253 
HR 3590 EAS/PP 
‘‘(ii) A comparable method reaching 
the same result as the method under clause 
(i). 
‘‘(2) LAWFULLY PRESENT.—For purposes of this 
section, an individual shall be treated as lawfully 
present only if the individual is, and is reasonably 
expected to be for the entire period of enrollment for 
which the credit under this section is being claimed, 
a citizen or national of the United States or an alien 
lawfully present in the United States. 
‘‘(3) SECRETARIAL AUTHORITY.—The Secretary 
of Health and Human Services, in consultation with 
the Secretary, shall prescribe rules setting forth the 
methods by which calculations of family size and 
household income are made for purposes of this sub-
section. Such rules shall be designed to ensure that the 
least burden is placed on individuals enrolling in 
qualified health plans through an Exchange and tax-
payers eligible for the credit allowable under this sec-
tion. 
‘‘(f) RECONCILIATION OF CREDIT AND ADVANCE CRED-
IT.— 
‘‘(1) IN GENERAL.—The amount of the credit al-
lowed under this section for any taxable year shall be 
reduced (but not below zero) by the amount of any
254 
HR 3590 EAS/PP 
advance payment of such credit under section 1412 of 
the Patient Protection and Affordable Care Act. 
‘‘(2) EXCESS ADVANCE PAYMENTS.— 
‘‘(A) IN
GENERAL.—If the advance pay-
ments to a taxpayer under section 1412 of the 
Patient Protection and Affordable Care Act for a 
taxable year exceed the credit allowed by this sec-
tion (determined without regard to paragraph 
(1)), the tax imposed by this chapter for the tax-
able year shall be increased by the amount of 
such excess. 
‘‘(B) LIMITATION ON INCREASE WHERE IN-
COME
LESS
THAN
400
PERCENT
OF
POVERTY 
LINE.— 
‘‘(i) IN GENERAL.—In the case of an 
applicable taxpayer whose household income 
is less than 400 percent of the poverty line 
for the size of the family involved for the 
taxable year, the amount of the increase 
under subparagraph (A) shall in no event 
exceed $400 ($250 in the case of a taxpayer 
whose tax is determined under section 1(c) 
for the taxable year). 
‘‘(ii) INDEXING
OF
AMOUNT.—In the 
case of any calendar year beginning after
255 
HR 3590 EAS/PP 
2014, each of the dollar amounts under 
clause (i) shall be increased by an amount 
equal to— 
‘‘(I) such dollar amount, multi-
plied by 
‘‘(II) the cost-of-living adjustment 
determined under section 1(f)(3) for 
the calendar year, determined by sub-
stituting ‘calendar year 2013’ for ‘cal-
endar year 1992’ in subparagraph (B) 
thereof. 
If the amount of any increase under clause 
(i) is not a multiple of $50, such increase 
shall be rounded to the next lowest multiple 
of $50. 
‘‘(g) REGULATIONS.—The Secretary shall prescribe 
such regulations as may be necessary to carry out the provi-
sions of this section, including regulations which provide 
for— 
‘‘(1) the coordination of the credit allowed under 
this section with the program for advance payment of 
the credit under section 1412 of the Patient Protec-
tion and Affordable Care Act, and 
‘‘(2) the application of subsection (f) where the 
filing status of the taxpayer for a taxable year is dif-
256 
HR 3590 EAS/PP 
ferent from such status used for determining the ad-
vance payment of the credit.’’. 
(b) DISALLOWANCE OF DEDUCTION.—Section 280C of 
the Internal Revenue Code of 1986 is amended by adding 
at the end the following new subsection: 
‘‘(g) CREDIT FOR HEALTH INSURANCE PREMIUMS.— 
No deduction shall be allowed for the portion of the pre-
miums paid by the taxpayer for coverage of 1 or more indi-
viduals under a qualified health plan which is equal to the 
amount of the credit determined for the taxable year under 
section 36B(a) with respect to such premiums.’’. 
(c) STUDY ON AFFORDABLE COVERAGE.— 
(1) STUDY AND REPORT.— 
(A) IN GENERAL.—Not later than 5 years 
after the date of the enactment of this Act, the 
Comptroller General shall conduct a study on the 
affordability of health insurance coverage, in-
cluding— 
(i) the impact of the tax credit for 
qualified health insurance coverage of indi-
viduals under section 36B of the Internal 
Revenue Code of 1986 and the tax credit for 
employee health insurance expenses of small 
employers under section 45R of such Code
257 
HR 3590 EAS/PP 
on maintaining and expanding the health 
insurance coverage of individuals; 
(ii) the availability of affordable health 
benefits plans, including a study of whether 
the percentage of household income used for 
purposes of section 36B(c)(2)(C) of the In-
ternal Revenue Code of 1986 (as added by 
this section) is the appropriate level for de-
termining whether employer-provided cov-
erage is affordable for an employee and 
whether such level may be lowered without 
significantly increasing the costs to the Fed-
eral Government and reducing employer- 
provided coverage; and 
(iii) the ability of individuals to main-
tain essential health benefits coverage (as 
defined in section 5000A(f) of the Internal 
Revenue Code of 1986). 
(B) REPORT.—The Comptroller General 
shall submit to the appropriate committees of 
Congress a report on the study conducted under 
subparagraph (A), together with legislative rec-
ommendations relating to the matters studied 
under such subparagraph.
258 
HR 3590 EAS/PP 
(2) APPROPRIATE COMMITTEES OF CONGRESS.— 
In this subsection, the term ‘‘appropriate committees 
of Congress’’ means the Committee on Ways and 
Means, the Committee on Education and Labor, and 
the Committee on Energy and Commerce of the House 
of Representatives and the Committee on Finance and 
the Committee on Health, Education, Labor and Pen-
sions of the Senate. 
(d) CONFORMING AMENDMENTS.— 
(1) Paragraph (2) of section 1324(b) of title 31, 
United States Code, is amended by inserting ‘‘36B,’’ 
after ‘‘36A,’’. 
(2) The table of sections for subpart C of part IV 
of subchapter A of chapter 1 of the Internal Revenue 
Code of 1986 is amended by inserting after the item 
relating to section 36A the following new item: 
‘‘Sec. 36B. Refundable credit for coverage under a qualified health plan.’’. 
(e) EFFECTIVE DATE.—The amendments made by this 
section shall apply to taxable years ending after December 
31, 2013. 
SEC. 1402. REDUCED COST-SHARING FOR INDIVIDUALS EN-
ROLLING IN QUALIFIED HEALTH PLANS. 
(a) IN GENERAL.—In the case of an eligible insured 
enrolled in a qualified health plan— 
(1) the Secretary shall notify the issuer of the 
plan of such eligibility; and
259 
HR 3590 EAS/PP 
(2) the issuer shall reduce the cost-sharing under 
the plan at the level and in the manner specified in 
subsection (c). 
(b) ELIGIBLE INSURED.—In this section, the term ‘‘eli-
gible insured’’ means an individual— 
(1) who enrolls in a qualified health plan in the 
silver level of coverage in the individual market of-
fered through an Exchange; and 
(2) whose household income exceeds 100 percent 
but does not exceed 400 percent of the poverty line for 
a family of the size involved. 
In the case of an individual described in section 
36B(c)(1)(B) of the Internal Revenue Code of 1986, the in-
dividual shall be treated as having household income equal 
to 100 percent for purposes of applying this section. 
(c) DETERMINATION OF REDUCTION IN COST-SHAR-
ING.— 
(1) REDUCTION IN OUT-OF-POCKET LIMIT.— 
(A) IN GENERAL.—The reduction in cost- 
sharing under this subsection shall first be 
achieved by reducing the applicable out-of pocket 
limit under section 1302(c)(1) in the case of— 
(i) an eligible insured whose household 
income is more than 100 percent but not 
more than 200 percent of the poverty line
260 
HR 3590 EAS/PP 
for a family of the size involved, by two- 
thirds; 
(ii) an eligible insured whose household 
income is more than 200 percent but not 
more than 300 percent of the poverty line 
for a family of the size involved, by one- 
half; and 
(iii) an eligible insured whose house-
hold income is more than 300 percent but 
not more than 400 percent of the poverty 
line for a family of the size involved, by 
one-third. 
(B) COORDINATION WITH ACTUARIAL VALUE 
LIMITS.— 
(i) IN GENERAL.—The Secretary shall 
ensure the reduction under this paragraph 
shall not result in an increase in the plan’s 
share of the total allowed costs of benefits 
provided under the plan above— 
(I) 90 percent in the case of an el-
igible insured described in paragraph 
(2)(A); 
(II) 80 percent in the case of an 
eligible insured described in paragraph 
(2)(B); and
261 
HR 3590 EAS/PP 
(III) 70 percent in the case of an 
eligible insured described in clause (ii) 
or (iii) of subparagraph (A). 
(ii) 
ADJUSTMENT.—The 
Secretary 
shall adjust the out-of pocket limits under 
paragraph (1) if necessary to ensure that 
such limits do not cause the respective actu-
arial values to exceed the levels specified in 
clause (i). 
(2) ADDITIONAL REDUCTION FOR LOWER INCOME 
INSUREDS.—The Secretary shall establish procedures 
under which the issuer of a qualified health plan to 
which this section applies shall further reduce cost- 
sharing under the plan in a manner sufficient to— 
(A) in the case of an eligible insured whose 
household income is not less than 100 percent 
but not more than 150 percent of the poverty 
line for a family of the size involved, increase the 
plan’s share of the total allowed costs of benefits 
provided under the plan to 90 percent of such 
costs; and 
(B) in the case of an eligible insured whose 
household income is more than 150 percent but 
not more than 200 percent of the poverty line for 
a family of the size involved, increase the plan’s
262 
HR 3590 EAS/PP 
share of the total allowed costs of benefits pro-
vided under the plan to 80 percent of such costs. 
(3) METHODS FOR REDUCING COST-SHARING.— 
(A) IN GENERAL.—An issuer of a qualified 
health plan making reductions under this sub-
section shall notify the Secretary of such reduc-
tions and the Secretary shall make periodic and 
timely payments to the issuer equal to the value 
of the reductions. 
(B) CAPITATED PAYMENTS.—The Secretary 
may establish a capitated payment system to 
carry out the payment of cost-sharing reductions 
under this section. Any such system shall take 
into account the value of the reductions and 
make appropriate risk adjustments to such pay-
ments. 
(4) ADDITIONAL
BENEFITS.—If a qualified 
health plan under section 1302(b)(5) offers benefits in 
addition to the essential health benefits required to be 
provided by the plan, or a State requires a qualified 
health plan under section 1311(d)(3)(B) to cover ben-
efits in addition to the essential health benefits re-
quired to be provided by the plan, the reductions in 
cost-sharing under this section shall not apply to such 
additional benefits.
263 
HR 3590 EAS/PP 
(5) SPECIAL
RULE
FOR
PEDIATRIC
DENTAL 
PLANS.—If an individual enrolls in both a qualified 
health plan and a plan described in section 
1311(d)(2)(B)(ii)(I) for any plan year, subsection (a) 
shall not apply to that portion of any reduction in 
cost-sharing under subsection (c) that (under regula-
tions prescribed by the Secretary) is properly allo-
cable to pediatric dental benefits which are included 
in the essential health benefits required to be provided 
by 
a 
qualified 
health 
plan 
under 
section 
1302(b)(1)(J). 
(d) SPECIAL RULES FOR INDIANS.— 
(1) INDIANS UNDER 300 PERCENT OF POVERTY.— 
If an individual enrolled in any qualified health plan 
in the individual market through an Exchange is an 
Indian (as defined in section 4(d) of the Indian Self- 
Determination and Education Assistance Act (25 
U.S.C. 450b(d))) whose household income is not more 
than 300 percent of the poverty line for a family of 
the size involved, then, for purposes of this section— 
(A) such individual shall be treated as an 
eligible insured; and 
(B) the issuer of the plan shall eliminate 
any cost-sharing under the plan.
264 
HR 3590 EAS/PP 
(2) ITEMS OR SERVICES FURNISHED THROUGH 
INDIAN HEALTH PROVIDERS.—If an Indian (as so de-
fined) enrolled in a qualified health plan is furnished 
an item or service directly by the Indian Health 
Service, an Indian Tribe, Tribal Organization, or 
Urban Indian Organization or through referral under 
contract health services— 
(A) no cost-sharing under the plan shall be 
imposed under the plan for such item or service; 
and 
(B) the issuer of the plan shall not reduce 
the payment to any such entity for such item or 
service by the amount of any cost-sharing that 
would be due from the Indian but for subpara-
graph (A). 
(3) PAYMENT.—The Secretary shall pay to the 
issuer of a qualified health plan the amount necessary 
to reflect the increase in actuarial value of the plan 
required by reason of this subsection. 
(e) 
RULES
FOR
INDIVIDUALS
NOT
LAWFULLY 
PRESENT.— 
(1) IN GENERAL.—If an individual who is an el-
igible insured is not lawfully present—
265 
HR 3590 EAS/PP 
(A) no cost-sharing reduction under this 
section shall apply with respect to the indi-
vidual; and 
(B) for purposes of applying this section, 
the determination as to what percentage a tax-
payer’s household income bears to the poverty 
level for a family of the size involved shall be 
made under one of the following methods: 
(i) A method under which— 
(I) the taxpayer’s family size is 
determined by not taking such individ-
uals into account, and 
(II) the taxpayer’s household in-
come is equal to the product of the tax-
payer’s household income (determined 
without regard to this subsection) and 
a fraction— 
(aa) the numerator of which 
is the poverty line for the tax-
payer’s family size determined 
after application of subclause (I), 
and 
(bb) 
the 
denominator 
of 
which is the poverty line for the
266 
HR 3590 EAS/PP 
taxpayer’s family size determined 
without regard to subclause (I). 
(ii) A comparable method reaching the 
same result as the method under clause (i). 
(2) LAWFULLY PRESENT.—For purposes of this 
section, an individual shall be treated as lawfully 
present only if the individual is, and is reasonably 
expected to be for the entire period of enrollment for 
which the cost-sharing reduction under this section is 
being claimed, a citizen or national of the United 
States or an alien lawfully present in the United 
States. 
(3) SECRETARIAL
AUTHORITY.—The Secretary, 
in consultation with the Secretary of the Treasury, 
shall prescribe rules setting forth the methods by 
which calculations of family size and household in-
come are made for purposes of this subsection. Such 
rules shall be designed to ensure that the least burden 
is placed on individuals enrolling in qualified health 
plans through an Exchange and taxpayers eligible for 
the credit allowable under this section. 
(f) DEFINITIONS AND SPECIAL RULES.—In this sec-
tion: 
(1) IN GENERAL.—Any term used in this section 
which is also used in section 36B of the Internal Rev-
267 
HR 3590 EAS/PP 
enue Code of 1986 shall have the meaning given such 
term by such section. 
(2) LIMITATIONS ON REDUCTION.—No cost-shar-
ing reduction shall be allowed under this section with 
respect to coverage for any month unless the month is 
a coverage month with respect to which a credit is al-
lowed to the insured (or an applicable taxpayer on 
behalf of the insured) under section 36B of such Code. 
(3) DATA USED FOR ELIGIBILITY.—Any deter-
mination under this section shall be made on the 
basis of the taxable year for which the advance deter-
mination is made under section 1412 and not the tax-
able year for which the credit under section 36B of 
such Code is allowed. 
Subpart B—Eligibility Determinations 
SEC. 1411. PROCEDURES FOR DETERMINING ELIGIBILITY 
FOR EXCHANGE PARTICIPATION, PREMIUM 
TAX CREDITS AND REDUCED COST-SHARING, 
AND INDIVIDUAL RESPONSIBILITY EXEMP-
TIONS. 
(a) ESTABLISHMENT
OF PROGRAM.—The Secretary 
shall establish a program meeting the requirements of this 
section for determining— 
(1) whether an individual who is to be covered 
in the individual market by a qualified health plan
268 
HR 3590 EAS/PP 
offered through an Exchange, or who is claiming a 
premium tax credit or reduced cost-sharing, meets the 
requirements of sections 1312(f)(3), 1402(e), and 
1412(d) of this title and section 36B(e) of the Internal 
Revenue Code of 1986 that the individual be a citizen 
or national of the United States or an alien lawfully 
present in the United States; 
(2) in the case of an individual claiming a pre-
mium tax credit or reduced cost-sharing under section 
36B of such Code or section 1402— 
(A) whether the individual meets the income 
and coverage requirements of such sections; and 
(B) the amount of the tax credit or reduced 
cost-sharing; 
(3) whether an individual’s coverage under an 
employer-sponsored health benefits plan is treated as 
unaffordable 
under 
sections 
36B(c)(2)(C) 
and 
5000A(e)(2); and 
(4) whether to grant a certification under section 
1311(d)(4)(H) attesting that, for purposes of the indi-
vidual responsibility requirement under section 
5000A of the Internal Revenue Code of 1986, an indi-
vidual is entitled to an exemption from either the in-
dividual responsibility requirement or the penalty 
imposed by such section.
269 
HR 3590 EAS/PP 
(b) INFORMATION REQUIRED TO BE PROVIDED BY AP-
PLICANTS.— 
(1) IN GENERAL.—An applicant for enrollment 
in a qualified health plan offered through an Ex-
change in the individual market shall provide— 
(A) the name, address, and date of birth of 
each individual who is to be covered by the plan 
(in this subsection referred to as an ‘‘enrollee’’); 
and 
(B) the information required by any of the 
following paragraphs that is applicable to an en-
rollee. 
(2) CITIZENSHIP OR IMMIGRATION STATUS.—The 
following information shall be provided with respect 
to every enrollee: 
(A) In the case of an enrollee whose eligi-
bility is based on an attestation of citizenship of 
the enrollee, the enrollee’s social security number. 
(B) In the case of an individual whose eligi-
bility is based on an attestation of the enrollee’s 
immigration status, the enrollee’s social security 
number (if applicable) and such identifying in-
formation with respect to the enrollee’s immigra-
tion status as the Secretary, after consultation
270 
HR 3590 EAS/PP 
with the Secretary of Homeland Security, deter-
mines appropriate. 
(3) ELIGIBILITY AND AMOUNT OF TAX CREDIT OR 
REDUCED COST-SHARING.—In the case of an enrollee 
with respect to whom a premium tax credit or re-
duced cost-sharing under section 36B of such Code or 
section 1402 is being claimed, the following informa-
tion: 
(A) INFORMATION REGARDING INCOME AND 
FAMILY SIZE.—The information described in sec-
tion 6103(l)(21) for the taxable year ending with 
or within the second calendar year preceding the 
calendar year in which the plan year begins. 
(B) CHANGES IN CIRCUMSTANCES.—The in-
formation described in section 1412(b)(2), in-
cluding information with respect to individuals 
who were not required to file an income tax re-
turn for the taxable year described in subpara-
graph (A) or individuals who experienced 
changes in marital status or family size or sig-
nificant reductions in income. 
(4) EMPLOYER-SPONSORED
COVERAGE.—In the 
case of an enrollee with respect to whom eligibility for 
a premium tax credit under section 36B of such Code 
or cost-sharing reduction under section 1402 is being
271 
HR 3590 EAS/PP 
established on the basis that the enrollee’s (or related 
individual’s) employer is not treated under section 
36B(c)(2)(C) of such Code as providing minimum es-
sential coverage or affordable minimum essential cov-
erage, the following information: 
(A) The name, address, and employer iden-
tification number (if available) of the employer. 
(B) Whether the enrollee or individual is a 
full-time employee and whether the employer 
provides such minimum essential coverage. 
(C) If the employer provides such minimum 
essential coverage, the lowest cost option for the 
enrollee’s or individual’s enrollment status and 
the enrollee’s or individual’s required contribu-
tion 
(within 
the 
meaning 
of 
section 
5000A(e)(1)(B) of such Code) under the em-
ployer-sponsored plan. 
(D) If an enrollee claims an employer’s 
minimum essential coverage is unaffordable, the 
information described in paragraph (3). 
If an enrollee changes employment or obtains addi-
tional employment while enrolled in a qualified 
health plan for which such credit or reduction is al-
lowed, the enrollee shall notify the Exchange of such 
change or additional employment and provide the in-
272 
HR 3590 EAS/PP 
formation described in this paragraph with respect to 
the new employer. 
(5) EXEMPTIONS FROM INDIVIDUAL RESPONSI-
BILITY REQUIREMENTS.—In the case of an individual 
who is seeking an exemption certificate under section 
1311(d)(4)(H) from any requirement or penalty im-
posed by section 5000A, the following information: 
(A) In the case of an individual seeking ex-
emption based on the individual’s status as a 
member of an exempt religious sect or division, 
as a member of a health care sharing ministry, 
as an Indian, or as an individual eligible for a 
hardship exemption, such information as the 
Secretary shall prescribe. 
(B) In the case of an individual seeking ex-
emption based on the lack of affordable coverage 
or the individual’s status as a taxpayer with 
household income less than 100 percent of the 
poverty line, the information described in para-
graphs (3) and (4), as applicable. 
(c) VERIFICATION
OF INFORMATION CONTAINED
IN 
RECORDS OF SPECIFIC FEDERAL OFFICIALS.— 
(1) 
INFORMATION
TRANSFERRED
TO
SEC-
RETARY.—An Exchange shall submit the information 
provided by an applicant under subsection (b) to the
273 
HR 3590 EAS/PP 
Secretary for verification in accordance with the re-
quirements of this subsection and subsection (d). 
(2) CITIZENSHIP OR IMMIGRATION STATUS.— 
(A) COMMISSIONER OF SOCIAL SECURITY.— 
The Secretary shall submit to the Commissioner 
of Social Security the following information for 
a determination as to whether the information 
provided is consistent with the information in 
the records of the Commissioner: 
(i) The name, date of birth, and social 
security number of each individual for 
whom such information was provided under 
subsection (b)(2). 
(ii) The attestation of an individual 
that the individual is a citizen. 
(B) SECRETARY
OF
HOMELAND
SECU-
RITY.— 
(i) IN GENERAL.—In the case of an in-
dividual— 
(I) who attests that the individual 
is an alien lawfully present in the 
United States; or 
(II) who attests that the indi-
vidual is a citizen but with respect to 
whom the Commissioner of Social Se-
274 
HR 3590 EAS/PP 
curity has notified the Secretary under 
subsection (e)(3) that the attestation is 
inconsistent with information in the 
records maintained by the Commis-
sioner; 
the Secretary shall submit to the Secretary 
of Homeland Security the information de-
scribed in clause (ii) for a determination as 
to whether the information provided is con-
sistent with the information in the records 
of the Secretary of Homeland Security. 
(ii) INFORMATION.—The information 
described in clause (ii) is the following: 
(I) The name, date of birth, and 
any identifying information with re-
spect to the individual’s immigration 
status 
provided 
under 
subsection 
(b)(2). 
(II) The attestation that the indi-
vidual is an alien lawfully present in 
the United States or in the case of an 
individual described in clause (i)(II), 
the attestation that the individual is a 
citizen.
275 
HR 3590 EAS/PP 
(3) ELIGIBILITY
FOR
TAX
CREDIT
AND
COST- 
SHARING
REDUCTION.—The Secretary shall submit 
the information described in subsection (b)(3)(A) pro-
vided under paragraph (3), (4), or (5) of subsection 
(b) to the Secretary of the Treasury for verification 
of household income and family size for purposes of 
eligibility. 
(4) METHODS.— 
(A) IN GENERAL.—The Secretary, in con-
sultation with the Secretary of the Treasury, the 
Secretary of Homeland Security, and the Com-
missioner of Social Security, shall provide that 
verifications and determinations under this sub-
section shall be done— 
(i) through use of an on-line system or 
otherwise for the electronic submission of, 
and response to, the information submitted 
under this subsection with respect to an ap-
plicant; or 
(ii) by determining the consistency of 
the information submitted with the infor-
mation maintained in the records of the 
Secretary of the Treasury, the Secretary of 
Homeland Security, or the Commissioner of
276 
HR 3590 EAS/PP 
Social Security through such other method 
as is approved by the Secretary. 
(B) 
FLEXIBILITY.—The 
Secretary 
may 
modify the methods used under the program es-
tablished by this section for the Exchange and 
verification of information if the Secretary deter-
mines such modifications would reduce the ad-
ministrative costs and burdens on the applicant, 
including allowing an applicant to request the 
Secretary of the Treasury to provide the infor-
mation described in paragraph (3) directly to 
the Exchange or to the Secretary. The Secretary 
shall not make any such modification unless the 
Secretary determines that any applicable re-
quirements under this section and section 6103 
of the Internal Revenue Code of 1986 with re-
spect to the confidentiality, disclosure, mainte-
nance, or use of information will be met. 
(d) VERIFICATION BY SECRETARY.—In the case of in-
formation provided under subsection (b) that is not required 
under subsection (c) to be submitted to another person for 
verification, the Secretary shall verify the accuracy of such 
information in such manner as the Secretary determines 
appropriate, 
including 
delegating 
responsibility 
for 
verification to the Exchange.
277 
HR 3590 EAS/PP 
(e) ACTIONS RELATING TO VERIFICATION.— 
(1) IN GENERAL.—Each person to whom the Sec-
retary provided information under subsection (c) 
shall report to the Secretary under the method estab-
lished under subsection (c)(4) the results of its 
verification and the Secretary shall notify the Ex-
change of such results. Each person to whom the Sec-
retary provided information under subsection (d) 
shall report to the Secretary in such manner as the 
Secretary determines appropriate. 
(2) VERIFICATION.— 
(A) ELIGIBILITY
FOR
ENROLLMENT
AND 
PREMIUM TAX CREDITS AND COST-SHARING RE-
DUCTIONS.—If information provided by an ap-
plicant under paragraphs (1), (2), (3), and (4) 
of subsection (b) is verified under subsections (c) 
and (d)— 
(i) the individual’s eligibility to enroll 
through the Exchange and to apply for pre-
mium tax credits and cost-sharing reduc-
tions shall be satisfied; and 
(ii) the Secretary shall, if applicable, 
notify the Secretary of the Treasury under 
section 1412(c) of the amount of any ad-
vance payment to be made.
278 
HR 3590 EAS/PP 
(B) EXEMPTION FROM INDIVIDUAL RESPON-
SIBILITY.—If information provided by an appli-
cant under subsection (b)(5) is verified under 
subsections (c) and (d), the Secretary shall issue 
the certification of exemption described in section 
1311(d)(4)(H). 
(3) INCONSISTENCIES
INVOLVING
ATTESTATION 
OF CITIZENSHIP OR LAWFUL PRESENCE.—If the infor-
mation provided by any applicant under subsection 
(b)(2) is inconsistent with information in the records 
maintained by the Commissioner of Social Security 
or Secretary of Homeland Security, whichever is ap-
plicable, the applicant’s eligibility will be determined 
in the same manner as an individual’s eligibility 
under the medicaid program is determined under sec-
tion 1902(ee) of the Social Security Act (as in effect 
on January 1, 2010). 
(4) INCONSISTENCIES INVOLVING OTHER INFOR-
MATION.— 
(A) IN GENERAL.—If the information pro-
vided by an applicant under subsection (b) 
(other than subsection (b)(2)) is inconsistent 
with information in the records maintained by 
persons under subsection (c) or is not verified 
under subsection (d), the Secretary shall notify
279 
HR 3590 EAS/PP 
the Exchange and the Exchange shall take the 
following actions: 
(i) REASONABLE
EFFORT.—The Ex-
change shall make a reasonable effort to 
identify and address the causes of such in-
consistency, 
including 
through 
typo-
graphical or other clerical errors, by con-
tacting the applicant to confirm the accu-
racy of the information, and by taking such 
additional actions as the Secretary, through 
regulation or other guidance, may identify. 
(ii) NOTICE
AND
OPPORTUNITY
TO 
CORRECT.—In the case the inconsistency or 
inability to verify is not resolved under sub-
paragraph (A), the Exchange shall— 
(I) notify the applicant of such 
fact; 
(II) provide the applicant an op-
portunity to either present satisfactory 
documentary evidence or resolve the in-
consistency with the person verifying 
the information under subsection (c) or 
(d) during the 90-day period beginning 
the date on which the notice required
280 
HR 3590 EAS/PP 
under subclause (I) is sent to the ap-
plicant. 
The Secretary may extend the 90-day pe-
riod under subclause (II) for enrollments oc-
curring during 2014. 
(B) SPECIFIC ACTIONS NOT INVOLVING CITI-
ZENSHIP OR LAWFUL PRESENCE.— 
(i) IN GENERAL.—Except as provided 
in paragraph (3), the Exchange shall, dur-
ing any period before the close of the period 
under subparagraph (A)(ii)(II), make any 
determination under paragraphs (2), (3), 
and (4) of subsection (a) on the basis of the 
information contained on the application. 
(ii) ELIGIBILITY OR AMOUNT OF CRED-
IT OR REDUCTION.—If an inconsistency in-
volving the eligibility for, or amount of, any 
premium tax credit or cost-sharing reduc-
tion is unresolved under this subsection as 
of the close of the period under subpara-
graph (A)(ii)(II), the Exchange shall notify 
the applicant of the amount (if any) of the 
credit or reduction that is determined on 
the basis of the records maintained by per-
sons under subsection (c).
281 
HR 3590 EAS/PP 
(iii) EMPLOYER
AFFORDABILITY.—If 
the Secretary notifies an Exchange that an 
enrollee is eligible for a premium tax credit 
under section 36B of such Code or cost-shar-
ing reduction under section 1402 because 
the enrollee’s (or related individual’s) em-
ployer does not provide minimum essential 
coverage through an employer-sponsored 
plan or that the employer does provide that 
coverage but it is not affordable coverage, 
the Exchange shall notify the employer of 
such fact and that the employer may be lia-
ble for the payment assessed under section 
4980H of such Code. 
(iv) EXEMPTION.—In any case where 
the inconsistency involving, or inability to 
verify, information provided under sub-
section (b)(5) is not resolved as of the close 
of 
the 
period 
under 
subparagraph 
(A)(ii)(II), the Exchange shall notify an ap-
plicant that no certification of exemption 
from any requirement or payment under 
section 5000A of such Code will be issued. 
(C) APPEALS
PROCESS.—The Exchange 
shall also notify each person receiving notice
282 
HR 3590 EAS/PP 
under this paragraph of the appeals processes es-
tablished under subsection (f). 
(f) APPEALS AND REDETERMINATIONS.— 
(1) IN GENERAL.—The Secretary, in consultation 
with the Secretary of the Treasury, the Secretary of 
Homeland Security, and the Commissioner of Social 
Security, shall establish procedures by which the Sec-
retary or one of such other Federal officers— 
(A) hears and makes decisions with respect 
to appeals of any determination under subsection 
(e); and 
(B) redetermines eligibility on a periodic 
basis in appropriate circumstances. 
(2) EMPLOYER LIABILITY.— 
(A) IN GENERAL.—The Secretary shall es-
tablish a separate appeals process for employers 
who are notified under subsection (e)(4)(C) that 
the employer may be liable for a tax imposed by 
section 4980H of the Internal Revenue Code of 
1986 with respect to an employee because of a 
determination that the employer does not provide 
minimum essential coverage through an em-
ployer-sponsored plan or that the employer does 
provide that coverage but it is not affordable cov-
283 
HR 3590 EAS/PP 
erage with respect to an employee. Such process 
shall provide an employer the opportunity to— 
(i) present information to the Ex-
change for review of the determination ei-
ther by the Exchange or the person making 
the determination, including evidence of the 
employer-sponsored plan and employer con-
tributions to the plan; and 
(ii) have access to the data used to 
make the determination to the extent allow-
able by law. 
Such process shall be in addition to any rights 
of appeal the employer may have under subtitle 
F of such Code. 
(B) 
CONFIDENTIALITY.—Notwithstanding 
any provision of this title (or the amendments 
made by this title) or section 6103 of the Inter-
nal Revenue Code of 1986, an employer shall not 
be entitled to any taxpayer return information 
with respect to an employee for purposes of de-
termining whether the employer is subject to the 
penalty under section 4980H of such Code with 
respect to the employee, except that— 
(i) the employer may be notified as to 
the name of an employee and whether or
284 
HR 3590 EAS/PP 
not the employee’s income is above or below 
the threshold by which the affordability of 
an employer’s health insurance coverage is 
measured; and 
(ii) this subparagraph shall not apply 
to an employee who provides a waiver (at 
such time and in such manner as the Sec-
retary may prescribe) authorizing an em-
ployer to have access to the employee’s tax-
payer return information. 
(g) CONFIDENTIALITY OF APPLICANT INFORMATION.— 
(1) IN GENERAL.—An applicant for insurance 
coverage or for a premium tax credit or cost-sharing 
reduction shall be required to provide only the infor-
mation strictly necessary to authenticate identity, de-
termine eligibility, and determine the amount of the 
credit or reduction. 
(2) RECEIPT OF INFORMATION.—Any person who 
receives information provided by an applicant under 
subsection (b) (whether directly or by another person 
at the request of the applicant), or receives informa-
tion from a Federal agency under subsection (c), (d), 
or (e), shall— 
(A) use the information only for the pur-
poses of, and to the extent necessary in, ensuring
285 
HR 3590 EAS/PP 
the efficient operation of the Exchange, including 
verifying the eligibility of an individual to enroll 
through an Exchange or to claim a premium tax 
credit or cost-sharing reduction or the amount of 
the credit or reduction; and 
(B) not disclose the information to any 
other person except as provided in this section. 
(h) PENALTIES.— 
(1) FALSE OR FRAUDULENT INFORMATION.— 
(A) CIVIL PENALTY.— 
(i) IN GENERAL.—If— 
(I) any person fails to provides 
correct information under subsection 
(b); and 
(II) such failure is attributable to 
negligence or disregard of any rules or 
regulations of the Secretary, 
such person shall be subject, in addition to 
any other penalties that may be prescribed 
by law, to a civil penalty of not more than 
$25,000 with respect to any failures involv-
ing an application for a plan year. For 
purposes of this subparagraph, the terms 
‘‘negligence’’ and ‘‘disregard’’ shall have the
286 
HR 3590 EAS/PP 
same meanings as when used in section 
6662 of the Internal Revenue Code of 1986. 
(ii) REASONABLE CAUSE EXCEPTION.— 
No penalty shall be imposed under clause 
(i) if the Secretary determines that there 
was a reasonable cause for the failure and 
that the person acted in good faith. 
(B) KNOWING AND WILLFUL VIOLATIONS.— 
Any person who knowingly and willfully pro-
vides false or fraudulent information under sub-
section (b) shall be subject, in addition to any 
other penalties that may be prescribed by law, to 
a civil penalty of not more than $250,000. 
(2) IMPROPER USE OR DISCLOSURE OF INFORMA-
TION.—Any person who knowingly and willfully uses 
or discloses information in violation of subsection (g) 
shall be subject, in addition to any other penalties 
that may be prescribed by law, to a civil penalty of 
not more than $25,000. 
(3) LIMITATIONS ON LIENS AND LEVIES.—The 
Secretary (or, if applicable, the Attorney General of 
the United States) shall not— 
(A) file notice of lien with respect to any 
property of a person by reason of any failure to 
pay the penalty imposed by this subsection; or
287 
HR 3590 EAS/PP 
(B) levy on any such property with respect 
to such failure. 
(i) STUDY OF ADMINISTRATION OF EMPLOYER RE-
SPONSIBILITY.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall, in consultation with the Sec-
retary of the Treasury, conduct a study of the proce-
dures that are necessary to ensure that in the admin-
istration of this title and section 4980H of the Inter-
nal Revenue Code of 1986 (as added by section 1513) 
that the following rights are protected: 
(A) The rights of employees to preserve their 
right to confidentiality of their taxpayer return 
information and their right to enroll in a quali-
fied health plan through an Exchange if an em-
ployer does not provide affordable coverage. 
(B) The rights of employers to adequate due 
process and access to information necessary to 
accurately determine any payment assessed on 
employers. 
(2) REPORT.—Not later than January 1, 2013, 
the Secretary of Health and Human Services shall re-
port the results of the study conducted under para-
graph (1), including any recommendations for legisla-
tive changes, to the Committees on Finance and
288 
HR 3590 EAS/PP 
Health, Education, Labor and Pensions of the Senate 
and the Committees of Education and Labor and 
Ways and Means of the House of Representatives. 
SEC. 1412. ADVANCE DETERMINATION AND PAYMENT OF 
PREMIUM TAX CREDITS AND COST-SHARING 
REDUCTIONS. 
(a) IN GENERAL.—The Secretary, in consultation with 
the Secretary of the Treasury, shall establish a program 
under which— 
(1) upon request of an Exchange, advance deter-
minations are made under section 1411 with respect 
to the income eligibility of individuals enrolling in a 
qualified health plan in the individual market 
through the Exchange for the premium tax credit al-
lowable under section 36B of the Internal Revenue 
Code of 1986 and the cost-sharing reductions under 
section 1402; 
(2) the Secretary notifies— 
(A) the Exchange and the Secretary of the 
Treasury of the advance determinations; and 
(B) the Secretary of the Treasury of the 
name and employer identification number of 
each employer with respect to whom 1 or more 
employee of the employer were determined to be 
eligible for the premium tax credit under section
289 
HR 3590 EAS/PP 
36B of the Internal Revenue Code of 1986 and 
the cost-sharing reductions under section 1402 
because— 
(i) the employer did not provide min-
imum essential coverage; or 
(ii) the employer provided such min-
imum essential coverage but it was deter-
mined under section 36B(c)(2)(C) of such 
Code to either be unaffordable to the em-
ployee or not provide the required min-
imum actuarial value; and 
(3) the Secretary of the Treasury makes advance 
payments of such credit or reductions to the issuers 
of the qualified health plans in order to reduce the 
premiums payable by individuals eligible for such 
credit. 
(b) ADVANCE DETERMINATIONS.— 
(1) IN GENERAL.—The Secretary shall provide 
under the program established under subsection (a) 
that advance determination of eligibility with respect 
to any individual shall be made— 
(A) during the annual open enrollment pe-
riod applicable to the individual (or such other 
enrollment period as may be specified by the 
Secretary); and
290 
HR 3590 EAS/PP 
(B) on the basis of the individual’s house-
hold income for the most recent taxable year for 
which the Secretary, after consultation with the 
Secretary of the Treasury, determines informa-
tion is available. 
(2) CHANGES
IN
CIRCUMSTANCES.—The Sec-
retary shall provide procedures for making advance 
determinations on the basis of information other than 
that described in paragraph (1)(B) in cases where in-
formation included with an application form dem-
onstrates substantial changes in income, changes in 
family size or other household circumstances, change 
in filing status, the filing of an application for unem-
ployment benefits, or other significant changes affect-
ing eligibility, including— 
(A) allowing an individual claiming a de-
crease of 20 percent or more in income, or filing 
an application for unemployment benefits, to 
have eligibility for the credit determined on the 
basis of household income for a later period or 
on the basis of the individual’s estimate of such 
income for the taxable year; and 
(B) the determination of household income 
in cases where the taxpayer was not required to
291 
HR 3590 EAS/PP 
file a return of tax imposed by this chapter for 
the second preceding taxable year. 
(c) PAYMENT OF PREMIUM TAX CREDITS AND COST- 
SHARING REDUCTIONS.— 
(1) IN GENERAL.—The Secretary shall notify the 
Secretary of the Treasury and the Exchange through 
which the individual is enrolling of the advance deter-
mination under section 1411. 
(2) PREMIUM TAX CREDIT.— 
(A) IN
GENERAL.—The Secretary of the 
Treasury shall make the advance payment under 
this section of any premium tax credit allowed 
under section 36B of the Internal Revenue Code 
of 1986 to the issuer of a qualified health plan 
on a monthly basis (or such other periodic basis 
as the Secretary may provide). 
(B) ISSUER RESPONSIBILITIES.—An issuer 
of a qualified health plan receiving an advance 
payment with respect to an individual enrolled 
in the plan shall— 
(i) reduce the premium charged the in-
sured for any period by the amount of the 
advance payment for the period; 
(ii) notify the Exchange and the Sec-
retary of such reduction;
292 
HR 3590 EAS/PP 
(iii) include with each billing state-
ment the amount by which the premium for 
the plan has been reduced by reason of the 
advance payment; and 
(iv) in the case of any nonpayment of 
premiums by the insured— 
(I) notify the Secretary of such 
nonpayment; and 
(II) allow a 3-month grace period 
for nonpayment of premiums before 
discontinuing coverage. 
(3) COST-SHARING REDUCTIONS.—The Secretary 
shall also notify the Secretary of the Treasury and the 
Exchange under paragraph (1) if an advance pay-
ment of the cost-sharing reductions under section 
1402 is to be made to the issuer of any qualified 
health plan with respect to any individual enrolled in 
the plan. The Secretary of the Treasury shall make 
such advance payment at such time and in such 
amount as the Secretary specifies in the notice. 
(d) NO FEDERAL PAYMENTS FOR INDIVIDUALS NOT 
LAWFULLY PRESENT.—Nothing in this subtitle or the 
amendments made by this subtitle allows Federal payments, 
credits, or cost-sharing reductions for individuals who are 
not lawfully present in the United States.
293 
HR 3590 EAS/PP 
(e) STATE FLEXIBILITY.—Nothing in this subtitle or 
the amendments made by this subtitle shall be construed 
to prohibit a State from making payments to or on behalf 
of an individual for coverage under a qualified health plan 
offered through an Exchange that are in addition to any 
credits or cost-sharing reductions allowable to the indi-
vidual under this subtitle and such amendments. 
SEC. 1413. STREAMLINING OF PROCEDURES FOR ENROLL-
MENT THROUGH AN EXCHANGE AND STATE 
MEDICAID, CHIP, AND HEALTH SUBSIDY PRO-
GRAMS. 
(a) IN GENERAL.—The Secretary shall establish a sys-
tem meeting the requirements of this section under which 
residents of each State may apply for enrollment in, receive 
a determination of eligibility for participation in, and con-
tinue participation in, applicable State health subsidy pro-
grams. Such system shall ensure that if an individual ap-
plying to an Exchange is found through screening to be eli-
gible for medical assistance under the State medicaid plan 
under title XIX, or eligible for enrollment under a State 
children’s health insurance program (CHIP) under title 
XXI of such Act, the individual is enrolled for assistance 
under such plan or program. 
(b) REQUIREMENTS RELATING TO FORMS AND NO-
TICE.—
294 
HR 3590 EAS/PP 
(1) REQUIREMENTS RELATING TO FORMS.— 
(A) IN GENERAL.—The Secretary shall de-
velop and provide to each State a single, stream-
lined form that— 
(i) may be used to apply for all appli-
cable State health subsidy programs within 
the State; 
(ii) may be filed online, in person, by 
mail, or by telephone; 
(iii) may be filed with an Exchange or 
with State officials operating one of the 
other applicable State health subsidy pro-
grams; and 
(iv) is structured to maximize an ap-
plicant’s ability to complete the form satis-
factorily, taking into account the character-
istics of individuals who qualify for appli-
cable State health subsidy programs. 
(B) STATE
AUTHORITY
TO
ESTABLISH 
FORM.—A State may develop and use its own 
single, streamlined form as an alternative to the 
form developed under subparagraph (A) if the al-
ternative form is consistent with standards pro-
mulgated by the Secretary under this section.
295 
HR 3590 EAS/PP 
(C) SUPPLEMENTAL ELIGIBILITY FORMS.— 
The Secretary may allow a State to use a sup-
plemental or alternative form in the case of indi-
viduals who apply for eligibility that is not de-
termined on the basis of the household income (as 
defined in section 36B of the Internal Revenue 
Code of 1986). 
(2) NOTICE.—The Secretary shall provide that 
an applicant filing a form under paragraph (1) shall 
receive notice of eligibility for an applicable State 
health subsidy program without any need to provide 
additional information or paperwork unless such in-
formation or paperwork is specifically required by 
law when information provided on the form is incon-
sistent with data used for the electronic verification 
under paragraph (3) or is otherwise insufficient to 
determine eligibility. 
(c) REQUIREMENTS RELATING TO ELIGIBILITY BASED 
ON DATA EXCHANGES.— 
(1) DEVELOPMENT OF SECURE INTERFACES.— 
Each State shall develop for all applicable State 
health subsidy programs a secure, electronic interface 
allowing an exchange of data (including information 
contained in the application forms described in sub-
section (b)) that allows a determination of eligibility
296 
HR 3590 EAS/PP 
for all such programs based on a single application. 
Such interface shall be compatible with the method es-
tablished 
for 
data 
verification 
under 
section 
1411(c)(4). 
(2) DATA MATCHING PROGRAM.—Each applica-
ble State health subsidy program shall participate in 
a data matching arrangement for determining eligi-
bility for participation in the program under para-
graph (3) that— 
(A) provides access to data described in 
paragraph (3); 
(B) applies only to individuals who— 
(i) receive assistance from an applica-
ble State health subsidy program; or 
(ii) apply for such assistance— 
(I) by filing a form described in 
subsection (b); or 
(II) by requesting a determination 
of eligibility and authorizing disclosure 
of the information described in para-
graph (3) to applicable State health 
coverage subsidy programs for purposes 
of determining and establishing eligi-
bility; and
297 
HR 3590 EAS/PP 
(C) consistent with standards promulgated 
by the Secretary, including the privacy and data 
security safeguards described in section 1942 of 
the Social Security Act or that are otherwise ap-
plicable to such programs. 
(3) DETERMINATION OF ELIGIBILITY.— 
(A) IN
GENERAL.—Each applicable State 
health subsidy program shall, to the maximum 
extent practicable— 
(i) establish, verify, and update eligi-
bility for participation in the program 
using the data matching arrangement under 
paragraph (2); and 
(ii) determine such eligibility on the 
basis of reliable, third party data, including 
information described in sections 1137, 
453(i), and 1942(a) of the Social Security 
Act, obtained through such arrangement. 
(B) EXCEPTION.—This paragraph shall not 
apply in circumstances with respect to which the 
Secretary determines that the administrative 
and other costs of use of the data matching ar-
rangement under paragraph (2) outweigh its ex-
pected gains in accuracy, efficiency, and pro-
gram participation.
298 
HR 3590 EAS/PP 
(4) SECRETARIAL
STANDARDS.—The Secretary 
shall, after consultation with persons in possession of 
the data to be matched and representatives of applica-
ble State health subsidy programs, promulgate stand-
ards governing the timing, contents, and procedures 
for data matching described in this subsection. Such 
standards shall take into account administrative and 
other costs and the value of data matching to the es-
tablishment, verification, and updating of eligibility 
for applicable State health subsidy programs. 
(d) ADMINISTRATIVE AUTHORITY.— 
(1) AGREEMENTS.—Subject to section 1411 and 
section 6103(l)(21) of the Internal Revenue Code of 
1986 and any other requirement providing safeguards 
of privacy and data integrity, the Secretary may es-
tablish model agreements, and enter into agreements, 
for the sharing of data under this section. 
(2) AUTHORITY
OF
EXCHANGE
TO
CONTRACT 
OUT.—Nothing in this section shall be construed to— 
(A) 
prohibit 
contractual 
arrangements 
through which a State medicaid agency deter-
mines eligibility for all applicable State health 
subsidy programs, but only if such agency com-
plies with the Secretary’s requirements ensuring
299 
HR 3590 EAS/PP 
reduced administrative costs, eligibility errors, 
and disruptions in coverage; or 
(B) change any requirement under title XIX 
that eligibility for participation in a State’s 
medicaid program must be determined by a pub-
lic agency. 
(e) APPLICABLE
STATE
HEALTH
SUBSIDY
PRO-
GRAM.—In this section, the term ‘‘applicable State health 
subsidy program’’ means— 
(1) the program under this title for the enroll-
ment in qualified health plans offered through an Ex-
change, including the premium tax credits under sec-
tion 36B of the Internal Revenue Code of 1986 and 
cost-sharing reductions under section 1402; 
(2) a State medicaid program under title XIX of 
the Social Security Act; 
(3) a State children’s health insurance program 
(CHIP) under title XXI of such Act; and 
(4) a State program under section 1331 estab-
lishing qualified basic health plans. 
SEC. 1414. DISCLOSURES TO CARRY OUT ELIGIBILITY RE-
QUIREMENTS FOR CERTAIN PROGRAMS. 
(a) DISCLOSURE OF TAXPAYER RETURN INFORMATION 
AND SOCIAL SECURITY NUMBERS.—
300 
HR 3590 EAS/PP 
(1) TAXPAYER
RETURN
INFORMATION.—Sub-
section (l) of section 6103 of the Internal Revenue 
Code of 1986 is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(21) DISCLOSURE OF RETURN INFORMATION TO 
CARRY OUT ELIGIBILITY REQUIREMENTS FOR CERTAIN 
PROGRAMS.— 
‘‘(A) IN
GENERAL.—The Secretary, upon 
written request from the Secretary of Health and 
Human Services, shall disclose to officers, em-
ployees, and contractors of the Department of 
Health and Human Services return information 
of any taxpayer whose income is relevant in de-
termining any premium tax credit under section 
36B or any cost-sharing reduction under section 
1402 of the Patient Protection and Affordable 
Care Act or eligibility for participation in a 
State medicaid program under title XIX of the 
Social Security Act, a State’s children’s health 
insurance program under title XXI of the Social 
Security Act, or a basic health program under 
section 1331 of Patient Protection and Affordable 
Care Act. Such return information shall be lim-
ited to—
301 
HR 3590 EAS/PP 
‘‘(i) taxpayer identity information 
with respect to such taxpayer, 
‘‘(ii) the filing status of such taxpayer, 
‘‘(iii) the number of individuals for 
whom a deduction is allowed under section 
151 with respect to the taxpayer (including 
the taxpayer and the taxpayer’s spouse), 
‘‘(iv) the modified gross income (as de-
fined in section 36B) of such taxpayer and 
each of the other individuals included under 
clause (iii) who are required to file a return 
of tax imposed by chapter 1 for the taxable 
year, 
‘‘(v) such other information as is pre-
scribed by the Secretary by regulation as 
might indicate whether the taxpayer is eli-
gible for such credit or reduction (and the 
amount thereof), and 
‘‘(vi) the taxable year with respect to 
which the preceding information relates or, 
if applicable, the fact that such information 
is not available. 
‘‘(B) INFORMATION
TO
EXCHANGE
AND 
STATE AGENCIES.—The Secretary of Health and 
Human Services may disclose to an Exchange
302 
HR 3590 EAS/PP 
established under the Patient Protection and Af-
fordable Care Act or its contractors, or to a State 
agency administering a State program described 
in subparagraph (A) or its contractors, any in-
consistency between the information provided by 
the Exchange or State agency to the Secretary 
and the information provided to the Secretary 
under subparagraph (A). 
‘‘(C) RESTRICTION ON USE OF DISCLOSED 
INFORMATION.—Return 
information 
disclosed 
under subparagraph (A) or (B) may be used by 
officers, employees, and contractors of the De-
partment of Health and Human Services, an 
Exchange, or a State agency only for the pur-
poses of, and to the extent necessary in— 
‘‘(i) establishing eligibility for partici-
pation in the Exchange, and verifying the 
appropriate amount of, any credit or reduc-
tion described in subparagraph (A), 
‘‘(ii) determining eligibility for par-
ticipation in the State programs described 
in subparagraph (A).’’. 
(2) 
SOCIAL
SECURITY
NUMBERS.—Section 
205(c)(2)(C) of the Social Security Act is amended by 
adding at the end the following new clause:
303 
HR 3590 EAS/PP 
‘‘(x) The Secretary of Health and 
Human Services, and the Exchanges estab-
lished under section 1311 of the Patient 
Protection and Affordable Care Act, are au-
thorized to collect and use the names and 
social security account numbers of individ-
uals as required to administer the provi-
sions of, and the amendments made by, the 
such Act.’’. 
(b) CONFIDENTIALITY AND DISCLOSURE.—Paragraph 
(3) of section 6103(a) of such Code is amended by striking 
‘‘or (20)’’ and inserting ‘‘(20), or (21)’’. 
(c) PROCEDURES AND RECORDKEEPING RELATED TO 
DISCLOSURES.—Paragraph (4) of section 6103(p) of such 
Code is amended— 
(1) by inserting ‘‘, or any entity described in 
subsection (l)(21),’’ after ‘‘or (20)’’ in the matter pre-
ceding subparagraph (A), 
(2) by inserting ‘‘or any entity described in sub-
section (l)(21),’’ after ‘‘or (o)(1)(A)’’ in subparagraph 
(F)(ii), and 
(3) by inserting ‘‘or any entity described in sub-
section (l)(21),’’ after ‘‘or (20)’’ both places it appears 
in the matter after subparagraph (F).
304 
HR 3590 EAS/PP 
(d) UNAUTHORIZED DISCLOSURE OR INSPECTION.— 
Paragraph (2) of section 7213(a) of such Code is amended 
by striking ‘‘or (20)’’ and inserting ‘‘(20), or (21)’’. 
SEC. 1415. PREMIUM TAX CREDIT AND COST-SHARING RE-
DUCTION PAYMENTS DISREGARDED FOR FED-
ERAL AND FEDERALLY-ASSISTED PROGRAMS. 
For purposes of determining the eligibility of any indi-
vidual for benefits or assistance, or the amount or extent 
of benefits or assistance, under any Federal program or 
under any State or local program financed in whole or in 
part with Federal funds— 
(1) any credit or refund allowed or made to any 
individual by reason of section 36B of the Internal 
Revenue Code of 1986 (as added by section 1401) 
shall not be taken into account as income and shall 
not be taken into account as resources for the month 
of receipt and the following 2 months; and 
(2) any cost-sharing reduction payment or ad-
vance payment of the credit allowed under such sec-
tion 36B that is made under section 1402 or 1412 
shall be treated as made to the qualified health plan 
in which an individual is enrolled and not to that in-
dividual.
305 
HR 3590 EAS/PP 
PART II—SMALL BUSINESS TAX CREDIT 
SEC. 1421. CREDIT FOR EMPLOYEE HEALTH INSURANCE EX-
PENSES OF SMALL BUSINESSES. 
(a) IN GENERAL.—Subpart D of part IV of subchapter 
A of chapter 1 of the Internal Revenue Code of 1986 (relat-
ing to business-related credits) is amended by inserting 
after section 45Q the following: 
‘‘SEC. 45R. EMPLOYEE HEALTH INSURANCE EXPENSES OF 
SMALL EMPLOYERS. 
‘‘(a) GENERAL RULE.—For purposes of section 38, in 
the case of an eligible small employer, the small employer 
health insurance credit determined under this section for 
any taxable year in the credit period is the amount deter-
mined under subsection (b). 
‘‘(b) HEALTH INSURANCE CREDIT AMOUNT.—Subject 
to subsection (c), the amount determined under this sub-
section with respect to any eligible small employer is equal 
to 50 percent (35 percent in the case of a tax-exempt eligible 
small employer) of the lesser of— 
‘‘(1) the aggregate amount of nonelective con-
tributions the employer made on behalf of its employ-
ees during the taxable year under the arrangement de-
scribed in subsection (d)(4) for premiums for quali-
fied health plans offered by the employer to its em-
ployees through an Exchange, or
306 
HR 3590 EAS/PP 
‘‘(2) the aggregate amount of nonelective con-
tributions which the employer would have made dur-
ing the taxable year under the arrangement if each 
employee taken into account under paragraph (1) had 
enrolled in a qualified health plan which had a pre-
mium equal to the average premium (as determined 
by the Secretary of Health and Human Services) for 
the small group market in the rating area in which 
the employee enrolls for coverage. 
‘‘(c) PHASEOUT OF CREDIT AMOUNT BASED ON NUM-
BER OF EMPLOYEES AND AVERAGE WAGES.—The amount 
of the credit determined under subsection (b) without regard 
to this subsection shall be reduced (but not below zero) by 
the sum of the following amounts: 
‘‘(1) Such amount multiplied by a fraction the 
numerator of which is the total number of full-time 
equivalent employees of the employer in excess of 10 
and the denominator of which is 15. 
‘‘(2) Such amount multiplied by a fraction the 
numerator of which is the average annual wages of 
the employer in excess of the dollar amount in effect 
under subsection (d)(3)(B) and the denominator of 
which is such dollar amount. 
‘‘(d) ELIGIBLE SMALL EMPLOYER.—For purposes of 
this section—
307 
HR 3590 EAS/PP 
‘‘(1) IN GENERAL.—The term ‘eligible small em-
ployer’ means, with respect to any taxable year, an 
employer— 
‘‘(A) which has no more than 25 full-time 
equivalent employees for the taxable year, 
‘‘(B) the average annual wages of which do 
not exceed an amount equal to twice the dollar 
amount in effect under paragraph (3)(B) for the 
taxable year, and 
‘‘(C) which has in effect an arrangement de-
scribed in paragraph (4). 
‘‘(2) FULL-TIME EQUIVALENT EMPLOYEES.— 
‘‘(A) IN
GENERAL.—The term ‘full-time 
equivalent employees’ means a number of em-
ployees equal to the number determined by divid-
ing— 
‘‘(i) the total number of hours of serv-
ice for which wages were paid by the em-
ployer to employees during the taxable year, 
by 
‘‘(ii) 2,080. 
Such number shall be rounded to the next lowest 
whole number if not otherwise a whole number. 
‘‘(B) EXCESS HOURS NOT COUNTED.—If an 
employee works in excess of 2,080 hours of serv-
308 
HR 3590 EAS/PP 
ice during any taxable year, such excess shall not 
be taken into account under subparagraph (A). 
‘‘(C) HOURS OF SERVICE.—The Secretary, 
in consultation with the Secretary of Labor, 
shall prescribe such regulations, rules, and guid-
ance as may be necessary to determine the hours 
of service of an employee, including rules for the 
application of this paragraph to employees who 
are not compensated on an hourly basis. 
‘‘(3) AVERAGE ANNUAL WAGES.— 
‘‘(A) IN
GENERAL.—The average annual 
wages of an eligible small employer for any tax-
able year is the amount determined by divid-
ing— 
‘‘(i) the aggregate amount of wages 
which were paid by the employer to employ-
ees during the taxable year, by 
‘‘(ii) the number of full-time equivalent 
employees of the employee determined under 
paragraph (2) for the taxable year. 
Such amount shall be rounded to the next lowest 
multiple of $1,000 if not otherwise such a mul-
tiple. 
‘‘(B) DOLLAR
AMOUNT.—For purposes of 
paragraph (1)(B)—
309 
HR 3590 EAS/PP 
‘‘(i) 2011, 2012, AND 2013.—The dollar 
amount in effect under this paragraph for 
taxable years beginning in 2011, 2012, or 
2013 is $20,000. 
‘‘(ii) SUBSEQUENT
YEARS.—In the 
case of a taxable year beginning in a cal-
endar year after 2013, the dollar amount in 
effect under this paragraph shall be equal to 
$20,000, multiplied by the cost-of-living ad-
justment determined under section 1(f)(3) 
for the calendar year, determined by sub-
stituting ‘calendar year 2012’ for ‘calendar 
year 1992’ in subparagraph (B) thereof. 
‘‘(4) CONTRIBUTION
ARRANGEMENT.—An ar-
rangement is described in this paragraph if it re-
quires an eligible small employer to make a nonelec-
tive contribution on behalf of each employee who en-
rolls in a qualified health plan offered to employees 
by the employer through an exchange in an amount 
equal to a uniform percentage (not less than 50 per-
cent) of the premium cost of the qualified health plan. 
‘‘(5) SEASONAL WORKER HOURS AND WAGES NOT 
COUNTED.—For purposes of this subsection— 
‘‘(A) IN GENERAL.—The number of hours of 
service worked by, and wages paid to, a seasonal
310 
HR 3590 EAS/PP 
worker of an employer shall not be taken into ac-
count in determining the full-time equivalent 
employees and average annual wages of the em-
ployer unless the worker works for the employer 
on more than 120 days during the taxable year. 
‘‘(B) DEFINITION OF SEASONAL WORKER.— 
The term ‘seasonal worker’ means a worker who 
performs labor or services on a seasonal basis as 
defined by the Secretary of Labor, including 
workers covered by section 500.20(s)(1) of title 
29, Code of Federal Regulations and retail work-
ers employed exclusively during holiday seasons. 
‘‘(e) OTHER RULES AND DEFINITIONS.—For purposes 
of this section— 
‘‘(1) EMPLOYEE.— 
‘‘(A) CERTAIN
EMPLOYEES
EXCLUDED.— 
The term ‘employee’ shall not include— 
‘‘(i) an employee within the meaning 
of section 401(c)(1), 
‘‘(ii) any 2-percent shareholder (as de-
fined in section 1372(b)) of an eligible small 
business which is an S corporation, 
‘‘(iii) any 5-percent owner (as defined 
in section 416(i)(1)(B)(i)) of an eligible 
small business, or
311 
HR 3590 EAS/PP 
‘‘(iv) any individual who bears any of 
the relationships described in subpara-
graphs (A) through (G) of section 152(d)(2) 
to, or is a dependent described in section 
152(d)(2)(H) of, an individual described in 
clause (i), (ii), or (iii). 
‘‘(B) LEASED EMPLOYEES.—The term ‘em-
ployee’ shall include a leased employee within 
the meaning of section 414(n). 
‘‘(2) CREDIT PERIOD.—The term ‘credit period’ 
means, with respect to any eligible small employer, 
the 2-consecutive-taxable year period beginning with 
the 1st taxable year in which the employer (or any 
predecessor) offers 1 or more qualified health plans to 
its employees through an Exchange. 
‘‘(3) NONELECTIVE
CONTRIBUTION.—The term 
‘nonelective contribution’ means an employer con-
tribution other than an employer contribution pursu-
ant to a salary reduction arrangement. 
‘‘(4) WAGES.—The term ‘wages’ has the meaning 
given such term by section 3121(a) (determined with-
out regard to any dollar limitation contained in such 
section). 
‘‘(5) AGGREGATION AND OTHER RULES MADE AP-
PLICABLE.—
312 
HR 3590 EAS/PP 
‘‘(A) AGGREGATION RULES.—All employers 
treated as a single employer under subsection 
(b), (c), (m), or (o) of section 414 shall be treated 
as a single employer for purposes of this section. 
‘‘(B) OTHER RULES.—Rules similar to the 
rules of subsections (c), (d), and (e) of section 52 
shall apply. 
‘‘(f) CREDIT MADE AVAILABLE TO TAX-EXEMPT ELIGI-
BLE SMALL EMPLOYERS.— 
‘‘(1) IN GENERAL.—In the case of a tax-exempt 
eligible small employer, there shall be treated as a 
credit allowable under subpart C (and not allowable 
under this subpart) the lesser of— 
‘‘(A) the amount of the credit determined 
under this section with respect to such employer, 
or 
‘‘(B) the amount of the payroll taxes of the 
employer during the calendar year in which the 
taxable year begins. 
‘‘(2) 
TAX-EXEMPT
ELIGIBLE
SMALL
EM-
PLOYER.—For purposes of this section, the term ‘tax- 
exempt eligible small employer’ means an eligible 
small employer which is any organization described 
in section 501(c) which is exempt from taxation 
under section 501(a).
313 
HR 3590 EAS/PP 
‘‘(3) PAYROLL TAXES.—For purposes of this sub-
section— 
‘‘(A) IN GENERAL.—The term ‘payroll taxes’ 
means— 
‘‘(i) amounts required to be withheld 
from the employees of the tax-exempt eligi-
ble small employer under section 3401(a), 
‘‘(ii) amounts required to be withheld 
from such employees under section 3101(b), 
and 
‘‘(iii) amounts of the taxes imposed on 
the tax-exempt eligible small employer 
under section 3111(b). 
‘‘(B) SPECIAL RULE.—A rule similar to the 
rule of section 24(d)(2)(C) shall apply for pur-
poses of subparagraph (A). 
‘‘(g) APPLICATION OF SECTION FOR CALENDAR YEARS 
2011, 2012, AND 2013.—In the case of any taxable year 
beginning in 2011, 2012, or 2013, the following modifica-
tions to this section shall apply in determining the amount 
of the credit under subsection (a): 
‘‘(1) NO CREDIT PERIOD REQUIRED.—The credit 
shall be determined without regard to whether the tax-
able year is in a credit period and for purposes of ap-
plying this section to taxable years beginning after
314 
HR 3590 EAS/PP 
2013, no credit period shall be treated as beginning 
with a taxable year beginning before 2014. 
‘‘(2) AMOUNT OF CREDIT.—The amount of the 
credit determined under subsection (b) shall be deter-
mined— 
‘‘(A) by substituting ‘35 percent (25 percent 
in the case of a tax-exempt eligible small em-
ployer)’ for ‘50 percent (35 percent in the case 
of a tax-exempt eligible small employer)’, 
‘‘(B) by reference to an eligible small em-
ployer’s nonelective contributions for premiums 
paid for health insurance coverage (within the 
meaning of section 9832(b)(1)) of an employee, 
and 
‘‘(C) by substituting for the average pre-
mium determined under subsection (b)(2) the 
amount the Secretary of Health and Human 
Services determines is the average premium for 
the small group market in the State in which the 
employer is offering health insurance coverage 
(or for such area within the State as is specified 
by the Secretary). 
‘‘(3) CONTRIBUTION
ARRANGEMENT.—An ar-
rangement shall not fail to meet the requirements of
315 
HR 3590 EAS/PP 
subsection (d)(4) solely because it provides for the of-
fering of insurance outside of an Exchange. 
‘‘(h) INSURANCE DEFINITIONS.—Any term used in this 
section which is also used in the Public Health Service Act 
or subtitle A of title I of the Patient Protection and Afford-
able Care Act shall have the meaning given such term by 
such Act or subtitle. 
‘‘(i) REGULATIONS.—The Secretary shall prescribe 
such regulations as may be necessary to carry out the provi-
sions of this section, including regulations to prevent the 
avoidance of the 2-year limit on the credit period through 
the use of successor entities and the avoidance of the limita-
tions under subsection (c) through the use of multiple enti-
ties.’’. 
(b) CREDIT TO BE PART OF GENERAL BUSINESS 
CREDIT.—Section 38(b) of the Internal Revenue Code of 
1986 (relating to current year business credit) is amended 
by striking ‘‘plus’’ at the end of paragraph (34), by striking 
the period at the end of paragraph (35) and inserting ‘‘, 
plus’’, and by inserting after paragraph (35) the following: 
‘‘(36) the small employer health insurance credit 
determined under section 45R.’’. 
(c) CREDIT ALLOWED AGAINST ALTERNATIVE MIN-
IMUM TAX.—Section 38(c)(4)(B) of the Internal Revenue 
Code of 1986 (defining specified credits) is amended by re-
316 
HR 3590 EAS/PP 
designating clauses (vi), (vii), and (viii) as clauses (vii), 
(viii), and (ix), respectively, and by inserting after clause 
(v) the following new clause: 
‘‘(vi) the credit determined under sec-
tion 45R,’’. 
(d) DISALLOWANCE OF DEDUCTION FOR CERTAIN EX-
PENSES FOR WHICH CREDIT ALLOWED.— 
(1) IN GENERAL.—Section 280C of the Internal 
Revenue Code of 1986 (relating to disallowance of de-
duction for certain expenses for which credit allowed), 
as amended by section 1401(b), is amended by adding 
at the end the following new subsection: 
‘‘(h) CREDIT FOR EMPLOYEE HEALTH INSURANCE EX-
PENSES OF SMALL EMPLOYERS.—No deduction shall be al-
lowed for that portion of the premiums for qualified health 
plans (as defined in section 1301(a) of the Patient Protec-
tion and Affordable Care Act), or for health insurance cov-
erage in the case of taxable years beginning in 2011, 2012, 
or 2013, paid by an employer which is equal to the amount 
of the credit determined under section 45R(a) with respect 
to the premiums.’’. 
(2) DEDUCTION FOR EXPIRING CREDITS.—Sec-
tion 196(c) of such Code is amended by striking 
‘‘and’’ at the end of paragraph (12), by striking the 
period at the end of paragraph (13) and inserting ‘‘,
317 
HR 3590 EAS/PP 
and’’, and by adding at the end the following new 
paragraph: 
‘‘(14) the small employer health insurance credit 
determined under section 45R(a).’’. 
(e) CLERICAL AMENDMENT.—The table of sections for 
subpart D of part IV of subchapter A of chapter 1 of the 
Internal Revenue Code of 1986 is amended by adding at 
the end the following: 
‘‘Sec. 45R. Employee health insurance expenses of small employers.’’. 
(f) EFFECTIVE DATES.— 
(1) IN
GENERAL.—The amendments made by 
this section shall apply to amounts paid or incurred 
in taxable years beginning after December 31, 2010. 
(2) MINIMUM TAX.—The amendments made by 
subsection (c) shall apply to credits determined under 
section 45R of the Internal Revenue Code of 1986 in 
taxable years beginning after December 31, 2010, and 
to carrybacks of such credits. 
Subtitle F—Shared Responsibility 
for Health Care 
PART I—INDIVIDUAL RESPONSIBILITY 
SEC. 1501. REQUIREMENT TO MAINTAIN MINIMUM ESSEN-
TIAL COVERAGE. 
(a) FINDINGS.—Congress makes the following findings: 
(1) IN GENERAL.—The individual responsibility 
requirement provided for in this section (in this sub-
319 
HR 3590 EAS/PP 
(C) The requirement, together with the other 
provisions of this Act, will add millions of new 
consumers to the health insurance market, in-
creasing the supply of, and demand for, health 
care services. According to the Congressional 
Budget Office, the requirement will increase the 
number and share of Americans who are insured. 
(D) The requirement achieves near-uni-
versal coverage by building upon and strength-
ening the private employer-based health insur-
ance system, which covers 176,000,000 Ameri-
cans nationwide. In Massachusetts, a similar re-
quirement has strengthened private employer- 
based coverage: despite the economic downturn, 
the number of workers offered employer-based 
coverage has actually increased. 
(E) Half of all personal bankruptcies are 
caused in part by medical expenses. By signifi-
cantly increasing health insurance coverage, the 
requirement, together with the other provisions of 
this Act, will improve financial security for fam-
ilies. 
(F) Under the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1001 et seq.), 
the Public Health Service Act (42 U.S.C. 201 et
320 
HR 3590 EAS/PP 
seq.), and this Act, the Federal Government has 
a significant role in regulating health insurance 
which is in interstate commerce. 
(G) Under sections 2704 and 2705 of the 
Public Health Service Act (as added by section 
1201 of this Act), if there were no requirement, 
many individuals would wait to purchase health 
insurance until they needed care. By signifi-
cantly increasing health insurance coverage, the 
requirement, together with the other provisions of 
this Act, will minimize this adverse selection and 
broaden the health insurance risk pool to include 
healthy individuals, which will lower health in-
surance premiums. The requirement is essential 
to creating effective health insurance markets in 
which improved health insurance products that 
are guaranteed issue and do not exclude coverage 
of pre-existing conditions can be sold. 
(H) Administrative costs for private health 
insurance, which were $90,000,000,000 in 2006, 
are 26 to 30 percent of premiums in the current 
individual and small group markets. By signifi-
cantly increasing health insurance coverage and 
the size of purchasing pools, which will increase 
economies of scale, the requirement, together with
321 
HR 3590 EAS/PP 
the other provisions of this Act, will significantly 
reduce administrative costs and lower health in-
surance premiums. The requirement is essential 
to creating effective health insurance markets 
that do not require underwriting and eliminate 
its associated administrative costs. 
(3) SUPREME COURT RULING.—In United States 
v. South-Eastern Underwriters Association (322 U.S. 
533 (1944)), the Supreme Court of the United States 
ruled that insurance is interstate commerce subject to 
Federal regulation. 
(b) IN GENERAL.—Subtitle D of the Internal Revenue 
Code of 1986 is amended by adding at the end the following 
new chapter: 
‘‘CHAPTER 48—MAINTENANCE OF 
MINIMUM ESSENTIAL COVERAGE 
‘‘Sec. 5000A. Requirement to maintain minimum essential coverage. 
‘‘SEC. 5000A. REQUIREMENT TO MAINTAIN MINIMUM ESSEN-
TIAL COVERAGE. 
‘‘(a) REQUIREMENT TO MAINTAIN MINIMUM ESSEN-
TIAL COVERAGE.—An applicable individual shall for each 
month beginning after 2013 ensure that the individual, and 
any dependent of the individual who is an applicable indi-
vidual, is covered under minimum essential coverage for 
such month.
322 
HR 3590 EAS/PP 
‘‘(b) SHARED RESPONSIBILITY PAYMENT.— 
‘‘(1) IN GENERAL.—If an applicable individual 
fails to meet the requirement of subsection (a) for 1 
or more months during any calendar year beginning 
after 2013, then, except as provided in subsection (d), 
there is hereby imposed a penalty with respect to the 
individual in the amount determined under sub-
section (c). 
‘‘(2) INCLUSION
WITH
RETURN.—Any penalty 
imposed by this section with respect to any month 
shall be included with a taxpayer’s return under 
chapter 1 for the taxable year which includes such 
month. 
‘‘(3) PAYMENT OF PENALTY.—If an individual 
with respect to whom a penalty is imposed by this 
section for any month— 
‘‘(A) is a dependent (as defined in section 
152) of another taxpayer for the other taxpayer’s 
taxable year including such month, such other 
taxpayer shall be liable for such penalty, or 
‘‘(B) files a joint return for the taxable year 
including such month, such individual and the 
spouse of such individual shall be jointly liable 
for such penalty. 
‘‘(c) AMOUNT OF PENALTY.—
323 
HR 3590 EAS/PP 
‘‘(1) IN
GENERAL.—The penalty determined 
under this subsection for any month with respect to 
any individual is an amount equal to 1⁄12 of the ap-
plicable dollar amount for the calendar year. 
‘‘(2) DOLLAR LIMITATION.—The amount of the 
penalty imposed by this section on any taxpayer for 
any taxable year with respect to all individuals for 
whom the taxpayer is liable under subsection (b)(3) 
shall not exceed an amount equal to 300 percent the 
applicable dollar amount (determined without regard 
to paragraph (3)(C)) for the calendar year with or 
within which the taxable year ends. 
‘‘(3) APPLICABLE DOLLAR AMOUNT.—For pur-
poses of paragraph (1)— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraphs (B) and (C), the applicable dollar 
amount is $750. 
‘‘(B) PHASE
IN.—The applicable dollar 
amount is $95 for 2014 and $350 for 2015. 
‘‘(C) SPECIAL
RULE
FOR
INDIVIDUALS 
UNDER AGE 18.—If an applicable individual has 
not attained the age of 18 as of the beginning of 
a month, the applicable dollar amount with re-
spect to such individual for the month shall be
325 
HR 3590 EAS/PP 
taxpayer for any taxable year, an amount equal 
to the sum of— 
‘‘(i) the modified gross income of the 
taxpayer, plus 
‘‘(ii) the aggregate modified gross in-
comes of all other individuals who— 
‘‘(I) were taken into account in 
determining the taxpayer’s family size 
under paragraph (1), and 
‘‘(II) were required to file a re-
turn of tax imposed by section 1 for 
the taxable year. 
‘‘(C) MODIFIED GROSS INCOME.—The term 
‘modified gross income’ means gross income— 
‘‘(i) decreased by the amount of any 
deduction allowable under paragraph (1), 
(3), (4), or (10) of section 62(a), 
‘‘(ii) increased by the amount of inter-
est received or accrued during the taxable 
year which is exempt from tax imposed by 
this chapter, and 
‘‘(iii) determined without regard to 
sections 911, 931, and 933. 
‘‘(D) POVERTY LINE.—
326 
HR 3590 EAS/PP 
‘‘(i) IN GENERAL.—The term ‘poverty 
line’ has the meaning given that term in 
section 2110(c)(5) of the Social Security Act 
(42 U.S.C. 1397jj(c)(5)). 
‘‘(ii) POVERTY
LINE
USED.—In the 
case of any taxable year ending with or 
within a calendar year, the poverty line 
used shall be the most recently published 
poverty line as of the 1st day of such cal-
endar year. 
‘‘(d) APPLICABLE INDIVIDUAL.—For purposes of this 
section— 
‘‘(1) IN GENERAL.—The term ‘applicable indi-
vidual’ means, with respect to any month, an indi-
vidual other than an individual described in para-
graph (2), (3), or (4). 
‘‘(2) RELIGIOUS EXEMPTIONS.— 
‘‘(A) 
RELIGIOUS
CONSCIENCE
EXEMP-
TION.—Such term shall not include any indi-
vidual for any month if such individual has in 
effect an exemption under section 1311(d)(4)(H) 
of the Patient Protection and Affordable Care 
Act which certifies that such individual is a 
member of a recognized religious sect or division 
thereof described in section 1402(g)(1) and an
327 
HR 3590 EAS/PP 
adherent of established tenets or teachings of such 
sect or division as described in such section. 
‘‘(B) HEALTH CARE SHARING MINISTRY.— 
‘‘(i) IN
GENERAL.—Such term shall 
not include any individual for any month 
if such individual is a member of a health 
care sharing ministry for the month. 
‘‘(ii) HEALTH
CARE
SHARING
MIN-
ISTRY.—The term ‘health care sharing min-
istry’ means an organization— 
‘‘(I) which is described in section 
501(c)(3) and is exempt from taxation 
under section 501(a), 
‘‘(II) members of which share a 
common set of ethical or religious be-
liefs and share medical expenses among 
members in accordance with those be-
liefs and without regard to the State in 
which a member resides or is em-
ployed, 
‘‘(III) members of which retain 
membership even after they develop a 
medical condition, 
‘‘(IV) which (or a predecessor of 
which) has been in existence at all
328 
HR 3590 EAS/PP 
times since December 31, 1999, and 
medical expenses of its members have 
been shared continuously and without 
interruption since at least December 
31, 1999, and 
‘‘(V) which conducts an annual 
audit which is performed by an inde-
pendent certified public accounting 
firm in accordance with generally ac-
cepted 
accounting 
principles 
and 
which is made available to the public 
upon request. 
‘‘(3) INDIVIDUALS NOT LAWFULLY PRESENT.— 
Such term shall not include an individual for any 
month if for the month the individual is not a citizen 
or national of the United States or an alien lawfully 
present in the United States. 
‘‘(4) INCARCERATED
INDIVIDUALS.—Such term 
shall not include an individual for any month if for 
the month the individual is incarcerated, other than 
incarceration pending the disposition of charges. 
‘‘(e) EXEMPTIONS.—No penalty shall be imposed 
under subsection (a) with respect to— 
‘‘(1) INDIVIDUALS
WHO
CANNOT
AFFORD
COV-
ERAGE.—
329 
HR 3590 EAS/PP 
‘‘(A) IN
GENERAL.—Any applicable indi-
vidual for any month if the applicable individ-
ual’s required contribution (determined on an 
annual basis) for coverage for the month exceeds 
8 percent of such individual’s household income 
for the taxable year described in section 
1412(b)(1)(B) of the Patient Protection and Af-
fordable Care Act. For purposes of applying this 
subparagraph, the taxpayer’s household income 
shall be increased by any exclusion from gross 
income for any portion of the required contribu-
tion made through a salary reduction arrange-
ment. 
‘‘(B) REQUIRED CONTRIBUTION.—For pur-
poses of this paragraph, the term ‘required con-
tribution’ means— 
‘‘(i) in the case of an individual eligi-
ble to purchase minimum essential coverage 
consisting of coverage through an eligible- 
employer-sponsored plan, the portion of the 
annual premium which would be paid by 
the individual (without regard to whether 
paid through salary reduction or otherwise) 
for self-only coverage, or
330 
HR 3590 EAS/PP 
‘‘(ii) in the case of an individual eligi-
ble only to purchase minimum essential 
coverage described in subsection (f)(1)(C), 
the annual premium for the lowest cost 
bronze plan available in the individual 
market through the Exchange in the State 
in the rating area in which the individual 
resides (without regard to whether the indi-
vidual purchased a qualified health plan 
through the Exchange), reduced by the 
amount of the credit allowable under section 
36B for the taxable year (determined as if 
the individual was covered by a qualified 
health plan offered through the Exchange for 
the entire taxable year). 
‘‘(C) SPECIAL RULES FOR INDIVIDUALS RE-
LATED
TO
EMPLOYEES.—For purposes of sub-
paragraph (B)(i), if an applicable individual is 
eligible for minimum essential coverage through 
an employer by reason of a relationship to an 
employee, the determination shall be made by 
reference to the affordability of the coverage to 
the employee. 
‘‘(D) INDEXING.—In the case of plan years 
beginning in any calendar year after 2014, sub-
331 
HR 3590 EAS/PP 
paragraph (A) shall be applied by substituting 
for ‘8 percent’ the percentage the Secretary of 
Health and Human Services determines reflects 
the excess of the rate of premium growth between 
the preceding calendar year and 2013 over the 
rate of income growth for such period. 
‘‘(2) TAXPAYERS WITH INCOME UNDER 100 PER-
CENT OF POVERTY LINE.—Any applicable individual 
for any month during a calendar year if the individ-
ual’s household income for the taxable year described 
in section 1412(b)(1)(B) of the Patient Protection and 
Affordable Care Act is less than 100 percent of the 
poverty line for the size of the family involved (deter-
mined in the same manner as under subsection 
(b)(4)). 
‘‘(3) MEMBERS OF INDIAN TRIBES.—Any appli-
cable individual for any month during which the in-
dividual is a member of an Indian tribe (as defined 
in section 45A(c)(6)). 
‘‘(4) MONTHS DURING SHORT COVERAGE GAPS.— 
‘‘(A) IN GENERAL.—Any month the last day 
of which occurred during a period in which the 
applicable individual was not covered by min-
imum essential coverage for a continuous period 
of less than 3 months.
332 
HR 3590 EAS/PP 
‘‘(B) SPECIAL RULES.—For purposes of ap-
plying this paragraph— 
‘‘(i) the length of a continuous period 
shall be determined without regard to the 
calendar years in which months in such pe-
riod occur, 
‘‘(ii) if a continuous period is greater 
than the period allowed under subpara-
graph (A), no exception shall be provided 
under this paragraph for any month in the 
period, and 
‘‘(iii) if there is more than 1 contin-
uous period described in subparagraph (A) 
covering months in a calendar year, the ex-
ception provided by this paragraph shall 
only apply to months in the first of such pe-
riods. 
The Secretary shall prescribe rules for the collec-
tion of the penalty imposed by this section in 
cases where continuous periods include months 
in more than 1 taxable year. 
‘‘(5) HARDSHIPS.—Any applicable individual 
who for any month is determined by the Secretary of 
Health 
and 
Human 
Services 
under 
section 
1311(d)(4)(H) to have suffered a hardship with re-
333 
HR 3590 EAS/PP 
spect to the capability to obtain coverage under a 
qualified health plan. 
‘‘(f) MINIMUM ESSENTIAL COVERAGE.—For purposes 
of this section— 
‘‘(1) IN GENERAL.—The term ‘minimum essen-
tial coverage’ means any of the following: 
‘‘(A) 
GOVERNMENT
SPONSORED
PRO-
GRAMS.—Coverage under— 
‘‘(i) the Medicare program under part 
A of title XVIII of the Social Security Act, 
‘‘(ii) the Medicaid program under title 
XIX of the Social Security Act, 
‘‘(iii) the CHIP program under title 
XXI of the Social Security Act, 
‘‘(iv) the TRICARE for Life program, 
‘‘(v) the veteran’s health care program 
under chapter 17 of title 38, United States 
Code, or 
‘‘(vi) a health plan under section 
2504(e) of title 22, United States Code (re-
lating to Peace Corps volunteers). 
‘‘(B) EMPLOYER-SPONSORED
PLAN.—Cov-
erage under an eligible employer-sponsored plan.
334 
HR 3590 EAS/PP 
‘‘(C) PLANS IN THE INDIVIDUAL MARKET.— 
Coverage under a health plan offered in the indi-
vidual market within a State. 
‘‘(D) GRANDFATHERED
HEALTH
PLAN.— 
Coverage under a grandfathered health plan. 
‘‘(E) OTHER COVERAGE.—Such other health 
benefits coverage, such as a State health benefits 
risk pool, as the Secretary of Health and Human 
Services, in coordination with the Secretary, rec-
ognizes for purposes of this subsection. 
‘‘(2) ELIGIBLE EMPLOYER-SPONSORED PLAN.— 
The term ‘eligible employer-sponsored plan’ means, 
with respect to any employee, a group health plan or 
group health insurance coverage offered by an em-
ployer to the employee which is— 
‘‘(A) a governmental plan (within the 
meaning of section 2791(d)(8) of the Public 
Health Service Act), or 
‘‘(B) any other plan or coverage offered in 
the small or large group market within a State. 
Such term shall include a grandfathered health plan 
described in paragraph (1)(D) offered in a group 
market. 
‘‘(3) EXCEPTED BENEFITS NOT TREATED AS MIN-
IMUM ESSENTIAL COVERAGE.—The term ‘minimum
335 
HR 3590 EAS/PP 
essential coverage’ shall not include health insurance 
coverage which consists of coverage of excepted bene-
fits— 
‘‘(A) described in paragraph (1) of sub-
section (c) of section 2791 of the Public Health 
Service Act; or 
‘‘(B) described in paragraph (2), (3), or (4) 
of such subsection if the benefits are provided 
under a separate policy, certificate, or contract 
of insurance. 
‘‘(4) INDIVIDUALS
RESIDING
OUTSIDE
UNITED 
STATES OR RESIDENTS OF TERRITORIES.—Any appli-
cable individual shall be treated as having minimum 
essential coverage for any month— 
‘‘(A) if such month occurs during any pe-
riod described in subparagraph (A) or (B) of sec-
tion 911(d)(1) which is applicable to the indi-
vidual, or 
‘‘(B) if such individual is a bona fide resi-
dent of any possession of the United States (as 
determined under section 937(a)) for such 
month. 
‘‘(5) INSURANCE-RELATED
TERMS.—Any term 
used in this section which is also used in title I of
336 
HR 3590 EAS/PP 
the Patient Protection and Affordable Care Act shall 
have the same meaning as when used in such title. 
‘‘(g) ADMINISTRATION AND PROCEDURE.— 
‘‘(1) IN GENERAL.—The penalty provided by this 
section shall be paid upon notice and demand by the 
Secretary, and except as provided in paragraph (2), 
shall be assessed and collected in the same manner as 
an assessable penalty under subchapter B of chapter 
68. 
‘‘(2) SPECIAL
RULES.—Notwithstanding any 
other provision of law— 
‘‘(A) WAIVER OF CRIMINAL PENALTIES.—In 
the case of any failure by a taxpayer to timely 
pay any penalty imposed by this section, such 
taxpayer shall not be subject to any criminal 
prosecution or penalty with respect to such fail-
ure. 
‘‘(B) LIMITATIONS ON LIENS AND LEVIES.— 
The Secretary shall not— 
‘‘(i) file notice of lien with respect to 
any property of a taxpayer by reason of 
any failure to pay the penalty imposed by 
this section, or 
‘‘(ii) levy on any such property with 
respect to such failure.’’.
337 
HR 3590 EAS/PP 
(c) CLERICAL AMENDMENT.—The table of chapters for 
subtitle D of the Internal Revenue Code of 1986 is amended 
by inserting after the item relating to chapter 47 the fol-
lowing new item: 
‘‘CHAPTER 48—MAINTENANCE OF MINIMUM ESSENTIAL COVERAGE.’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to taxable years ending after December 
31, 2013. 
SEC. 1502. REPORTING OF HEALTH INSURANCE COVERAGE. 
(a) IN GENERAL.—Part III of subchapter A of chapter 
61 of the Internal Revenue Code of 1986 is amended by 
inserting after subpart C the following new subpart: 
‘‘Subpart D—Information Regarding Health 
Insurance Coverage 
‘‘Sec. 6055. Reporting of health insurance coverage. 
‘‘SEC. 6055. REPORTING OF HEALTH INSURANCE COV-
ERAGE. 
‘‘(a) IN GENERAL.—Every person who provides min-
imum essential coverage to an individual during a calendar 
year shall, at such time as the Secretary may prescribe, 
make a return described in subsection (b). 
‘‘(b) FORM AND MANNER OF RETURN.— 
‘‘(1) IN GENERAL.—A return is described in this 
subsection if such return— 
‘‘(A) is in such form as the Secretary may 
prescribe, and
338 
HR 3590 EAS/PP 
‘‘(B) contains— 
‘‘(i) the name, address and TIN of the 
primary insured and the name and TIN of 
each other individual obtaining coverage 
under the policy, 
‘‘(ii) the dates during which such indi-
vidual was covered under minimum essen-
tial coverage during the calendar year, 
‘‘(iii) in the case of minimum essential 
coverage which consists of health insurance 
coverage, information concerning— 
‘‘(I) whether or not the coverage is 
a qualified health plan offered through 
an Exchange established under section 
1311 of the Patient Protection and Af-
fordable Care Act, and 
‘‘(II) in the case of a qualified 
health plan, the amount (if any) of 
any advance payment under section 
1412 of the Patient Protection and Af-
fordable Care Act of any cost-sharing 
reduction under section 1402 of such 
Act or of any premium tax credit 
under section 36B with respect to such 
coverage, and
339 
HR 3590 EAS/PP 
‘‘(iv) such other information as the 
Secretary may require. 
‘‘(2) INFORMATION RELATING TO EMPLOYER-PRO-
VIDED
COVERAGE.—If minimum essential coverage 
provided to an individual under subsection (a) con-
sists of health insurance coverage of a health insur-
ance issuer provided through a group health plan of 
an employer, a return described in this subsection 
shall include— 
‘‘(A) the name, address, and employer iden-
tification number of the employer maintaining 
the plan, 
‘‘(B) the portion of the premium (if any) 
required to be paid by the employer, and 
‘‘(C) if the health insurance coverage is a 
qualified health plan in the small group market 
offered through an Exchange, such other infor-
mation as the Secretary may require for admin-
istration of the credit under section 45R (relat-
ing to credit for employee health insurance ex-
penses of small employers). 
‘‘(c) STATEMENTS TO BE FURNISHED TO INDIVIDUALS 
WITH RESPECT TO WHOM INFORMATION IS REPORTED.— 
‘‘(1) IN
GENERAL.—Every person required to 
make a return under subsection (a) shall furnish to
340 
HR 3590 EAS/PP 
each individual whose name is required to be set forth 
in such return a written statement showing— 
‘‘(A) the name and address of the person re-
quired to make such return and the phone num-
ber of the information contact for such person, 
and 
‘‘(B) the information required to be shown 
on the return with respect to such individual. 
‘‘(2) TIME FOR FURNISHING STATEMENTS.—The 
written statement required under paragraph (1) shall 
be furnished on or before January 31 of the year fol-
lowing the calendar year for which the return under 
subsection (a) was required to be made. 
‘‘(d) 
COVERAGE
PROVIDED
BY
GOVERNMENTAL 
UNITS.—In the case of coverage provided by any govern-
mental unit or any agency or instrumentality thereof, the 
officer or employee who enters into the agreement to provide 
such coverage (or the person appropriately designated for 
purposes of this section) shall make the returns and state-
ments required by this section. 
‘‘(e) MINIMUM ESSENTIAL COVERAGE.—For purposes 
of this section, the term ‘minimum essential coverage’ has 
the meaning given such term by section 5000A(f).’’. 
(b) ASSESSABLE PENALTIES.—
341 
HR 3590 EAS/PP 
(1) Subparagraph (B) of section 6724(d)(1) of 
the Internal Revenue Code of 1986 (relating to defini-
tions) is amended by striking ‘‘or’’ at the end of 
clause (xxii), by striking ‘‘and’’ at the end of clause 
(xxiii) and inserting ‘‘or’’, and by inserting after 
clause (xxiii) the following new clause: 
‘‘(xxiv) section 6055 (relating to re-
turns relating to information regarding 
health insurance coverage), and’’. 
(2) Paragraph (2) of section 6724(d) of such 
Code is amended by striking ‘‘or’’ at the end of sub-
paragraph (EE), by striking the period at the end of 
subparagraph (FF) and inserting ‘‘, or’’ and by in-
serting after subparagraph (FF) the following new 
subparagraph: 
‘‘(GG) section 6055(c) (relating to state-
ments relating to information regarding health 
insurance coverage).’’. 
(c) NOTIFICATION
OF NONENROLLMENT.—Not later 
than June 30 of each year, the Secretary of the Treasury, 
acting through the Internal Revenue Service and in con-
sultation with the Secretary of Health and Human Serv-
ices, shall send a notification to each individual who files 
an individual income tax return and who is not enrolled 
in minimum essential coverage (as defined in section 5000A
342 
HR 3590 EAS/PP 
of the Internal Revenue Code of 1986). Such notification 
shall contain information on the services available through 
the Exchange operating in the State in which such indi-
vidual resides. 
(d) CONFORMING AMENDMENT.—The table of subparts 
for part III of subchapter A of chapter 61 of such Code 
is amended by inserting after the item relating to subpart 
C the following new item: 
‘‘SUBPART D—INFORMATION REGARDING HEALTH INSURANCE COVERAGE’’. 
(e) EFFECTIVE DATE.—The amendments made by this 
section shall apply to calendar years beginning after 2013. 
PART II—EMPLOYER RESPONSIBILITIES 
SEC. 1511. AUTOMATIC ENROLLMENT FOR EMPLOYEES OF 
LARGE EMPLOYERS. 
The Fair Labor Standards Act of 1938 is amended by 
inserting after section 18 (29 U.S.C. 218) the following: 
‘‘SEC. 18A. AUTOMATIC ENROLLMENT FOR EMPLOYEES OF 
LARGE EMPLOYERS. 
‘‘In accordance with regulations promulgated by the 
Secretary, an employer to which this Act applies that has 
more than 200 full-time employees and that offers employees 
enrollment in 1 or more health benefits plans shall auto-
matically enroll new full-time employees in one of the plans 
offered (subject to any waiting period authorized by law) 
and to continue the enrollment of current employees in a 
health benefits plan offered through the employer. Any auto-
343 
HR 3590 EAS/PP 
matic enrollment program shall include adequate notice 
and the opportunity for an employee to opt out of any cov-
erage the individual or employee were automatically en-
rolled in. Nothing in this section shall be construed to super-
sede any State law which establishes, implements, or con-
tinues in effect any standard or requirement relating to em-
ployers in connection with payroll except to the extent that 
such standard or requirement prevents an employer from 
instituting the automatic enrollment program under this 
section.’’. 
SEC. 1512. EMPLOYER REQUIREMENT TO INFORM EMPLOY-
EES OF COVERAGE OPTIONS. 
The Fair Labor Standards Act of 1938 is amended by 
inserting after section 18A (as added by section 1513) the 
following: 
‘‘SEC. 18B. NOTICE TO EMPLOYEES. 
‘‘(a) IN GENERAL.—In accordance with regulations 
promulgated by the Secretary, an employer to which this 
Act applies, shall provide to each employee at the time of 
hiring (or with respect to current employees, not later than 
March 1, 2013), written notice— 
‘‘(1) informing the employee of the existence of 
an Exchange, including a description of the services 
provided by such Exchange, and the manner in which
344 
HR 3590 EAS/PP 
the employee may contact the Exchange to request as-
sistance; 
‘‘(2) if the employer plan’s share of the total al-
lowed costs of benefits provided under the plan is less 
than 60 percent of such costs, that the employee may 
be eligible for a premium tax credit under section 
36B of the Internal Revenue Code of 1986 and a cost 
sharing reduction under section 1402 of the Patient 
Protection and Affordable Care Act if the employee 
purchases a qualified health plan through the Ex-
change; and 
‘‘(3) if the employee purchases a qualified health 
plan through the Exchange, the employee will lose the 
employer contribution (if any) to any health benefits 
plan offered by the employer and that all or a portion 
of such contribution may be excludable from income 
for Federal income tax purposes. 
‘‘(b) EFFECTIVE DATE.—Subsection (a) shall take ef-
fect with respect to employers in a State beginning on 
March 1, 2013.’’. 
SEC. 1513. SHARED RESPONSIBILITY FOR EMPLOYERS. 
(a) IN GENERAL.—Chapter 43 of the Internal Revenue 
Code of 1986 is amended by adding at the end the following:
345 
HR 3590 EAS/PP 
‘‘SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS 
REGARDING HEALTH COVERAGE. 
‘‘(a) LARGE EMPLOYERS NOT OFFERING HEALTH 
COVERAGE.—If— 
‘‘(1) any applicable large employer fails to offer 
to its full-time employees (and their dependents) the 
opportunity to enroll in minimum essential coverage 
under an eligible employer-sponsored plan (as defined 
in section 5000A(f)(2)) for any month, and 
‘‘(2) at least one full-time employee of the appli-
cable large employer has been certified to the em-
ployer under section 1411 of the Patient Protection 
and Affordable Care Act as having enrolled for such 
month in a qualified health plan with respect to 
which an applicable premium tax credit or cost-shar-
ing reduction is allowed or paid with respect to the 
employee, 
then there is hereby imposed on the employer an assessable 
payment equal to the product of the applicable payment 
amount and the number of individuals employed by the em-
ployer as full-time employees during such month. 
‘‘(b) LARGE EMPLOYERS WITH WAITING PERIODS EX-
CEEDING 30 DAYS.— 
‘‘(1) IN GENERAL.—In the case of any applicable 
large employer which requires an extended waiting 
period to enroll in any minimum essential coverage
346 
HR 3590 EAS/PP 
under an employer-sponsored plan (as defined in sec-
tion 5000A(f)(2)), there is hereby imposed on the em-
ployer an assessable payment, in the amount specified 
in paragraph (2), for each full-time employee of the 
employer to whom the extended waiting period ap-
plies. 
‘‘(2) AMOUNT.—For purposes of paragraph (1), 
the amount specified in this paragraph for a full-time 
employee is— 
‘‘(A) in the case of an extended waiting pe-
riod which exceeds 30 days but does not exceed 
60 days, $400, and 
‘‘(B) in the case of an extended waiting pe-
riod which exceeds 60 days, $600. 
‘‘(3) EXTENDED
WAITING
PERIOD.—The term 
‘extended waiting period’ means any waiting period 
(as defined in section 2701(b)(4) of the Public Health 
Service Act) which exceeds 30 days. 
‘‘(c) LARGE EMPLOYERS OFFERING COVERAGE WITH 
EMPLOYEES WHO QUALIFY FOR PREMIUM TAX CREDITS 
OR COST-SHARING REDUCTIONS.— 
‘‘(1) IN GENERAL.—If— 
‘‘(A) an applicable large employer offers to 
its full-time employees (and their dependents) the 
opportunity to enroll in minimum essential cov-
347 
HR 3590 EAS/PP 
erage under an eligible employer-sponsored plan 
(as defined in section 5000A(f)(2)) for any 
month, and 
‘‘(B) 1 or more full-time employees of the 
applicable large employer has been certified to 
the employer under section 1411 of the Patient 
Protection and Affordable Care Act as having en-
rolled for such month in a qualified health plan 
with respect to which an applicable premium tax 
credit or cost-sharing reduction is allowed or 
paid with respect to the employee, 
then there is hereby imposed on the employer an as-
sessable payment equal to the product of the number 
of full-time employees of the applicable large employer 
described in subparagraph (B) for such month and 
400 percent of the applicable payment amount. 
‘‘(2) 
OVERALL
LIMITATION.—The 
aggregate 
amount of tax determined under paragraph (1) with 
respect to all employees of an applicable large em-
ployer for any month shall not exceed the product of 
the applicable payment amount and the number of 
individuals employed by the employer as full-time 
employees during such month. 
‘‘(d) DEFINITIONS AND SPECIAL RULES.—For pur-
poses of this section—
348 
HR 3590 EAS/PP 
‘‘(1) APPLICABLE PAYMENT AMOUNT.—The term 
‘applicable payment amount’ means, with respect to 
any month, 1⁄12 of $750. 
‘‘(2) APPLICABLE LARGE EMPLOYER.— 
‘‘(A) IN
GENERAL.—The term ‘applicable 
large employer’ means, with respect to a cal-
endar year, an employer who employed an aver-
age of at least 50 full-time employees on business 
days during the preceding calendar year. 
‘‘(B) EXEMPTION
FOR
CERTAIN
EMPLOY-
ERS.— 
‘‘(i) IN GENERAL.—An employer shall 
not be considered to employ more than 50 
full-time employees if— 
‘‘(I) the employer’s workforce ex-
ceeds 50 full-time employees for 120 
days or fewer during the calendar 
year, and 
‘‘(II) the employees in excess of 50 
employed during such 120-day period 
were seasonal workers. 
‘‘(ii) DEFINITION OF SEASONAL WORK-
ERS.—The term ‘seasonal worker’ means a 
worker who performs labor or services on a 
seasonal basis as defined by the Secretary of
349 
HR 3590 EAS/PP 
Labor, including workers covered by section 
500.20(s)(1) of title 29, Code of Federal 
Regulations and retail workers employed ex-
clusively during holiday seasons. 
‘‘(C) RULES FOR DETERMINING EMPLOYER 
SIZE.—For purposes of this paragraph— 
‘‘(i) APPLICATION
OF
AGGREGATION 
RULE FOR EMPLOYERS.—All persons treated 
as a single employer under subsection (b), 
(c), (m), or (o) of section 414 of the Internal 
Revenue Code of 1986 shall be treated as 1 
employer. 
‘‘(ii) EMPLOYERS NOT IN EXISTENCE 
IN PRECEDING YEAR.—In the case of an em-
ployer which was not in existence through-
out the preceding calendar year, the deter-
mination of whether such employer is an 
applicable large employer shall be based on 
the average number of employees that it is 
reasonably expected such employer will em-
ploy on business days in the current cal-
endar year. 
‘‘(iii) PREDECESSORS.—Any reference 
in this subsection to an employer shall in-
350 
HR 3590 EAS/PP 
clude a reference to any predecessor of such 
employer. 
‘‘(3) APPLICABLE
PREMIUM
TAX
CREDIT
AND 
COST-SHARING
REDUCTION.—The term ‘applicable 
premium tax credit and cost-sharing reduction’ 
means— 
‘‘(A) any premium tax credit allowed under 
section 36B, 
‘‘(B) any cost-sharing reduction under sec-
tion 1402 of the Patient Protection and Afford-
able Care Act, and 
‘‘(C) any advance payment of such credit or 
reduction under section 1412 of such Act. 
‘‘(4) FULL-TIME EMPLOYEE.— 
‘‘(A) IN GENERAL.—The term ‘full-time em-
ployee’ means an employee who is employed on 
average at least 30 hours of service per week. 
‘‘(B) HOURS OF SERVICE.—The Secretary, 
in consultation with the Secretary of Labor, 
shall prescribe such regulations, rules, and guid-
ance as may be necessary to determine the hours 
of service of an employee, including rules for the 
application of this paragraph to employees who 
are not compensated on an hourly basis. 
‘‘(5) INFLATION ADJUSTMENT.—
351 
HR 3590 EAS/PP 
‘‘(A) IN GENERAL.—In the case of any cal-
endar year after 2014, each of the dollar 
amounts in subsection (b)(2) and (d)(1) shall be 
increased by an amount equal to the product 
of— 
‘‘(i) such dollar amount, and 
‘‘(ii) the premium adjustment percent-
age (as defined in section 1302(c)(4) of the 
Patient Protection and Affordable Care Act) 
for the calendar year. 
‘‘(B) ROUNDING.—If the amount of any in-
crease under subparagraph (A) is not a multiple 
of $10, such increase shall be rounded to the next 
lowest multiple of $10. 
‘‘(6) OTHER DEFINITIONS.—Any term used in 
this section which is also used in the Patient Protec-
tion and Affordable Care Act shall have the same 
meaning as when used in such Act. 
‘‘(7) TAX NONDEDUCTIBLE.—For denial of de-
duction for the tax imposed by this section, see section 
275(a)(6). 
‘‘(e) ADMINISTRATION AND PROCEDURE.— 
‘‘(1) IN GENERAL.—Any assessable payment pro-
vided by this section shall be paid upon notice and 
demand by the Secretary, and shall be assessed and
352 
HR 3590 EAS/PP 
collected in the same manner as an assessable penalty 
under subchapter B of chapter 68. 
‘‘(2) TIME FOR PAYMENT.—The Secretary may 
provide for the payment of any assessable payment 
provided by this section on an annual, monthly, or 
other periodic basis as the Secretary may prescribe. 
‘‘(3) COORDINATION WITH CREDITS, ETC..—The 
Secretary shall prescribe rules, regulations, or guid-
ance for the repayment of any assessable payment 
(including interest) if such payment is based on the 
allowance or payment of an applicable premium tax 
credit or cost-sharing reduction with respect to an 
employee, such allowance or payment is subsequently 
disallowed, and the assessable payment would not 
have been required to be made but for such allowance 
or payment.’’. 
(b) CLERICAL AMENDMENT.—The table of sections for 
chapter 43 of such Code is amended by adding at the end 
the following new item: 
‘‘Sec. 4980H. Shared responsibility for employers regarding health coverage.’’. 
(c) STUDY AND REPORT OF EFFECT OF TAX ON WORK-
ERS’ WAGES.— 
(1) IN GENERAL.—The Secretary of Labor shall 
conduct a study to determine whether employees’ 
wages are reduced by reason of the application of the 
assessable payments under section 4980H of the Inter-
353 
HR 3590 EAS/PP 
nal Revenue Code of 1986 (as added by the amend-
ments made by this section). The Secretary shall 
make such determination on the basis of the National 
Compensation Survey published by the Bureau of 
Labor Statistics. 
(2) REPORT.—The Secretary shall report the re-
sults of the study under paragraph (1) to the Com-
mittee on Ways and Means of the House of Represent-
atives and to the Committee on Finance of the Senate. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to months beginning after December 31, 
2013. 
SEC. 1514. REPORTING OF EMPLOYER HEALTH INSURANCE 
COVERAGE. 
(a) IN GENERAL.—Subpart D of part III of subchapter 
A of chapter 61 of the Internal Revenue Code of 1986, as 
added by section 1502, is amended by inserting after section 
6055 the following new section: 
‘‘SEC. 6056. LARGE EMPLOYERS REQUIRED TO REPORT ON 
HEALTH INSURANCE COVERAGE. 
‘‘(a) IN GENERAL.—Every applicable large employer 
required to meet the requirements of section 4980H with 
respect to its full-time employees during a calendar year 
shall, at such time as the Secretary may prescribe, make 
a return described in subsection (b).
354 
HR 3590 EAS/PP 
‘‘(b) FORM AND MANNER OF RETURN.—A return is de-
scribed in this subsection if such return— 
‘‘(1) is in such form as the Secretary may pre-
scribe, and 
‘‘(2) contains— 
‘‘(A) the name, date, and employer identi-
fication number of the employer, 
‘‘(B) a certification as to whether the em-
ployer offers to its full-time employees (and their 
dependents) the opportunity to enroll in min-
imum essential coverage under an eligible em-
ployer-sponsored plan (as defined in section 
5000A(f)(2)), 
‘‘(C) if the employer certifies that the em-
ployer did offer to its full-time employees (and 
their dependents) the opportunity to so enroll— 
‘‘(i) the length of any waiting period 
(as defined in section 2701(b)(4) of the Pub-
lic Health Service Act) with respect to such 
coverage, 
‘‘(ii) the months during the calendar 
year for which coverage under the plan was 
available,
355 
HR 3590 EAS/PP 
‘‘(iii) the monthly premium for the 
lowest cost option in each of the enrollment 
categories under the plan, and 
‘‘(iv) the applicable large employer’s 
share of the total allowed costs of benefits 
provided under the plan, 
‘‘(D) the number of full-time employees for 
each month during the calendar year, 
‘‘(E) the name, address, and TIN of each 
full-time employee during the calendar year and 
the months (if any) during which such employee 
(and any dependents) were covered under any 
such health benefits plans, and 
‘‘(F) such other information as the Sec-
retary may require. 
‘‘(c) STATEMENTS TO BE FURNISHED TO INDIVIDUALS 
WITH RESPECT TO WHOM INFORMATION IS REPORTED.— 
‘‘(1) IN
GENERAL.—Every person required to 
make a return under subsection (a) shall furnish to 
each full-time employee whose name is required to be 
set forth in such return under subsection (b)(2)(E) a 
written statement showing— 
‘‘(A) the name and address of the person re-
quired to make such return and the phone num-
356 
HR 3590 EAS/PP 
ber of the information contact for such person, 
and 
‘‘(B) the information required to be shown 
on the return with respect to such individual. 
‘‘(2) TIME FOR FURNISHING STATEMENTS.—The 
written statement required under paragraph (1) shall 
be furnished on or before January 31 of the year fol-
lowing the calendar year for which the return under 
subsection (a) was required to be made. 
‘‘(d) COORDINATION WITH OTHER REQUIREMENTS.— 
To the maximum extent feasible, the Secretary may provide 
that— 
‘‘(1) any return or statement required to be pro-
vided under this section may be provided as part of 
any return or statement required under section 6051 
or 6055, and 
‘‘(2) in the case of an applicable large employer 
offering health insurance coverage of a health insur-
ance issuer, the employer may enter into an agree-
ment with the issuer to include information required 
under this section with the return and statement re-
quired to be provided by the issuer under section 
6055. 
‘‘(e) 
COVERAGE
PROVIDED
BY
GOVERNMENTAL 
UNITS.—In the case of any applicable large employer which
358 
HR 3590 EAS/PP 
‘‘(HH) section 6056(c) (relating to state-
ments relating to large employers required to re-
port on health insurance coverage).’’. 
(c) CONFORMING AMENDMENT.—The table of sections 
for subpart D of part III of subchapter A of chapter 61 
of such Code, as added by section 1502, is amended by add-
ing at the end the following new item: 
‘‘Sec. 6056. Large employers required to report on health insurance coverage.’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to periods beginning after December 31, 
2013. 
SEC. 1515. OFFERING OF EXCHANGE-PARTICIPATING QUALI-
FIED HEALTH PLANS THROUGH CAFETERIA 
PLANS. 
(a) IN GENERAL.—Subsection (f) of section 125 of the 
Internal Revenue Code of 1986 is amended by adding at 
the end the following new paragraph: 
‘‘(3) CERTAIN EXCHANGE-PARTICIPATING QUALI-
FIED HEALTH PLANS NOT QUALIFIED.— 
‘‘(A) IN
GENERAL.—The term ‘qualified 
benefit’ shall not include any qualified health 
plan (as defined in section 1301(a) of the Pa-
tient Protection and Affordable Care Act) offered 
through an Exchange established under section 
1311 of such Act.
359 
HR 3590 EAS/PP 
‘‘(B) EXCEPTION FOR EXCHANGE-ELIGIBLE 
EMPLOYERS.—Subparagraph (A) shall not apply 
with respect to any employee if such employee’s 
employer is a qualified employer (as defined in 
section 1312(f)(2) of the Patient Protection and 
Affordable Care Act) offering the employee the 
opportunity to enroll through such an Exchange 
in a qualified health plan in a group market.’’. 
(b) CONFORMING AMENDMENTS.—Subsection (f) of sec-
tion 125 of such Code is amended— 
(1) by striking ‘‘For purposes of this section, the 
term’’ and inserting ‘‘For purposes of this section— 
‘‘(1) IN GENERAL.—The term’’, and 
(2) by striking ‘‘Such term shall not include’’ 
and inserting the following: 
‘‘(2) LONG-TERM CARE INSURANCE NOT QUALI-
FIED.—The term ‘qualified benefit’ shall not include’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2013. 
Subtitle G—Miscellaneous 
Provisions 
SEC. 1551. DEFINITIONS. 
Unless specifically provided for otherwise, the defini-
tions contained in section 2791 of the Public Health Service
360 
HR 3590 EAS/PP 
Act (42 U.S.C. 300gg–91) shall apply with respect to this 
title. 
SEC. 1552. TRANSPARENCY IN GOVERNMENT. 
Not later than 30 days after the date of enactment of 
this Act, the Secretary of Health and Human Services shall 
publish on the Internet website of the Department of Health 
and Human Services, a list of all of the authorities pro-
vided to the Secretary under this Act (and the amendments 
made by this Act). 
SEC. 1553. PROHIBITION AGAINST DISCRIMINATION ON AS-
SISTED SUICIDE. 
(a) IN GENERAL.—The Federal Government, and any 
State or local government or health care provider that re-
ceives Federal financial assistance under this Act (or under 
an amendment made by this Act) or any health plan cre-
ated under this Act (or under an amendment made by this 
Act), may not subject an individual or institutional health 
care entity to discrimination on the basis that the entity 
does not provide any health care item or service furnished 
for the purpose of causing, or for the purpose of assisting 
in causing, the death of any individual, such as by assisted 
suicide, euthanasia, or mercy killing. 
(b) DEFINITION.—In this section, the term ‘‘health care 
entity’’ includes an individual physician or other health 
care professional, a hospital, a provider-sponsored organi-
361 
HR 3590 EAS/PP 
zation, a health maintenance organization, a health insur-
ance plan, or any other kind of health care facility, organi-
zation, or plan. 
(c) CONSTRUCTION
AND TREATMENT
OF CERTAIN 
SERVICES.—Nothing in subsection (a) shall be construed to 
apply to, or to affect, any limitation relating to— 
(1) the withholding or withdrawing of medical 
treatment or medical care; 
(2) the withholding or withdrawing of nutrition 
or hydration; 
(3) abortion; or 
(4) the use of an item, good, benefit, or service 
furnished for the purpose of alleviating pain or dis-
comfort, even if such use may increase the risk of 
death, so long as such item, good, benefit, or service 
is not also furnished for the purpose of causing, or the 
purpose of assisting in causing, death, for any reason. 
(d) ADMINISTRATION.—The Office for Civil Rights of 
the Department of Health and Human Services is des-
ignated to receive complaints of discrimination based on 
this section. 
SEC. 1554. ACCESS TO THERAPIES. 
Notwithstanding any other provision of this Act, the 
Secretary of Health and Human Services shall not promul-
gate any regulation that—
362 
HR 3590 EAS/PP 
(1) creates any unreasonable barriers to the abil-
ity of individuals to obtain appropriate medical care; 
(2) impedes timely access to health care services; 
(3) interferes with communications regarding a 
full range of treatment options between the patient 
and the provider; 
(4) restricts the ability of health care providers 
to provide full disclosure of all relevant information 
to patients making health care decisions; 
(5) violates the principles of informed consent 
and the ethical standards of health care professionals; 
or 
(6) limits the availability of health care treat-
ment for the full duration of a patient’s medical 
needs. 
SEC. 1555. FREEDOM NOT TO PARTICIPATE IN FEDERAL 
HEALTH INSURANCE PROGRAMS. 
No individual, company, business, nonprofit entity, or 
health insurance issuer offering group or individual health 
insurance coverage shall be required to participate in any 
Federal health insurance program created under this Act 
(or any amendments made by this Act), or in any Federal 
health insurance program expanded by this Act (or any 
such amendments), and there shall be no penalty or fine
363 
HR 3590 EAS/PP 
imposed upon any such issuer for choosing not to partici-
pate in such programs. 
SEC. 1556. EQUITY FOR CERTAIN ELIGIBLE SURVIVORS. 
(a) REBUTTABLE PRESUMPTION.—Section 411(c)(4) 
of the Black Lung Benefits Act (30 U.S.C. 921(c)(4)) is 
amended by striking the last sentence. 
(b) CONTINUATION OF BENEFITS.—Section 422(l) of 
the Black Lung Benefits Act (30 U.S.C. 932(l)) is amended 
by striking ‘‘, except with respect to a claim filed under 
this part on or after the effective date of the Black Lung 
Benefits Amendments of 1981’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply with respect to claims filed under part 
B or part C of the Black Lung Benefits Act (30 U.S.C. 
921 et seq., 931 et seq.) after January 1, 2005, that are 
pending on or after the date of enactment of this Act. 
SEC. 1557. NONDISCRIMINATION. 
(a) IN GENERAL.—Except as otherwise provided for 
in this title (or an amendment made by this title), an indi-
vidual shall not, on the ground prohibited under title VI 
of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), 
title IX of the Education Amendments of 1972 (20 U.S.C. 
1681 et seq.), the Age Discrimination Act of 1975 (42 
U.S.C. 6101 et seq.), or section 504 of the Rehabilitation 
Act of 1973 (29 U.S.C. 794), be excluded from participation
364 
HR 3590 EAS/PP 
in, be denied the benefits of, or be subjected to discrimina-
tion under, any health program or activity, any part of 
which is receiving Federal financial assistance, including 
credits, subsidies, or contracts of insurance, or under any 
program or activity that is administered by an Executive 
Agency or any entity established under this title (or amend-
ments). The enforcement mechanisms provided for and 
available under such title VI, title IX, section 504, or such 
Age Discrimination Act shall apply for purposes of viola-
tions of this subsection. 
(b) CONTINUED APPLICATION OF LAWS.—Nothing in 
this title (or an amendment made by this title) shall be 
construed to invalidate or limit the rights, remedies, proce-
dures, or legal standards available to individuals aggrieved 
under title VI of the Civil Rights Act of 1964 (42 U.S.C. 
2000d et seq.), title VII of the Civil Rights Act of 1964 (42 
U.S.C. 2000e et seq.), title IX of the Education Amendments 
of 1972 (20 U.S.C. 1681 et seq.), section 504 of the Rehabili-
tation Act of 1973 (29 U.S.C. 794), or the Age Discrimina-
tion Act of 1975 (42 U.S.C. 611 et seq.), or to supersede 
State laws that provide additional protections against dis-
crimination on any basis described in subsection (a). 
(c) REGULATIONS.—The Secretary may promulgate 
regulations to implement this section.
365 
HR 3590 EAS/PP 
SEC. 1558. PROTECTIONS FOR EMPLOYEES. 
The Fair Labor Standards Act of 1938 is amended by 
inserting after section 18B (as added by section 1512) the 
following: 
‘‘SEC. 18C. PROTECTIONS FOR EMPLOYEES. 
‘‘(a) PROHIBITION.—No employer shall discharge or in 
any manner discriminate against any employee with re-
spect to his or her compensation, terms, conditions, or other 
privileges of employment because the employee (or an indi-
vidual acting at the request of the employee) has— 
‘‘(1) received a credit under section 36B of the 
Internal Revenue Code of 1986 or a subsidy under 
section 1402 of this Act; 
‘‘(2) provided, caused to be provided, or is about 
to provide or cause to be provided to the employer, the 
Federal Government, or the attorney general of a 
State information relating to any violation of, or any 
act or omission the employee reasonably believes to be 
a violation of, any provision of this title (or an 
amendment made by this title); 
‘‘(3) testified or is about to testify in a pro-
ceeding concerning such violation; 
‘‘(4) assisted or participated, or is about to assist 
or participate, in such a proceeding; or 
‘‘(5) objected to, or refused to participate in, any 
activity, policy, practice, or assigned task that the
366 
HR 3590 EAS/PP 
employee (or other such person) reasonably believed to 
be in violation of any provision of this title (or 
amendment), or any order, rule, regulation, standard, 
or ban under this title (or amendment). 
‘‘(b) COMPLAINT PROCEDURE.— 
‘‘(1) IN
GENERAL.—An employee who believes 
that he or she has been discharged or otherwise dis-
criminated against by any employer in violation of 
this section may seek relief in accordance with the 
procedures, notifications, burdens of proof, remedies, 
and statutes of limitation set forth in section 2087(b) 
of title 15, United States Code. 
‘‘(2) NO LIMITATION ON RIGHTS.—Nothing in 
this section shall be deemed to diminish the rights, 
privileges, or remedies of any employee under any 
Federal or State law or under any collective bar-
gaining agreement. The rights and remedies in this 
section may not be waived by any agreement, policy, 
form, or condition of employment.’’. 
SEC. 1559. OVERSIGHT. 
The Inspector General of the Department of Health 
and Human Services shall have oversight authority with 
respect to the administration and implementation of this 
title as it relates to such Department.
367 
HR 3590 EAS/PP 
SEC. 1560. RULES OF CONSTRUCTION. 
(a) NO EFFECT ON ANTITRUST LAWS.—Nothing in 
this title (or an amendment made by this title) shall be 
construed to modify, impair, or supersede the operation of 
any of the antitrust laws. For the purposes of this section, 
the term ‘‘antitrust laws’’ has the meaning given such term 
in subsection (a) of the first section of the Clayton Act, ex-
cept that such term includes section 5 of the Federal Trade 
Commission Act to the extent that such section 5 applies 
to unfair methods of competition. 
(b) RULE OF CONSTRUCTION REGARDING HAWAII’S 
PREPAID HEALTH CARE ACT.—Nothing in this title (or an 
amendment made by this title) shall be construed to modify 
or limit the application of the exemption for Hawaii’s Pre-
paid Health Care Act (Haw. Rev. Stat. §§ 393–1 et seq.) 
as provided for under section 514(b)(5) of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 
1144(b)(5)). 
(c) STUDENT HEALTH INSURANCE PLANS.—Nothing 
in this title (or an amendment made by this title) shall 
be construed to prohibit an institution of higher education 
(as such term is defined for purposes of the Higher Edu-
cation Act of 1965) from offering a student health insurance 
plan, to the extent that such requirement is otherwise per-
mitted under applicable Federal, State or local law.
368 
HR 3590 EAS/PP 
(d) NO EFFECT ON EXISTING REQUIREMENTS.—Noth-
ing in this title (or an amendment made by this title, unless 
specified by direct statutory reference) shall be construed 
to modify any existing Federal requirement concerning the 
State agency responsible for determining eligibility for pro-
grams identified in section 1413. 
SEC. 1561. HEALTH INFORMATION TECHNOLOGY ENROLL-
MENT STANDARDS AND PROTOCOLS. 
Title XXX of the Public Health Service Act (42 U.S.C. 
300jj et seq.) is amended by adding at the end the following: 
‘‘Subtitle C—Other Provisions 
‘‘SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLL-
MENT STANDARDS AND PROTOCOLS. 
‘‘(a) IN GENERAL.— 
‘‘(1) STANDARDS
AND
PROTOCOLS.—Not later 
than 180 days after the date of enactment of this title, 
the Secretary, in consultation with the HIT Policy 
Committee and the HIT Standards Committee, shall 
develop interoperable and secure standards and proto-
cols that facilitate enrollment of individuals in Fed-
eral and State health and human services programs, 
as determined by the Secretary. 
‘‘(2) METHODS.—The Secretary shall facilitate 
enrollment in such programs through methods deter-
mined appropriate by the Secretary, which shall in-
369 
HR 3590 EAS/PP 
clude providing individuals and third parties author-
ized by such individuals and their designees notifica-
tion of eligibility and verification of eligibility re-
quired under such programs. 
‘‘(b) CONTENT.—The standards and protocols for elec-
tronic enrollment in the Federal and State programs de-
scribed in subsection (a) shall allow for the following: 
‘‘(1) Electronic matching against existing Fed-
eral and State data, including vital records, employ-
ment history, enrollment systems, tax records, and 
other data determined appropriate by the Secretary to 
serve as evidence of eligibility and in lieu of paper- 
based documentation. 
‘‘(2) Simplification and submission of electronic 
documentation, digitization of documents, and sys-
tems verification of eligibility. 
‘‘(3) Reuse of stored eligibility information (in-
cluding documentation) to assist with retention of eli-
gible individuals. 
‘‘(4) Capability for individuals to apply, recer-
tify and manage their eligibility information online, 
including at home, at points of service, and other 
community-based locations. 
‘‘(5) Ability to expand the enrollment system to 
integrate new programs, rules, and functionalities, to
1820 
HR 3590 EAS/PP 
the Committee on Energy and Commerce of the 
House of Representatives a report containing the 
findings and recommendations of the study con-
ducted under this paragraph. 
(E) FUNDING LIMITATION.—Funding for the 
study conducted under this subsection shall not 
exceed $500,000. 
(3) CONGRESSIONAL ACTION.—After receiving the 
report submitted by the Secretary under paragraph 
(2)(D), the Committee on Finance of the Senate and 
the Committee on Ways and Means and the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives shall, as they deem appropriate, take ac-
tion based on the recommendations contained in the 
report. 
(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums as 
are necessary for the purpose of carrying out this sub-
section. 
(d) CONFORMING AMENDMENTS.— 
(1) TITLE XX.—Title XX of the Social Security 
Act (42 U.S.C. 1397 et seq.), as amended by section 
6703(a), is amended— 
(A) in the heading of section 2001, by strik-
ing ‘‘TITLE’’ and inserting ‘‘SUBTITLE’’; and