I 
114TH CONGRESS 
1ST SESSION H. R. 2400 
To establish the Office of the Special Inspector General for Monitoring the 
Affordable Care Act, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 18, 2015 
Mr. ROSKAM (for himself, Mr. COLE, Mr. FLORES, Mr. HOLDING, Mr. JOR-
DAN, Mr. KELLY of Pennsylvania, Mr. MARCHANT, Mr. MARINO, Mr. 
MEEHAN, Mr. MURPHY of Pennsylvania, Mrs. NOEM, Mr. ROE of Ten-
nessee, Mr. RENACCI, and Mr. SMITH of Missouri) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Natural Resources, Edu-
cation and the Workforce, Ways and Means, Oversight and Government 
Reform, House Administration, the Judiciary, Rules, and Appropriations, 
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 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 Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Special Inspector Gen-
eral 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 trans-
parency. 
(2) Presidential candidate Barack Obama re-
peatedly 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 bring-
ing 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. 
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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 peo-
ple to stay involved in this process.’’. 
(5) In a September 26, 2011, interview, Brian 
Lamb, the CEO of C–SPAN confirmed the negotia-
tions of the health reform law had not been broad-
cast 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 dis-
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cussions 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, trans-
parency 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 eco-
nomics at the Massachusetts Institute of Tech-
nology, 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 statis-
tically sophisticated micro-simulation model’’ which 
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could assess the impact of changes in Federal health 
care policies. 
(9) Dr. Gruber described himself as a health re-
form architect who contributed to the crafting of the 
Affordable Care Act in a 2012 opinion editorial, not-
ing, ‘‘Several of the architects of Massachusetts re-
form, including myself, worked closely with the Ad-
ministration 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 Administra-
tion and Congress to help craft the Patient Protec-
tion 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 
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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 re-
fers to the law’s small business tax credits as a por-
tion of the bill that he ‘‘actually wrote.’’. 
(15) Dr. Gruber’s initial contract with the De-
partment 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 Ad-
viser. 
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(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 in-
cluding 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 Uni-
versity 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 Uni-
versity 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 peo-
ple are going to pay in you made explicit healthy 
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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 basi-
cally, 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 trans-
parent 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 implementa-
tion 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, ex-
tended, 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) re-
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quires applicable large employers with more than 50 
full-time employees to provide qualifying health in-
surance to their employees or pay a fine, and the ef-
fective date under such section specified the amend-
ments made by such section applied to months be-
ginning after December 31, 2013. 
(27) Contrary to the plain meaning of the stat-
utory requirement, and acting without authority pro-
vided by law, the Internal Revenue Service published 
in the Federal Register Notice 2013–45 to change 
the effective date of the employer mandate require-
ment, 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 transi-
tion 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 cer-
tain Affordable Care Act requirements made by rep-
resentatives of the United States territories, writing 
to the Secretary of Commerce for the Common-
wealth of the Northern Mariana Islands, ‘‘However 
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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 Admin-
istrator of the Centers for Medicare & Medicaid 
Services notified representatives of the United States 
territories that they would in fact receive an exemp-
tion 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) defini-
tion of ‘State’ for new PHS Act requirements and 
funding opportunities included in title I of the Af-
fordable Care Act. Under this definition, the new 
market reforms in the PHS Act apply to the terri-
tories. We have been informed by representatives of 
the territories that this interpretation is under-
mining the stability of the territories’ health insur-
ance markets. After a careful review of this situation 
and the relevant statutory language, HHS has deter-
mined that the new provisions of the PHS Act en-
acted in title I are appropriately governed by the 
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definition of ‘State’ set forth in that title, and there-
fore 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 def-
icit, saving over $200 billion over 10 years and more 
than $1 trillion in the second decade. The law re-
duces health care costs . . . [and] is improving our 
economic competitiveness[.]’’. 
(31) $70.2 billion of the White House’s esti-
mated savings was to come from the Community 
Living Assistance Services and Supports (CLASS) 
Act provisions of the Affordable Care Act, a pro-
gram 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 Medi-
care Fee-for-Service and Medicare Advantage cuts 
and reductions in payments to hospitals, skilled 
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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 hos-
pitals 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 em-
ployer mandate requirement to provide employees 
health insurance, a requirement that the Obama Ad-
ministration has repeatedly delayed and modified, 
causing penalties and associated savings to not ac-
crue. 
(34) Initial estimates of savings under the Af-
fordable Care Act projected at least $15.5 billion in 
savings over the next decade attributable to Medi-
care cuts through the Independent Payment Advi-
sory 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.’’. 
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(36) The Congressional Budget Office esti-
mated in February 2014 that health insurance sub-
sidies 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 esti-
mated 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 can-
cellations as required by the Affordable Care Act, 
the changes came too late for approximately 2.4 mil-
lion Americans to keep the plans they had and liked. 
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(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 Presi-
dent, 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 Manhat-
tan Institute calculates that the Affordable Care Act 
would increase individual marketplace health insur-
ance 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 in-
crease from the average plan purchased by an indi-
vidual 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 coinsur-
ance rates in the pre-Affordable Care Act market. 
For the sickest patients needing specialty drugs, the 
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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 Af-
fordable 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 in-
formed decisions about their health care plan cov-
erage under the Affordable Care Act have been with-
held 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 tick-
et.’’. 
(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, in-
cluding more than $150 million in cost overruns, ac-
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cording 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 un-
able to even use the site, as the website was demon-
strably 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 prin-
cipal HealthCare.gov vendor was highly insecure and 
put the information of more than 6 million Medicare 
beneficiaries at ‘‘greater risk from malware, inappro-
priate access or theft’’. 
(53) An April 2014 study by Avalere Health de-
termined that 38 percent of health insurance plans 
offered on the exchanges under the Affordable Care 
Act had no information about drug coverage avail-
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able. Avalere also found that nearly 1 in 4 plans of-
fered insufficient information on which doctors and 
hospitals are covered. 
(54) In September 2014, the Administrator of 
the Centers for Medicare and Medicaid Services re-
ported to Congress that 7.3 million Americans had 
enrolled in plans through exchanges under the Af-
fordable Care Act, meeting enrollment targets esti-
mated 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 ‘‘mis-
take’’ that included some 400,000 dental insurance 
enrollments, the inclusion of which allowed the ad-
ministration 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 dif-
ferent options for the 2015 open enrollment period, 
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including opting to revert to enrolling via the Fed-
eral HealthCare.gov website. 
(57) The Affordable Care Act provides opportu-
nities 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 re-
funds.’’. 
(59) A July 2014 undercover study by the Gov-
ernment Accountability Office determined that ficti-
tious applicants were able to obtain health insurance 
coverage and taxpayer-funded subsidies on the Fed-
eral exchanges using falsified documents in 11 out 
of 12 cases. 
(60) The Affordable Care Act has had a nega-
tive impact on the American economy. 
(61) A February 2014 calculation by the Con-
gressional 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 
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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 spend-
ing and policy implementation for Afghanistan re-
construction (SIGAR), Iraq reconstruction (SIGIR), 
and the Troubled Asset Relief Program (SIGTARP). 
(64) SIGAR, SIGIR, and SIGTARP have suc-
cessfully 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 ad-
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dition to producing $192 million in seizures and 
court-ordered penalties, as well as 90 criminal con-
victions. 
(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 Fed-
eral Government’s independent inspectors general 
correctly states, ‘‘Section 6(a)(1) of the IG Act re-
flects 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 lan-
guage and Congressional intent. The IG Act is clear: 
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no law restricting access to records applies to In-
spectors 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 Govern-
ment 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 In-
spector 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; RE-
MOVAL.— 
(1) APPOINTMENT.—The head of the Office is 
the Special Inspector General for Monitoring the Af-
fordable Care Act (in this section referred to as the 
‘‘Special Inspector General’’), who shall be appointed 
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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 ac-
counting, auditing, financial analysis, law, manage-
ment analysis, health care expertise and financing, 
public administration, or investigations. 
(3) DEADLINE
FOR
APPOINTMENT.—The ap-
pointment 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 an-
nual 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 nation-
wide administration of Federal law. 
(6) REMOVAL.—The Special Inspector General 
shall be removable from office in accordance with 
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the provisions of section 3(b) of the Inspector Gen-
eral 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 super-
vising 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 activi-
ties 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 super-
vision of, the Secretary of Health and Human Serv-
ices. 
(2) INDEPENDENCE TO CONDUCT INVESTIGA-
TIONS 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 
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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 De-
partment 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 in-
vestigations of the implementation and administra-
tion of programs and activities established under, 
and payment system changes made by, the Afford-
able Care Act, including by collecting and summa-
rizing the following: 
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(A) A description of the individual man-
date 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 de-
creases 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 Af-
fordable Care Act (including a State-run ex-
change, a federally administered exchange, and 
a Small Business Health Options Program). 
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(C) A description of any increases or de-
creases in the maximum out-of-pocket costs af-
fecting individuals enrolling in qualified health 
plans through such a State-run exchange, a fed-
erally administered exchange, and a Small 
Business Health Options Program. 
(D) A description of any increases or de-
creases in the size of physician and other health 
care provider networks affecting individuals en-
rolling 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 in-
surance coverage lost because of the treatment 
under title I of the Patient Protection and Af-
fordable 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 sec-
tion 36B of the Internal Revenue Code of 1986 
(and the amount (if any) of the advance pay-
ment of the credit under section 1412 of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18082)) and any cost-sharing reduction 
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under section 1402 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18071) 
(and the amount (if any) of the advance pay-
ment of the reduction under section 1412 of 
such Act (42 U.S.C. 18082)) provided to indi-
viduals 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, esti-
mates, analysis, goals, or targets made by any 
employee of the Federal Government or any 
contractor of the Federal Government in car-
rying out duties associated with the Patient 
Protection and Affordable Care Act with re-
spect to the enrollment of individuals in a quali-
fied health plan through an exchange estab-
lished 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 essen-
tial coverage or pay a fine under section 4980H 
of the Internal Revenue Code of 1986, includ-
ing a description of the type and number of em-
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ployers providing such coverage and the type 
and number of employers paying such fines. 
(I) A description of any projections, esti-
mates, analyses, goals, or targets made by any 
employee of the Federal Government or any 
contractor of the Federal Government in car-
rying out duties associated with the Patient 
Protection and Affordable Care Act with re-
spect 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 as-
sociated with the Patient Protection and Af-
fordable Care Act relating to any employers 
converting full-time employees to part-time em-
ployees or hiring new part-time employees in-
stead of full-time employees for the purposes of 
avoiding the fines provided for under the em-
ployer mandate requirement described in sub-
paragraph (H). 
(K) A description of any reports, meetings, 
discussions, or materials of any employee of the 
Federal Government or any contractor of the 
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Federal Government in carrying out duties as-
sociated with the Patient Protection and Af-
fordable Care Act relating to any employers hir-
ing no more than 50 employees for the purposes 
of avoiding the requirement to provide min-
imum 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 as-
sociated with the Patient Protection and Af-
fordable Care Act relating to any employers 
dropping the health insurance coverage offered 
to their employees, or employees’ spouses or de-
pendents, for the purposes of avoiding the re-
quirement to provide minimum essential cov-
erage or pay a fine under the employer mandate 
requirement described in subparagraph (H). 
(M) A description of the transitional rein-
surance program established under section 
1341 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18061), including a de-
scription of reinsurance contributions collected 
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or required to be collected under such program, 
a description of any reinsurance payments 
made or required to be made to health insur-
ance 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 selec-
tion in the marketplace, and an explanation of 
any premium-stabilizing effects of such pro-
gram. 
(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), in-
cluding 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 ad-
justments 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 de-
scription of any plans participating in such pro-
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gram, a description of any risk adjustment pay-
ments made or required to be made under such 
program, a description of the health insurance 
coverage and related costs for high-cost individ-
uals for plans related to such program, an ex-
planation of the impact of such program on ad-
verse selection in the marketplace, and an ex-
planation 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 Inter-
net 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 associ-
ated with such development. 
(R) A description of any threats, risks, 
problems, or functionality issues identified by 
any employee of the Federal Government or any 
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contractor of the Federal Government in car-
rying 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 Gov-
ernment or any contractor of the Federal Gov-
ernment 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 develop-
ment to allow health insurance issuers and 
plans and government entities to verify infor-
mation is accurate for purposes of enrollments 
in qualified health plans through exchanges es-
tablished under title I of the Patient Protection 
and Affordable Care Act, including that data 
verification and validation can occur with re-
spect to information provided or stored by indi-
viduals, 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 In-
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ternal 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 reduc-
tion 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 du-
ties, and an explanation of the resources and 
personnel required to carry out such duties, in-
cluding a description of any new resources or 
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personnel required to carry out such duties not 
already available to the Internal Revenue Serv-
ice. 
(W) A description of any plans of the In-
ternal Revenue Service to verify the eligibility of 
individuals enrolling in qualified health plans 
for any credits under section 36B of the Inter-
nal 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 reduc-
tion 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 In-
ternal 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, in-
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cluding a description of any such calculations 
completed. 
(Y) A description of any plans by the In-
ternal Revenue Service to notify individuals de-
termined to be ineligible for such credits or re-
ductions, including a description of such notifi-
cations completed. 
(Z) A description of any plans by the In-
ternal Revenue Service to recapture such over-
payments of such credits and reductions for in-
dividuals determined to be ineligible, including 
a description of such recapturing completed. 
(AA) A description of the impact of the Af-
fordable Care Act on the right of conscience, in-
cluding 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 ap-
proved contraceptives; 
(ii) individuals; and 
(iii) medical professionals. 
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(BB) A description of abortion coverage 
offered under qualified health plans purchased 
through State-run exchanges, federally adminis-
tered exchanges, and Small Business Health 
Options Programs, including costs associated 
with such coverage. 
(CC) A description of any actions by De-
partments or Agencies of the Federal Govern-
ment to modify or delay the programs or activi-
ties authorized by the Affordable Care Act, in-
cluding 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 tak-
ing such actions, whether such actions could be 
expected to result in worsened medical out-
comes for individuals affected by such alter-
ations or reductions, and an explanation of the 
medical information used to determine whether 
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