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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4805 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 4805

  To delay the provision of the Affordable Care Act premium and cost-
 sharing subsidies until the eligibility verification process for such 
            subsidies is completed, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              June 5, 2014

   Mrs. Black (for herself, Mr. Griffin of Arkansas, Mr. Harris, Mr. 
Tiberi, Mr. Fincher, Mr. Sam Johnson of Texas, Mr. Duncan of Tennessee, 
 Mr. Kelly of Pennsylvania, and Ms. Jenkins) introduced the following 
 bill; which was referred to the Committee on Energy and Commerce, and 
  in addition to the Committee on Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL

 
  To delay the provision of the Affordable Care Act premium and cost-
 sharing subsidies until the eligibility verification process for such 
            subsidies is completed, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``No Subsidies Without Verification 
Act of 2014''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) On July 5, 2013, the Department of Health and Human 
        Services released more than 600 pages of a final rule to 
        implement the provisions of the Patient Protection and 
        Affordable Care Act and the health care provisions of the 
        Health Care and Education Reconciliation Act of 2010 (commonly 
        referred to as ``Obamacare'' or the ``ACA'').
            (2) Such final rule included an announcement that the 
        Federal Government would no longer verify that each applicant 
        for premium tax credits or cost-sharing reductions for coverage 
        offered through an Exchange established under the Patient 
        Protection and Affordable Care Act are actually qualified for 
        such credits or reductions. Instead, the Administration would 
        rely on self-attestation and sample audits of a sample 
        population to ``protect'' the integrity of this new $1 trillion 
        entitlement program.
            (3) The Department of Health and Human Services later 
        announced a change in such policy and stated it would extend 
        the sample population to 100 percent. This change, though 
        announced, was never made to the final rule, meaning there was 
        no guarantee to the American people that applicants would be 
        verified.
            (4) It is estimated that not verifying eligibility for such 
        credits and reductions could likely equate to approximately 
        $250 billion in fraudulent payments through payments of such 
        Obamacare premium tax credits and cost-sharing reductions.
            (5) The final rule provides that the Department of Health 
        and Human Services will offer to perform this verification 
        procedure for States that are establishing a State-based 
        Exchange, but will be unable to do so until 2015. As a result, 
        such States will not be required to randomly verify employer-
        sponsored coverage until 2015.
            (6) In order to protect taxpayers after the Department of 
        Health and Human Services failed to implement a new rule that 
        it would ensure Congress and taxpayers that verification of 
        eligibility would be performed, the House of Representatives 
        advanced legislation, H.R. 2775, the No Subsidies Without 
        Verification Act. This legislation would have provided the 
        force of law to ensure that verification would occur prior to 
        the issuance of any Obamacare premium tax credit or cost-
        sharing reduction.
            (7) On September 12, 2013, this legislation was passed in 
        the House of Representatives with bipartisan support by a 235 
        to 191 vote margin.
            (8) On September 10, 2013, the Obama Administration issued 
        a Statement of Administration Policy to H.R. 2775 that stated 
        ``the Administration strongly opposes House passage of H.R. 
        2775 because the goal of the bill is already being accomplished 
        while the text of the bill would create delays that could cost 
        millions of hard-working middle-class families the security of 
        affordable health coverage and care they deserve''.
            (9) The Statement of Administration Policy also stated that 
        ``H.R. 2775 is unnecessary because the Secretary of Health and 
        Human Services has already put in place an effective and 
        efficient system for verification of eligibility for premium 
        tax credits and cost sharing reductions.''.
            (10) On October 16, 2013, the Senate removed the 
        verification mechanism of H.R. 2775 and replaced it with 
        language that required a report to Congress by the Secretary of 
        Health and Human Services no later than January 1, 2014.
            (11) On January 1, 2014, the Department of Health and Human 
        Services submitted a mandated report to Congress entitled, 
        ``Verification of Household Income and Other Qualifications for 
        the Provision of Affordable Care At Premium Tax Credits and 
        Cost-Sharing Reductions''.
            (12) This report to Congress states, ``In accordance with 
        statute and applicable implementing regulations, when a 
        consumer submits an application for insurance affordability 
        programs (which include APTCs, CSRs, Medicaid, the Children's 
        Health Insurance Program (CHIP), and the Basic Health Program 
        (BHP)), the Exchange verifies information provided by the 
        consumer on the application as a component of making an 
        eligibility determination. The processes for verifying 
        information in order to determine eligibility for enrollment in 
        a qualified health plan (QHP) through the Exchange and for APTC 
        under section 36B of the Internal Revenue Code (the Code) and 
        CSRs under section 1402 of the ACA are specified in the ACA and 
        its implementing regulations. Pursuant to both statute and 
        applicable regulations, the Exchanges have implemented numerous 
        processes to carry out the verification of information provided 
        by applicants.''.
            (13) Beginning in 2014, Federal subsidies have been made 
        available to help individuals purchase health insurance through 
        an Exchange through premium tax credits and cost-sharing 
        reductions. On April 2014, the Department of Health and Human 
        Services delayed implementation of income verification systems 
        in order to increase sign-ups for health care plans through the 
        healthcare.gov website.
            (14) Various reports indicate that the internal portions of 
        the healthcare.gov website are yet to be finalized, thus 
        leaving the Department of Health and Human Services unable to 
        perform the verification it stated it was performing. The Obama 
        Administration is operating a new Federal entitlement program 
        that fails to prevent fraudulent subsidy claims before 
        administered. In doing so, the Department of Health and Human 
        Services has created a new ``pay and chase'' program that 
        places taxpayers at financial risk of fraudulent claims.

SEC. 3. DELAYING PROVISION OF ACA PREMIUM AND COST-SHARING SUBSIDIES 
              UNTIL ELIGIBILITY VERIFICATION PROCESS FOR SUCH SUBSIDIES 
              IS COMPLETE.

    (a) In General.--Notwithstanding any other provision of law, in the 
case of an individual with respect to whom a premium tax credit under 
section 36B of the Internal Revenue Code of 1986 or reduced cost-
sharing under section 1402 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18071) is being claimed, no such credit or 
reduction shall be allowed before the first date of the first coverage 
month beginning on or after the date on which the process to verify, in 
accordance with section 1411 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18081), the household income and coverage 
requirements of such individual for purposes of determining eligibility 
for, and the accurate amount of, such credit or reduction, 
respectively, has been completed. For purposes of the previous 
sentence, the verification process described in such sentence with 
respect to an individual shall not be treated as complete unless a 
manual or electronic review has been completed of applicable 
information required to be submitted by such individual under section 
1411(b) of such Act (42 U.S.C. 18081(b)) and any inconsistency of such 
information with records of the Secretary of the Treasury, Secretary of 
Homeland Security, or the Commissioner of Social Security has been 
resolved.
    (b) Treatment of Individual Mandate.--Notwithstanding any other 
provision of law, no penalty shall be imposed under section 5000A of 
the Internal Revenue Code of 1986 with respect to an individual for any 
month--
            (1) with respect to which a premium tax credit under 
        section 36B of the Internal Revenue Code of 1986 is being 
        claimed for such individual; and
            (2) that begins before the date on which the verification 
        process described in subsection (a) has been completed, in 
        accordance with such subsection, with respect to such claim for 
        such individual.
    (c) Application Provisions.--
            (1) Effective date.--Subject to paragraph (2), the 
        provisions of this section shall apply to coverage months 
        beginning on or after the date of the enactment of this Act.
            (2) Treatment of individuals currently receiving 
        subsidies.--
                    (A) Suspension of certain subsidies.--In the case 
                of an individual with respect to whom a premium tax 
                credit under section 36B of the Internal Revenue Code 
                of 1986 or reduced cost-sharing under section 1402 of 
                the Patient Protection and Affordable Care Act (42 
                U.S.C. 18071) has been claimed before the date of the 
                enactment of this Act and for whom such a credit or 
                reduction has been allowed before such date, such 
                allowance shall be suspended until the coverage month 
                described in subsection (a) with respect to such claim 
                for such individual.
                    (B) Special enrollment period.--
                            (i) In general.--The Secretary of Health 
                        and Human Services shall take such steps as are 
                        necessary to establish a special enrollment 
                        period of 45 days, beginning on the date of 
                        completion of the verification process 
                        described in subsection (a), with respect to an 
                        individual described in clause (ii), for such 
                        individual to enroll in qualified health plans 
                        offered through Exchanges established under 
                        title I of the Patient Protection and 
                        Affordable Care Act.
                            (ii) Individual described.--For purposes of 
                        clause (i), an individual described in this 
                        clause is an individual--
                                    (I) who is enrolled in a qualified 
                                health plan described in clause (i) 
                                before the date of the enactment of 
                                this Act;
                                    (II) to whom the suspension under 
                                subparagraph (A) applies;
                                    (III) who terminated enrollment in 
                                the qualified health plan during such 
                                period of suspension; and
                                    (IV) who, after the completion of 
                                the verification process described in 
                                subsection (a) with respect to such 
                                individual, seeks to enroll in such a 
                                qualified health plan.
                                 <all>
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