraph, the term `medical health 
                                services' does not include routine 
                                dental, vision, and hearing services, 
                                midwifery services, vaccinations, 
                                necessary medical services provided to 
                                children, services required by law or 
                                by a third party, and such other 
                                services as the Secretary of Health and 
                                Human Services may provide in 
                                implementing section 1311(d)(4)(H) of 
                                the Patient Protection and Affordable 
                                Care Act.
                                  ``(II) Attestation required.--Clause 
                                (i)(II) shall apply to an individual 
                                for months in a taxable year only if 
                                the information provided by the 
                                individual under section 1411(b)(5)(A) 
                                of such Act includes an attestation 
                                that the individual has not received 
                                medical health services during the 
                                preceding taxable year.''.
  (b) Effective Date.--The amendment made by subsection (a) shall apply 
to taxable years beginning after December 31, 2013.
  (c) Construction.--Nothing in the amendment made by subsection (a) 
shall preempt any State law requiring the provision of medical 
treatment for children, especially those who are seriously ill.

                       I. SUMMARY AND BACKGROUND

                         A. Purpose and Summary

    The bill, H.R. 2061, as reported by the Committee on Ways 
and Means, expands the religious conscience exemption from the 
Affordable Care Act individual mandate to include individuals 
for whom the acceptance of medical health services would be 
inconsistent with their religious beliefs.

                 B. Background and Need for Legislation

    While the Committee continues to actively pursue health 
care reform to relieve unnecessary burdens on the broader 
economy and on taxpayers in need of access to quality health 
care, the Committee also believes it is important to provide 
immediate relief from taxes imposing excessive constraints on 
individual choice and personal religious belief. The Committee 
believes that expanding the religious conscience exemption from 
the Affordable Care Act individual mandate will relieve an 
unfair tax burden.

                         C. Legislative History

Background

    H.R. 2061 was introduced on April 28, 2015, and was 
referred to the Committee on Ways and Means.

Committee action

    The Committee on Ways and Means marked up H.R. 2061, the 
``Equitable Access to Care and Health Act'' on September 17, 
2015, and ordered the bill, as amended, favorably reported 
(with a quorum being present).

Committee hearings

    The harmful effects of the individual mandate were 
discussed at no less than three hearings during the 114th 
Congress:
           Health Subcommittee Hearing on the 
        Individual and Employer Mandates in the President's 
        Healthcare Law (April 14, 2015);
           Full Committee Hearing on Obamacare 
        Implementation and the Department of Health and Human 
        Services FY 16 Budget Request (June 10, 2015); and
           Oversight Subcommittee Hearing on Rising 
        Health Insurance Premiums Under Obamacare (June 24, 
        2015).

                      II. EXPLANATION OF THE BILL

 A. Additional Religious Exemption From Health Coverage Responsibility 
      Requirement (sec. 2 of the bill and sec. 5000A of the Code)

                              PRESENT LAW

Requirement to maintain coverage

    Effective as of 2014, individuals must be covered by a 
health plan that provides at least minimum essential coverage 
or be subject to a tax for failure to maintain the coverage.\1\ 
If an individual is a dependent\2\ of another taxpayer, the 
other taxpayer is liable for any tax for failure to maintain 
the required coverage with respect to the individual. The tax 
is imposed for any month that an individual does not have 
minimum essential coverage, unless the individual qualifies for 
an exemption for the month as described below.
---------------------------------------------------------------------------
    \1\Section 5000A which was added to the Code by section 1501 of the 
Patient Protection and Affordable Care Act (``PPACA''), Pub. L. No 111-
148, enacted March 23, 2010, as amended by section 10106 of PPACA and 
1002 of the Health Care and Education Reconciliation Act of 2010 
(``HCERA''), Pub. L. No. 111-152, enacted March 30, 2010. PPACA and 
HCERA are collectively referred to as the Affordable Care Act 
(``ACA''). Except where otherwise stated, all references are to the 
Internal Revenue Code of 1986, as amended.
    \2\Sec. 152.
---------------------------------------------------------------------------

Minimum essential coverage

    Minimum essential coverage includes government-sponsored 
programs, eligible employer-sponsored plans, plans in the 
individual market, grandfathered group health plans and 
grandfathered health insurance coverage, and other coverage as 
recognized by the Secretary of HHS in coordination with the 
Secretary of the Treasury. Certain individuals present or 
residing outside of the U.S.\3\ and bona fide residents of 
territories of the U.S.\4\ are deemed to maintain minimum 
essential coverage.
---------------------------------------------------------------------------
    \3\This rule applies to any month that occurs during a period 
described in section 911(d)(1)(A) or (B) which is applicable to an 
individual. Such periods include: (1) for a United States citizen, an 
uninterrupted period which includes an entire taxable year during which 
the individual is a bona fide resident of a foreign country or 
countries, and (2) for a United States citizen or resident, a period of 
12 consecutive months during which the individual is present in a 
foreign country at least 330 full days.
    \4\Bona fide residence in a territory is determined under section 
937(a). For this purpose, the territories include Puerto Rico, Guam, 
the Northern Marianna Islands, American Samoa, and United States Virgin 
Islands.
---------------------------------------------------------------------------
    Minimum essential coverage does not include coverage that 
consists of certain excepted benefits.\5\ Excepted benefits 
include: (1) coverage only for accident, or disability income 
insurance; (2) coverage issued as a supplement to liability 
insurance; (3) liability insurance, including general liability 
insurance and automobile liability insurance; (4) workers' 
compensation or similar insurance; (5) automobile medical 
payment insurance; (6) credit-only insurance; (7) coverage for 
on-site medical clinics; and (8) other similar insurance 
coverage, specified in regulations, under which benefits for 
medical care are secondary or incidental to other insurance 
benefits. Other excepted benefits that do not constitute 
minimum essential coverage if offered under a separate policy, 
certificate or contract of insurance include long term care, 
limited scope dental and vision benefits, coverage for a 
disease or specified illness, hospital indemnity or other fixed 
indemnity insurance or Medicare supplemental health insurance.
---------------------------------------------------------------------------
    \5\Sec. 2791(c)(1)-(4) of PHSA (42 U.S.C. sec. 300gg-91(c)(1-4)). A 
parallel definition of excepted benefits is provided in section 
9832(c)(1)-(4).
---------------------------------------------------------------------------

Tax on failure to maintain minimum essential coverage

    The tax for failure to maintain minimum essential coverage 
for any calendar month is one-twelfth of the tax calculated as 
an annual amount. The annual amount is equal to the greater of 
the flat dollar amount or the excess income amount. The flat 
dollar amount is the lesser of sum of the individual annual 
dollar amounts for the members of the taxpayer's family and 300 
percent of adult individual dollar amount. The excess income 
amount is a specified percentage of the excess of the 
taxpayer's household income for the taxable year over the 
threshold amount of income for required income tax return 
filing for that taxpayer.\6\ The total annual household payment 
may not exceed the national average annual premium for bronze 
level health plans offered through American Health Benefit 
Exchanges that year for the family size. The individual adult 
annual dollar amount is phased in over the first three years as 
follows: $95 for 2014; $325 for 2015; and $695 in 2016.\7\ For 
an individual who has not attained age 18, the individual 
annual dollar amount is one half of the adult amount. The 
specified percentage of income is phased in as follows: one 
percent for 2014; two percent in 2015; and 2.5 percent 
beginning after 2015.
---------------------------------------------------------------------------
    \6\Sec. 6012(a).
    \7\For years after 2016, the $695 amount is indexed to CPI-U, 
rounded to the next lowest multiple of $50.
---------------------------------------------------------------------------

Exemptions

    Exemptions from the requirement to maintain minimum 
essential coverage are provided for the following: (1) an 
individual for whom coverage is unaffordable because the 
required contribution exceeds eight percent of household 
income, (2) an individual with household income below the 
income tax return filing threshold, (3) a member of an Indian 
tribe, (4) a member of certain recognized religious sects 
(``religious conscience exemption'') or a health sharing 
ministry, (5) an individual with a coverage gap for a 
continuous period of less than three months, and (6) an 
individual who is determined by the Secretary of Health and 
Human Services to have suffered a hardship with respect to the 
capability to obtain coverage.\8\
---------------------------------------------------------------------------
    \8\These exemptions are generally provided under section 5000A(e). 
The religious conscience exemption and health care sharing ministry 
exemption are provided under section 5000A(d)(2).
---------------------------------------------------------------------------
    The religious conscience exemption applies to members of 
religious sects (or divisions thereof) which are recognized 
religious sects for purposes of a previously existing exemption 
under the Self-Employment Contributions Act (``SECA''),\9\ who 
are adherents of established tenets or teachings of the sect 
(or division) as described under the SECA exemption. The SECA 
exemption requires the Commissioner of Social Security to find 
that (1) the sect (or division) has established tenets or 
teachings that are conscientiously opposed to accepting 
benefits of any private or public insurance that makes payments 
in the event of death, disability, old age, or retirement, or 
makes payments toward the costs of, or provides services for, 
medical care (including the benefits of any insurance system 
established by the Social Security Act), and (2) it is the 
practice, and has been for a substantial period of time, for 
members of the sect (or division) to make reasonable provision 
for dependent members in view of their general level of living, 
and (3) the sect (or division) has been in existence 
continuously since December 31, 1950. For members of the sect 
to qualify for the religious conscience exemption, an exemption 
must be obtained from an American Health Benefit Exchange in 
accordance with Health and Human Services regulations.\10\
---------------------------------------------------------------------------
    \9\SECA consists of sections 1401-1403, relating to Social Security 
and Medicare taxes applicable to self-employed individuals. The SECA 
exemption for members of certain recognized religious sects is provided 
under section 1402(g)(1).
    \10\Secs. 1311(d)(4)(H) and 1411(b)(5)(A) of the ACA and 45 C.F.R. 
sec 155.615(b).
---------------------------------------------------------------------------

                           REASONS FOR CHANGE

    The Committee believes that the present law religious 
conscience exemption from the requirement to maintain minimum 
essential coverage is too narrow. It only covers individuals 
who, due to membership in a recognized religious sect, do not 
accept the benefits of any private or public insurance, 
including Social Security and Medicare. The exemption does not 
apply to individuals who, as a matter of faith, do not use 
medical care services. The Committee believes that these 
individuals should not be required to purchase health insurance 
to pay for medical care services.

                        EXPLANATION OF PROVISION

    The provision expands the religious conscience exemption to 
include any individual who relies solely on a religious method 
of healing, and for whom the acceptance of medical health 
services would be inconsistent with the religious beliefs of 
the individual. For purposes of this exemption, medical health 
services do not include routine dental, vision, and hearing 
services, midwifery services, vaccinations, necessary medical 
services provided to children, services required by law or by a 
third party, and such other services as the Secretary of Health 
and Human Services may provide.
    This exemption will apply to an individual for months in a 
taxable year only if the information required to be provided to 
obtain the exemption includes an attestation that the 
individual has not received medical health services during the 
preceding taxable year. The provision also specifies that 
nothing in the provision preempts any State law requiring the 
provision of medical treatment for children, especially those 
who are seriously ill.

                             EFFECTIVE DATE

    The provision is effective for taxable years beginning 
after December 31, 2013.

                      III. VOTES OF THE COMMITTEE

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the vote of the Committee on Ways and Means in its 
consideration of H.R. 2061, the ``Equitable Access to Care and 
Health Act'' on September 17, 2015.

                       MOTION TO REPORT THE BILL

    The bill, H.R. 2061, as amended, was ordered favorably 
reported to the House of Representatives by a voice vote (with 
a quorum being present).

                     IV. BUDGET EFFECTS OF THE BILL

               A. Committee Estimate of Budgetary Effects

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 2061, as 
reported.
    The bill, as reported, is estimated to have the following 
effect on Federal budget receipts for fiscal years 2016-2025:

                                       ESTIMATED REVENUE EFFECTS\1\\2\\3\
                                                  Fiscal Years
                                              [Millions of Dollars]
----------------------------------------------------------------------------------------------------------------
  2016      2017      2018     2019     2020     2021     2022     2023     2024     2025    2016-20    2016-25
----------------------------------------------------------------------------------------------------------------
   -135      -120     -100     -110     -115     -115     -125     -135     -140     -140       -580    -1,235
----------------------------------------------------------------------------------------------------------------
[\1\]Estimate provided by the staff of the Joint Committee on Taxation and the Congressional Budget Office.
[\2\]Estimate includes the following change in off-budget receipts:

----------------------------------------------------------------------------------------------------------------
  2016      2017      2018     2019     2020     2021     2022     2023     2024     2025    2016-20    2016-25
----------------------------------------------------------------------------------------------------------------
  [\3\]         5    [\3\]    [\3\]    [\3\]    [\3\]        5        5        5        5          5        25
[\3\]Gain of less than $500,000.
[\4\]Estimate includes the following change in outlays:

----------------------------------------------------------------------------------------------------------------
  2016      2017      2018     2019     2020     2021     2022     2023     2024     2025    2016-20    2016-25
----------------------------------------------------------------------------------------------------------------
    -15       -35      -55      -60      -65      -70      -75      -75      -80      -85       -230       -615

    Pursuant to clause 8 of rule XIII of the Rules of the House 
of Representatives, the following statement is made by the 
Joint Committee on Taxation with respect to the provisions of 
the bill amending the Internal Revenue Code of 1986: the gross 
budgetary effect (before incorporating macroeconomic effects) 
in any fiscal year is less than 0.25 percent of the current 
projected gross domestic product of the United States for that 
fiscal year; therefore, the bill is not ``major legislation'' 
for purposes of requiring that the estimate include the 
budgetary effects of changes in economic output, employment, 
capital stock and other macroeconomic variables.

B. Statement Regarding New Budget Authority and Tax Expenditures Budget 
                               Authority

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee states that the 
bill involves no new or increased budget authority. The 
Committee further states that there are no new or increased tax 
expenditures.

      C. Cost Estimate Prepared by the Congressional Budget Office

    In compliance with clause 3(c)(3) of rule XIII of the Rules 
of the House of Representatives, requiring a cost estimate 
prepared by the CBO, the following statement by CBO is 
provided.

                                     U.S. Congress,
                               Congressional Budget Office,
                                Washington, DC, September 25, 2015.
Hon. Paul Ryan,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2061, the 
Equitable Access to Care and Health Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sarah Masi.
            Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 2061--Equitable Access to Care and Health Act

    Summary: H.R. 2061 would expand the religious conscience 
exemption from the requirement that most people in the United 
States must obtain health insurance coverage or pay a penalty 
for not doing so (a provision of the Affordable Care Act known 
as the individual mandate). Specifically, the bill would newly 
exempt members of religious sects or divisions that do not meet 
the criteria for the religious conscience exemption under 
current law, but who rely solely on a religious method of 
healing and for whom the acceptance of medical health services 
would be inconsistent with their religious beliefs.\1\
---------------------------------------------------------------------------
    \1\Under current law, people qualify for the religious conscience 
exemption from the individual mandate only if they are members of 
religious sects or divisions that are conscientiously opposed to 
accepting insurance benefits--including Social Security and Medicare--
and who meet other requirements listed under section 1402(g)(1) of the 
Internal Revenue Code.
---------------------------------------------------------------------------
    On net, CBO and the staff of the Joint Committee on 
Taxation (JCT) estimate that enacting H.R. 2061 would increase 
federal deficits by $1.2 billion over the 2016-2025 period. 
That 10-year total consists of a $1.9 billion net reduction in 
revenues, primarily stemming from forgone penalties from 
uninsured individuals, partially offset by a $0.6 billion 
decrease in direct spending resulting from fewer people 
enrolling in Medicaid and subsidized health insurance coverage 
obtained through exchanges. The estimated reduction in revenues 
exceeds the estimated reduction in direct spending because CBO 
and JCT estimate that most of the people that would newly claim 
an exemption from the individual mandate under the bill are and 
will continue to be uninsured under current law. Pay-as-you-go 
procedures apply because enacting the legislation would affect 
direct spending and revenues.
    CBO and JCT estimate that enacting the legislation would 
not increase net direct spending in any of the four consecutive 
10-year periods beginning in 2026; however, the agencies 
estimate that enacting the legislation would increase on-budget 
deficits by at least $5?billion in at least one of the four 
consecutive 10-year periods beginning in 2026.
    JCT has determined that the bill contains no 
intergovernmental or private-sector mandates as defined in the 
Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary effects of H.R. 2061 are shown in the following 
table. The spending effects of the legislation fall primarily 
within budget function 550 (health). For this estimate, CBO 
assumes that H.R. 2061 will be enacted near the end of calendar 
year 2015.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                        By fiscal year, in millions of dollars--
                               -------------------------------------------------------------------------------------------------------------------------
                                  2016      2017      2018      2019      2020      2021      2022      2023      2024      2025    2016-2020  2016-2025
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               CHANGES IN DIRECT SPENDING
 
Estimated Budget Authority....       -15       -35       -55       -60       -65       -70       -75       -75       -80       -85       -230       -615
Estimated Outlays.............       -15       -35       -55       -60       -65       -70       -75       -75       -80       -85       -230       -615
 
                                                                   CHANGES IN REVENUES
 
Estimated Revenuesa...........      -150      -155      -155      -170      -180      -185      -200      -210      -220      -225       -810     -1,850
    On-Budget.................      -150      -160      -155      -170      -180      -185      -205      -215      -225      -230       -815     -1,875
    Off-Budgetb...............         *         5         *         *         *         *         5         5         5         5          5         25
 
                                NET INCREASE OR DECREASE (-) IN THE DEFICIT FROM CHANGES IN DIRECT SPENDING AND REVENUES
 
Impact on Deficit.............       135       120       100       110       115       115       125       135       140       140        580      1,235
    On-Budget.................       135       125       100       110       115       115       130       140       145       145        585      1,260
    Off-Budgetb...............         *        -5         *         *         *         *        -5        -5        -5        -5         -5       -25
--------------------------------------------------------------------------------------------------------------------------------------------------------
Sources:Congressional Budget Office; staff of the Joint Committee on Taxation.
Note:* = for revenues, an increase of less than $0.5 million; for deficits, a reduction of less than $0.5 million.
a.Negative numbers indicate a reduction in revenues, and positive numbers indicate an increase in revenues.
b.All off-budget effects would come from changes in revenues. (The payroll taxes for Social Security are classified as ``off-budget.'')

    Basis of estimate: CBO and JCT estimate that enacting H.R. 
2061 would increase the number of people claiming an exemption 
from the individual mandate by roughly 200,000 annually. That 
estimate stems primarily from two judgments, both of which are 
highly uncertain:
     CBO and JCT estimate that up to 500,000 people 
would newly qualify for the religious conscience exemption, on 
the basis of a review of the limited information that is 
publicly available. However, the agencies anticipate that a 
significant share of those people qualify for other exemptions 
from the mandate under current law and therefore would not 
newly claim an exemption under the bill. In particular, some 
may qualify for income-based exemptions such as having income 
below the threshold for filing income tax returns or having 
income below 138 percent of federal poverty guidelines and 
being ineligible for Medicaid because their state did not 
expand the program.
     CBO and JCT expect that some people may falsely 
claim the expanded religious conscience exemption under the 
bill; however, that number would be limited for two reasons. 
First, people would have to apply for the exemption through the 
health insurance exchange in their area (as is the case under 
current law) and the current application requires people to 
provide detailed information about the religious sect or 
division to which they belong.\2\ Second, H.R. 2061 would 
require people to attest that they have not received medical 
health services, with limited exceptions, during the preceding 
taxable year.
---------------------------------------------------------------------------
    \2\See https://marketplace.cms.gov/applications-and-forms/
religious-sect-exemption.pdf.
---------------------------------------------------------------------------
    Of the estimated 200,000 people who would newly claim an 
exemption from the individual mandate under the bill, CBO and 
JCT estimate that roughly 90 percent would otherwise pay a 
penalty for being uninsured. (The agencies estimate that most 
of the people affected by this bill will be uninsured under 
current law because the acceptance of medical health services 
would be inconsistent with their religious beliefs.) As a 
result, the agencies estimate that enacting H.R. 2061 would 
reduce collections from penalties assessed to uninsured 
individuals by $2.0 billion over the 2016-2025 period.
    The remaining 10 percent of people newly claiming an 
exemption from the individual mandate would be insured under 
current law and would forgo health insurance coverage as a 
result of the bill, the agencies estimate. Some of those people 
would falsely claim the new exemption under the bill; others 
are expected to obtain health insurance under current law in 
order to comply with the individual mandate, even though they 
will not use that insurance because of their religious 
convictions. Accordingly, under the bill, fewer people would 
enroll in Medicaid, subsidized health insurance coverage 
obtained through exchanges, and employment-based health 
insurance, which the agencies estimate would reduce outlays by 
$0.6 billion and increase revenues by $0.1 billion over the 
2016-2025 period. The effects on revenues stem from increases 
in taxable compensation associated with reductions in 
employment-based insurance and increases in tax liability 
associated with reductions in the number of people receiving 
tax credits to purchase health insurance through exchanges.
    On net, CBO and JCT estimate that enacting H.R. 2061 would 
increase federal deficits by $1.2 billion over the 2016-2025 
period, which consists of a $1.9 billion net reduction in 
revenues and a $0.6 billion decrease in direct spending. The 
net decrease in revenues reflects an estimated $1.9 billion 
reduction in on-budget revenues, partially offset by an 
estimated $25 million increase in off-budget (Social Security) 
revenues.
    Pay-As-You-Go considerations: The Statutory Pay-As-You-Go 
Act of 2010 establishes budget-reporting and enforcement 
procedures for legislation affecting direct spending or 
revenues. The changes in outlays and revenues that are subject 
to those pay-as-you-go procedures are shown in the following 
table. Only on-budget changes to outlays or revenues are 
subject to pay-as-you-go procedures.

         CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 2061, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON WAYS AND MEANS ON SEPTEMBER 17, 2015
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                         By fiscal year, in millions of dollars--
                                 -----------------------------------------------------------------------------------------------------------------------
                                   2015     2016     2017     2018     2019     2020     2021     2022     2023     2024     2025   2015-2020  2015-2025
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                          NET INCREASE IN THE ON-BUDGET DEFICIT
 
Statutory Pay-As-You-Go Impact..       0      135      125      100      110      115      115      130      140      145      145        585      1,260
Memorandum:
    Changes in Outlays..........       0      -15      -35      -55      -60      -65      -70      -75      -75      -80      -85       -230       -615
    Changes in Revenues.........       0     -150     -160     -155     -170     -180     -185     -205     -215     -225     -230       -815    -1,875
--------------------------------------------------------------------------------------------------------------------------------------------------------
Sources: Congressional Budget Office; staff of the Joint Committee on Taxation.

    Increase in long-term deficit and net direct spending: CBO 
and JCT estimate that enacting the legislation would not 
increase net direct spending by at least $5 billion in any of 
the four consecutive 10-year periods beginning in 2026; 
however, CBO and JCT estimate that enacting the legislation 
would increase on-budget deficits by at least $5 billion in at 
least one of the four consecutive 10-year periods beginning in 
2026. Specifically, on the basis of the budgetary effects 
projected for the 2021-2025 period, CBO and JCT estimate that 
the deficit increase resulting from enactment of the bill would 
grow by between 4 percent and 5 percent per year, thereby 
increasing on-budget deficits by a total of more than $5 
billion during the decade from 2056 through 2065.
    Intergovernmental and private-sector impact: JCT has 
determined that the bill contains no intergovernmental or 
private-sector mandates as defined in UMRA.
    Estimate prepared by: Federal costs: Sarah Masi and staff 
of the Joint Committee on Taxation; Impact on state, local, and 
tribal governments: staff of the Joint Committee on Taxation; 
Impact on the private sector: staff of the Joint Committee on 
Taxation.
    Estimate approved by: Holly Harvey, Deputy Assistant 
Director for Budget Analysis.

     V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE 

          A. Committee Oversight Findings and Recommendations

    With respect to clause 3(c)(1) of rule XIII of the Rules of 
the House of Representatives (relating to oversight findings), 
the Committee advises that it was as a result of the 
Committee's review of the provisions of H.R. 2061 that the 
Committee concluded that it is appropriate to report the bill, 
as amended, favorably to the House of Representatives with the 
recommendation that the bill do pass.

        B. Statement of General Performance Goals and Objectives

    With respect to clause 3(c)(4) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that the 
bill contains no measure that authorizes funding, so no 
statement of general performance goals and objectives for which 
any measure authorizes funding is required.

              C. Information Relating to Unfunded Mandates

    This information is provided in accordance with section 423 
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
    The Committee has determined that the bill does not contain 
Federal mandates on the private sector. The Committee has 
determined that the bill does not impose a Federal 
intergovernmental mandate on State, local, or tribal 
governments.

                 D. Applicability of House Rule XXI5(b)

    Rule XXI5(b) of the Rules of the House of Representatives 
provides, in part, that ``A bill or joint resolution, 
amendment, or conference report carrying a Federal income tax 
rate increase may not be considered as passed or agreed to 
unless so determined by a vote of not less than three-fifths of 
the Members voting, a quorum being present.'' The Committee has 
carefully reviewed the bill, and states that the bill does not 
involve any Federal income tax rate increases within the 
meaning of the rule.

                       E. Tax Complexity Analysis

    The following statement is made pursuant to clause 3(h)(1) 
of rule XIII of the Rules of the House of Representatives. 
Section 4022(b) of the Internal Revenue Service Restructuring 
and Reform Act of 1998 (``IRS Reform Act'') requires the staff 
of the Joint Committee on Taxation (in consultation with the 
Internal Revenue Service and the Treasury Department) to 
provide a tax complexity analysis. The complexity analysis is 
required for all legislation reported by the Senate Committee 
on Finance, the House Committee on Ways and Means, or any 
committee of conference if the legislation includes a provision 
that directly or indirectly amends the Internal Revenue Code 
and has widespread applicability to individuals or small 
businesses.
    Pursuant to clause 3(h)(1) of rule XIII of the Rules of the 
House of Representatives, the staff of the Joint Committee on 
Taxation has determined that a complexity analysis is not 
required under section 4022(b) of the IRS Reform Act because 
the bill contains no provisions that amend the Internal Revenue 
Code and that have ``widespread applicability'' to individuals 
or small businesses, within the meaning of the rule.

  F. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
                                Benefits

    With respect to clause 9 of rule XXI of the Rules of the 
House of Representatives, the Committee has carefully reviewed 
the provisions of the bill, and states that the provisions of 
the bill do not contain any congressional earmarks, limited tax 
benefits, or limited tariff benefits within the meaning of the 
rule.

                   G. Duplication of Federal Programs

    In compliance with Sec. 3(g)(2) of H. Res. 5 (114th 
Congress), the Committee states that no provision of the bill 
establishes or reauthorizes: (1) a program of the Federal 
Government known to be duplicative of another Federal program, 
(2) a program included in any report from the Government 
Accountability Office to Congress pursuant to section 21 of 
Public Law 111-139, or (3) a program related to a program 
identified in the most recent Catalog of Federal Domestic 
Assistance, published pursuant to the Federal Program 
Information Act (Public Law 95-220, as amended by Public Law 
98-169).

                 H. Disclosure of Directed Rule Makings

    In compliance with Sec. 3(i) of H. Res. 5 (114th Congress), 
the following statement is made concerning directed rule 
makings: The Committee estimates that the bill requires no 
directed rule makings within the meaning of such section.

             VI. CHANGES IN EXISTING LAW MADE BY THE BILL,

                              AS REPORTED

  A. Text of Existing Law Amended or Repealed by the Bill, as Reported

    In compliance with clause 3(e)(1)(A) of rule XIII of the 
Rules of the House of Representatives, the text of each section 
proposed to be amended or repealed by the bill, as reported, is 
shown below:

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e)(1)(B) of rule XIII of the 
Rules of the House of Representatives, changes in existing law 
proposed by the bill, as reported, are shown as follows 
(existing law proposed to be omitted is enclosed in black 
brackets, new matter is printed in italic, and existing law in 
which no change is proposed is shown in roman):

           SECTION 5000A OF THE INTERNAL REVENUE CODE OF 1986

SEC. 5000A. REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.

  (a) Requirement to Maintain Minimum Essential Coverage.--An 
applicable individual shall for each month beginning after 2013 
ensure that the individual, and any dependent of the individual 
who is an applicable individual, is covered under minimum 
essential coverage for such month.
  (b) Shared Responsibility Payment.--
          (1) In general.--If a taxpayer who is an applicable 
        individual, or an applicable individual for whom the 
        taxpayer is liable under paragraph (3), fails to meet 
        the requirement of subsection (a) for 1 or more months, 
        then, except as provided in subsection (e), there is 
        hereby imposed on the taxpayer a penalty with respect 
        to such failures in the amount determined under 
        subsection (c).
          (2) Inclusion with return.--Any penalty imposed by 
        this section with respect to any month shall be 
        included with a taxpayer's return under chapter 1 for 
        the taxable year which includes such month.
          (3) Payment of penalty.--If an individual with 
        respect to whom a penalty is imposed by this section 
        for any month--
                  (A) is a dependent (as defined in section 
                152) of another taxpayer for the other 
                taxpayer's taxable year including such month, 
                such other taxpayer shall be liable for such 
                penalty, or
                  (B) files a joint return for the taxable year 
                including such month, such individual and the 
                spouse of such individual shall be jointly 
                liable for such penalty.
  (c) Amount of Penalty.--
          (1) In general.--The amount of the penalty imposed by 
        this section on any taxpayer for any taxable year with 
        respect to failures described in subsection (b)(1) 
        shall be equal to the lesser of--
                  (A) the sum of the monthly penalty amounts 
                determined under paragraph (2) for months in 
                the taxable year during which 1 or more such 
                failures occurred, or
                  (B) an amount equal to the national average 
                premium for qualified health plans which have a 
                bronze level of coverage, provide coverage for 
                the applicable family size involved, and are 
                offered through Exchanges for plan years 
                beginning in the calendar year with or within 
                which the taxable year ends.
          (2) Monthly penalty amounts.--For purposes of 
        paragraph (1)(A), the monthly penalty amount with 
        respect to any taxpayer for any month during which any 
        failure described in subsection (b)(1) occurred is an 
        amount equal to \1/12\ of the greater of the following 
        amounts:
                  (A) Flat dollar amount.--An amount equal to 
                the lesser of--
                          (i) the sum of the applicable dollar 
                        amounts for all individuals with 
                        respect to whom such failure occurred 
                        during such month, or
                          (ii) 300 percent of the applicable 
                        dollar amount (determined without 
                        regard to paragraph (3)(C)) for the 
                        calendar year with or within which the 
                        taxable year ends.
                  (B) Percentage of income.--An amount equal to 
                the following percentage of the excess of the 
                taxpayer's household income for the taxable 
                year over the amount of gross income specified 
                in section 6012(a)(1) with respect to the 
                taxpayer for the taxable year:
                          (i) 1.0 percent for taxable years 
                        beginning in 2014.
                          (ii) 2.0 percent for taxable years 
                        beginning in 2015.
                          (iii) 2.5 percent for taxable years 
                        beginning after 2015.
          (3) Applicable dollar amount.--For purposes of 
        paragraph (1)--
                  (A) In general.--Except as provided in 
                subparagraphs (B) and (C), the applicable 
                dollar amount is $695.
                  (B) Phase in.--The applicable dollar amount 
                is $95 for 2014 and $325 for 2015.
                  (C) Special rule for individuals under age 
                18.--If an applicable individual has not 
                attained the age of 18 as of the beginning of a 
                month, the applicable dollar amount with 
                respect to such individual for the month shall 
                be equal to one-half of the applicable dollar 
                amount for the calendar year in which the month 
                occurs.
                  (D) Indexing of amount.--In the case of any 
                calendar year beginning after 2016, the 
                applicable dollar amount shall be equal to 
                $695, increased by an amount equal to--
                          (i) $695, multiplied by
                          (ii) the cost-of-living adjustment 
                        determined under section 1(f)(3) for 
                        the calendar year, determined by 
                        substituting ``calendar year 2015'' for 
                        ``calendar year 1992'' in subparagraph 
                        (B) thereof.
                If the amount of any increase under clause (i) 
                is not a multiple of $50, such increase shall 
                be rounded to the next lowest multiple of $50.
          (4) Terms relating to income and families.--For 
        purposes of this section--
                  (A) Family size.--The family size involved 
                with respect to any taxpayer shall be equal to 
                the number of individuals for whom the taxpayer 
                is allowed a deduction under section 151 
                (relating to allowance of deduction for 
                personal exemptions) for the taxable year.
                  (B) Household income.--The term ``household 
                income'' means, with respect to any taxpayer 
                for any taxable year, an amount equal to the 
                sum of--
                          (i) the modified adjusted gross 
                        income of the taxpayer, plus
                          (ii) the aggregate modified adjusted 
                        gross incomes of all other individuals 
                        who--
                                  (I) were taken into account 
                                in determining the taxpayer's 
                                family size under paragraph 
                                (1), and
                                  (II) were required to file a 
                                return of tax imposed by 
                                section 1 for the taxable year.
                  (C) Modified adjusted gross income.--The term 
                ``modified adjusted gross income'' means 
                adjusted gross income increased by--
                          (i) any amount excluded from gross 
                        income under section 911, and
                          (ii) any amount of interest received 
                        or accrued by the taxpayer during the 
                        taxable year which is exempt from tax.
  (d) Applicable Individual.--For purposes of this section--
          (1) In general.--The term ``applicable individual'' 
        means, with respect to any month, an individual other 
        than an individual described in paragraph (2), (3), or 
        (4).
          (2) Religious exemptions.--
                  [(A) Religious conscience exemption.--Such 
                term shall not include any individual for any 
                month if such individual has in effect an 
                exemption under section 1311(d)(4)(H) of the 
                Patient Protection and Affordable Care Act 
                which certifies that such individual is--
                          [(i) a member of a recognized 
                        religious sect or division thereof 
                        which is described in section 
                        1402(g)(1), and
                          [(ii) an adherent of established 
                        tenets or teachings of such sect or 
                        division as described in such section.]
                  (A) Religious conscience exemptions.--
                          (i) In general.--Such term shall not 
                        include any individual for any month if 
                        such individual has in effect an 
                        exemption under section 1311(d)(4)(H) 
                        of the Patient Protection and 
                        Affordable Care Act which certifies 
                        that--
                                  (I) such individual is a 
                                member of a recognized 
                                religious sect or division 
                                thereof which is described in 
                                section 1402(g)(1), and is 
                                adherent of established tenets 
                                or teachings of such sect or 
                                division as described in such 
                                section, or
                                  (II) such individual is a 
                                member of a religious sect or 
                                division thereof which is not 
                                described in section 
                                1402(g)(1), who relies solely 
                                on a religious method of 
                                healing, and for whom the 
                                acceptance of medical health 
                                services would be inconsistent 
                                with the religious beliefs of 
                                the individual.
                          (ii) Special rules.--
                                  (I) Medical health services 
                                defined.--For purposes of this 
                                subparagraph, the term 
                                ``medical health services'' 
                                does not include routine 
                                dental, vision, and hearing 
                                services, midwifery services, 
                                vaccinations, necessary medical 
                                services provided to children, 
                                services required by law or by 
                                a third party, and such other 
                                services as the Secretary of 
                                Health and Human Services may 
                                provide in implementing section 
                                1311(d)(4)(H) of the Patient 
                                Protection and Affordable Care 
                                Act.
                                  (II) Attestation required.--
                                Clause (i)(II) shall apply to 
                                an individual for months in a 
                                taxable year only if the 
                                information provided by the 
                                individual under section 
                                1411(b)(5)(A) of such Act 
                                includes an attestation that 
                                the individual has not received 
                                medical health services during 
                                the preceding taxable year.
                  (B) Health care sharing ministry.--
                          (i) In general.--Such term shall not 
                        include any individual for any month if 
                        such individual is a member of a health 
                        care sharing ministry for the month.
                          (ii) Health care sharing ministry.--
                        The term ``health care sharing 
                        ministry'' means an organization--
                                  (I) which is described in 
                                section 501(c)(3) and is exempt 
                                from taxation under section 
                                501(a),
                                  (II) members of which share a 
                                common set of ethical or 
                                religious beliefs and share 
                                medical expenses among members 
                                in accordance with those 
                                beliefs and without regard to 
                                the State in which a member 
                                resides or is employed,
                                  (III) members of which retain 
                                membership even after they 
                                develop a medical condition,
                                  (IV) which (or a predecessor 
                                of which) has been in existence 
                                at all times since December 31, 
                                1999, and medical expenses of 
                                its members have been shared 
                                continuously and without 
                                interruption since at least 
                                December 31, 1999, and
                                  (V) which conducts an annual 
                                audit which is performed by an 
                                independent certified public 
                                accounting firm in accordance 
                                with generally accepted 
                                accounting principles and which 
                                is made available to the public 
                                upon request.
          (3) Individuals not lawfully present.--Such term 
        shall not include an individual for any month if for 
        the month the individual is not a citizen or national 
        of the United States or an alien lawfully present in 
        the United States.
          (4) Incarcerated individuals.--Such term shall not 
        include an individual for any month if for the month 
        the individual is incarcerated, other than 
        incarceration pending the disposition of charges.
  (e) Exemptions.--No penalty shall be imposed under subsection 
(a) with respect to--
          (1) Individuals who cannot afford coverage.--
                  (A) In general.--Any applicable individual 
                for any month if the applicable individual's 
                required contribution (determined on an annual 
                basis) for coverage for the month exceeds 8 
                percent of such individual's household income 
                for the taxable year described in section 
                1412(b)(1)(B) of the Patient Protection and 
                Affordable Care Act. For purposes of applying 
                this subparagraph, the taxpayer's household 
                income shall be increased by any exclusion from 
                gross income for any portion of the required 
                contribution made through a salary reduction 
                arrangement.
                  (B) Required contribution.--For purposes of 
                this paragraph, the term ``required 
                contribution'' means--
                          (i) in the case of an individual 
                        eligible to purchase minimum essential 
                        coverage consisting of coverage through 
                        an eligible-employer-sponsored plan, 
                        the portion of the annual premium which 
                        would be paid by the individual 
                        (without regard to whether paid through 
                        salary reduction or otherwise) for 
                        self-only coverage, or
                          (ii) in the case of an individual 
                        eligible only to purchase minimum 
                        essential coverage described in 
                        subsection (f)(1)(C), the annual 
                        premium for the lowest cost bronze plan 
                        available in the individual market 
                        through the Exchange in the State in 
                        the rating area in which the individual 
                        resides (without regard to whether the 
                        individual purchased a qualified health 
                        plan through the Exchange), reduced by 
                        the amount of the credit allowable 
                        under section 36B for the taxable year 
                        (determined as if the individual was 
                        covered by a qualified health plan 
                        offered through the Exchange for the 
                        entire taxable year).
                  (C) Special rules for individuals related to 
                employees.--For purposes of subparagraph 
                (B)(i), if an applicable individual is eligible 
                for minimum essential coverage through an 
                employer by reason of a relationship to an 
                employee, the determination under subparagraph 
                (A) shall be made by reference to required 
                contribution of the employee.
                  (D) Indexing.--In the case of plan years 
                beginning in any calendar year after 2014, 
                subparagraph (A) shall be applied by 
                substituting for ``8 percent'' the percentage 
                the Secretary of Health and Human Services 
                determines reflects the excess of the rate of 
                premium growth between the preceding calendar 
                year and 2013 over the rate of income growth 
                for such period.
          (2) Taxpayers with income below filing threshold.--
        Any applicable individual for any month during a 
        calendar year if the individual's household income for 
        the taxable year described in section 1412(b)(1)(B) of 
        the Patient Protection and Affordable Care Act is the 
        amount of gross income specified in section 6012(a)(1) 
        with respect to the taxpayer.
          (3) Members of Indian tribes.--Any applicable 
        individual for any month during which the individual is 
        a member of an Indian tribe (as defined in section 
        45A(c)(6)).
          (4) Months during short coverage gaps.--
                  (A) In general.--Any month the last day of 
                which occurred during a period in which the 
                applicable individual was not covered by 
                minimum essential coverage for a continuous 
                period of less than 3 months.
                  (B) Special rules.--For purposes of applying 
                this paragraph--
                          (i) the length of a continuous period 
                        shall be determined without regard to 
                        the calendar years in which months in 
                        such period occur,
                          (ii) if a continuous period is 
                        greater than the period allowed under 
                        subparagraph (A), no exception shall be 
                        provided under this paragraph for any 
                        month in the period, and
                          (iii) if there is more than 1 
                        continuous period described in 
                        subparagraph (A) covering months in a 
                        calendar year, the exception provided 
                        by this paragraph shall only apply to 
                        months in the first of such periods.
                The Secretary shall prescribe rules for the 
                collection of the penalty imposed by this 
                section in cases where continuous periods 
                include months in more than 1 taxable year.
          (5) Hardships.--Any applicable individual who for any 
        month is determined by the Secretary of Health and 
        Human Services under section 1311(d)(4)(H) to have 
        suffered a hardship with respect to the capability to 
        obtain coverage under a qualified health plan.
  (f) Minimum Essential Coverage.--For purposes of this 
section--
          (1) In general.--The term ``minimum essential 
        coverage'' means any of the following:
                  (A) Government sponsored programs.--Coverage 
                under--
                          (i) the Medicare program under part A 
                        of title XVIII of the Social Security 
                        Act,
                          (ii) the Medicaid program under title 
                        XIX of the Social Security Act,
                          (iii) the CHIP program under title 
                        XXI of the Social Security Act,
                          (iv) medical coverage under chapter 
                        55 of title 10, United States Code, 
                        including coverage under the TRICARE 
                        program;
                          (v) a health care program under 
                        chapter 17 or 18 of title 38, United 
                        States Code, as determined by the 
                        Secretary of Veterans Affairs, in 
                        coordination with the Secretary of 
                        Health and Human Services and the 
                        Secretary,
                          (vi) a health plan under section 
                        2504(e) of title 22, United States Code 
                        (relating to Peace Corps volunteers); 
                        or
                          (vii) the Nonappropriated Fund Health 
                        Benefits Program of the Department of 
                        Defense, established under section 349 
                        of the National Defense Authorization 
                        Act for Fiscal Year 1995 (Public Law 
                        103-337; 10 U.S.C. 1587 note).
                  (B) Employer-sponsored plan.--Coverage under 
                an eligible employer-sponsored plan.
                  (C) Plans in the individual market.--Coverage 
                under a health plan offered in the individual 
                market within a State.
                  (D) Grandfathered health plan.--Coverage 
                under a grandfathered health plan.
                  (E) Other coverage.--Such other health 
                benefits coverage, such as a State health 
                benefits risk pool, as the Secretary of Health 
                and Human Services, in coordination with the 
                Secretary, recognizes for purposes of this 
                subsection.
          (2) Eligible employer-sponsored plan.--The term 
        ``eligible employer-sponsored plan'' means, with 
        respect to any employee, a group health plan or group 
        health insurance coverage offered by an employer to the 
        employee which is--
                  (A) a governmental plan (within the meaning 
                of section 2791(d)(8) of the Public Health 
                Service Act), or
                  (B) any other plan or coverage offered in the 
                small or large group market within a State.
        Such term shall include a grandfathered health plan 
        described in paragraph (1)(D) offered in a group 
        market.
          (3) Excepted benefits not treated as minimum 
        essential coverage.--The term ``minimum essential 
        coverage'' shall not include health insurance coverage 
        which consists of coverage of excepted benefits--
                  (A) described in paragraph (1) of subsection 
                (c) of section 2791 of the Public Health 
                Service Act; or
                  (B) described in paragraph (2), (3), or (4) 
                of such subsection if the benefits are provided 
                under a separate policy, certificate, or 
                contract of insurance.
          (4) Individuals residing outside United States or 
        residents of territories.--Any applicable individual 
        shall be treated as having minimum essential coverage 
        for any month--
                  (A) if such month occurs during any period 
                described in subparagraph (A) or (B) of section 
                911(d)(1) which is applicable to the 
                individual, or
                  (B) if such individual is a bona fide 
                resident of any possession of the United States 
                (as determined under section 937(a)) for such 
                month.
          (5) Insurance-related terms.--Any term used in this 
        section which is also used in title I of the Patient 
        Protection and Affordable Care Act shall have the same 
        meaning as when used in such title.
  (g) Administration and Procedure.--
          (1) In general.--The penalty provided by this section 
        shall be paid upon notice and demand by the Secretary, 
        and except as provided in paragraph (2), shall be 
        assessed and collected in the same manner as an 
        assessable penalty under subchapter B of chapter 68.
          (2) Special rules.--Notwithstanding any other 
        provision of law--
                  (A) Waiver of criminal penalties.--In the 
                case of any failure by a taxpayer to timely pay 
                any penalty imposed by this section, such 
                taxpayer shall not be subject to any criminal 
                prosecution or penalty with respect to such 
                failure.
                  (B) Limitations on liens and levies.--The 
                Secretary shall not--
                          (i) file notice of lien with respect 
                        to any property of a taxpayer by reason 
                        of any failure to pay the penalty 
                        imposed by this section, or
                          (ii) levy on any such property with 
                        respect to such failure.

      B. Changes in Existing Law Proposed by the Bill, as Reported

    In compliance with clause 3(e)(1)(B) of rule XIII of the 
Rules of the House of Representatives, changes in existing law 
proposed by the bill, as reported, are shown as follows 
(existing law proposed to be omitted is enclosed in black 
brackets, new matter is printed in italic, existing law in 
which no change is proposed is shown in roman):

   Text of Existing Law Amended or Repealed by the Bill, as Reported

  In compliance with clause 3(e)(1)(A) of rule XIII of the 
Rules of the House of Representatives, the text of each section 
proposed to be amended or repealed by the bill, as reported, is 
shown below:

           SECTION 5000A OF THE INTERNAL REVENUE CODE OF 1986

SEC. 5000A. REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.

  (a) Requirement to Maintain Minimum Essential Coverage.--An 
applicable individual shall for each month beginning after 2013 
ensure that the individual, and any dependent of the individual 
who is an applicable individual, is covered under minimum 
essential coverage for such month.
  (b) Shared Responsibility Payment.--
          (1) In general.--If a taxpayer who is an applicable 
        individual, or an applicable individual for whom the 
        taxpayer is liable under paragraph (3), fails to meet 
        the requirement of subsection (a) for 1 or more months, 
        then, except as provided in subsection (e), there is 
        hereby imposed on the taxpayer a penalty with respect 
        to such failures in the amount determined under 
        subsection (c).
          (2) Inclusion with return.--Any penalty imposed by 
        this section with respect to any month shall be 
        included with a taxpayer's return under chapter 1 for 
        the taxable year which includes such month.
          (3) Payment of penalty.--If an individual with 
        respect to whom a penalty is imposed by this section 
        for any month--
                  (A) is a dependent (as defined in section 
                152) of another taxpayer for the other 
                taxpayer's taxable year including such month, 
                such other taxpayer shall be liable for such 
                penalty, or
                  (B) files a joint return for the taxable year 
                including such month, such individual and the 
                spouse of such individual shall be jointly 
                liable for such penalty.
  (c) Amount of Penalty.--
          (1) In general.--The amount of the penalty imposed by 
        this section on any taxpayer for any taxable year with 
        respect to failures described in subsection (b)(1) 
        shall be equal to the lesser of--
                  (A) the sum of the monthly penalty amounts 
                determined under paragraph (2) for months in 
                the taxable year during which 1 or more such 
                failures occurred, or
                  (B) an amount equal to the national average 
                premium for qualified health plans which have a 
                bronze level of coverage, provide coverage for 
                the applicable family size involved, and are 
                offered through Exchanges for plan years 
                beginning in the calendar year with or within 
                which the taxable year ends.
          (2) Monthly penalty amounts.--For purposes of 
        paragraph (1)(A), the monthly penalty amount with 
        respect to any taxpayer for any month during which any 
        failure described in subsection (b)(1) occurred is an 
        amount equal to \1/12\ of the greater of the following 
        amounts:
                  (A) Flat dollar amount.--An amount equal to 
                the lesser of--
                          (i) the sum of the applicable dollar 
                        amounts for all individuals with 
                        respect to whom such failure occurred 
                        during such month, or
                          (ii) 300 percent of the applicable 
                        dollar amount (determined without 
                        regard to paragraph (3)(C)) for the 
                        calendar year with or within which the 
                        taxable year ends.
                  (B) Percentage of income.--An amount equal to 
                the following percentage of the excess of the 
                taxpayer's household income for the taxable 
                year over the amount of gross income specified 
                in section 6012(a)(1) with respect to the 
                taxpayer for the taxable year:
                          (i) 1.0 percent for taxable years 
                        beginning in 2014.
                          (ii) 2.0 percent for taxable years 
                        beginning in 2015.
                          (iii) 2.5 percent for taxable years 
                        beginning after 2015.
          (3) Applicable dollar amount.--For purposes of 
        paragraph (1)--
                  (A) In general.--Except as provided in 
                subparagraphs (B) and (C), the applicable 
                dollar amount is $695.
                  (B) Phase in.--The applicable dollar amount 
                is $95 for 2014 and $325 for 2015.
                  (C) Special rule for individuals under age 
                18.--If an applicable individual has not 
                attained the age of 18 as of the beginning of a 
                month, the applicable dollar amount with 
                respect to such individual for the month shall 
                be equal to one-half of the applicable dollar 
                amount for the calendar year in which the month 
                occurs.
                  (D) Indexing of amount.--In the case of any 
                calendar year beginning after 2016, the 
                applicable dollar amount shall be equal to 
                $695, increased by an amount equal to--
                          (i) $695, multiplied by
                          (ii) the cost-of-living adjustment 
                        determined under section 1(f)(3) for 
                        the calendar year, determined by 
                        substituting ``calendar year 2015'' for 
                        ``calendar year 1992'' in subparagraph 
                        (B) thereof.
                If the amount of any increase under clause (i) 
                is not a multiple of $50, such increase shall 
                be rounded to the next lowest multiple of $50.
          (4) Terms relating to income and families.--For 
        purposes of this section--
                  (A) Family size.--The family size involved 
                with respect to any taxpayer shall be equal to 
                the number of individuals for whom the taxpayer 
                is allowed a deduction under section 151 
                (relating to allowance of deduction for 
                personal exemptions) for the taxable year.
                  (B) Household income.--The term ``household 
                income'' means, with respect to any taxpayer 
                for any taxable year, an amount equal to the 
                sum of--
                          (i) the modified adjusted gross 
                        income of the taxpayer, plus
                          (ii) the aggregate modified adjusted 
                        gross incomes of all other individuals 
                        who--
                                  (I) were taken into account 
                                in determining the taxpayer's 
                                family size under paragraph 
                                (1), and
                                  (II) were required to file a 
                                return of tax imposed by 
                                section 1 for the taxable year.
                  (C) Modified adjusted gross income.--The term 
                ``modified adjusted gross income'' means 
                adjusted gross income increased by--
                          (i) any amount excluded from gross 
                        income under section 911, and
                          (ii) any amount of interest received 
                        or accrued by the taxpayer during the 
                        taxable year which is exempt from tax.
  (d) Applicable Individual.--For purposes of this section--
          (1) In general.--The term ``applicable individual'' 
        means, with respect to any month, an individual other 
        than an individual described in paragraph (2), (3), or 
        (4).
          (2) Religious exemptions.--
                  (A) Religious conscience exemption.--Such 
                term shall not include any individual for any 
                month if such individual has in effect an 
                exemption under section 1311(d)(4)(H) of the 
                Patient Protection and Affordable Care Act 
                which certifies that such individual is--
                          (i) a member of a recognized 
                        religious sect or division thereof 
                        which is described in section 
                        1402(g)(1), and
                          (ii) an adherent of established 
                        tenets or teachings of such sect or 
                        division as described in such section.
                  (B) Health care sharing ministry.--
                          (i) In general.--Such term shall not 
                        include any individual for any month if 
                        such individual is a member of a health 
                        care sharing ministry for the month.
                          (ii) Health care sharing ministry.--
                        The term ``health care sharing 
                        ministry'' means an organization--
                                  (I) which is described in 
                                section 501(c)(3) and is exempt 
                                from taxation under section 
                                501(a),
                                  (II) members of which share a 
                                common set of ethical or 
                                religious beliefs and share 
                                medical expenses among members 
                                in accordance with those 
                                beliefs and without regard to 
                                the State in which a member 
                                resides or is employed,
                                  (III) members of which retain 
                                membership even after they 
                                develop a medical condition,
                                  (IV) which (or a predecessor 
                                of which) has been in existence 
                                at all times since December 31, 
                                1999, and medical expenses of 
                                its members have been shared 
                                continuously and without 
                                interruption since at least 
                                December 31, 1999, and
                                  (V) which conducts an annual 
                                audit which is performed by an 
                                independent certified public 
                                accounting firm in accordance 
                                with generally accepted 
                                accounting principles and which 
                                is made available to the public 
                                upon request.
          (3) Individuals not lawfully present.--Such term 
        shall not include an individual for any month if for 
        the month the individual is not a citizen or national 
        of the United States or an alien lawfully present in 
        the United States.
          (4) Incarcerated individuals.--Such term shall not 
        include an individual for any month if for the month 
        the individual is incarcerated, other than 
        incarceration pending the disposition of charges.
  (e) Exemptions.--No penalty shall be imposed under subsection 
(a) with respect to--
          (1) Individuals who cannot afford coverage.--
                  (A) In general.--Any applicable individual 
                for any month if the applicable individual's 
                required contribution (determined on an annual 
                basis) for coverage for the month exceeds 8 
                percent of such individual's household income 
                for the taxable year described in section 
                1412(b)(1)(B) of the Patient Protection and 
                Affordable Care Act. For purposes of applying 
                this subparagraph, the taxpayer's household 
                income shall be increased by any exclusion from 
                gross income for any portion of the required 
                contribution made through a salary reduction 
                arrangement.
                  (B) Required contribution.--For purposes of 
                this paragraph, the term ``required 
                contribution'' means--
                          (i) in the case of an individual 
                        eligible to purchase minimum essential 
                        coverage consisting of coverage through 
                        an eligible-employer-sponsored plan, 
                        the portion of the annual premium which 
                        would be paid by the individual 
                        (without regard to whether paid through 
                        salary reduction or otherwise) for 
                        self-only coverage, or
                          (ii) in the case of an individual 
                        eligible only to purchase minimum 
                        essential coverage described in 
                        subsection (f)(1)(C), the annual 
                        premium for the lowest cost bronze plan 
                        available in the individual market 
                        through the Exchange in the State in 
                        the rating area in which the individual 
                        resides (without regard to whether the 
                        individual purchased a qualified health 
                        plan through the Exchange), reduced by 
                        the amount of the credit allowable 
                        under section 36B for the taxable year 
                        (determined as if the individual was 
                        covered by a qualified health plan 
                        offered through the Exchange for the 
                        entire taxable year).
                  (C) Special rules for individuals related to 
                employees.--For purposes of subparagraph 
                (B)(i), if an applicable individual is eligible 
                for minimum essential coverage through an 
                employer by reason of a relationship to an 
                employee, the determination under subparagraph 
                (A) shall be made by reference to required 
                contribution of the employee.
                  (D) Indexing.--In the case of plan years 
                beginning in any calendar year after 2014, 
                subparagraph (A) shall be applied by 
                substituting for ``8 percent'' the percentage 
                the Secretary of Health and Human Services 
                determines reflects the excess of the rate of 
                premium growth between the preceding calendar 
                year and 2013 over the rate of income growth 
                for such period.
          (2) Taxpayers with income below filing threshold.--
        Any applicable individual for any month during a 
        calendar year if the individual's household income for 
        the taxable year described in section 1412(b)(1)(B) of 
        the Patient Protection and Affordable Care Act is the 
        amount of gross income specified in section 6012(a)(1) 
        with respect to the taxpayer.
          (3) Members of indian tribes.--Any applicable 
        individual for any month during which the individual is 
        a member of an Indian tribe (as defined in section 
        45A(c)(6)).
          (4) Months during short coverage gaps.--
                  (A) In general.--Any month the last day of 
                which occurred during a period in which the 
                applicable individual was not covered by 
                minimum essential coverage for a continuous 
                period of less than 3 months.
                  (B) Special rules.--For purposes of applying 
                this paragraph--
                          (i) the length of a continuous period 
                        shall be determined without regard to 
                        the calendar years in which months in 
                        such period occur,
                          (ii) if a continuous period is 
                        greater than the period allowed under 
                        subparagraph (A), no exception shall be 
                        provided under this paragraph for any 
                        month in the period, and
                          (iii) if there is more than 1 
                        continuous period described in 
                        subparagraph (A) covering months in a 
                        calendar year, the exception provided 
                        by this paragraph shall only apply to 
                        months in the first of such periods.
                The Secretary shall prescribe rules for the 
                collection of the penalty imposed by this 
                section in cases where continuous periods 
                include months in more than 1 taxable year.
          (5) Hardships.--Any applicable individual who for any 
        month is determined by the Secretary of Health and 
        Human Services under section 1311(d)(4)(H) to have 
        suffered a hardship with respect to the capability to 
        obtain coverage under a qualified health plan.
  (f) Minimum Essential Coverage.--For purposes of this 
section--
          (1) In general.--The term ``minimum essential 
        coverage'' means any of the following:
                  (A) Government sponsored programs.--Coverage 
                under--
                          (i) the Medicare program under part A 
                        of title XVIII of the Social Security 
                        Act,
                          (ii) the Medicaid program under title 
                        XIX of the Social Security Act,
                          (iii) the CHIP program under title 
                        XXI of the Social Security Act,
                          (iv) medical coverage under chapter 
                        55 of title 10, United States Code, 
                        including coverage under the TRICARE 
                        program;
                          (v) a health care program under 
                        chapter 17 or 18 of title 38, United 
                        States Code, as determined by the 
                        Secretary of Veterans Affairs, in 
                        coordination with the Secretary of 
                        Health and Human Services and the 
                        Secretary,
                          (vi) a health plan under section 
                        2504(e) of title 22, United States Code 
                        (relating to Peace Corps volunteers); 
                        or
                          (vii) the Nonappropriated Fund Health 
                        Benefits Program of the Department of 
                        Defense, established under section 349 
                        of the National Defense Authorization 
                        Act for Fiscal Year 1995 (Public Law 
                        103-337; 10 U.S.C. 1587 note).
                  (B) Employer-sponsored plan.--Coverage under 
                an eligible employer-sponsored plan.
                  (C) Plans in the individual market.--Coverage 
                under a health plan offered in the individual 
                market within a State.
                  (D) Grandfathered health plan.--Coverage 
                under a grandfathered health plan.
                  (E) Other coverage.--Such other health 
                benefits coverage, such as a State health 
                benefits risk pool, as the Secretary of Health 
                and Human Services, in coordination with the 
                Secretary, recognizes for purposes of this 
                subsection.
          (2) Eligible employer-sponsored plan.--The term 
        ``eligible employer-sponsored plan'' means, with 
        respect to any employee, a group health plan or group 
        health insurance coverage offered by an employer to the 
        employee which is--
                  (A) a governmental plan (within the meaning 
                of section 2791(d)(8) of the Public Health 
                Service Act), or
                  (B) any other plan or coverage offered in the 
                small or large group market within a State.
        Such term shall include a grandfathered health plan 
        described in paragraph (1)(D) offered in a group 
        market.
          (3) Excepted benefits not treated as minimum 
        essential coverage.--The term ``minimum essential 
        coverage'' shall not include health insurance coverage 
        which consists of coverage of excepted benefits--
                  (A) described in paragraph (1) of subsection 
                (c) of section 2791 of the Public Health 
                Service Act; or
                  (B) described in paragraph (2), (3), or (4) 
                of such subsection if the benefits are provided 
                under a separate policy, certificate, or 
                contract of insurance.
          (4) Individuals residing outside United States or 
        residents of territories.--Any applicable individual 
        shall be treated as having minimum essential coverage 
        for any month--
                  (A) if such month occurs during any period 
                described in subparagraph (A) or (B) of section 
                911(d)(1) which is applicable to the 
                individual, or
                  (B) if such individual is a bona fide 
                resident of any possession of the United States 
                (as determined under section 937(a)) for such 
                month.
          (5) Insurance-related terms.--Any term used in this 
        section which is also used in title I of the Patient 
        Protection and Affordable Care Act shall have the same 
        meaning as when used in such title.
  (g) Administration and Procedure.--
          (1) In general.--The penalty provided by this section 
        shall be paid upon notice and demand by the Secretary, 
        and except as provided in paragraph (2), shall be 
        assessed and collected in the same manner as an 
        assessable penalty under subchapter B of chapter 68.
          (2) Special rules.--Notwithstanding any other 
        provision of law--
                  (A) Waiver of criminal penalties.--In the 
                case of any failure by a taxpayer to timely pay 
                any penalty imposed by this section, such 
                taxpayer shall not be subject to any criminal 
                prosecution or penalty with respect to such 
                failure.
                  (B) Limitations on liens and levies.--The 
                Secretary shall not--
                          (i) file notice of lien with respect 
                        to any property of a taxpayer by reason 
                        of any failure to pay the penalty 
                        imposed by this section, or
                          (ii) levy on any such property with 
                        respect to such failure.

                         VII. ADDITIONAL VIEWS

    H.R. 2061--the Equitable Access to Care and Health Act--
costs $1.2 billion in lost tax revenue and this revenue loss is 
not offset. When combined with the other bills under 
consideration at the committee's markup, the total cost of lost 
revenue is over $400 billion over the next ten years--and the 
Majority did not set forth any options to pay for this cost. 
Not one cost offset option was offered by the Majority at the 
markup. It is unacceptable in this time of fiscal austerity to 
not pay the cost of these bills. It is irresponsible to add 
over $400 billion in lost revenue to the deficit.
    This bill modifies the religious exemption of the 
individual shared responsibility provision of the Affordable 
Care Act (ACA). The ACA at Section 1501(d)(2)(A) cross 
references the existing religious exemption in the Internal 
Revenue Code at Section 1402(g)(1) for payroll tax purposes. 
Current law provides an exemption from the individual 
responsibility requirement for individuals who are members of 
religious sects that object to accepting benefits of any 
private or public insurance that makes payments in the event of 
death, disability, old age, or retirement--including any 
benefits established under the Social Security Act--provided 
that the members of the sect make reasonable provision for 
dependent members in view of their general level of living. It 
exempts individuals who do not accept benefits from government 
insurance programs like Social Security and Medicare from the 
individual responsibility requirement. Thus the current law 
mostly applies to Amish and Mennonite groups; it does not 
include Christian Scientists and other religious sects (who do 
use some public insurance benefits).
    H.R. 2061 would expand the scope of individuals who can 
claim a religious conscience exemption to the individual shared 
responsibility provision. The bill would allow anyone who is a 
member of a religious sect that relies solely on religious 
methods of healing and for whom medical care is inconsistent 
with religious beliefs to claim a religious exemption from the 
individual mandate requirement. This definition is drafted 
narrowly so that individuals eligible to claim an exemption may 
not accept medical care beyond religious methods of healing or 
those services identified in the legislation (e.g., routine 
hearing, dental, and vision care).
    The new legislation does not exempt individuals based on 
their objections to specific types of the medical care (e.g., 
refusal of blood transfusions or contraception, but acceptance 
of other medical care).
                                           Sander M. Levin,
                                                    Ranking Member.

                                  [all]
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