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 sub-
sequently 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 Representa-
tives 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’’. 
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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 Pa-
tient Protection and Affordable Care Act and the 
health care provisions of the Health Care and Edu-
cation Reconciliation Act of 2010 (commonly re-
ferred 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 Administra-
tion 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. 
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(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 estab-
lishing 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 De-
partment 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 pro-
vided 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 bipar-
tisan support by a 235 to 191 vote margin. 
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(8) On September 10, 2013, the Obama Admin-
istration issued a Statement of Administration Pol-
icy to H.R. 2775 that stated ‘‘the Administration 
strongly opposes House passage of H.R. 2775 be-
cause the goal of the bill is already being accom-
plished 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 al-
ready 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 re-
placed 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 House-
hold Income and Other Qualifications for the Provi-
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sion of Affordable Care At Premium Tax Credits 
and Cost-Sharing Reductions’’. 
(12) This report to Congress states, ‘‘In accord-
ance with statute and applicable implementing regu-
lations, when a consumer submits an application for 
insurance affordability programs (which include 
APTCs, CSRs, Medicaid, the Children’s Health In-
surance 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 imple-
menting regulations. Pursuant to both statute and 
applicable regulations, the Exchanges have imple-
mented 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 pre-
mium tax credits and cost-sharing reductions. On 
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April 2014, the Department of Health and Human 
Services delayed implementation of income verifica-
tion 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 Administra-
tion 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 SUB-
SIDIES IS COMPLETE. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, in the case of an individual with respect to 
whom a premium tax credit under section 36B of the In-
ternal Revenue Code of 1986 or reduced cost-sharing 
under section 1402 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18071) is being claimed, no such 
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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 re-
quirements 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 re-
view has been completed of applicable information re-
quired to be submitted by such individual under section 
1411(b) of such Act (42 U.S.C. 18081(b)) and any incon-
sistency 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.—Not-
withstanding 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 
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(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 cov-
erage months beginning on or after the date of the 
enactment of this Act. 
(2) TREATMENT OF INDIVIDUALS CURRENTLY 
RECEIVING SUBSIDIES.— 
(A) 
SUSPENSION
OF
CERTAIN
SUB-
SIDIES.—In the case of an individual with re-
spect to whom a premium tax credit under sec-
tion 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 be-
fore such date, such allowance shall be sus-
pended until the coverage month described in 
subsection (a) with respect to such claim for 
such individual. 
(B) SPECIAL ENROLLMENT PERIOD.— 
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(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, be-
ginning 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 de-
scribed in this clause is an individual— 
(I) who is enrolled in a qualified 
health plan described in clause (i) be-
fore 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 
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(IV) who, after the completion of 
the verification process described in 
subsection (a) with respect to such in-
dividual, seeks to enroll in such a 
qualified health plan. 
Æ 
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