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[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 1368 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                S. 1368

To establish the Office of the Special Inspector General for Monitoring 
            the Affordable Care Act, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              May 19, 2015

  Mr. Roberts (for himself and Mr. Portman) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
To establish the Office of the Special Inspector General for Monitoring 
            the Affordable Care Act, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Special Inspector General for 
Monitoring the ACA Act of 2015'' or the ``SIGMA Act of 2015''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) The writing, passage, and implementation of the 
        Affordable Care Act has utterly lacked transparency.
            (2) Presidential candidate Barack Obama repeatedly promised 
        that if elected President, he would hold open, public 
        negotiations on health care reform among public and private 
        stakeholders, including at a Democratic Presidential debate on 
        January 31, 2008, when he said, ``That's what I will do in 
        bringing all parties together, not negotiating behind closed 
        doors, but bringing all parties together, and broadcasting 
        those negotiations on C-SPAN so that the American people can 
        see what the choices are, because part of what we have to do is 
        enlist the American people in this process.''.
            (3) Then-Senator Obama repeated this promise multiple 
        times, including at an Ohio town hall on March 1, 2008, when he 
        said, ``But here's the thing: we're gonna do all these 
        negotiations on C-SPAN. So the American people will be able to 
        watch these negotiations.''.
            (4) Then-Senator Obama also repeated this promise at a 
        Virginia town hall on August 21, 2008, when he said, ``I'm 
        going to have all the negotiations around a big table. We'll 
        have doctors and nurses and hospital administrators. Insurance 
        companies, drug companies--they'll get a seat at the table . . 
        . But what we will do is, we'll have the negotiations televised 
        on C-SPAN, so that people can see who is making arguments on 
        behalf of their constituents, and who are making arguments on 
        behalf of the drug companies or the insurance companies. And 
        so, that approach, I think is what is going to allow people to 
        stay involved in this process.''.
            (5) In a September 26, 2011, interview, Brian Lamb, the CEO 
        of C-SPAN confirmed the negotiations of the health reform law 
        had not been broadcast publicly, noting, ``The President said 
        that they were all going to be on C-SPAN. He never asked us.''.
            (6) President Obama, in leading the national health reform 
        debate, broke his promise, admitting in a January 25, 2010, 
        interview with ABC News that locking the public out of key 
        health reform discussions was a ``mistake'' and explaining, 
        ``We had to make so many decisions quickly in a very difficult 
        set of circumstances that after awhile, we started worrying 
        more about getting the policy right than getting the process 
        right. But I had campaigned on process--part of what I had 
        campaigned on was changing how Washington works, opening up, 
        transparency and I think it is--I think the health care debate 
        as it unfolded legitimately raised concerns not just among my 
        opponents, but also amongst supporters that we just don't know 
        what's going on. And it's an ugly process and it looks like 
        there are a bunch of backroom deals.''.
            (7) On March 9, 2010, then-Speaker of the House Nancy 
        Pelosi said of what would become the Affordable Care Act, ``We 
        have to pass the bill so that you can find out what is in 
        it.''.
            (8) Dr. Jonathan Gruber, a professor of economics at the 
        Massachusetts Institute of Technology, was awarded a contract 
        by the Department of Health and Human Services to provide 
        ``technical assistance in evaluating options for national 
        healthcare reform'' due to his ``proprietary statistically 
        sophisticated micro-simulation model'' which could assess the 
        impact of changes in Federal health care policies.
            (9) Dr. Gruber described himself as a health reform 
        architect who contributed to the crafting of the Affordable 
        Care Act in a 2012 opinion editorial, noting, ``Several of the 
        architects of Massachusetts reform, including myself, worked 
        closely with the Administration and Congress to translate the 
        lessons from Massachusetts onto the national stage.''.
            (10) Dr. Gruber's MIT biography has described him as ``a 
        key architect'' of the Massachusetts health reform effort and a 
        2009 and 2010 ``technical consultant'' who ``worked with both 
        the Administration and Congress to help craft the Patient 
        Protection and Affordable Care Act.''.
            (11) An October 11, 2011, report by NBC News described 
        White House visitor logs that show Dr. Gruber had at least five 
        meetings at the White House in 2009 in the lead up to the 
        passage of the Affordable Care Act, including a meeting in the 
        Oval Office with President Obama to evaluate options for 
        national health reform.
            (12) In a video posted April 12, 2012, by the Obama 
        Presidential campaign to YouTube, Dr. Gruber states that he 
        went ``down to Washington to help President Obama develop his 
        national version of that law.''.
            (13) A March 28, 2012, article in the New York Times 
        reports that ``After Mr. Gruber helped the administration put 
        together the basic principles of the proposal, the White House 
        lent him to Capitol Hill to help congressional staff members 
        draft the specifics of the legislation.''.
            (14) In a January 18, 2012, lecture on the structure of the 
        Affordable Care Act, Dr. Gruber refers to the law's small 
        business tax credits as a portion of the bill that he 
        ``actually wrote.''.
            (15) Dr. Gruber's initial contract with the Department of 
        Health and Human Services (HHS) was for $297,000, and later a 
        Federal grant of $95,000 brought his total Federal compensation 
        for work on the Affordable Care Act to at least $392,000.
            (16) In 2009, the White House annual report to Congress on 
        Presidential staff salaries lists that twenty-two White House 
        staffers made the highest Presidential staff salary rate of 
        $172,200, including the White House Chief of Staff, senior 
        advisers, White House Counsel, and National Security Adviser.
            (17) In 2010, the White House annual report to Congress on 
        Presidential staff salaries lists that twenty-three White House 
        staffers made the highest Presidential staff salary rate of 
        $172,200, again including the President's top management, 
        policy, communications, and security advisers.
            (18) In 2009 and 2010, each of President Obama's most 
        senior White House staff received less compensation than Dr. 
        Gruber.
            (19) In a November 5, 2012, speech at the University of 
        Rhode Island, Dr. Gruber described the mechanism of the 
        Affordable Care Act, stating, ``It's a very clever, you know, 
        basic exploitation of the lack of economic understanding of the 
        American voter.''.
            (20) At an October 17, 2013, panel at the University of 
        Pennsylvania, Dr. Gruber described the Affordable Care Act, 
        stating, ``This bill was written in a tortured way to make sure 
        CBO did not score the mandate as taxes. If CBO scored the 
        mandate as taxes, the bill dies. Okay, so it's written to do 
        that.''.
            (21) In the same speech, Dr. Gruber stated that, ``if you 
        had a law which said that healthy people are going to pay in 
        you made explicit healthy people pay in and sick people get 
        money, it would not have passed.''.
            (22) Dr. Gruber went on to claim, ``Lack of transparency is 
        a huge political advantage. And basically, call it the 
        stupidity of the American voter or whatever, but basically that 
        was really, really critical for the thing to pass.''.
            (23) Since the passage of the Affordable Care Act, 
        President Obama called for a new, more transparent approach to 
        the health reform law moving forward, saying in a January 25, 
        2010, ABC News interview, ``The process didn't run the way I 
        ideally would like it to and that we have to move forward in a 
        way that recaptures that sense of opening things up more.''.
            (24) The Obama Administration's implementation of the 
        Affordable Care Act has been marked by Executive overreach.
            (25) On at least 28 occasions, President Obama and his 
        administration have unilaterally delayed, extended, or changed 
        provisions of the Affordable Care Act, including in 
        contravention of the law and the Constitution of the United 
        States.
            (26) Section 1513 of the Patient Protection and Affordable 
        Care Act (26 U.S.C. 4980h note) requires applicable large 
        employers with more than 50 full-time employees to provide 
        qualifying health insurance to their employees or pay a fine, 
        and the effective date under such section specified the 
        amendments made by such section applied to months beginning 
        after December 31, 2013.
            (27) Contrary to the plain meaning of the statutory 
        requirement, and acting without authority provided by law, the 
        Internal Revenue Service published in the Federal Register 
        Notice 2013-45 to change the effective date of the employer 
        mandate requirement, stating, ``Section 1513(d) of the 
        Affordable Care Act provides that section 4980H applies to 
        months after December 31, 2013; however Notice 2013-45, issued 
        on July 9, 2013, provides as transition relief that no 
        assessable payments under section 4980H will apply for 2014.''.
            (28) On July 12, 2013, the Director for the Center for 
        Consumer Information and Insurance Oversight at the Centers for 
        Medicare & Medicaid Services denied the request for exemption 
        from certain Affordable Care Act requirements made by 
        representatives of the United States territories, writing to 
        the Secretary of Commerce for the Commonwealth of the Northern 
        Mariana Islands, ``However meritorious your request might be, 
        [the Department of Health and Human Services] is not authorized 
        to choose which provisions [of the Affordable Care Act] . . . 
        might apply to the territories.''.
            (29) A year later, on July 16, 2014, the Administrator of 
        the Centers for Medicare & Medicaid Services notified 
        representatives of the United States territories that they 
        would in fact receive an exemption from requirements under the 
        Affordable Care Act, despite the previous explanation from CMS 
        that CMS does not have the legal authority to provide such an 
        exemption. As the CMS Administrator now rationalized, 
        ``Currently, the Department uses the existing Public Health 
        Service Act (PHS Act) definition of `State' for new PHS Act 
        requirements and funding opportunities included in title I of 
        the Affordable Care Act. Under this definition, the new market 
        reforms in the PHS Act apply to the territories. We have been 
        informed by representatives of the territories that this 
        interpretation is undermining the stability of the territories' 
        health insurance markets. After a careful review of this 
        situation and the relevant statutory language, HHS has 
        determined that the new provisions of the PHS Act enacted in 
        title I are appropriately governed by the definition of `State' 
        set forth in that title, and therefore that these new 
        provisions do not apply to the territories.''.
            (30) The Obama Administration has claimed that the 
        Affordable Care Act will save money and improve the economy, 
        with WhiteHouse.gov stating, ``In keeping with the President's 
        pledge that reform must fix our health care system without 
        adding to the deficit, the Affordable Care Act reduces the 
        deficit, saving over $200 billion over 10 years and more than 
        $1 trillion in the second decade. The law reduces health care 
        costs . . . [and] is improving our economic 
        competitiveness[.]''.
            (31) $70.2 billion of the White House's estimated savings 
        was to come from the Community Living Assistance Services and 
        Supports (CLASS) Act provisions of the Affordable Care Act, a 
        program that was deemed actuarially unsound and never 
        implemented by the Obama Administration.
            (32) An April 2010 report from the Office of the Actuary 
        for the Centers for Medicare & Medicaid Services describes that 
        additional savings under the Affordable Care Act were to be 
        paid for with Medicare Fee-for-Service and Medicare Advantage 
        cuts and reductions in payments to hospitals, skilled nursing 
        facilities, and home health centers. These cuts have been 
        delayed and may never materialize. Even if implemented, the 
        projected savings may never accrue as the CMS Actuary's report 
        concludes that such cuts will cause about 15 percent of 
        hospitals and post-acute care facilities like nursing homes to 
        go out of business.
            (33) $52 billion in deficit reduction savings was projected 
        to come from employer penalties paid to the Government for 
        failure to comply with the employer mandate requirement to 
        provide employees health insurance, a requirement that the 
        Obama Administration has repeatedly delayed and modified, 
        causing penalties and associated savings to not accrue.
            (34) Initial estimates of savings under the Affordable Care 
        Act projected at least $15.5 billion in savings over the next 
        decade attributable to Medicare cuts through the Independent 
        Payment Advisory Board, which has not yet been appointed and 
        through which no cuts or savings have been realized.
            (35) On September 9, 2009, President Obama pledged to a 
        joint session of Congress, ``I will not sign a [health care 
        reform] plan that adds one dime to our deficits--either now or 
        in the future.''.
            (36) The Congressional Budget Office estimated in February 
        2014 that health insurance subsidies under the Affordable Care 
        Act would cost the Federal Government $47 billion in fiscal 
        year 2015 and $1.197 trillion over fiscal years 2015-2024.
            (37) The Committees on Finance and Health, Education, 
        Labor, and Pensions of the Senate estimated in September 2014 
        that the Affordable Care Act will add at least $340 billion to 
        Federal budget deficits.
            (38) Dr. Gruber stated, ``The [Affordable Care Act] isn't 
        designed to save money.''.
            (39) On at least 37 occasions, President Obama or a top 
        official in the executive branch repeated the promise that ``If 
        you like the [health insurance] plan you have, you can keep it. 
        If you like the doctor you have, you can keep your doctor.''.
            (40) The Associated Press calculated at least 4.7 million 
        Americans had their health insurance cancelled for 2014 and 
        later, when the President issued a last-minute fix to try to 
        prevent these cancellations as required by the Affordable Care 
        Act, the changes came too late for approximately 2.4 million 
        Americans to keep the plans they had and liked.
            (41) The nonpartisan, fact-checking publication Politifact 
        rated ``If you like your health care plan, you can keep it.'' 
        as the Lie of the Year for 2013.
            (42) Then-Presidential candidate Barack Obama repeatedly 
        promised that, if elected President, his national health care 
        reforms would, ``cut the cost of a typical family's premium by 
        up to $2,500 a year.''.
            (43) A November 2013 analysis by the Manhattan Institute 
        calculates that the Affordable Care Act would increase 
        individual marketplace health insurance premiums by 41 percent 
        nationwide between 2013 and 2014.
            (44) A December 2013 study by Health Pocket, Inc., found 
        that the average individual deductible for a Bronze plan was 
        $5,081 a year, a 42-percent increase from the average plan 
        purchased by an individual in 2013.
            (45) A February 2013 study by Health Pocket Inc., found 
        that exchange plans under the Affordable Care Act averaged a 
        34-percent increase in drug-cost sharing compared to copayment 
        and coinsurance rates in the pre-Affordable Care Act market. 
        For the sickest patients needing specialty drugs, the study 
        found copayments increased by 226 percent under a Bronze plan 
        via the Affordable Care Act.
            (46) A December 2013 study by McKinsey and Company found 
        that insurers offered almost three times as many narrow or 
        ultranarrow network plans in 2014 compared to 2013. Fully 70 
        percent of Affordable Care Act plans analyzed had narrow or 
        ultranarrow network coverage, meaning coverage for fewer 
        doctors and hospitals than plans sold on the individual market 
        before the law took effect.
            (47) Details consumers require to make informed decisions 
        about their health care plan coverage under the Affordable Care 
        Act have been withheld or lacked transparency.
            (48) On September 26, 2013, President Obama said, ``It will 
        say clearly what each plan covers, what each plan costs. The 
        price will be right there. It will be fully transparent . . . 
        And so if you've ever tried to buy insurance on your own, I 
        promise you this is a lot easier. It's like booking a hotel or 
        a plane ticket.''.
            (49) HealthCare.gov was established as the website to 
        implement the Federal exchange portion of the Act at a cost of 
        as much as $840 million, including more than $150 million in 
        cost overruns, according to the Government Accountability 
        Office in March 2014.
            (50) On October 1, 2013, HealthCare.gov launched without 
        adequate security testing, leaving the approximately 250,000 
        unique users it drew not only vulnerable to identity theft by 
        hackers, but unable to even use the site, as the website was 
        demonstrably unable to handle even 1,100 simultaneous users.
            (51) For the subsequent months after its launch, 
        HealthCare.gov continued to be plagued by crippling 
        malfunctions, and the dismal performance of the website led 
        only to problems and frustration for millions of Americans.
            (52) A June 2013 study by the Department of Health and 
        Human Services' Office of Inspector General revealed that 
        software designed by a principal HealthCare.gov vendor was 
        highly insecure and put the information of more than 6 million 
        Medicare beneficiaries at ``greater risk from malware, 
        inappropriate access or theft''.
            (53) An April 2014 study by Avalere Health determined that 
        38 percent of health insurance plans offered on the exchanges 
        under the Affordable Care Act had no information about drug 
        coverage available. Avalere also found that nearly 1 in 4 plans 
        offered insufficient information on which doctors and hospitals 
        are covered.
            (54) In September 2014, the Administrator of the Centers 
        for Medicare and Medicaid Services reported to Congress that 
        7.3 million Americans had enrolled in plans through exchanges 
        under the Affordable Care Act, meeting enrollment targets 
        estimated by the Congressional Budget Office and held as a goal 
        by the Obama Administration.
            (55) Four months later, HHS Secretary Burwell stated that 
        this enrollment data was a ``mistake'' that included some 
        400,000 dental insurance enrollments, the inclusion of which 
        allowed the administration to claim for months that the 
        Affordable Care Act was performing as anticipated which was not 
        in fact a true or accurate representation of the data they had, 
        but would not release to the public.
            (56) Since implementation of the ACA began, the HHS 
        Secretary has granted over $1 billion in Federal taxpayer 
        dollars to States to help build websites for their own State-
        based exchanges, yet development and usability issues on short 
        timelines repeatedly caused these same States to seek different 
        options for the 2015 open enrollment period, including opting 
        to revert to enrolling via the Federal HealthCare.gov website.
            (57) The Affordable Care Act provides opportunities for 
        fraud within subsidy and tax credit issuance.
            (58) A September 2013 report by the Treasury Inspector 
        General for Tax Administration concluded that, ``the IRS's 
        existing fraud detection system may not be capable of 
        identifying ACA refund fraud or schemes prior to the issuance 
        of tax return refunds.''.
            (59) A July 2014 undercover study by the Government 
        Accountability Office determined that fictitious applicants 
        were able to obtain health insurance coverage and taxpayer-
        funded subsidies on the Federal exchanges using falsified 
        documents in 11 out of 12 cases.
            (60) The Affordable Care Act has had a negative impact on 
        the American economy.
            (61) A February 2014 calculation by the Congressional 
        Budget Office found the Affordable Care Act will significantly 
        harm the American economy, reducing the number of hours worked 
        by millions of full-time employees worth of hours. The CBO 
        study noted, ``The reduction in CBO's projections of hours 
        worked represents a decline in the number of full-time-
        equivalent workers of about 2 million in 2017, rising to about 
        2.5 million in 2024.''.
            (62) History has shown the Special Inspector General model 
        to be successful at saving taxpayer dollars and rooting our 
        waste, fraud, and abuse in large Federal Government programs.
            (63) Congress and the President have enacted legislation 
        creating Special Inspectors General on three occasions, 
        including to oversee Federal spending and policy implementation 
        for Afghanistan reconstruction (SIGAR), Iraq reconstruction 
        (SIGIR), and the Troubled Asset Relief Program (SIGTARP).
            (64) SIGAR, SIGIR, and SIGTARP have successfully conducted 
        audits and investigations saving the Federal Government 
        billions in waste, fraud, and abuse, and have helped to 
        identify and prosecute theft and corruption.
            (65) As of an October 2014 report, SIGAR has produced 57 
        referrals for suspension and debarment of Federal contractors 
        and employees and produced over $500 million in direct taxpayer 
        savings.
            (66) According to its final report, SIGIR cost $245 million 
        to operate, but resulted in $645 million in direct savings to 
        the Federal Government, in addition to producing $192 million 
        in seizures and court-ordered penalties, as well as 90 criminal 
        convictions.
            (67) As of an October 2014 report, SIGTARP has produced 146 
        convictions and $7.38 billion in fines, penalties, and 
        restitution to the Government and victims.
            (68) On August 5, 2014, the Associated Press reported that 
        47 Federal inspectors general sent an unprecedented joint 
        letter to Congress to decry, ``Obama administration efforts to 
        delay or stall their investigations,'' citing three examples 
        where Federal agencies have hindered substantive inspector 
        general oversight work by refusing to provide information or 
        documents they are entitled to under the law.
            (69) The letter from more than half of the Federal 
        Government's independent inspectors general correctly states, 
        ``Section 6(a)(1) of the IG Act reflects the clear intent of 
        Congress that an Inspector General is entitled to timely and 
        unimpeded access to all records available to an agency that 
        relate to that Inspector General's oversight activities. The 
        constricted interpretations of Section 6(a)(1) by these and 
        other agencies conflict with the actual language and 
        Congressional intent. The IG Act is clear: no law restricting 
        access to records applies to Inspectors General unless that law 
        expressly so states, and that unrestricted access extends to 
        all records available to the agency, regardless of location or 
        form.''.
            (70) Congress has a responsibility to exercise prudent 
        stewardship of public dollars, to ensure that laws are well and 
        faithfully executed by the executive branch, to provide for 
        efficacious services for the American people, and to ensure 
        that those who cheat, steal from, or defraud the Federal 
        Government are held to account.

SEC. 3. SPECIAL INSPECTOR GENERAL FOR MONITORING THE AFFORDABLE CARE 
              ACT.

    (a) Office of Special Inspector General.--There is hereby 
established the Office of the Special Inspector General for Monitoring 
the Affordable Care Act (in this section, referred to as the 
``Office'') to carry out the duties described under subsection (e).
    (b) Appointment of Inspector General; Removal.--
            (1) Appointment.--The head of the Office is the Special 
        Inspector General for Monitoring the Affordable Care Act (in 
        this section referred to as the ``Special Inspector General''), 
        who shall be appointed by the President, by and with the advice 
        and consent of the Senate.
            (2) Qualifications.--The appointment of the Special 
        Inspector General shall be made solely on the basis of 
        integrity and demonstrated ability in accounting, auditing, 
        financial analysis, law, management analysis, health care 
        expertise and financing, public administration, or 
        investigations.
            (3) Deadline for appointment.--The appointment of an 
        individual as the Special Inspector General shall be made not 
        later than 30 days after the date of the enactment of this Act.
            (4) Compensation.--The annual rate of basic pay of the 
        Special Inspector General shall be the annual rate of basic pay 
        provided for positions at level IV of the Executive Schedule 
        under section 5315 of title 5, United States Code.
            (5) Prohibition on political activities.--For purposes of 
        section 7324 of title 5, United States Code, the Special 
        Inspector General shall not be considered an employee who 
        determines policies to be pursued by the United States in the 
        nationwide administration of Federal law.
            (6) Removal.--The Special Inspector General shall be 
        removable from office in accordance with the provisions of 
        section 3(b) of the Inspector General Act of 1978 (5 U.S.C. 
        App.).
    (c) Assistant Inspectors General.--The Special Inspector General 
shall, in accordance with applicable laws and regulations governing the 
civil service--
            (1) appoint an Assistant Inspector General for Auditing who 
        shall have the responsibility for supervising the performance 
        of auditing activities relating to the duties described under 
        subsection (e); and
            (2) appoint an Assistant Inspector General for 
        Investigations who shall have the responsibility for 
        supervising the performance of investigative activities 
        relating to such duties.
    (d) Supervision.--
            (1) In general.--Except as provided under paragraph (2), 
        the Special Inspector General shall report directly to, and be 
        under the general supervision of, the Secretary of Health and 
        Human Services.
            (2) Independence to conduct investigations and audits.--No 
        employee or officer of any of the following entities shall 
        prevent or prohibit the Special Inspector General from 
        initiating, carrying out, or completing any audit or 
        investigation related to the duties described under subsection 
        (e) or from issuing any subpoena during the course of any such 
        audit or investigation:
                    (A) The Executive Office of the President and the 
                Office of Personnel Management.
                    (B) The Department of Health and Human Services.
                    (C) The Department of the Treasury.
                    (D) The Social Security Administration, the 
                Department of Homeland Security, the Department of 
                Veterans Affairs, the Department of Defense, the 
                Department of Labor, and the Peace Corps.
                    (E) Any other Federal agency involved in 
                implementing or administering the Affordable Care Act.
    (e) Duties.--
            (1) Oversight of the implementation and administration of 
        the affordable care act.--It shall be the duty of the Special 
        Inspector General to conduct, supervise, and coordinate audits 
        and investigations of the implementation and administration of 
        programs and activities established under, and payment system 
        changes made by, the Affordable Care Act, including by 
        collecting and summarizing the following:
                    (A) A description of the individual mandate 
                requirement for applicable individuals to maintain 
                minimum essential coverage or pay a penalty under 
                section 5000A of the Internal Revenue Code of 1986, 
                including a description of the number of individuals 
                maintaining such coverage and the number of individuals 
                paying such penalties.
                    (B) A description of any increases or decreases 
                in--
                            (i) premiums for qualified health plans (as 
                        defined in section 1301 of the Patient 
                        Protection and Affordable Care Act (42 U.S.C. 
                        18021));
                            (ii) deductibles under qualified health 
                        plans; and
                            (iii) cost-sharing under qualified health 
                        plans, including by copayments and coinsurance,
                affecting individuals enrolling in coverage under such 
                plans through an exchange established under title I of 
                the Patient Protection and Affordable Care Act 
                (including a State-run exchange, a federally 
                administered exchange, and a Small Business Health 
                Options Program).
                    (C) A description of any increases or decreases in 
                the maximum out-of-pocket costs affecting individuals 
                enrolling in qualified health plans through such a 
                State-run exchange, a federally administered exchange, 
                and a Small Business Health Options Program.
                    (D) A description of any increases or decreases in 
                the size of physician and other health care provider 
                networks affecting individuals enrolling in qualified 
                health plans through such a State-run exchange, a 
                federally administered exchange, and a Small Business 
                Health Options Program.
                    (E) A description of any type of health insurance 
                coverage lost because of the treatment under title I of 
                the Patient Protection and Affordable Care Act of 
                grandfathered health plans (as defined in section 
                1251(e) of such Act (42 U.S.C. 18011(e))).
                    (F) A description of any credits under section 36B 
                of the Internal Revenue Code of 1986 (and the amount 
                (if any) of the advance payment of the credit under 
                section 1412 of the Patient Protection and Affordable 
                Care Act (42 U.S.C. 18082)) and any cost-sharing 
                reduction under section 1402 of the Patient Protection 
                and Affordable Care Act (42 U.S.C. 18071) (and the 
                amount (if any) of the advance payment of the reduction 
                under section 1412 of such Act (42 U.S.C. 18082)) 
                provided to individuals enrolling under qualified 
                health plans through an exchange established under 
                title I of the Patient Protection and Affordable Care 
                Act.
                    (G) A description of any projections, estimates, 
                analysis, goals, or targets made by any employee of the 
                Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act with respect 
                to the enrollment of individuals in a qualified health 
                plan through an exchange established under title I of 
                the Patient Protection and Affordable Care Act.
                    (H) A description of the employer mandate 
                requirement that applicable large employers provide 
                eligible employees with minimum essential coverage or 
                pay a fine under section 4980H of the Internal Revenue 
                Code of 1986, including a description of the type and 
                number of employers providing such coverage and the 
                type and number of employers paying such fines.
                    (I) A description of any projections, estimates, 
                analyses, goals, or targets made by any employee of the 
                Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act with respect 
                to employers providing minimum essential coverage to 
                applicable employees.
                    (J) A description of any reports, meetings, 
                discussions, or materials of any employee of the 
                Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act relating to 
                any employers converting full-time employees to part-
                time employees or hiring new part-time employees 
                instead of full-time employees for the purposes of 
                avoiding the fines provided for under the employer 
                mandate requirement described in subparagraph (H).
                    (K) A description of any reports, meetings, 
                discussions, or materials of any employee of the 
                Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act relating to 
                any employers hiring no more than 50 employees for the 
                purposes of avoiding the requirement to provide minimum 
                essential coverage or pay a fine under the employer 
                mandate requirement described in subparagraph (H).
                    (L) A description of any reports, meetings, 
                discussions, or materials of any employee of the 
                Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act relating to 
                any employers dropping the health insurance coverage 
                offered to their employees, or employees' spouses or 
                dependents, for the purposes of avoiding the 
                requirement to provide minimum essential coverage or 
                pay a fine under the employer mandate requirement 
                described in subparagraph (H).
                    (M) A description of the transitional reinsurance 
                program established under section 1341 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18061), 
                including a description of reinsurance contributions 
                collected or required to be collected under such 
                program, a description of any reinsurance payments made 
                or required to be made to health insurance issuers 
                under such program, a description of the health 
                insurance coverage and related costs for high-cost 
                individuals for plans related to such program, an 
                explanation of the impact of such reinsurance program 
                on adverse selection in the marketplace, and an 
                explanation of any premium-stabilizing effects of such 
                program.
                    (N) A description of the temporary risk corridors 
                for qualified health plans established under section 
                1342 of the Patient Protection and Affordable Care Act 
                (42 U.S.C. 18062), including a description of 
                participating plans and the allowable costs and target 
                amounts of such plans, a description of risk corridor 
                ratios of such plans, and a description of payment 
                adjustments made under such program.
                    (O) A description of the permanent risk adjustment 
                program established under section 1343 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18063), 
                including a description of any plans participating in 
                such program, a description of any risk adjustment 
                payments made or required to be made under such 
                program, a description of the health insurance coverage 
                and related costs for high-cost individuals for plans 
                related to such program, an explanation of the impact 
                of such program on adverse selection in the 
                marketplace, and an explanation of any premium-
                stabilizing effects of such program.
                    (P) A list of all contracts awarded under the 
                Affordable Care Act and an analysis of whether Federal 
                contracting procedures were followed when awarding any 
                contract associated with such Act.
                    (Q) A description of the development of the health 
                insurance marketplace for the Internet portal 
                established under section 1103 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18003), 
                including a description of the design, features, and 
                security systems of such web portal and a description 
                of all costs associated with such development.
                    (R) A description of any threats, risks, problems, 
                or functionality issues identified by any employee of 
                the Federal Government or any contractor of the Federal 
                Government in carrying out duties associated with the 
                Patient Protection and Affordable Care Act prior to the 
                launch of such web portal on October 1, 2013.
                    (S) A description of any decisionmaking or 
                activities by any employee of the Federal Government or 
                any contractor of the Federal Government in carrying 
                out duties associated with the Patient Protection and 
                Affordable Care Act in response to such threats, risks, 
                problems, or functionality issues.
                    (T) A description of the systems (on the Federal 
                and State levels) in place or in development to allow 
                health insurance issuers and plans and government 
                entities to verify information is accurate for purposes 
                of enrollments in qualified health plans through 
                exchanges established under title I of the Patient 
                Protection and Affordable Care Act, including that data 
                verification and validation can occur with respect to 
                information provided or stored by individuals, the 
                Department of Health and Human Services, the qualified 
                health plans, States, and other applicable Federal 
                agencies, including for purposes of credits under 
                section 36B of the Internal Revenue Code of 1986 (and 
                the amount (if any) of the advance payment of the 
                credit under section 1412 of the Patient Protection and 
                Affordable Care Act (42 U.S.C. 18082)) and any cost-
                sharing reduction under section 1402 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18071) 
                (and the amount (if any) of the advance payment of the 
                reduction under section 1412 of such Act (42 U.S.C. 
                18082)).
                    (U) A description of the development of the Federal 
                Data Services Hub, including its design, features, and 
                security systems, and a description of the type of data 
                accessed through such data hub, and a description of 
                the actual storage location of such data accessed 
                through such data hub.
                    (V) A list of the duties and responsibilities 
                assigned to the Internal Revenue Service as a result of 
                the enactment of the Affordable Care Act, a description 
                of any plans of the Internal Revenue Service for how to 
                carry out such duties, and an explanation of the 
                resources and personnel required to carry out such 
                duties, including a description of any new resources or 
                personnel required to carry out such duties not already 
                available to the Internal Revenue Service.
                    (W) A description of any plans of the Internal 
                Revenue Service to verify the eligibility of 
                individuals enrolling in qualified health plans for any 
                credits under section 36B of the Internal Revenue Code 
                of 1986 (and the amount (if any) of the advance payment 
                of the credit under section 1412 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18082)) 
                and any cost-sharing reduction under section 1402 of 
                the Patient Protection and Affordable Care Act (42 
                U.S.C. 18071) (and the amount (if any) of the advance 
                payment of the reduction under section 1412 of such Act 
                (42 U.S.C. 18082)), including a description of any such 
                verification completed and a description of any such 
                individuals determined to be ineligible.
                    (X) A description of any plans by the Internal 
                Revenue Service to calculate the amount of overpayment 
                of any such credit or reduction for which an individual 
                enrolled in a qualified health plan was determined to 
                be ineligible, including a description of any such 
                calculations completed.
                    (Y) A description of any plans by the Internal 
                Revenue Service to notify individuals determined to be 
                ineligible for such credits or reductions, including a 
                description of such notifications completed.
                    (Z) A description of any plans by the Internal 
                Revenue Service to recapture such overpayments of such 
                credits and reductions for individuals determined to be 
                ineligible, including a description of such recapturing 
                completed.
                    (AA) A description of the impact of the Affordable 
                Care Act on the right of conscience, including on--
                            (i) religious employers and institutions 
                        that were not exempted from the mandate issued 
                        by the Department of Health and Human Services 
                        requiring individual and group health plans to 
                        cover sterilization and Food and Drug 
                        Administration approved contraceptives;
                            (ii) individuals; and
                            (iii) medical professionals.
                    (BB) A description of abortion coverage offered 
                under qualified health plans purchased through State-
                run exchanges, federally administered exchanges, and 
                Small Business Health Options Programs, including costs 
                associated with such coverage.
                    (CC) A description of any actions by Departments or 
                Agencies of the Federal Government to modify or delay 
                the programs or activities authorized by the Affordable 
                Care Act, including an explanation from the head of 
                such Department or Agency of the specific authority 
                used to implement such a modification or delay.
                    (DD) A description of the Independent Payment 
                Advisory Board under section 1899A of the Social 
                Security Act (42 U.S.C. 1395kkk) and any actions taken 
                to alter or reduce the use of medical products, 
                treatments or procedures, including an explanation from 
                the Independent Payment Advisory Board of the reasons 
                for taking such actions, whether such actions could be 
                expected to result in worsened medical outcomes for 
                individuals affected by such alterations or reductions, 
                and an explanation of the medical information used to 
                determine whether such alterations or reductions could 
                be expected to result in such worsened outcomes.
                    (EE) A description of individuals enrolled in the 
                Medicaid program under title XIX of the Social Security 
                Act through an exchange established under title I of 
                the Patient Protection and Affordable Care Act, 
                including a description of the cost of health care 
                services utilized by such individuals and a description 
                of the cost to States and the cost to the Federal 
                Government to provide health care services to such 
                individuals.
                    (FF) Any additional topic related to the 
                implementation and administration of the Affordable 
                Care Act, the inclusion of which helps to provide the 
                public a full and objective accounting of such law.
            (2) Data to be included.--In carrying out the duties 
        described under paragraph (1), the Special Inspector General 
        shall, to the greatest extent possible, collect and summarize 
        data described under such paragraph according to each type of 
        insurance marketplace and according to the age and gender of 
        individuals enrolling in coverage under qualified health plans 
        through an exchange established under title I of the Patient 
        Protection and Affordable Care Act.
            (3) Other duties related to oversight.--The Special 
        Inspector General shall establish, maintain, and oversee such 
        systems, procedures, and controls as the Special Inspector 
        General considers appropriate to discharge the duties described 
        under paragraph (1).
            (4) Duties and responsibilities under the inspector general 
        act of 1978.--In addition to the duties described under 
        paragraphs (1) and (2), the Special Inspector General shall 
        also have the duties and responsibilities of inspectors general 
        under the Inspector General Act of 1978 (5 U.S.C. App.).
    (f) Coordination of Efforts.--In carrying out the duties, 
responsibilities, and authorities of the Special Inspector General 
under this section, the Special Inspector General shall coordinate 
with, and receive the cooperation of each of the following:
            (1) The Inspector General of the Department of Health and 
        Human Services.
            (2) The Inspector General of the Department of the 
        Treasury.
            (3) The Inspectors General of the Social Security 
        Administration, the Department of Homeland Security, the 
        Department of Veterans Affairs, the Department of Defense, the 
        Department of Labor, and the Peace Corps.
            (4) The inspector general of any other Federal entity, as 
        determined by the Special Inspector General.
    (g) Powers and Authorities.--
            (1) Authority to access materials, request information, 
        compel response, and other authorities under the inspector 
        general act of 1978.--In carrying out the duties described 
        under subsection (e), the Special Inspector General shall have 
        all of the authorities provided under section 6 of the 
        Inspector General Act of 1978 (5 U.S.C. App.).
            (2) Exemption from requirement for initial determination by 
        attorney general.--For purposes of section 6(e) of the 
        Inspector General Act of 1978 (5 U.S.C. App.), the Special 
        Inspector General shall be considered exempt from the 
        requirement of an initial determination of eligibility by the 
        Attorney General under paragraph (2) of such section.
            (3) Audit standards.--The Special Inspector General shall 
        carry out the duties specified under subsection (e)(1) in 
        accordance with section 4(b)(1) of the Inspector General Act of 
        1978 (5 U.S.C. App.).
    (h) Personnel, Facilities, and Other Resources.--
            (1) Personnel.--The Special Inspector General may select, 
        appoint, and employ such officers and employees as may be 
        necessary for carrying out the duties of the Special Inspector 
        General, subject to the provisions of title 5, United States 
        Code, governing appointments in the competitive service, and 
        the provisions of chapter 51 and subchapter III of chapter 53 
        of such title, relating to classification and General Schedule 
        pay rates.
            (2) Employment of experts and consultants.--The Special 
        Inspector General may obtain services as authorized by section 
        3109 of title 5, United States Code, at daily rates not to 
        exceed the equivalent rate prescribed for grade GS-15 of the 
        General Schedule by section 5332 of such title.
            (3) Contracting authority.--To the extent and in such 
        amounts as may be provided in advance by appropriations Acts, 
        the Special Inspector General may enter into contracts and 
        other arrangements for audits, studies, analyses, and other 
        services with public agencies and with private persons, and 
        make such payments as may be necessary to carry out the duties 
        of the Special Inspector General.
            (4) Resources.--The Secretary of Health and Human Services 
        shall provide the Special Inspector General with appropriate 
        and adequate office space at appropriate locations of the 
        Department of Health and Human Services together with such 
        equipment, office supplies, and communications facilities and 
        services as may be necessary for the operation of such offices, 
        and shall provide necessary maintenance services for such 
        offices and the equipment and facilities located therein.
            (5) Assistance from federal agencies.--
                    (A) In general.--Upon request of the Special 
                Inspector General for information or assistance from 
                any Department, Agency, or other entity of the Federal 
                Government (including any entity listed under 
                subsection (d)(2)), the head of such entity shall, 
                insofar as is practicable and not in contravention of 
                any existing law, furnish such information or 
                assistance to the Special Inspector General, or an 
                authorized designee.
                    (B) Reporting of refused assistance.--
                            (i) Reporting to health and human services 
                        and congress.--In accordance with clause (ii), 
                        as the case may be, whenever information or 
                        assistance requested by the Special Inspector 
                        General is, in the judgment of the Special 
                        Inspector General, unreasonably refused or not 
                        provided, the Special Inspector General shall 
                        report the circumstances to the Secretary of 
                        Health and Human Services and to the 
                        appropriate congressional committees without 
                        delay.
                            (ii) Reporting to the public on refusal or 
                        noncooperation in transparency.--Whenever any 
                        information described in clause (i) is 
                        requested by the Special Inspector General and 
                        unreasonably refused or not provided, the 
                        report to the Secretary of Health and Human 
                        Services and the appropriate congressional 
                        committees shall be titled ``Notice of Refusal 
                        or Noncooperation in Transparency'' and shall 
                        be published on a publicly available website in 
                        an accessible format without delay.
            (6) Use of personnel, facilities, and other resources of 
        the office.--Upon the request of the Special Inspector General, 
        an Inspector General--
                    (A) may detail, on a reimbursable basis, to the 
                Office any of the personnel of such Inspector General's 
                office for the purpose of carrying out this section; 
                and
                    (B) may provide, on a reimbursable basis, any of 
                the facilities or other resources of the Office for the 
                purpose of carrying out this section.
    (i) Reports.--
            (1) Initial report.--Not later than 90 days after the date 
        of the enactment of this Act, the Special Inspector General 
        shall submit to the appropriate congressional committees and 
        the Secretary of Health and Human Services a report 
        summarizing, for the period beginning on the date of the 
        enactment of the Health Care and Education Reconciliation Act 
        of 2010 and ending on the completion of a fiscal year quarter 
        after the date of enactment of this Act, the activities during 
        such period of the Special Inspector General required under 
        subsection (e).
            (2) Quarterly reports.--Beginning with the first full 
        fiscal year quarter after the date of the enactment of this 
        Act, not later than 30 days after the end of each fiscal year 
        quarter, during which the Affordable Care Act is in effect, the 
        Special Inspector General shall submit to the appropriate 
        congressional committees and the Secretary of Health and Human 
        Services a report summarizing, for the period of that quarter 
        and, to the extent possible, the period from the end of such 
        quarter to the time of the submission of the report, the 
        activities during such period of the Special Inspector General 
        required under subsection (e).
            (3) Comments on report.--Not later than 30 days after 
        receipt of a report under this subsection, the Secretary of 
        Health and Human Services shall submit to the appropriate 
        congressional committees any comments on the matters covered by 
        the report.
            (4) Public availability; recordkeeping.--
                    (A) In general.--The Special Inspector General 
                shall publish on a publicly available website each 
                report described under this subsection and any comments 
                on the matters covered by the report submitted pursuant 
                to paragraph (3).
                    (B) Requirement to index.--Except as provided in 
                subparagraph (C), the Special Inspector General shall, 
                to the greatest extent possible, index and publish on 
                the publicly available website information for each 
                source used in each report described under this 
                subsection, including whenever applicable the document 
                name, author, and owner.
                    (C) Exception to index requirement.--The Special 
                Inspector General may except with a written note of 
                exclusion certain information required to be published 
                pursuant to subparagraph (B) that the Special Inspector 
                General determines is--
                            (i) necessary to protect an individual that 
                        provided the information; or
                            (ii) classified.
                    (D) Recordkeeping requirement.--All source material 
                and information used to create a report described under 
                this subsection, including information excepted under 
                subparagraph (C), shall be identified, indexed (in a 
                classified annex, if necessary), and maintained 
                (including any written note of exclusion) by the 
                Special Inspector General.
            (5) Protected information.--To the extent possible, 
        information submitted in any report required under this 
        subsection shall be in a form that is not prohibited from 
        disclosure under section 552a of title 5, United States Code 
        (commonly known as the Privacy Act of 1974).
            (6) Aggregated information.--The Special Inspector General 
        shall, to the maximum extent possible, aggregate any personally 
        identifiable information submitted in a report required under 
        this subsection.
    (j) Amendment to the Inspector General Act.--Section 8D of the 
Inspector General Act (5 U.S.C. App.) is amended in subsections (e) and 
(f) by inserting after ``for Tax Administration'', each place it 
appears, the following: ``and the Special Inspector General for 
Monitoring the Affordable Care Act''.
    (k) Termination.--The Office of the Special Inspector General shall 
terminate the earlier of--
            (1) January 1, 2025; or
            (2) the date on which the final report required by 
        subsection (h) is submitted for the last year the Affordable 
        Care Act is in effect.
    (l) Definitions.--In this section:
            (1) Affordable care act.--The term ``Affordable Care Act'' 
        means the Patient Protection and Affordable Care Act and title 
        I and subtitle B of title II of the Health Care and Education 
        Reconciliation Act of 2010.
            (2) Appropriate congressional committees.--The term 
        ``appropriate congressional committees'' means--
                    (A) the Committees on Appropriations; the Budget; 
                Education and the Workforce; Energy and Commerce; 
                Homeland Security; the Judiciary; Oversight and 
                Government Reform; Small Business; and Ways and Means 
                of the House of Representatives; and
                    (B) the Committees on Appropriations; the Budget; 
                Commerce, Science, and Transportation; Finance; Health, 
                Education, Labor, and Pensions; Homeland Security and 
                Governmental Affairs; the Judiciary; and Small Business 
                and Entrepreneurship of the Senate.
                                 <all>
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