Number: 111- 31
Date: December 30, 2009

The Senate Passes H.R. 3590,
The Patient Protection and Affordable Care Act


On December 24, 2009, the Senate passed H.R. 3590, the “Patient Protection and Affordable Care Act,” by a vote of 60-39. The House previously passed related legislation, H.R. 3962 (see Legislative Bulletin 111-24). Because there are some differences between the two versions of the bill, H.R. 3590 now returns to the House for further action. The House may either adopt the Senate bill or request a conference committee be established to reconcile the differences.

The bill includes the following provisions of interest to SSA.


State Exchanges and Marketing Requirements – Enrollment

•  Would require each State to establish an “American Health Benefit Exchange” to facilitate the purchase of qualified health plans for individuals and employees of small businesses.

•  Would require the Secretary of Health and Human Services (HHS) to establish a system under which residents of each State may apply for certain needs-based programs using a single, streamlined form filed with the State Exchange or with State officials operating other State health subsidy programs. Such applications may be filed online, in person, by mail, or over the phone.

•  Would require the Secretary of HHS to establish an initial enrollment period, an annual enrollment period and certain other enrollment periods for specific groups.

•  Would require the Exchanges to begin January 1, 2014.


Health Care Affordability Tax Credits – Eligibility

Citizenship Status Verification

•  Would require the Exchanges, for purposes of preventing illegal immigrants from participating in an Exchange and obtaining premium tax credits and reduced cost sharing, to submit an applicant's name, SSN, date of birth, and attestation of U.S. citizenship to the Secretary of HHS, who would, in turn, submit the information to SSA.

•  Would require SSA to determine whether an applicant's name, SSN, date of birth, and allegation of U.S. citizenship are consistent with SSA records and report such determination to the Secretary of HHS.

•  Would require the Secretary of HHS to verify citizenship with the Department of Homeland Security (DHS), upon notification from SSA that it cannot confirm citizenship.

•  Would require such determinations to be made through the use of an online or electronic system developed by the Secretary of HHS, in consultation the Commissioner and DHS.

•  Would require, for any applicant whose claim of U.S. citizenship cannot be verified, the use of the citizenship verification procedures specified in section 1902(ee) of the Social Security Act, as added by the Children's Health Insurance Reauthorization Program Act of 2009, P.L. 111-3. Such verification procedures would require the State to make a reasonable effort to identify and address the causes of the inconsistent information and, after such efforts are made, the State would allow the individual 90 days to resolve the inconsistency with the Commissioner, or to present paper documentation of citizenship to the State.

•  Would require the Secretary of HHS to consult with the Commissioner and others to establish procedures related to appeals and periodic redeterminations of eligibility.

•  Would authorize the Secretary of HHS and the Exchanges to collect and use the Social Security number for purposes of carrying out this Act.

•  Would restrict use of the personal information submitted to an Exchange to ensuring the efficient operation of an Exchange, verifying eligibility to enroll in an Exchange, or claiming a premium tax credit or cost-sharing reduction. Would also establish penalties for disclosure of information collected by the Exchange.

•  Would require such citizenship verifications to begin with enrollment in the Exchange. (As noted, enrollment in the Exchange would begin January 1, 2014, but would likely be preceded by an initial enrollment period defined by the Secretary of HHS.)

National High-Risk Pool Program

•  Would require the Secretary of HHS – or States or nonprofit private entities under contract with 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.

•  Would be effective beginning 90 days after enactment through January 1, 2014.

Income Verification

•  Would require individuals buying health insurance through an Exchange to provide income data in order to receive a premium tax credit. (SSA would not be involved in these determinations.)


 Extension of Medicare Coverage for Environmental Health Hazards

•  Would require the Commissioner, in consultation with the Secretary of HHS, to determine whether individuals in geographic locations under declarations of public health emergencies have been affected by environmental health hazards, such as asbestos. The Commissioner would be authorized to draw funds from the Health Insurance and Supplemental Medical Insurance Trust Funds to administer this workload.

•  Would be effective upon enactment.



Temporary Freeze of the Part B Income-Related Premium

•  Would freeze the current income thresholds for imposing income-related Medicare Part B premiums for the period of 2011 through 2019.

TRICARE Special Enrollment Period

•  Would establish a 12-month Medicare Part B special enrollment period (SEP) for TRICARE beneficiaries who are entitled to Medicare Part A by virtue of entitlement to disability insurance benefits or End State Renal Disease benefits, but who have declined Medicare Part B.

•  Would define the SEP as the 12 months following the last day of the initial enrollment period or, for individuals notified of retroactive Part A and Part B entitlement, the 12-month period beginning with the month of notification of entitlement to Part B.

•  Would require the Department of Defense, in collaboration with the Secretary of HHS and the Commissioner, to identify and notify individuals eligible to enroll during the SEP. Medicare Part B premium penalties would be waived.

•  Would be effective upon enactment.



•  Would impose an income-related monthly adjustment amount (IRMAA) premium increase for Medicare Part D beneficiaries whose Modified Adjusted Gross Income (MAGI) exceeds the thresholds used under Medicare Part B (for 2009, $85,000 per individuals, $170,000 per couple).

•  Would expand the Internal Revenue Service's current authority to disclose income information to SSA for purposes of adjusting the Part B subsidy to include the Part D subsidy adjustments and appeals.

•  Would be effective beginning January 1, 2011.


Special Rules for Widows and Widowers

•  Would prohibit conducting Part D Low Income Subsidy (LIS)-eligibility redeterminations on the surviving spouse of an LIS-eligible couple for one year after the date the next redetermination would have occurred after the death of the spouse.

•  Would be effective beginning January 1, 2011.


Medicaid Coverage for the Lowest Income Populations

•  Would expand Medicaid eligibility to non-elderly individuals who are not entitled to or enrolled in Medicare Part A, or enrolled in Medicare Part B, and whose income, based on the modified gross income standard, does not exceed 133 percent of the Federal poverty level.

•  Would be effective January 1, 2014.

Incentives for Prevention of Chronic Diseases in Medicaid

•  Would exclude incentives provided to Medicaid beneficiaries participating in the newly created prevention of chronic diseases programs from being counted when determining eligibility for, or the amount of, benefits under Medicaid or any program funded in whole or in part by Federal funds.

•  Would be effective January 1, 2011, or the date the Secretary of HHS develops criteria for the new program criteria, whichever is earlier.




W-2 Reporting Requirements

•  Would require employers to report on Forms W-2 the aggregate cost of sponsored health coverage.

•  Would be effective for taxable years beginning after December 31, 2010.

Additional W-2 Related Provisions

Hospital Insurance Tax on High-Income Taxpayers

•  Would impose an additional 0.9 percent tax for certain high-income wage earners and self-employed individuals. For joint filers, the additional tax would apply to any earnings above $250,000. For all others, the additional tax would be imposed for earnings above $200,000.

•  Would be effective for taxable years beginning after December 31, 2012.

Excise Tax on High-Cost Employer-Sponsored Health Coverage

•  Would create an excise tax on high-cost employer sponsored health coverage, including government civilian employment health insurance and health spending account programs.

•  Would be effective January 1, 2013.




Complete “One PI” Integrated Data Repository

•  Would require the Integrated Data Repository, maintained by the Centers for Medicare and Medicaid Services, to include, at a minimum, claims and payment data from certain programs, including the Old-Age, Survivors, and Disability Insurance programs.

•  Would require the Secretary of HHS to enter into agreements with specified individuals, including the Commissioner, to share and match data in the respective agencies' systems of records for purposes of identifying potential fraud, waste and abuse under Medicare and Medicaid.

•  Would be effective upon enactment.

Medicare and Medicaid Program Integrity

•  Would require the Commissioner, upon request of the Inspector General of HHS, to enter into agreements to match data in SSA's system of records to HHS's system of records. Such agreements must provide for the safeguarding of data.

•  Would be effective at a date specified by the Secretary of HHS, but no earlier than January 1, 2011.



Interagency Working Group on Health Care Quality

•  Would require the President to convene an Interagency Working Group on Health Care Quality that would collaborate between Federal departments and agencies to develop strategies to improve health outcomes. The working group would be composed of senior-level officials from Federal departments and agencies, including SSA.

•  The working group would be required to provide annual reports to Congress—and make such reports public on an Internet website—the first of which would be due December 31, 2010.

Race/Ethnicity Data

•  Would require the Secretary of HHS to ensure that any federally conducted or supported health care or public health program, activity, or survey to include the collection of data related to race, ethnicity, sex, primary language and disability status, among others.

•  Would also require the Secretary to analyze and disseminate such information to other appropriate Federal agencies.

•  Would be effective for data collection not later than 2 years after the date of enactment.

Community Living Assistance Supports and Services (CLASS) Act

•  Would exclude benefits paid under the CLASS program from being used to determine initial or continuing eligibility under any Federal, State, or locally funded assistance program.

•  Would be effective January 1, 2011.