I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘No Subsidies Without 

5 Verification Act of 2014’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) On July 5, 2013, the Department of Health 

4 and Human Services released more than 600 pages 

5 of a final rule to implement the provisions of the Pa6 tient Protection and Affordable Care Act and the 

7 health care provisions of the Health Care and Edu8 cation Reconciliation Act of 2010 (commonly re9 ferred to as ‘‘Obamacare’’ or the ‘‘ACA’’). 

10 (2) Such final rule included an announcement 

11 that the Federal Government would no longer verify 

12 that each applicant for premium tax credits or cost13 sharing reductions for coverage offered through an 

14 Exchange established under the Patient Protection 

15 and Affordable Care Act are actually qualified for 

16 such credits or reductions. Instead, the Administra17 tion would rely on self-attestation and sample audits 

18 of a sample population to ‘‘protect’’ the integrity of 

19 this new $1 trillion entitlement program. 

20 (3) The Department of Health and Human 

21 Services later announced a change in such policy 

22 and stated it would extend the sample population to 

23 100 percent. This change, though announced, was 

24 never made to the final rule, meaning there was no 

25 guarantee to the American people that applicants 

26 would be verified. 


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1 (4) It is estimated that not verifying eligibility 

2 for such credits and reductions could likely equate to 

3 approximately $250 billion in fraudulent payments 

4 through payments of such Obamacare premium tax 

5 credits and cost-sharing reductions. 

6 (5) The final rule provides that the Department 

7 of Health and Human Services will offer to perform 

8 this verification procedure for States that are estab9 lishing a State-based Exchange, but will be unable 

10 to do so until 2015. As a result, such States will not 

11 be required to randomly verify employer-sponsored 

12 coverage until 2015. 

13 (6) In order to protect taxpayers after the De14 partment of Health and Human Services failed to 

15 implement a new rule that it would ensure Congress 

16 and taxpayers that verification of eligibility would be 

17 performed, the House of Representatives advanced 

18 legislation, H.R. 2775, the No Subsidies Without 

19 Verification Act. This legislation would have pro20 vided the force of law to ensure that verification 

21 would occur prior to the issuance of any Obamacare 

22 premium tax credit or cost-sharing reduction. 

23 (7) On September 12, 2013, this legislation was 

24 passed in the House of Representatives with bipar25 tisan support by a 235 to 191 vote margin. 


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1 (8) On September 10, 2013, the Obama Admin2 istration issued a Statement of Administration Pol3 icy to H.R. 2775 that stated ‘‘the Administration 

4 strongly opposes House passage of H.R. 2775 be5 cause the goal of the bill is already being accom6 plished while the text of the bill would create delays 

7 that could cost millions of hard-working middle-class 

8 families the security of affordable health coverage 

9 and care they deserve’’. 

10 (9) The Statement of Administration Policy 

11 also stated that ‘‘H.R. 2775 is unnecessary because 

12 the Secretary of Health and Human Services has al13 ready put in place an effective and efficient system 

14 for verification of eligibility for premium tax credits 

15 and cost sharing reductions.’’. 

16 (10) On October 16, 2013, the Senate removed 

17 the verification mechanism of H.R. 2775 and re18 placed it with language that required a report to 

19 Congress by the Secretary of Health and Human 

20 Services no later than January 1, 2014. 

21 (11) On January 1, 2014, the Department of 

22 Health and Human Services submitted a mandated 

23 report to Congress entitled, ‘‘Verification of House24 hold Income and Other Qualifications for the ProviVerDate Mar 15 2010 23:43 Jun 06, 2014 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4805.IH H4805

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1 sion of Affordable Care At Premium Tax Credits 

2 and Cost-Sharing Reductions’’. 

3 (12) This report to Congress states, ‘‘In accord4 ance with statute and applicable implementing regu5 lations, when a consumer submits an application for 

6 insurance affordability programs (which include 

7 APTCs, CSRs, Medicaid, the Children’s Health In8 surance Program (CHIP), and the Basic Health 

9 Program (BHP)), the Exchange verifies information 

10 provided by the consumer on the application as a 

11 component of making an eligibility determination. 

12 The processes for verifying information in order to 

13 determine eligibility for enrollment in a qualified 

14 health plan (QHP) through the Exchange and for 

15 APTC under section 36B of the Internal Revenue 

16 Code (the Code) and CSRs under section 1402 of 

17 the ACA are specified in the ACA and its imple18 menting regulations. Pursuant to both statute and 

19 applicable regulations, the Exchanges have imple20 mented numerous processes to carry out the 

21 verification of information provided by applicants.’’. 

22 (13) Beginning in 2014, Federal subsidies have 

23 been made available to help individuals purchase 

24 health insurance through an Exchange through pre25 mium tax credits and cost-sharing reductions. On 


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1 April 2014, the Department of Health and Human 

2 Services delayed implementation of income verifica3 tion systems in order to increase sign-ups for health 

4 care plans through the healthcare.gov website. 

5 (14) Various reports indicate that the internal 

6 portions of the healthcare.gov website are yet to be 

7 finalized, thus leaving the Department of Health and 

8 Human Services unable to perform the verification it 

9 stated it was performing. The Obama Administra10 tion is operating a new Federal entitlement program 

11 that fails to prevent fraudulent subsidy claims before 

12 administered. In doing so, the Department of Health 

13 and Human Services has created a new ‘‘pay and 

14 chase’’ program that places taxpayers at financial 

15 risk of fraudulent claims. 

16 SEC. 3. DELAYING PROVISION OF ACA PREMIUM AND COST17 SHARING SUBSIDIES UNTIL ELIGIBILITY 

18 VERIFICATION PROCESS FOR SUCH SUB19 SIDIES IS COMPLETE. 

20 (a) IN GENERAL.—Notwithstanding any other provi21 sion of law, in the case of an individual with respect to 

22 whom a premium tax credit under section 36B of the In23 ternal Revenue Code of 1986 or reduced cost-sharing 

24 under section 1402 of the Patient Protection and Afford25 able Care Act (42 U.S.C. 18071) is being claimed, no such 


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1 credit or reduction shall be allowed before the first date 

2 of the first coverage month beginning on or after the date 

3 on which the process to verify, in accordance with section 

4 1411 of the Patient Protection and Affordable Care Act 

5 (42 U.S.C. 18081), the household income and coverage re6 quirements of such individual for purposes of determining 

7 eligibility for, and the accurate amount of, such credit or 

8 reduction, respectively, has been completed. For purposes 

9 of the previous sentence, the verification process described 

10 in such sentence with respect to an individual shall not 

11 be treated as complete unless a manual or electronic re12 view has been completed of applicable information re13 quired to be submitted by such individual under section 

14 1411(b) of such Act (42 U.S.C. 18081(b)) and any incon15 sistency of such information with records of the Secretary 

16 of the Treasury, Secretary of Homeland Security, or the 

17 Commissioner of Social Security has been resolved. 

18 (b) TREATMENT OF INDIVIDUAL MANDATE.—Not19 withstanding any other provision of law, no penalty shall 

20 be imposed under section 5000A of the Internal Revenue 

21 Code of 1986 with respect to an individual for any 

22 month— 

23 (1) with respect to which a premium tax credit 

24 under section 36B of the Internal Revenue Code of 

25 1986 is being claimed for such individual; and 


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1 (2) that begins before the date on which the 

2 verification process described in subsection (a) has 

3 been completed, in accordance with such subsection, 

4 with respect to such claim for such individual. 

5 (c) APPLICATION PROVISIONS.— 

6 (1) EFFECTIVE DATE.—Subject to paragraph 

7 (2), the provisions of this section shall apply to cov8 erage months beginning on or after the date of the 

9 enactment of this Act. 

10 (2) TREATMENT OF INDIVIDUALS CURRENTLY

11 RECEIVING SUBSIDIES.— 

12 (A) SUSPENSION OF CERTAIN SUB13 SIDIES.—In the case of an individual with re14 spect to whom a premium tax credit under sec15 tion 36B of the Internal Revenue Code of 1986 

16 or reduced cost-sharing under section 1402 of 

17 the Patient Protection and Affordable Care Act 

18 (42 U.S.C. 18071) has been claimed before the 

19 date of the enactment of this Act and for whom 

20 such a credit or reduction has been allowed be21 fore such date, such allowance shall be sus22 pended until the coverage month described in 

23 subsection (a) with respect to such claim for 

24 such individual. 

25 (B) SPECIAL ENROLLMENT PERIOD.— 


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1 (i) IN GENERAL.—The Secretary of 

2 Health and Human Services shall take 

3 such steps as are necessary to establish a 

4 special enrollment period of 45 days, be5 ginning on the date of completion of the 

6 verification process described in subsection 

7 (a), with respect to an individual described 

8 in clause (ii), for such individual to enroll 

9 in qualified health plans offered through 

10 Exchanges established under title I of the 

11 Patient Protection and Affordable Care 

12 Act. 

13 (ii) INDIVIDUAL DESCRIBED.—For 

14 purposes of clause (i), an individual de15 scribed in this clause is an individual— 

16 (I) who is enrolled in a qualified 

17 health plan described in clause (i) be18 fore the date of the enactment of this 

19 Act; 

20 (II) to whom the suspension 

21 under subparagraph (A) applies; 

22 (III) who terminated enrollment 

23 in the qualified health plan during 

24 such period of suspension; and 


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1 (IV) who, after the completion of 

2 the verification process described in 

3 subsection (a) with respect to such in4 dividual, seeks to enroll in such a 

5 qualified health plan. 

Æ 


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