Stopping Illegal Obamacare Subsidies Act

Bill: 114-s-118
Sponsor: full_name: Sen. Vitter, David [R-LA]
Introduced: 2015-01-07
Policy area: Health
Subjects: Child health

Comprehensive health care

Government studies and investigations

Health care costs and insurance

Health care coverage and access

Income tax credits

Medicaid
Latest action: action_date: 2015-01-07
text: Read twice and referred to the Committee on Finance.

Summaries:
action_date: 2015-01-07
action_desc: Introduced in Senate
text: <p><b>Stopping Illegal Obamacare Subsidies Act </b></p> <p> Prohibits American Health Benefit Exchanges from providing for automatic enrollment in health plans until the Inspector General (IG) of the Department of Health and Human Services (HHS) verifies that each state exchange and the federal exchange established under the Patient Protection and Affordable Care Act (PPACA) have resolved the inconsistencies outlined in the June 14 IG report.</p> <p>Directs the Secretary of HHS to make public the steps that the Centers for Medicare and Medicaid Services (CMS) and the federal exchange will take to clear any inconsistencies that arose on or before the enactment of this Act and to ensure that the systems used by the CMS to determine or assess eligibility for premium tax credits, cost-sharing reductions, Medicaid under title XIX of the Social Security Act (SSAct), and the State Children's Health Insurance Program under SSAct title XXI can resolve such inconsistencies within 30 days after enactment of this Act.</p> <p>Directs the Secretary to make public the methods that the CMS use to monitor, track, and measure the progress of the federal and state exchanges in resolving inconsistencies.</p> <p>Suspends for plan year 2015 the availability of premium assistance tax credits and the reduced cost-sharing program under PPACA; and allows them to resume only after the Commissioner of the Social Security Administration declares affirmatively that all inconsistencies related to invalid Social Security numbers have been resolved, and the IG determines that this is so.</p> <p>Directs the Secretary to request additional information from any applicant for a qualified health plan on a state or federal exchange whose information contains inconsistencies. Requires the applicant to: (1) be withdrawn from the premium assistance credit and reduced cost-sharing programs if the additional information is not provided within 90 days, and (2) re-enroll in a qualified health plan with appropriate and accurate information during the next open enrollment period.</p>

tv_txt: II 114th CONGRESS 1st Session S. 118 IN THE SENATE OF THE UNITED STATES January 7, 2015 Mr. Vitter introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To require the Secretary of Health and Human Services to address certain inconsistencies between the self-attested information provided by an applicant in enrolling in a health plan on an Exchange and being determined eligible for premium tax credits and cost-sharing reductions or in being determined to be eligible for enrollment in a State Medicaid plan or a State child health plan under the State Children's Health Insurance Program and the data received through the Federal Data Services Hub or from other data sources.

1. Short title This Act may be cited as the Stopping Illegal Obamacare Subsidies Act . 2. Limitation on auto-enrollment Notwithstanding any other provision of law, American Health Benefit Exchanges shall not provide for automatic enrollment in health plans under such exchanges until the Inspector General of the Department of Health and Human Services verifies that each State Exchange established under section 1311 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 13031 ) and the Federal Exchange established under section 1321 of such Act ( 42 U.S.C. 18041 ) has resolved the inconsistencies (as defined in section 3(a)) outlined in the June 2014 report of such Inspector General. 3. Process for applications with inconsistencies (a) In general The Secretary of Health and Human Services (referred to in this section as the Secretary ) shall make public the steps that the Centers for Medicare & Medicaid Services and the Federal Exchange will take to clear any inconsistencies that arose on or before the date of enactment of this Act and to ensure that the systems used by the Centers for Medicare & Medicaid Services to determine or assess eligibility for premium tax credits, cost-sharing reductions, Medicaid, and the State Children's Health Insurance Program (CHIP) can resolve such inconsistencies not later than 30 days after the date of enactment of this Act. (b) Methods To monitor progress Not later than 30 days after the date of enactment of this Act, the Secretary shall make public the methods that the Centers for Medicare & Medicaid Services use to monitor, track, and measure the progress of the Federal Exchange and State Exchanges in resolving inconsistencies. (c) Suspension of financial assistance programs Premium assistance tax credits under section 36B of the Internal Revenue Code of 1986 and the reduced cost-sharing program under section 1402 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18071 ) shall not be available for plan year 2015. Such premium tax credit and cost-sharing programs shall resume only after— (1) the Commissioner of the Social Security Administration affirmatively declares that all inconsistencies related to invalid social security numbers have been resolved; and (2) the Inspector General of the Department of Health and Human Services determines that all inconsistencies, as defined in section 4(1), have been resolved. (d) Requests for additional information (1) In general If applicant information provided by an individual seeking to enroll in a qualified health plan on a State or Federal Exchange contains inconsistencies, the Secretary shall request additional information from the individual, and the individual shall have 90 days to provide such information. (2) Restrictions during inconsistency period During the inconsistency period, an individual may be enrolled in a qualified health plan, but may not participate in the premium assistance credit program under section 36B of the Internal Revenue Code of 1986 or the reduced cost-sharing program under section 1402 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18071 ). An individual who cooperates with a request for additional information and whom the Secretary later determines to be eligible for such programs, shall retroactively receive the benefits of such programs that such individual was eligible to receive for the inconsistency period. (3) Failure to submit additional information If the applicant does not submit additional information requested under subparagraph (A)— (A) (i) the applicant shall be withdrawn from the premium assistance credit program under section 36B of the Internal Revenue Code of 1986 and the reduced cost-sharing program under section 1402 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18071 ), as applicable, at the end of the inconsistency period; and (ii) the Secretary shall send notification of such disenrollment to the applicable health insurance issuer; and (B) the applicant shall re-enroll in a qualified health plan with appropriate and accurate information during the next open enrollment period. 4. Definitions In this Act— (1) the term inconsistencies means differences between the self-attested information provided by an applicant in enrolling in a health plan on an Exchange and being determined eligible for premium tax credits and cost-sharing reductions or in being determined to be eligible for enrollment in a State Medicaid plan or a State child health plan under the State Children's Health Insurance Program (CHIP) and the data received through the Federal Data Services Hub or from other data sources, including differences with respect to— (A) citizenship; (B) income; (C) coverage under an eligible employer-sponsored plan; (D) incarceration status; or (E) any other issue that would impact individual’s eligibility for financial assistance programs under the Patient Protection and Affordable Care Act (including the amendments made by such Act); and (2) the term inconsistency period means the 90-day period beginning on the date the notice of an inconsistency is sent to the applicant.