II 118th CONGRESS 1st Session S. 2374 IN THE SENATE OF THE UNITED STATES July 19, 2023 Mr. Vance introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To exclude certain individuals subject to certain deferred action from eligibility for health plans offered on the Exchanges, advance payments of the premium tax credit, cost-sharing reductions, a Basic Health Program, and for Medicaid and the Children's Health Insurance Programs, and for other purposes.

1. Short title This Act may be cited as the No Obamacare for Illegal Aliens Act . 2. Treatment of individuals subject to certain deferred action for purposes of enrollment in health plans offered on the Exchanges (a) Enrollment ineligibility Section 1312(f)(3) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18032(f)(3) ) is amended by adding at the end the following: Any alien who is lawfully present solely because such individual was granted deferred action pursuant to the memorandum of the Department of Homeland Security entitled Exercising Prosecutorial Discretion with Respect to Individuals Who Came to the United States as Children issued on June 15, 2012, shall not be treated as lawfully present for purposes of the preceding sentence. . (b) Ineligibility for credit for coverage under a qualified health plan Paragraph (2) of section 36B(e) of the Internal Revenue Code of 1986 is amended by adding at the end the following: Any alien who is lawfully present solely because such individual was granted deferred action pursuant to the memorandum of the Department of Homeland Security entitled Exercising Prosecutorial Discretion with Respect to Individuals Who Came to the United States as Children issued on June 15, 2012, shall not be treated as lawfully present for purposes of the preceding sentence. . 3. Ensuring that taxpayer funds for health insurance coverage are available only to authorized individuals (a) Basic health programs (1) In general Section 1331(e)) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18051(e) ) is amended— (A) by redesignating paragraph (2) as paragraph (3); (B) in paragraph (1), by striking the second sentence; and (C) by inserting after paragraph (1), the following new paragraph: (2) Exclusions Such term shall not include the following: (A) Any individual who is not a qualified individual under section 1312 who is eligible to be covered by a qualified health plan offered through an Exchange. (B) Any individual who is neither a citizen or national of the United States nor an alien lawfully present in the United States. Any alien who is lawfully present solely because such individual was granted deferred action pursuant to the memorandum of the Department of Homeland Security entitled Exercising Prosecutorial Discretion with Respect to Individuals Who Came to the United States as Children issued on June 15, 2012, shall not be treated as lawfully present for purposes of the preceding sentence. . (2) Limitation on use of funds Section 1331(d)) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18051(d) ) is amended by adding at the end the following new paragraph: (5) Prohibition on use of pass-Through funding for certain individuals No amounts transferred to a State under this section may be used to offset the cost of health insurance coverage (including through premium or cost sharing reductions) or to provide any other benefit with respect to an individual who is not an eligible individual (as defined in subsection (e)). . (b) State innovation waivers (1) In general Section 1332(a)(2)(B) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18052(a)(2)(B) ) is amended by inserting (other than the requirement described in section 1312(f)(3)) before the period. (2) Prohibition on use of pass-Through funding for certain individuals Section 1332(a)(3) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18052(a)(3) ) is amended by adding at the end the following new sentence: No amounts paid to a State under this paragraph may be used to offset the cost of health insurance coverage (including through premium or cost sharing reductions) or to provide any other benefit with respect to an individual who is not a citizen or national of the United States or an alien lawfully present in the United States. Any alien who is lawfully present solely because such individual was granted deferred action pursuant to the memorandum of the Department of Homeland Security entitled Exercising Prosecutorial Discretion with Respect to Individuals Who Came to the United States as Children issued on June 15, 2012, shall not be treated as lawfully present for purposes of the preceding sentence. . (c) Medicaid and CHIP (1) Exclusion from definition of qualified alien under PRWORA Section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 ( 8 U.S.C. 1641 ) is amended by adding at the end the following new subsection: (d) Treatment of certain deferred action under Medicaid and CHIP For purposes of this title, the term qualified alien shall not include any alien who is lawfully present solely because such individual was granted deferred action pursuant to the memorandum of the Department of Homeland Security entitled Exercising Prosecutorial Discretion with Respect to Individuals Who Came to the United States as Children issued on June 15, 2012, but only with respect to the designated Federal program defined in section 402(b)(3)(C) (relating to the Medicaid program) and the State Children's Health Insurance Program established under title XXI of the Social Security Act ( 42 U.S.C. 1397aa et seq. ). An individual granted deferred action pursuant to the memorandum described in the preceding sentence shall not be treated as lawfully present or lawfully residing for purposes of the designated Federal program defined in section 402(b)(3)(C) (relating to the Medicaid program) or the State Children's Health Insurance Program established under title XXI of the Social Security Act ( 42 U.S.C. 1397aa et seq. ). . (2) Exclusion from CHIPRA coverage option (A) Medicaid Section 1903(v)(4) of the Social Security Act ( 42 U.S.C. 1396b(v)(4) ) is amended— (i) in subparagraph (A), by striking A State may and inserting Subject to subparagraph (D), a State may ; and (ii) by adding at the end the following new subparagraph: (D) Any alien who is lawfully present in the United States solely because such individual was granted deferred action pursuant to the memorandum of the Department of Homeland Security entitled Exercising Prosecutorial Discretion with Respect to Individuals Who Came to the United States as Children issued on June 15, 2012, shall not be treated as lawfully present or lawfully residing for purposes of an election by a State to provide medical assistance to a category of aliens under subparagraph (A) and shall not be considered to be described within either or both of the eligibility categories described in such subparagraph. . (B) CHIP Section 2107(e)(1)(O) of the Social Security Act ( 42 U.S.C. 1397gg(e)(1)(O) ) is amended by inserting , and subject to subparagraph (D) of such paragraph after title XIX . (3) Exclusion from other pregnancy-related coverage options under CHIP (A) Definition of child Section 2110(c)(1) of the Social Security Act ( 42 U.S.C. 1397jj(c)(1) ) is amended by adding at the end the following new sentence: Such term, including as applied under section 457.10 of title 42, Code of Federal Regulations (as in effect on the date of enactment of this sentence), shall not include any alien who is lawfully present solely because such individual was granted deferred action pursuant to the memorandum of the Department of Homeland Security entitled Exercising Prosecutorial Discretion with Respect to Individuals Who Came to the United States as Children issued on June 15, 2012, and any such individual shall not be treated as lawfully present or lawfully residing in the United States for purposes of eligibility for child health assistance under a State plan under this title. . (B) Targeted low-income pregnant women Section 2112 of the Social Security Act ( 42 U.S.C. 1397ll ) is amended— (i) in subsection (d)(2), by inserting after and below subparagraph (C), the following new flush sentence: Such term shall not include any alien who is lawfully present solely because such individual was granted deferred action pursuant to the memorandum of the Department of Homeland Security entitled Exercising Prosecutorial Discretion with Respect to Individuals Who Came to the United States as Children issued on June 15, 2012, and any such individual shall not be treated as lawfully present or lawfully residing in the United States for purposes of eligibility for pregnancy-related assistance or child health assistance under a State plan under this title. ; and (ii) in subsection (f), by adding at the end the following new paragraph: (4) Limitation Notwithstanding paragraph (3), a State shall not provide child health assistance under any authority described in paragraph (1)(A) or pregnancy-related services under a waiver specified in paragraph (1)(B) to any alien who is lawfully present solely because such individual was granted deferred action pursuant to the memorandum of the Department of Homeland Security entitled Exercising Prosecutorial Discretion with Respect to Individuals Who Came to the United States as Children issued on June 15, 2012, and any such individual shall not be treated as lawfully present or lawfully residing in the United States for purposes of eligibility for pregnancy-related assistance or child health assistance under a State plan under this title. . (d) Rescission of certain waivers Not later than 30 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall rescind any waiver approved under section 1331 or 1332 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18051 , 18052) or under title XIX or XXI of the Social Security Act ( 42 U.S.C. 1396 et seq. , 1397aa et seq,) before such date that would not have been so approved had the amendments made by this section been in effect at the time of such approval.