II 

114TH CONGRESS 

1ST SESSION S. 42 

To require the Secretary of Health and Human Services to address certain 

inconsistencies between the self-attested information provided by an applicant in enrolling in a health plan on an Exchange and being determined 

eligible for premium tax credits and cost-sharing reductions or in being 

determined to be eligible for enrollment in a State Medicaid plan or 

a State child health plan under the State Children’s Health Insurance 

Program and the data received through the Federal Data Services Hub 

or from other data sources. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 7, 2015 

Mr. VITTER introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To require the Secretary of Health and Human Services 

to address certain inconsistencies between the self-attested information provided by an applicant in enrolling 

in a health plan on an Exchange and being determined 

eligible for premium tax credits and cost-sharing reductions or in being determined to be eligible for enrollment 

in a State Medicaid plan or a State child health plan 

under the State Children’s Health Insurance Program 

and the data received through the Federal Data Services 

Hub or from other data sources. 


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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 ‘‘Stopping Illegal 

5 Obamacare Subsidies Act’’. 

6 SEC. 2. LIMITATION ON AUTO-ENROLLMENT. 

7 Notwithstanding any other provision of law, Amer8 ican Health Benefit Exchanges shall not provide for auto9 matic enrollment in health plans under such exchanges 

10 until the Inspector General of the Department of Health 

11 and Human Services verifies that each State Exchange es12 tablished under section 1311 of the Patient Protection and 

13 Affordable Care Act (42 U.S.C. 13031) and the Federal 

14 Exchange established under section 1321 of such Act (42 

15 U.S.C. 18041) has resolved the inconsistencies (as defined 

16 in section 3(a)) outlined in the June 2014 report of such 

17 Inspector General. 

18 SEC. 3. PROCESS FOR APPLICATIONS WITH INCONSIST19 ENCIES. 

20 (a) IN GENERAL.—The Secretary of Health and 

21 Human Services (referred to in this section as the ‘‘Sec22 retary’’) shall make public the steps that the Centers for 

23 Medicare & Medicaid Services and the Federal Exchange 

24 will take to clear any inconsistencies that arose on or be25 fore the date of enactment of this Act and to ensure that 


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1 the systems used by the Centers for Medicare & Medicaid 

2 Services to determine or assess eligibility for premium tax 

3 credits, cost-sharing reductions, Medicaid, and the State 

4 Children’s Health Insurance Program (CHIP) can resolve 

5 such inconsistencies not later than 30 days after the date 

6 of enactment of this Act. 

7 (b) METHODS TO MONITOR PROGRESS.—Not later 

8 than 30 days after the date of enactment of this Act, the 

9 Secretary shall make public the methods that the Centers 

10 for Medicare & Medicaid Services use to monitor, track, 

11 and measure the progress of the Federal Exchange and 

12 State Exchanges in resolving inconsistencies. 

13 (c) SUSPENSION OF FINANCIAL ASSISTANCE PRO14 GRAMS.—Premium assistance tax credits under section 

15 36B of the Internal Revenue Code of 1986 and the re16 duced cost-sharing program under section 1402 of the Pa17 tient Protection and Affordable Care Act (42 U.S.C. 

18 18071) shall not be available for plan year 2015. Such 

19 premium tax credit and cost-sharing programs shall re20 sume only after— 

21 (1) the Commissioner of the Social Security Ad22 ministration affirmatively declares that all inconsist23 encies related to invalid social security numbers have 

24 been resolved; and 


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1 (2) the Inspector General of the Department of 

2 Health and Human Services determines that all in3 consistencies, as defined in section 4(1), have been 

4 resolved. 

5 (d) REQUESTS FOR ADDITIONAL INFORMATION.— 

6 (1) IN GENERAL.—If applicant information pro7 vided by an individual seeking to enroll in a qualified 

8 health plan on a State or Federal Exchange contains 

9 inconsistencies, the Secretary shall request addi10 tional information from the individual, and the indi11 vidual shall have 90 days to provide such informa12 tion. 

13 (2) RESTRICTIONS DURING INCONSISTENCY PE14 RIOD.—During the inconsistency period, an indi15 vidual may be enrolled in qualified health plan, but 

16 may not participate in the premium assistance credit 

17 program under section 36B of the Internal Revenue 

18 Code of 1986 or the reduced cost-sharing program 

19 under section 1402 of the Patient Protection and 

20 Affordable Care Act (42 U.S.C. 18071). An indi21 vidual who cooperates with a request for additional 

22 information and whom the Secretary later deter23 mines to be eligible for such programs, shall retro24 actively receive the benefits of such programs that 


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1 such individual was eligible to receive for the incon2 sistency period. 

3 (3) FAILURE TO SUBMIT ADDITIONAL INFORMA4 TION.—If the applicant does not submit additional 

5 information requested under subparagraph (A)— 

6 (A)(i) the applicant shall be withdrawn 

7 from the premium assistance credit program 

8 under section 36B of the Internal Revenue 

9 Code of 1986 and the reduced cost-sharing pro10 gram under section 1402 of the Patient Protec11 tion and Affordable Care Act (42 U.S.C. 

12 18071), as applicable, at the end of the incon13 sistency period; and 

14 (ii) the Secretary shall send notification of 

15 such disenrollment to the applicable health in16 surance issuer; and 

17 (B) the applicant shall re-enroll in a quali18 fied health plan with appropriate and accurate 

19 information during the next open enrollment 

20 period. 

21 SEC. 4. DEFINITIONS. 

22 In this Act— 

23 (1) the term ‘‘inconsistencies’’ means dif24 ferences between the self-attested information pro25 vided by an applicant in enrolling in a health plan 


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1 on an Exchange and being determined eligible for 

2 premium tax credits and cost-sharing reductions or 

3 in being determined to be eligible for enrollment in 

4 a State Medicaid plan or a State child health plan 

5 under the State Children’s Health Insurance Pro6 gram (CHIP) and the data received through the 

7 Federal Data Services Hub or from other data 

8 sources, including differences with respect to— 

9 (A) citizenship; 

10 (B) income; 

11 (C) coverage under an eligible employer12 sponsored plan; 

13 (D) incarceration status; or 

14 (E) any other issue that would impact in15 dividual’s eligibility for financial assistance pro16 grams under the Patient Protection and Afford17 able Care Act (including the amendments made 

18 by such Act); and 

19 (2) the term ‘‘inconsistency period’’ means the 

20 90-day period beginning on the date the notice of an 

21 inconsistency is sent to the applicant. 

Æ 


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