Number: 111- 24
Date: November 10, 2009

The House Passes H.R. 3962,
The Affordable Health Care for America Act


On November 7, 2009, the House passed H.R. 3962, the “Affordable Health Care for America Act,” by a vote of 220-­­215. 1

The bill includes the following provisions of interest to SSA.



State Exchanges and Marketing Requirements – Enrollment

•  Would create a new independent agency, the Health Choices Administration, led by a Health Choices Commissioner (HCC). The HCC would be required to establish a Health Insurance Exchange to provide individuals and employers access to a variety of affordable quality health insurance coverage choices, including a public health insurance option.

•  Would require the HCC to broadly disseminate information on the Exchange enrollment process. The HCC would be allowed to work with “other appropriate entities” to facilitate the providing of such information and assist with the enrollment process to individuals and employers.

•  Would require the HCC to establish an annual enrollment period (AEP) for enrollment in an Exchange-participating health benefits plan and for affordability credits. The AEP would be from September – November of each year, or such other time to maximize the timeliness of income verifications (not to be less than 30 days).

•  Would phase-in individual and employer participation in the Exchange from 2013 to 2015.

Health Care Affordability Tax Credits – Eligibility

Citizenship Status Verification

•  Would require the HCC, for purposes of preventing illegal immigrants from obtaining affordability tax credits, to verify with SSA the citizenship status of individuals applying for the affordability credit. Such individuals must be enrolled in an exchange-participating health benefits package.

•  Would require the HCC to enter into an agreement with SSA to verify the citizenship status of an affordability credit applicant who alleges U.S. citizenship.

•  Would require SSA to determine whether an individual's name, SSN, date of birth, and allegation of U.S. citizenship are consistent with SSA records.

•  Would require the HCC to verify citizenship with DHS, upon notification from SSA that it cannot confirm citizenship.

•  Would grant individuals whose claims of citizenship cannot be verified 90 days to present satisfactory evidence of citizenship or to resolve the inconsistency with SSA, except that, for the first two years of the exchange (2013-2014), the HCC and SSA may extend that 90-day period.

•  Would appropriate $30 million, without fiscal year limit, to SSA to establish this citizenship verification program. Would require the HCC and SSA to enter into annual reimbursable agreements for HCC to fund SSA's full costs to administer the program, including systems and operational costs.

•  Would require such verifications to begin with enrollment in the Exchange. (As noted above, enrollment in the Exchange would begin in 2013.)

•  National High-Risk Pool Program
Would require the Department of Health and Human Services (HHS) to verify the citizenship of individuals applying for health benefits under a new temporary national high-risk program, using the citizenship verification procedures described above.

•  Would require SSA to perform these citizenship verifications. SSA would be reimbursed by HHS at an agreed-upon level.

•  Would be effective from January 1, 2010 through 2013.

•  CHIP & Medicaid Citizenship Verifications
Would require States to confirm citizenship with DHS when SSA cannot confirm such status for CHIP- and Medicaid-eligibility purposes.

•  Would be effective with the implementation of the CHIP and Medicaid verification process on January 1, 2010

Income Verification

•  Would create affordability tax credits for individuals with income up to 400 percent of poverty level, and would authorize the HCC to request from the Department of Treasury such tax return data as may be necessary to make income eligibility determinations, based on modified adjusted gross income for the affordability credit.

•  Would require the HCC to establish procedures for verification of income in situations where an individual's income has substantially changed.

•  Would require the HCC to establish alternative procedures to verify income if no tax return is available for the most recent completed tax year.



Medicare Savings Program (MSP) Effective Filing Date

•  Would establish that the application filing date for MSP benefits would be the date SSA electronically submits Low Income Subsidy (LIS) program data to a State Medicaid Agency. Using such an application date would fulfill the State's obligation to furnish medical assistance with “reasonable promptness.” (Note: The MIPPA stated that the date the individual filed for LIS was the filing date.) For purposes of determining medical assistance coverage, including retroactive coverage, the date the individual files the LIS application would constitute the MSP filing date.

•  Would be effective January 1, 2010.



IRS Data for LIS Outreach

•  Would require the Internal Revenue Service to disclose, at the request of the Commissioner, certain tax return information (e.g., wages, retirement income, unearned income, etc.) for only those individuals that SSA has already determined, using all other reasonably available information, likely to be eligible for LIS. Such tax return information would be from the most recent year for which tax return information is available.

•  Such disclosures would be effective 12 months after the date of enactment .

Income Subsidy Resource Limit Change

•  Would increase the Low Income Subsidy (LIS) alternate resource limits to $17,000 per individual and $34,000 per couple and would increase these limits each year thereafter by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of the previous year.

•  Would be effective with LIS eligibility determinations made on or after January 1, 2012.



Exemption of Clinical Trial Funding for SSI Purposes

•  Would exclude from income and resource determinations under the Supplemental Security Income program the first $2,000 received by an individual for participation in a clinical trial to test a treatment for a rare disease or condition.

•  Effective with the earlier of the following: The date the Commissioner promulgates regulations or 180 days after enactment.



Sale of Residence as Life-Changing Event for Income-Related Monthly Adjustment Amount

•  Would include the sale of a primary residence as a life-changing event, allowing beneficiaries to present more recent tax data to use in calculating Medicare Part B premiums.

•  Would apply to payments and premiums for years beginning with 2011.

TRICARE Special Enrollment Period

•  Would establish a 12-month Medicare Part B special enrollment period for TRICARE beneficiaries who are entitled to Medicare Part A by virtue of entitlement to disability insurance benefits, but are not currently enrolled in Medicare Part B.

•  Would require the Department of Defense to identify and notify individuals eligible to enroll during the special enrollment period.

•  Would waive Medicare Part B premium penalties for TRICARE beneficiaries enrolled during the special enrollment period.

•  Would be effective with elections made on or after the date of enactment.



Medicaid Coverage for the Lowest Income Populations

•  Would expand Medicaid eligibility to individuals under age 65 who are not eligible for Medicare and whose income does not exceed 150 percent of the Federal poverty level.

•  Expanded eligibility for various subgroups would be phased in, beginning with eligibility for non-disabled adults under age 65 effective upon enactment, and followed by eligibility for children beginning in 2014.



Race/Ethnicity Data

•  Would give HHS broad authority to determine those agencies whose programs have a significant impact on health and require them to collect and share full and complete statistics on key health indicators and the Nation's health. Would also require HHS to facilitate and fund analyses on health disparities conducted in cooperation with SSA and the Census Bureau.

•  Would appropriate $300 million for FY 2011-2015 and $330 million from the Public Health Investment Fund for purposes of carrying out, in part, the collection of information related to health disparities.

•  Would be effective upon enactment.

Community Living Assistance Supports and Services (CLASS) Act

•  Would establish a voluntary government-run, long-term care insurance program that would defray the costs of nursing home and in-home care in the event of a disability.

•  Would require the Secretary of HHS to designate an entity, other than the State Disability Determination Services, to make eligibility determinations for CLASS benefits.



1 Two additional Health Reform bills, S. 1679 and S. 1796, have been independently developed in the Senate. These two bills will be consolidated for consideration before the full Senate.