I 
114TH CONGRESS 
1ST SESSION H. R. 3659 
To amend the Patient Protection and Affordable Care Act to remove citizen-
ship and immigration barriers to access the Exchanges under such Act. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 30, 2015 
Mr. GUTIE´RREZ (for himself and Ms. JUDY CHU of California) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend the Patient Protection and Affordable Care Act 
to remove citizenship and immigration barriers to access 
the Exchanges under such Act. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Exchange Inclusion 
for a Healthy America Act of 2015’’. 
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SEC. 2. REMOVING CITIZENSHIP AND IMMIGRATION BAR-
RIERS TO ACCESS TO AFFORDABLE HEALTH 
CARE UNDER THE ACA. 
(a) IN GENERAL.— 
(1) PREMIUM TAX CREDITS.—Section 36B of 
the Internal Revenue Code of 1986 is amended— 
(A) in subsection (c)(1)(B)— 
(i) by amending the subparagraph 
heading to read as follows: ‘‘SPECIAL RULE 
FOR
CERTAIN
INDIVIDUALS
INELIGIBLE 
FOR MEDICAID DUE TO STATUS’’; and 
(ii) in clause (ii), by striking ‘‘lawfully 
present in the United States, but’’ and in-
serting ‘‘who’’; and 
(B) by striking subsection (e). 
(2) COST-SHARING REDUCTIONS.—Section 1402 
of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18071) is amended by striking sub-
section (e). 
(3) 
PREEXISTING
CONDITION
INSURANCE 
PLAN.—Section 1101(d) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18001(d)) is 
amended by striking paragraph (1) and redesig-
nating paragraphs (2) and (3) as paragraphs (1) 
and (2), respectively. 
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(4) BASIC
HEALTH
PROGRAM
ELIGIBILITY.— 
Section 1331(e)(1)(B) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 
amended by striking ‘‘lawfully present in the United 
States,’’. 
(5) RESTRICTIONS ON FEDERAL PAYMENTS.— 
Section 1412 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18082) is amended by 
striking subsection (d). 
(6) REQUIREMENT TO MAINTAIN MINIMUM ES-
SENTIAL
COVERAGE.—Subsection (d) of section 
5000A of the Internal Revenue Code of 1986 is 
amended by striking paragraph (3) and by redesig-
nating paragraph (4) as paragraph (3). 
(b) CONFORMING AMENDMENTS.— 
(1) ESTABLISHMENT
OF
PROGRAM.—Section 
1411(a) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18081(a)) is amended by strik-
ing paragraph (1) and redesignating paragraphs (2), 
(3), and (4) as paragraphs (1), (2), and (3), respec-
tively. 
(2) QUALIFIED INDIVIDUALS.—Section 1312(f) 
of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18032(f)) is amended— 
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(A) in the subsection heading, by striking 
the semicolon and all that follows through 
‘‘RESIDENTS’’; and 
(B) by striking paragraph (3). 
(c) RULE OF CONSTRUCTION.—Nothing in this Act 
shall be construed as affecting the application of para-
graph (a)(3) of section 155.305 of title 45, Code of Fed-
eral Regulations (relating to residency requirements for 
eligibility for enrollment in the Exchanges), or of para-
graph (f)(4) of such section (relating to tax filing require-
ments for advance payments of the premium tax credit) 
or any successor to either such paragraph. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to years, plan years, and taxable 
years, as applicable, beginning after December 31, 2015. 
SEC. 3. TREATMENT OF INDIVIDUALS GRANTED DEFERRED 
ACTION. 
(a) IN GENERAL.—For purposes of eligibility under 
any of the provisions referred to in subsection (c), notwith-
standing paragraph (8) of section 152.2 of title 45, Code 
of Federal Regulations, individuals described in subsection 
(b) shall be considered lawfully present in the United 
States. 
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(b) INDIVIDUALS DESCRIBED.—For purposes of sub-
section (a), the individuals described in this subsection are 
the following: 
(1) An individual with deferred action under 
the Department of Homeland Security’s deferred ac-
tion for childhood arrivals process, as described in 
the Secretary of Homeland Security’s June 15, 
2012, memorandum. 
(2) An individual with deferred action under 
the Department of Homeland Security’s deferred ac-
tion process for expanded deferred action for child-
hood arrivals and parents of United States citizens 
and lawful permanent residents, as described in the 
Secretary of Homeland Security’s November 20, 
2014, memorandum. 
(c) PROVISIONS DESCRIBED.—For purposes of sub-
section (a), the provisions described in this subsection are 
the following: 
(1) EXCHANGE ELIGIBILITY.—Section 1311 of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18031). 
(2) REDUCED
COST-SHARING
ELIGIBILITY.— 
Section 1402 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18071). 
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(3) PREMIUM
SUBSIDY
ELIGIBILITY.—Section 
36B of the Internal Revenue Code of 1986. 
Æ 
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