[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2400 Introduced in House (IH)]
114th CONGRESS
1st Session
H. R. 2400
To establish the Office of the Special Inspector General for Monitoring
the Affordable Care Act, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 18, 2015
Mr. Roskam (for himself, Mr. Cole, Mr. Flores, Mr. Holding, Mr. Jordan,
Mr. Kelly of Pennsylvania, Mr. Marchant, Mr. Marino, Mr. Meehan, Mr.
Murphy of Pennsylvania, Mrs. Noem, Mr. Roe of Tennessee, Mr. Renacci,
and Mr. Smith of Missouri) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on Natural Resources, Education and the Workforce, Ways
and Means, Oversight and Government Reform, House Administration, the
Judiciary, Rules, and Appropriations, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To establish the Office of the Special Inspector General for Monitoring
the Affordable Care Act, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Special Inspector General for
Monitoring the ACA Act of 2015'' or the ``SIGMA Act of 2015''.
SEC. 2. FINDINGS.
The Congress finds the following:
(1) The writing, passage, and implementation of the
Affordable Care Act has utterly lacked transparency.
(2) Presidential candidate Barack Obama repeatedly promised
that if elected President, he would hold open, public
negotiations on health care reform among public and private
stakeholders, including at a Democratic Presidential debate on
January 31, 2008, when he said, ``That's what I will do in
bringing all parties together, not negotiating behind closed
doors, but bringing all parties together, and broadcasting
those negotiations on C-SPAN so that the American people can
see what the choices are, because part of what we have to do is
enlist the American people in this process.''.
(3) Then-Senator Obama repeated this promise multiple
times, including at an Ohio town hall on March 1, 2008, when he
said, ``But here's the thing: we're gonna do all these
negotiations on C-SPAN. So the American people will be able to
watch these negotiations.''.
(4) Then-Senator Obama also repeated this promise at a
Virginia town hall on August 21, 2008, when he said, ``I'm
going to have all the negotiations around a big table. We'll
have doctors and nurses and hospital administrators. Insurance
companies, drug companies--they'll get a seat at the table . .
. But what we will do is, we'll have the negotiations televised
on C-SPAN, so that people can see who is making arguments on
behalf of their constituents, and who are making arguments on
behalf of the drug companies or the insurance companies. And
so, that approach, I think is what is going to allow people to
stay involved in this process.''.
(5) In a September 26, 2011, interview, Brian Lamb, the CEO
of C-SPAN confirmed the negotiations of the health reform law
had not been broadcast publicly, noting, ``The President said
that they were all going to be on C-SPAN. He never asked us.''.
(6) President Obama, in leading the national health reform
debate, broke his promise, admitting in a January 25, 2010,
interview with ABC News that locking the public out of key
health reform discussions was a ``mistake'' and explaining,
``We had to make so many decisions quickly in a very difficult
set of circumstances that after awhile, we started worrying
more about getting the policy right than getting the process
right. But I had campaigned on process--part of what I had
campaigned on was changing how Washington works, opening up,
transparency and I think it is--I think the health care debate
as it unfolded legitimately raised concerns not just among my
opponents, but also amongst supporters that we just don't know
what's going on. And it's an ugly process and it looks like
there are a bunch of backroom deals.''.
(7) On March 9, 2010, then-Speaker of the House Nancy
Pelosi said of what would become the Affordable Care Act, ``We
have to pass the bill so that you can find out what is in
it.''.
(8) Dr. Jonathan Gruber, a professor of economics at the
Massachusetts Institute of Technology, was awarded a contract
by the Department of Health and Human Services to provide
``technical assistance in evaluating options for national
healthcare reform'' due to his ``proprietary statistically
sophisticated micro-simulation model'' which could assess the
impact of changes in Federal health care policies.
(9) Dr. Gruber described himself as a health reform
architect who contributed to the crafting of the Affordable
Care Act in a 2012 opinion editorial, noting, ``Several of the
architects of Massachusetts reform, including myself, worked
closely with the Administration and Congress to translate the
lessons from Massachusetts onto the national stage.''.
(10) Dr. Gruber's MIT biography has described him as ``a
key architect'' of the Massachusetts health reform effort and a
2009 and 2010 ``technical consultant'' who ``worked with both
the Administration and Congress to help craft the Patient
Protection and Affordable Care Act.''.
(11) An October 11, 2011, report by NBC News described
White House visitor logs that show Dr. Gruber had at least five
meetings at the White House in 2009 in the lead up to the
passage of the Affordable Care Act, including a meeting in the
Oval Office with President Obama to evaluate options for
national health reform.
(12) In a video posted April 12, 2012, by the Obama
presidential campaign to YouTube, Dr. Gruber states that he
went ``down to Washington to help President Obama develop his
national version of that law.''.
(13) A March 28, 2012, article in the New York Times
reports that ``After Mr. Gruber helped the administration put
together the basic principles of the proposal, the White House
lent him to Capitol Hill to help congressional staff members
draft the specifics of the legislation.''.
(14) In a January 18, 2012, lecture on the structure of the
Affordable Care Act, Dr. Gruber refers to the law's small
business tax credits as a portion of the bill that he
``actually wrote.''.
(15) Dr. Gruber's initial contract with the Department of
Health and Human Services (HHS) was for $297,000, and later a
Federal grant of $95,000 brought his total Federal compensation
for work on the Affordable Care Act to at least $392,000.
(16) In 2009, the White House annual report to Congress on
Presidential staff salaries lists that twenty-two White House
staffers made the highest Presidential staff salary rate of
$172,200, including the White House Chief of Staff, senior
advisers, White House Counsel, and National Security Adviser.
(17) In 2010, the White House annual report to Congress on
Presidential staff salaries lists that twenty-three White House
staffers made the highest Presidential staff salary rate of
$172,200, again including the President's top management,
policy, communications, and security advisers.
(18) In 2009 and 2010, each of President Obama's most
senior White House staff received less compensation than Dr.
Gruber.
(19) In a November 5, 2012, speech at the University of
Rhode Island, Dr. Gruber described the mechanism of the
Affordable Care Act, stating, ``It's a very clever, you know,
basic exploitation of the lack of economic understanding of the
American voter.''.
(20) At an October 17, 2013, panel at the University of
Pennsylvania, Dr. Gruber described the Affordable Care Act,
stating, ``This bill was written in a tortured way to make sure
CBO did not score the mandate as taxes. If CBO scored the
mandate as taxes, the bill dies. Okay, so it's written to do
that.''.
(21) In the same speech, Dr. Gruber stated that, ``if you
had a law which said that healthy people are going to pay in
you made explicit healthy people pay in and sick people get
money, it would not have passed.''.
(22) Dr. Gruber went on to claim, ``Lack of transparency is
a huge political advantage. And basically, call it the
stupidity of the American voter or whatever, but basically that
was really, really critical for the thing to pass.''.
(23) Since the passage of the Affordable Care Act,
President Obama called for a new, more transparent approach to
the health reform law moving forward, saying in a January 25,
2010, ABC News interview, ``The process didn't run the way I
ideally would like it to and that we have to move forward in a
way that recaptures that sense of opening things up more.''.
(24) The Obama Administration's implementation of the
Affordable Care Act has been marked by Executive overreach.
(25) On at least 28 occasions, President Obama and his
administration have unilaterally delayed, extended, or changed
provisions of the Affordable Care Act, including in
contravention of the law and the Constitution of the United
States.
(26) Section 1513 of the Patient Protection and Affordable
Care Act (26 U.S.C. 4980h note) requires applicable large
employers with more than 50 full-time employees to provide
qualifying health insurance to their employees or pay a fine,
and the effective date under such section specified the
amendments made by such section applied to months beginning
after December 31, 2013.
(27) Contrary to the plain meaning of the statutory
requirement, and acting without authority provided by law, the
Internal Revenue Service published in the Federal Register
Notice 2013-45 to change the effective date of the employer
mandate requirement, stating, ``Section 1513(d) of the
Affordable Care Act provides that section 4980H applies to
months after December 31, 2013; however Notice 2013-45, issued
on July 9, 2013, provides as transition relief that no
assessable payments under section 4980H will apply for 2014.''.
(28) On July 12, 2013, the Director for the Center for
Consumer Information and Insurance Oversight at the Centers for
Medicare & Medicaid Services denied the request for exemption
from certain Affordable Care Act requirements made by
representatives of the United States territories, writing to
the Secretary of Commerce for the Commonwealth of the Northern
Mariana Islands, ``However meritorious your request might be,
[the Department of Health and Human Services] is not authorized
to choose which provisions [of the Affordable Care Act] . . .
might apply to the territories.''.
(29) A year later, on July 16, 2014, the Administrator of
the Centers for Medicare & Medicaid Services notified
representatives of the United States territories that they
would in fact receive an exemption from requirements under the
Affordable Care Act, despite the previous explanation from CMS
that CMS does not have the legal authority to provide such an
exemption. As the CMS Administrator now rationalized,
``Currently, the Department uses the existing Public Health
Service Act (PHS Act) definition of `State' for new PHS Act
requirements and funding opportunities included in title I of
the Affordable Care Act. Under this definition, the new market
reforms in the PHS Act apply to the territories. We have been
informed by representatives of the territories that this
interpretation is undermining the stability of the territories'
health insurance markets. After a careful review of this
situation and the relevant statutory language, HHS has
determined that the new provisions of the PHS Act enacted in
title I are appropriately governed by the definition of `State'
set forth in that title, and therefore that these new
provisions do not apply to the territories.''.
(30) The Obama Administration has claimed that the
Affordable Care Act will save money and improve the economy,
with WhiteHouse.gov stating, ``In keeping with the President's
pledge that reform must fix our health care system without
adding to the deficit, the Affordable Care Act reduces the
deficit, saving over $200 billion over 10 years and more than
$1 trillion in the second decade. The law reduces health care
costs . . . [and] is improving our economic
competitiveness[.]''.
(31) $70.2 billion of the White House's estimated savings
was to come from the Community Living Assistance Services and
Supports (CLASS) Act provisions of the Affordable Care Act, a
program that was deemed actuarially unsound and never
implemented by the Obama Administration.
(32) An April 2010 report from the Office of the Actuary
for the Centers for Medicare & Medicaid Services describes that
additional savings under the Affordable Care Act were to be
paid for with Medicare Fee-for-Service and Medicare Advantage
cuts and reductions in payments to hospitals, skilled nursing
facilities, and home health centers. These cuts have been
delayed and may never materialize. Even if implemented, the
projected savings may never accrue as the CMS Actuary's report
concludes that such cuts will cause about 15 percent of
hospitals and post-acute care facilities like nursing homes to
go out of business.
(33) $52 billion in deficit reduction savings was projected
to come from employer penalties paid to the Government for
failure to comply with the employer mandate requirement to
provide employees health insurance, a requirement that the
Obama Administration has repeatedly delayed and modified,
causing penalties and associated savings to not accrue.
(34) Initial estimates of savings under the Affordable Care
Act projected at least $15.5 billion in savings over the next
decade attributable to Medicare cuts through the Independent
Payment Advisory Board, which has not yet been appointed and
through which no cuts or savings have been realized.
(35) On September 9, 2009, President Obama pledged to a
joint session of Congress, ``I will not sign a [health care
reform] plan that adds one dime to our deficits--either now or
in the future.''.
(36) The Congressional Budget Office estimated in February
2014 that health insurance subsidies under the Affordable Care
Act would cost the Federal Government $47 billion in fiscal
year 2015 and $1.197 trillion over fiscal years 2015-2024.
(37) The Committees on Finance and Health, Education,
Labor, and Pensions of the Senate estimated in September 2014
that the Affordable Care Act will add at least $340 billion to
Federal budget deficits.
(38) Dr. Gruber stated, ``The [Affordable Care Act] isn't
designed to save money.''.
(39) On at least 37 occasions, President Obama or a top
official in the executive branch repeated the promise that ``If
you like the [health insurance] plan you have, you can keep it.
If you like the doctor you have, you can keep your doctor.''.
(40) The Associated Press calculated at least 4.7 million
Americans had their health insurance cancelled for 2014 and
later, when the President issued a last-minute fix to try to
prevent these cancellations as required by the Affordable Care
Act, the changes came too late for approximately 2.4 million
Americans to keep the plans they had and liked.
(41) The nonpartisan, fact-checking publication Politifact
rated ``If you like your health care plan, you can keep it.''
as the Lie of the Year for 2013.
(42) Then-Presidential candidate Barack Obama repeatedly
promised that, if elected President, his national health care
reforms would, ``cut the cost of a typical family's premium by
up to $2,500 a year.''.
(43) A November 2013 analysis by the Manhattan Institute
calculates that the Affordable Care Act would increase
individual marketplace health insurance premiums by 41 percent
nationwide between 2013 and 2014.
(44) A December 2013 study by Health Pocket, Inc., found
that the average individual deductible for a Bronze plan was
$5,081 a year, a 42-percent increase from the average plan
purchased by an individual in 2013.
(45) A February 2013 study by Health Pocket Inc., found
that exchange plans under the Affordable Care Act averaged a
34-percent increase in drug-cost sharing compared to copayment
and coinsurance rates in the pre-Affordable Care Act market.
For the sickest patients needing specialty drugs, the study
found copayments increased by 226 percent under a Bronze plan
via the Affordable Care Act.
(46) A December 2013 study by McKinsey and Company found
that insurers offered almost three times as many narrow or
ultranarrow network plans in 2014 compared to 2013. Fully 70
percent of Affordable Care Act plans analyzed had narrow or
ultranarrow network coverage, meaning coverage for fewer
doctors and hospitals than plans sold on the individual market
before the law took effect.
(47) Details consumers require to make informed decisions
about their health care plan coverage under the Affordable Care
Act have been withheld or lacked transparency.
(48) On September 26, 2013, President Obama said, ``It will
say clearly what each plan covers, what each plan costs. The
price will be right there. It will be fully transparent . . .
And so if you've ever tried to buy insurance on your own, I
promise you this is a lot easier. It's like booking a hotel or
a plane ticket.''.
(49) HealthCare.gov was established as the website to
implement the Federal exchange portion of the Act at a cost of
as much as $840 million, including more than $150 million in
cost overruns, according to the Government Accountability
Office in March 2014.
(50) On October 1, 2013, HealthCare.gov launched without
adequate security testing, leaving the approximately 250,000
unique users it drew not only vulnerable to identity theft by
hackers, but unable to even use the site, as the website was
demonstrably unable to handle even 1,100 simultaneous users.
(51) For the subsequent months after its launch,
HealthCare.gov continued to be plagued by crippling
malfunctions, and the dismal performance of the website led
only to problems and frustration for millions of Americans.
(52) A June 2013 study by the Department of Health and
Human Services' Office of Inspector General revealed that
software designed by a principal HealthCare.gov vendor was
highly insecure and put the information of more than 6 million
Medicare beneficiaries at ``greater risk from malware,
inappropriate access or theft''.
(53) An April 2014 study by Avalere Health determined that
38 percent of health insurance plans offered on the exchanges
under the Affordable Care Act had no information about drug
coverage available. Avalere also found that nearly 1 in 4 plans
offered insufficient information on which doctors and hospitals
are covered.
(54) In September 2014, the Administrator of the Centers
for Medicare and Medicaid Services reported to Congress that
7.3 million Americans had enrolled in plans through exchanges
under the Affordable Care Act, meeting enrollment targets
estimated by the Congressional Budget Office and held as a goal
by the Obama Administration.
(55) Four months later, HHS Secretary Burwell stated that
this enrollment data was a ``mistake'' that included some
400,000 dental insurance enrollments, the inclusion of which
allowed the administration to claim for months that the
Affordable Care Act was performing as anticipated which was not
in fact a true or accurate representation of the data they had,
but would not release to the public.
(56) Since implementation of the ACA began, the HHS
Secretary has granted over $1 billion in Federal taxpayer
dollars to States to help build websites for their own State-
based exchanges, yet development and usability issues on short
timelines repeatedly caused these same States to seek different
options for the 2015 open enrollment period, including opting
to revert to enrolling via the Federal HealthCare.gov website.
(57) The Affordable Care Act provides opportunities for
fraud within subsidy and tax credit issuance.
(58) A September 2013 report by the Treasury Inspector
General for Tax Administration concluded that, ``the IRS's
existing fraud detection system may not be capable of
identifying ACA refund fraud or schemes prior to the issuance
of tax return refunds.''.
(59) A July 2014 undercover study by the Government
Accountability Office determined that fictitious applicants
were able to obtain health insurance coverage and taxpayer-
funded subsidies on the Federal exchanges using falsified
documents in 11 out of 12 cases.
(60) The Affordable Care Act has had a negative impact on
the American economy.
(61) A February 2014 calculation by the Congressional
Budget Office found the Affordable Care Act will significantly
harm the American economy, reducing the number of hours worked
by millions of full-time employees worth of hours. The CBO
study noted, ``The reduction in CBO's projections of hours
worked represents a decline in the number of full-time-
equivalent workers of about 2 million in 2017, rising to about
2.5 million in 2024.''.
(62) History has shown the Special Inspector General model
to be successful at saving taxpayer dollars and rooting our
waste, fraud, and abuse in large Federal Government programs.
(63) Congress and the President have enacted legislation
creating Special Inspectors General on three occasions,
including to oversee Federal spending and policy implementation
for Afghanistan reconstruction (SIGAR), Iraq reconstruction
(SIGIR), and the Troubled Asset Relief Program (SIGTARP).
(64) SIGAR, SIGIR, and SIGTARP have successfully conducted
audits and investigations saving the Federal Government
billions in waste, fraud, and abuse, and have helped to
identify and prosecute theft and corruption.
(65) As of an October 2014 report, SIGAR has produced 57
referrals for suspension and debarment of Federal contractors
and employees and produced over $500 million in direct taxpayer
savings.
(66) According to its final report, SIGIR cost $245 million
to operate, but resulted in $645 million in direct savings to
the Federal Government, in addition to producing $192 million
in seizures and court-ordered penalties, as well as 90 criminal
convictions.
(67) As of an October 2014 report, SIGTARP has produced 146
convictions and $7.38 billion in fines, penalties, and
restitution to the Government and victims.
(68) On August 5, 2014, the Associated Press reported that
47 Federal inspectors general sent an unprecedented joint
letter to Congress to decry, ``Obama administration efforts to
delay or stall their investigations,'' citing three examples
where Federal agencies have hindered substantive inspector
general oversight work by refusing to provide information or
documents they are entitled to under the law.
(69) The letter from more than half of the Federal
Government's independent inspectors general correctly states,
``Section 6(a)(1) of the IG Act reflects the clear intent of
Congress that an Inspector General is entitled to timely and
unimpeded access to all records available to an agency that
relate to that Inspector General's oversight activities. The
constricted interpretations of Section 6(a)(1) by these and
other agencies conflict with the actual language and
Congressional intent. The IG Act is clear: no law restricting
access to records applies to Inspectors General unless that law
expressly so states, and that unrestricted access extends to
all records available to the agency, regardless of location or
form.''.
(70) Congress has a responsibility to exercise prudent
stewardship of public dollars, to ensure that laws are well and
faithfully executed by the executive branch, to provide for
efficacious services for the American people, and to ensure
that those who cheat, steal from, or defraud the Federal
Government are held to account.
SEC. 3. SPECIAL INSPECTOR GENERAL FOR MONITORING THE AFFORDABLE CARE
ACT.
(a) Office of Special Inspector General.--There is hereby
established the Office of the Special Inspector General for Monitoring
the Affordable Care Act (in this section, referred to as the
``Office'') to carry out the duties described under subsection (e).
(b) Appointment of Inspector General; Removal.--
(1) Appointment.--The head of the Office is the Special
Inspector General for Monitoring the Affordable Care Act (in
this section referred to as the ``Special Inspector General''),
who shall be appointed by the President, by and with the advice
and consent of the Senate.
(2) Qualifications.--The appointment of the Special
Inspector General shall be made solely on the basis of
integrity and demonstrated ability in accounting, auditing,
financial analysis, law, management analysis, health care
expertise and financing, public administration, or
investigations.
(3) Deadline for appointment.--The appointment of an
individual as the Special Inspector General shall be made not
later than 30 days after the date of the enactment of this Act.
(4) Compensation.--The annual rate of basic pay of the
Special Inspector General shall be the annual rate of basic pay
provided for positions at level IV of the Executive Schedule
under section 5315 of title 5, United States Code.
(5) Prohibition on political activities.--For purposes of
section 7324 of title 5, United States Code, the Special
Inspector General shall not be considered an employee who
determines policies to be pursued by the United States in the
nationwide administration of Federal law.
(6) Removal.--The Special Inspector General shall be
removable from office in accordance with the provisions of
section 3(b) of the Inspector General Act of 1978 (5 U.S.C.
App.).
(c) Assistant Inspectors General.--The Special Inspector General
shall, in accordance with applicable laws and regulations governing the
civil service--
(1) appoint an Assistant Inspector General for Auditing who
shall have the responsibility for supervising the performance
of auditing activities relating to the duties described under
subsection (e); and
(2) appoint an Assistant Inspector General for
Investigations who shall have the responsibility for
supervising the performance of investigative activities
relating to such duties.
(d) Supervision.--
(1) In general.--Except as provided under paragraph (2),
the Special Inspector General shall report directly to, and be
under the general supervision of, the Secretary of Health and
Human Services.
(2) Independence to conduct investigations and audits.--No
employee or officer of any of the following entities shall
prevent or prohibit the Special Inspector General from
initiating, carrying out, or completing any audit or
investigation related to the duties described under subsection
(e) or from issuing any subpoena during the course of any such
audit or investigation:
(A) The Executive Office of the President and the
Office of Personnel Management.
(B) The Department of Health and Human Services.
(C) The Department of the Treasury.
(D) The Social Security Administration, the
Department of Homeland Security, the Department of
Veterans Affairs, the Department of Defense, the
Department of Labor, and the Peace Corps.
(E) Any other Federal agency involved in
implementing or administering the Affordable Care Act.
(e) Duties.--
(1) Oversight of the implementation and administration of
the affordable care act.--It shall be the duty of the Special
Inspector General to conduct, supervise, and coordinate audits
and investigations of the implementation and administration of
programs and activities established under, and payment system
changes made by, the Affordable Care Act, including by
collecting and summarizing the following:
(A) A description of the individual mandate
requirement for applicable individuals to maintain
minimum essential coverage or pay a penalty under
section 5000A of the Internal Revenue Code of 1986,
including a description of the number of individuals
maintaining such coverage and the number of individuals
paying such penalties.
(B) A description of any increases or decreases
in--
(i) premiums for qualified health plans (as
defined in section 1301 of the Patient
Protection and Affordable Care Act (42 U.S.C.
18021));
(ii) deductibles under qualified health
plans; and
(iii) cost-sharing under qualified health
plans, including by copayments and coinsurance,
affecting individuals enrolling in coverage under such
plans through an exchange established under title I of
the Patient Protection and Affordable Care Act
(including a State-run exchange, a federally
administered exchange, and a Small Business Health
Options Program).
(C) A description of any increases or decreases in
the maximum out-of-pocket costs affecting individuals
enrolling in qualified health plans through such a
State-run exchange, a federally administered exchange,
and a Small Business Health Options Program.
(D) A description of any increases or decreases in
the size of physician and other health care provider
networks affecting individuals enrolling in qualified
health plans through such a State-run exchange, a
federally administered exchange, and a Small Business
Health Options Program.
(E) A description of any type of health insurance
coverage lost because of the treatment under title I of
the Patient Protection and Affordable Care Act of
grandfathered health plans (as defined in section
1251(e) of such Act (42 U.S.C. 18011(e))).
(F) A description of any credits under section 36B
of the Internal Revenue Code of 1986 (and the amount
(if any) of the advance payment of the credit under
section 1412 of the Patient Protection and Affordable
Care Act (42 U.S.C. 18082)) and any cost-sharing
reduction under section 1402 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18071) (and the
amount (if any) of the advance payment of the reduction
under section 1412 of such Act (42 U.S.C. 18082))
provided to individuals enrolling under qualified
health plans through an exchange established under
title I of the Patient Protection and Affordable Care
Act.
(G) A description of any projections, estimates,
analysis, goals, or targets made by any employee of the
Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act with respect
to the enrollment of individuals in a qualified health
plan through an exchange established under title I of
the Patient Protection and Affordable Care Act.
(H) A description of the employer mandate
requirement that applicable large employers provide
eligible employees with minimum essential coverage or
pay a fine under section 4980H of the Internal Revenue
Code of 1986, including a description of the type and
number of employers providing such coverage and the
type and number of employers paying such fines.
(I) A description of any projections, estimates,
analyses, goals, or targets made by any employee of the
Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act with respect
to employers providing minimum essential coverage to
applicable employees.
(J) A description of any reports, meetings,
discussions, or materials of any employee of the
Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act relating to
any employers converting full-time employees to part-
time employees or hiring new part-time employees
instead of full-time employees for the purposes of
avoiding the fines provided for under the employer
mandate requirement described in subparagraph (H).
(K) A description of any reports, meetings,
discussions, or materials of any employee of the
Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act relating to
any employers hiring no more than 50 employees for the
purposes of avoiding the requirement to provide minimum
essential coverage or pay a fine under the employer
mandate requirement described in subparagraph (H).
(L) A description of any reports, meetings,
discussions, or materials of any employee of the
Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act relating to
any employers dropping the health insurance coverage
offered to their employees, or employees' spouses or
dependents, for the purposes of avoiding the
requirement to provide minimum essential coverage or
pay a fine under the employer mandate requirement
described in subparagraph (H).
(M) A description of the transitional reinsurance
program established under section 1341 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18061),
including a description of reinsurance contributions
collected or required to be collected under such
program, a description of any reinsurance payments made
or required to be made to health insurance issuers
under such program, a description of the health
insurance coverage and related costs for high-cost
individuals for plans related to such program, an
explanation of the impact of such reinsurance program
on adverse selection in the marketplace, and an
explanation of any premium-stabilizing effects of such
program.
(N) A description of the temporary risk corridors
for qualified health plans established under section
1342 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18062), including a description of
participating plans and the allowable costs and target
amounts of such plans, a description of risk corridor
ratios of such plans, and a description of payment
adjustments made under such program.
(O) A description of the permanent risk adjustment
program established under section 1343 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18063),
including a description of any plans participating in
such program, a description of any risk adjustment
payments made or required to be made under such
program, a description of the health insurance coverage
and related costs for high-cost individuals for plans
related to such program, an explanation of the impact
of such program on adverse selection in the
marketplace, and an explanation of any premium-
stabilizing effects of such program.
(P) A list of all contracts awarded under the
Affordable Care Act and an analysis of whether Federal
contracting procedures were followed when awarding any
contract associated with such Act.
(Q) A description of the development of the health
insurance marketplace for the Internet portal
established under section 1103 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18003),
including a description of the design, features, and
security systems of such web portal and a description
of all costs associated with such development.
(R) A description of any threats, risks, problems,
or functionality issues identified by any employee of
the Federal Government or any contractor of the Federal
Government in carrying out duties associated with the
Patient Protection and Affordable Care Act prior to the
launch of such web portal on October 1, 2013.
(S) A description of any decisionmaking or
activities by any employee of the Federal Government or
any contractor of the Federal Government in carrying
out duties associated with the Patient Protection and
Affordable Care Act in response to such threats, risks,
problems, or functionality issues.
(T) A description of the systems (on the Federal
and State levels) in place or in development to allow
health insurance issuers and plans and government
entities to verify information is accurate for purposes
of enrollments in qualified health plans through
exchanges established under title I of the Patient
Protection and Affordable Care Act, including that data
verification and validation can occur with respect to
information provided or stored by individuals, the
Department of Health and Human Services, the qualified
health plans, States, and other applicable Federal
agencies, including for purposes of credits under
section 36B of the Internal Revenue Code of 1986 (and
the amount (if any) of the advance payment of the
credit under section 1412 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18082)) and any cost-
sharing reduction under section 1402 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18071)
(and the amount (if any) of the advance payment of the
reduction under section 1412 of such Act (42 U.S.C.
18082)).
(U) A description of the development of the Federal
Data Services Hub, including its design, features, and
security systems, and a description of the type of data
accessed through such data hub, and a description of
the actual storage location of such data accessed
through such data hub.
(V) A list of the duties and responsibilities
assigned to the Internal Revenue Service as a result of
the enactment of the Affordable Care Act, a description
of any plans of the Internal Revenue Service for how to
carry out such duties, and an explanation of the
resources and personnel required to carry out such
duties, including a description of any new resources or
personnel required to carry out such duties not already
available to the Internal Revenue Service.
(W) A description of any plans of the Internal
Revenue Service to verify the eligibility of
individuals enrolling in qualified health plans for any
credits under section 36B of the Internal Revenue Code
of 1986 (and the amount (if any) of the advance payment
of the credit under section 1412 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18082))
and any cost-sharing reduction under section 1402 of
the Patient Protection and Affordable Care Act (42
U.S.C. 18071) (and the amount (if any) of the advance
payment of the reduction under section 1412 of such Act
(42 U.S.C. 18082)), including a description of any such
verification completed and a description of any such
individuals determined to be ineligible.
(X) A description of any plans by the Internal
Revenue Service to calculate the amount of overpayment
of any such credit or reduction for which an individual
enrolled in a qualified health plan was determined to
be ineligible, including a description of any such
calculations completed.
(Y) A description of any plans by the Internal
Revenue Service to notify individuals determined to be
ineligible for such credits or reductions, including a
description of such notifications completed.
(Z) A description of any plans by the Internal
Revenue Service to recapture such overpayments of such
credits and reductions for individuals determined to be
ineligible, including a description of such recapturing
completed.
(AA) A description of the impact of the Affordable
Care Act on the right of conscience, including on--
(i) religious employers and institutions
that were not exempted from the mandate issued
by the Department of Health and Human Services
requiring individual and group health plans to
cover sterilization and Food and Drug
Administration approved contraceptives;
(ii) individuals; and
(iii) medical professionals.
(BB) A description of abortion coverage offered
under qualified health plans purchased through State-
run exchanges, federally administered exchanges, and
Small Business Health Options Programs, including costs
associated with such coverage.
(CC) A description of any actions by Departments or
Agencies of the Federal Government to modify or delay
the programs or activities authorized by the Affordable
Care Act, including an explanation from the head of
such Department or Agency of the specific authority
used to implement such a modification or delay.
(DD) A description of the Independent Payment
Advisory Board under section 1899A of the Social
Security Act (42 U.S.C. 1395kkk) and any actions taken
to alter or reduce the use of medical products,
treatments or procedures, including an explanation from
the Independent Payment Advisory Board of the reasons
for taking such actions, whether such actions could be
expected to result in worsened medical outcomes for
individuals affected by such alterations or reductions,
and an explanation of the medical information used to
determine whether such alterations or reductions could
be expected to result in such worsened outcomes.
(EE) A description of individuals enrolled in the
Medicaid program under title XIX of the Social Security
Act through an exchange established under title I of
the Patient Protection and Affordable Care Act,
including a description of the cost of health care
services utilized by such individuals and a description
of the cost to States and the cost to the Federal
Government to provide health care services to such
individuals.
(FF) Any additional topic related to the
implementation and administration of the Affordable
Care Act, the inclusion of which helps to provide the
public a full and objective accounting of such law.
(2) Data to be included.--In carrying out the duties
described under paragraph (1), the Special Inspector General
shall, to the greatest extent possible, collect and summarize
data described under such paragraph according to each type of
insurance marketplace and according to the age and gender of
individuals enrolling in coverage under qualified health plans
through an exchange established under title I of the Patient
Protection and Affordable Care Act.
(3) Other duties related to oversight.--The Special
Inspector General shall establish, maintain, and oversee such
systems, procedures, and controls as the Special Inspector
General considers appropriate to discharge the duties described
under paragraph (1).
(4) Duties and responsibilities under the inspector general
act of 1978.--In addition to the duties described under
paragraphs (1) and (2), the Special Inspector General shall
also have the duties and responsibilities of inspectors general
under the Inspector General Act of 1978 (5 U.S.C. App.).
(f) Coordination of Efforts.--In carrying out the duties,
responsibilities, and authorities of the Special Inspector General
under this section, the Special Inspector General shall coordinate
with, and receive the cooperation of each of the following:
(1) The Inspector General of the Department of Health and
Human Services.
(2) The Inspector General of the Department of the
Treasury.
(3) The Inspectors General of the Social Security
Administration, the Department of Homeland Security, the
Department of Veterans Affairs, the Department of Defense, the
Department of Labor, and the Peace Corps.
(4) The inspector general of any other Federal entity, as
determined by the Special Inspector General.
(g) Powers and Authorities.--
(1) Authority to access materials, request information,
compel response, and other authorities under the inspector
general act of 1978.--In carrying out the duties described
under subsection (e), the Special Inspector General shall have
all of the authorities provided under section 6 of the
Inspector General Act of 1978 (5 U.S.C. App.).
(2) Exemption from requirement for initial determination by
attorney general.--For purposes of section 6(e) of the
Inspector General Act of 1978 (5 U.S.C. App.), the Special
Inspector General shall be considered exempt from the
requirement of an initial determination of eligibility by the
Attorney General under paragraph (2) of such section.
(3) Audit standards.--The Special Inspector General shall
carry out the duties specified under subsection (e)(1) in
accordance with section 4(b)(1) of the Inspector General Act of
1978 (5 U.S.C. App.).
(h) Personnel, Facilities, and Other Resources.--
(1) Personnel.--The Special Inspector General may select,
appoint, and employ such officers and employees as may be
necessary for carrying out the duties of the Special Inspector
General, subject to the provisions of title 5, United States
Code, governing appointments in the competitive service, and
the provisions of chapter 51 and subchapter III of chapter 53
of such title, relating to classification and General Schedule
pay rates.
(2) Employment of experts and consultants.--The Special
Inspector General may obtain services as authorized by section
3109 of title 5, United States Code, at daily rates not to
exceed the equivalent rate prescribed for grade GS-15 of the
General Schedule by section 5332 of such title.
(3) Contracting authority.--To the extent and in such
amounts as may be provided in advance by appropriations Acts,
the Special Inspector General may enter into contracts and
other arrangements for audits, studies, analyses, and other
services with public agencies and with private persons, and
make such payments as may be necessary to carry out the duties
of the Special Inspector General.
(4) Resources.--The Secretary of Health and Human Services
shall provide the Special Inspector General with appropriate
and adequate office space at appropriate locations of the
Department of Health and Human Services together with such
equipment, office supplies, and communications facilities and
services as may be necessary for the operation of such offices,
and shall provide necessary maintenance services for such
offices and the equipment and facilities located therein.
(5) Assistance from federal agencies.--
(A) In general.--Upon request of the Special
Inspector General for information or assistance from
any Department, Agency, or other entity of the Federal
Government (including any entity listed under
subsection (d)(2)), the head of such entity shall,
insofar as is practicable and not in contravention of
any existing law, furnish such information or
assistance to the Special Inspector General, or an
authorized designee.
(B) Reporting of refused assistance.--
(i) Reporting to health and human services
and congress.--In accordance with clause (ii),
as the case may be, whenever information or
assistance requested by the Special Inspector
General is, in the judgment of the Special
Inspector General, unreasonably refused or not
provided, the Special Inspector General shall
report the circumstances to the Secretary of
Health and Human Services and to the
appropriate congressional committees without
delay.
(ii) Reporting to the public on refusal or
noncooperation in transparency.--Whenever any
information described in clause (i) is
requested by the Special Inspector General and
unreasonably refused or not provided, the
report to the Secretary of Health and Human
Services and the appropriate congressional
committees shall be titled ``Notice of Refusal
or Noncooperation in Transparency'' and shall
be published on a publicly available website in
an accessible format without delay.
(6) Use of personnel, facilities, and other resources of
the office.--Upon the request of the Special Inspector General,
an Inspector General--
(A) may detail, on a reimbursable basis, to the
Office any of the personnel of such Inspector General's
office for the purpose of carrying out this section;
and
(B) may provide, on a reimbursable basis, any of
the facilities or other resources of the Office for the
purpose of carrying out this section.
(i) Reports.--
(1) Initial report.--Not later than 90 days after the date
of the enactment of this Act, the Special Inspector General
shall submit to the appropriate congressional committees and
the Secretary of Health and Human Services a report
summarizing, for the period beginning on the date of the
enactment of the Health Care and Education Reconciliation Act
of 2010 and ending on the completion of a fiscal year quarter
after the date of enactment of this Act, the activities during
such period of the Special Inspector General required under
subsection (e).
(2) Quarterly reports.--Beginning with the first full
fiscal year quarter after the date of the enactment of this
Act, not later than 30 days after the end of each fiscal year
quarter, during which the Affordable Care Act is in effect, the
Special Inspector General shall submit to the appropriate
congressional committees and the Secretary of Health and Human
Services a report summarizing, for the period of that quarter
and, to the extent possible, the period from the end of such
quarter to the time of the submission of the report, the
activities during such period of the Special Inspector General
required under subsection (e).
(3) Comments on report.--Not later than 30 days after
receipt of a report under this subsection, the Secretary of
Health and Human Services shall submit to the appropriate
congressional committees any comments on the matters covered by
the report.
(4) Public availability; recordkeeping.--
(A) In general.--The Special Inspector General
shall publish on a publicly available website each
report described under this subsection and any comments
on the matters covered by the report submitted pursuant
to paragraph (3).
(B) Requirement to index.--Except as provided in
subparagraph (C), the Special Inspector General shall,
to the greatest extent possible, index and publish on
the publicly available website information for each
source used in each report described under this
subsection, including whenever applicable the document
name, author, and owner.
(C) Exception to index requirement.--The Special
Inspector General may except with a written note of
exclusion certain information required to be published
pursuant to subparagraph (B) that the Special Inspector
General determines is--
(i) necessary to protect an individual that
provided the information; or
(ii) classified.
(D) Recordkeeping requirement.--All source material
and information used to create a report described under
this subsection, including information excepted under
subparagraph (C), shall be identified, indexed (in a
classified annex, if necessary), and maintained
(including any written note of exclusion) by the
Special Inspector General.
(5) Protected information.--To the extent possible,
information submitted in any report required under this
subsection shall be in a form that is not prohibited from
disclosure under section 552a of title 5, United States Code
(commonly known as the Privacy Act of 1974).
(6) Aggregated information.--The Special Inspector General
shall, to the maximum extent possible, aggregate any personally
identifiable information submitted in a report required under
this subsection.
(j) Amendment to the Inspector General Act.--Section 8D of the
Inspector General Act (5 U.S.C. App.) is amended in subsections (e) and
(f) by inserting after ``for Tax Administration'', each place it
appears, the following: ``and the Special Inspector General for
Monitoring the Affordable Care Act''.
(k) Termination.--The Office of the Special Inspector General shall
terminate the earlier of--
(1) January 1, 2025; or
(2) the date on which the final report required by
subsection (h) is submitted for the last year the Affordable
Care Act is in effect.
(l) Definitions.--In this section:
(1) Affordable care act.--The term ``Affordable Care Act''
means the Patient Protection and Affordable Care Act and title
I and subtitle B of title II of the Health Care and Education
Reconciliation Act of 2010.
(2) Appropriate congressional committees.--The term
``appropriate congressional committees'' means--
(A) the Committees on Appropriations; the Budget;
Education and the Workforce; Energy and Commerce;
Homeland Security; the Judiciary; Oversight and
Government Reform; Small Business; and Ways and Means
of the House of Representatives; and
(B) the Committees on Appropriations; the Budget;
Commerce, Science, and Transportation; Finance; Health,
Education, Labor, and Pensions; Homeland Security and
Governmental Affairs; the Judiciary; and Small Business
and Entrepreneurship of the Senate.
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