What This Bill Does
This bill creates a system that lets people claim free or low-cost health insurance when they file their federal income taxes. When someone files taxes without health coverage, they can agree to let the IRS share their information with health insurance programs to determine if they qualify for assistance. The bill also changes how income is calculated for these programs to make coverage more stable and predictable.
##
Who It Affects
- Adults and children without health insurance
- Families applying for Medicaid or the Children's Health Insurance Program (a program that provides health coverage for children whose families earn too much for Medicaid)
- People buying insurance through health insurance marketplaces (also called Exchanges, which are websites where people compare and buy health plans)
- Tax return preparers who prepare people's tax forms
- State agencies that run Medicaid and CHIP programs
- The Internal Revenue Service and Department of Health and Human Services
##
Key Provisions
- The Treasury Department must set up a program by January 1, 2026 that lets uninsured people agree to share their tax information with health insurance marketplaces to find out if they qualify for free or low-cost coverage (Sec. 3(a))
- When someone agrees to share their tax information, they can be automatically enrolled in a health plan with zero net premium (meaning they pay nothing) if no one in their household opts out or chooses a different plan (Sec. 3(b)(1))
- Health insurance marketplaces must minimize the amount of extra paperwork people need to complete by using information already on their tax returns and checking reliable third-party data sources (Sec. 4(a)(1))
- States must accept eligibility determinations for Medicaid and CHIP based on recent tax year income for people who apply between January and April, which makes eligibility easier to understand and more stable (Sec. 5(a)(1))
- Federal funds are appropriated as needed to build the computer systems and hire staff required to run this program (Sec. 7(a))
##
What Changes
Currently, people without health insurance must separately apply to health insurance programs and provide their own financial information. Under this bill, people can automatically start the enrollment process when filing taxes, and their tax information gets shared (only if they consent) to determine eligibility. This eliminates a separate application step.
The bill also changes which year's income is used to determine if someone qualifies for financial help. For people applying January through April, the previous calendar year's tax return income will be used, rather than using more recent income data that might be different. This creates consistency and reduces confusion.
People will no longer be automatically enrolled in insurance that costs them money, but will be enrolled only if zero-premium options exist and they do not refuse enrollment.
##
Important Definitions
- **Insurance affordability program**: Any program that helps pay for health insurance, including Medicaid, CHIP, plans sold through health insurance marketplaces with tax credits (financial aid), and state health programs
- **Minimum essential coverage**: Health insurance that meets federal requirements
- **Zero net premium**: A health plan that costs the person $0.00 per month after all financial help is applied
- **Relevant return information**: Tax information that may help determine if someone qualifies for health insurance assistance
- **Household member**: A taxpayer, their spouse, and any person they claim as a dependent on their tax return
- **Modified adjusted gross income**: Income calculated in a specific way used for determining who qualifies for financial help (defined in the tax code)
##
Effective Date
- The main enrollment program must be established by January 1, 2026 (Sec. 3(a))
- Changes to income eligibility rules for Medicaid and CHIP take effect January 1, 2025 (Sec. 5(a)(3))
- Changes to how premium tax credits and cost-sharing reductions work take effect January 1, 2026 and expire December 31, 2032 (Sec. 5(b)(3))
II
118TH CONGRESS
1ST SESSION
S. 423
To streamline enrollment in health insurance affordability programs and
minimum essential coverage, and for other purposes.
IN THE SENATE OF THE UNITED STATES
FEBRUARY 14, 2023
Mr. VAN HOLLEN introduced the following bill; which was read twice and
referred to the Committee on Finance
A BILL
To streamline enrollment in health insurance affordability
programs and minimum essential coverage, and for other
purposes.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Easy Enrollment in
4
Health Care Act’’.
5
SEC. 2. DEFINITIONS.
6
In this Act:
7
(1) CHIP PROGRAM.—The term ‘‘CHIP pro-
8
gram’’ means a State plan for child health assist-
9
ance under title XXI of the Social Security Act (42
10
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•S 423 IS
U.S.C. 1397aa et seq.), including any waiver of such
1
a plan.
2
(2) EXCHANGE.—The term ‘‘Exchange’’ means
3
an American Health Benefit Exchange established
4
under subtitle D of title I of the Patient Protection
5
and Affordable Care Act (42 U.S.C. 18021 et seq.).
6
(3) FAMILY SIZE.—The term ‘‘family size’’ has
7
the meaning given such term in section 36B(d) of
8
the Internal Revenue Code of 1986.
9
(4) GROUP HEALTH PLAN.—The term ‘‘group
10
health plan’’ has the meaning given such term in
11
section 5000(b)(1) of the Internal Revenue Code of
12
1986.
13
(5) HOUSEHOLD INCOME.—The term ‘‘house-
14
hold income’’ has the meaning given such term in
15
section 36B(d) of the Internal Revenue Code of
16
1986.
17
(6) HOUSEHOLD MEMBER.—The term ‘‘house-
18
hold member’’ means the taxpayer, the taxpayer’s
19
spouse, and any dependent of the taxpayer.
20
(7) INSURANCE
AFFORDABILITY
PROGRAM.—
21
The term ‘‘insurance affordability program’’ means
22
any of the following:
23
(A) A Medicaid program.
24
(B) A CHIP program.
25
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•S 423 IS
(C) The program under title I of the Pa-
1
tient Protection and Affordable Care Act (42
2
U.S.C. 18001 et seq.) for the enrollment in
3
qualified health plans offered through an Ex-
4
change, including the premium tax credits
5
under section 36B of the Internal Revenue
6
Code of 1986, cost-sharing reductions under
7
section 1402 of the Patient Protection and Af-
8
fordable Care Act (42 U.S.C. 18071), and the
9
advance payment of such credits and reductions
10
under section 1412(a)(3) of the Patient Protec-
11
tion and Affordable Care Act (42 U.S.C.
12
18082(a)(3)).
13
(D) A State basic health program under
14
section 1331 of the Patient Protection and Af-
15
fordable Care Act (42 U.S.C. 18051).
16
(E) Any other Federal, State, or local pro-
17
gram that provides assistance for some or all of
18
the cost of minimum essential coverage and re-
19
quires eligibility for such program to be based
20
in whole or in part on income, including such
21
a program carried out through a waiver under
22
section 1332 of the Patient Protection and Af-
23
fordable Care Act (42 U.S.C. 18052) or a State
24
program supplementing the advanced payment
25
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•S 423 IS
of tax credits and cost-sharing reductions under
1
section 1412(a)(3) of such Act.
2
(8) MEDICAID PROGRAM.—The term ‘‘Medicaid
3
program’’ means a State plan for medical assistance
4
under title XIX of the Social Security Act (42
5
U.S.C. 1396 et seq.), including any waiver of such
6
a plan.
7
(9) MINIMUM
ESSENTIAL
COVERAGE.—The
8
term ‘‘minimum essential coverage’’ has the meaning
9
given such term in section 5000A(f) of the Internal
10
Revenue Code of 1986.
11
(10) MODIFIED
ADJUSTED
GROSS
INCOME.—
12
The term ‘‘modified adjusted gross income’’ has the
13
meaning given such term in section 36B(d)(2)(B) of
14
the Internal Revenue Code of 1986.
15
(11) NET
PREMIUM.—The term ‘‘net pre-
16
mium’’, with respect to a health plan or other form
17
of minimum essential coverage—
18
(A) except as provided in subparagraph
19
(B), means the payment from or on behalf of
20
an individual required to enroll in such plan or
21
coverage, after application of the premium tax
22
credit under section 36B of the Internal Rev-
23
enue Code of 1986, the advance payment of
24
such credit under section 1412(a)(3) of the Pa-
25
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•S 423 IS
tient Protection and Affordable Care Act (42
1
U.S.C. 18082(a)(3)), and any other assistance
2
provided by an insurance affordability program;
3
and
4
(B) does not include any amounts de-
5
scribed in section 36B(b)(3)(D) of the Internal
6
Revenue Code of 1986 or section 1303(b)(2) of
7
the Patient Protection and Affordable Care Act
8
(42 U.S.C. 18023(b)(2)).
9
(12) POVERTY LINE.—The term ‘‘poverty line’’
10
has the meaning given such term in section
11
36B(d)(3) of the Internal Revenue Code of 1986.
12
(13) QUALIFIED
HEALTH
PLAN.—The term
13
‘‘qualified health plan’’ has the meaning given such
14
term in section 1301(a) of the Patient Protection
15
and Affordable Care Act (42 U.S.C. 18021(a)).
16
(14) RELEVANT RETURN INFORMATION.—The
17
term ‘‘relevant return information’’ means, with re-
18
spect to a taxpayer, any return information, as de-
19
fined in section 6103(b)(2) of the Internal Revenue
20
Code of 1986, which may be relevant, as determined
21
by the Secretary of the Treasury in consultation
22
with the Secretary of Health and Human Services,
23
with respect to—
24
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•S 423 IS
(A) determining, or facilitating determina-
1
tion of, the eligibility of any household member
2
of the taxpayer for any insurance affordability
3
program, either directly or through enabling ac-
4
cess to additional information potentially rel-
5
evant to such eligibility; or
6
(B) enrolling, or facilitating the enrollment
7
of, such individual in minimum essential cov-
8
erage.
9
(15) SINGLE, STREAMLINED
APPLICATION.—
10
The term ‘‘single, streamlined application’’ means
11
the form described in section 1413(b)(1)(A) of the
12
Patient Protection and Affordable Care Act (42
13
U.S.C. 18083(b)(1)(A)).
14
(16) TAX RETURN PREPARER.—The term ‘‘tax
15
return preparer’’ has the meaning given such term
16
in section 7701(a)(36) of the Internal Revenue Code
17
of 1986.
18
(17) ZERO NET PREMIUM.—The term ‘‘zero net
19
premium’’, with respect to a health plan or other
20
form of minimum essential coverage, means a net
21
premium of $0.00 for such plan or coverage.
22
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•S 423 IS
SEC. 3. FEDERAL INCOME TAX RETURNS USED TO FACILI-
1
TATE ENROLLMENT INTO INSURANCE AF-
2
FORDABILITY PROGRAMS.
3
(a) IN GENERAL.—Not later than January 1, 2026,
4
the Secretary shall establish a program which allows any
5
taxpayer who is not covered under minimum essential cov-
6
erage at the time their return of tax for the taxable year
7
is filed, as well as any other household member who is
8
not covered under such coverage, to, in conjunction with
9
the filing of their return of tax for any taxable year which
10
begins after December 31, 2024, elect to—
11
(1) have a determination made as to whether
12
the household member who is not covered under
13
such coverage is eligible for an insurance afford-
14
ability program; and
15
(2) have such household member enrolled into
16
minimum essential coverage, provided that—
17
(A) such coverage is provided through a
18
zero-net-premium plan, and
19
(B) the taxpayer does not—
20
(i) opt out of coverage through the
21
zero-net-premium plan, or
22
(ii) select a different plan.
23
(b) TAXPAYER REQUIREMENTS AND CONSENT.—
24
(1) IN GENERAL.—Pursuant to the program es-
25
tablished under subsection (a), the taxpayer may, in
26
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•S 423 IS
conjunction with the filing of their return of tax for
1
the taxable year—
2
(A) identify any household member who is
3
not covered under minimum essential coverage
4
at the time of such filing; and
5
(B) with respect to each household member
6
identified under subparagraph (A), elect wheth-
7
er to—
8
(i)
in
accordance
with
section
9
6103(l)(23) of the Internal Revenue Code
10
of 1986 (as added by subsection (f)), con-
11
sent to the disclosure and transfer to the
12
applicable Exchange of any relevant return
13
information for purposes of determining
14
whether such household member may be el-
15
igible for any insurance affordability pro-
16
gram and facilitating enrollment into such
17
program and minimum essential coverage,
18
including any further disclosure and trans-
19
fer by the Exchange to any other entity as
20
is deemed necessary to accomplish such
21
purposes; and
22
(ii) in the case consent is provided
23
under clause (i) with respect to such
24
household member, enroll such household
25
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•S 423 IS
member in any minimum essential cov-
1
erage that is available with a zero net pre-
2
mium, if—
3
(I) the member is eligible for
4
such coverage through an insurance
5
affordability program; and
6
(II) the member does not, by the
7
end of the special enrollment period
8
described in section 4(c)(1)(A)—
9
(aa) select a different plan
10
offering minimum essential cov-
11
erage; or
12
(bb) opt out of such cov-
13
erage that is available with a zero
14
net premium.
15
(2) ESTABLISHMENT
OF
OPTIONS
FOR
TAX-
16
PAYER CONSENT AND ELECTION.—For purposes of
17
paragraph (1)(B), the Secretary, in consultation
18
with the Secretary of Health and Human Services,
19
may provide the elections under such paragraph as
20
a single election or as 2 elections.
21
(3) SUPPLEMENTAL FORM.—
22
(A) IN GENERAL.—In the case of a tax-
23
payer who has consented to disclosure and
24
transfer of relevant return information pursu-
25
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•S 423 IS
ant to paragraph (1)(B)(i), such taxpayer shall
1
be enrolled in the insurance affordability pro-
2
gram only if the taxpayer submits a supple-
3
mental form which is designed to collect addi-
4
tional information necessary (as determined by
5
the Secretary of Health and Human Services)
6
to establish eligibility for and enrollment in an
7
insurance affordability program, which may in-
8
clude (except as provided in subparagraph (B)),
9
with respect to each individual described in
10
paragraph (1)(A), the following:
11
(i) State of residence.
12
(ii) Date of birth.
13
(iii) Employment and the availability
14
of benefits under a group health plan at
15
the time the return of tax is filed.
16
(iv) Any changed circumstances de-
17
scribed in section 1412(b)(2) of the Pa-
18
tient Protection and Affordable Care Act;
19
(42 U.S.C. 18082(b)(2)).
20
(v) Solely for the purpose of facili-
21
tating automatic renewal of coverage and
22
eligibility redeterminations under section
23
1413(c)(3)(A) of such Act (42 U.S.C.
24
18083(c)(3)(A)), authorization for the Sec-
25
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•S 423 IS
retary to disclose relevant return informa-
1
tion for subsequent taxable years to insur-
2
ance affordability programs.
3
(vi) Any methods preferred by the
4
taxpayer or household member for the pur-
5
pose of being contacted by the applicable
6
Exchange or insurance affordability pro-
7
gram with respect to any eligibility deter-
8
mination for, or enrollment in, an insur-
9
ance affordability program or minimum es-
10
sential coverage, such as an email address
11
or a phone number for calls or text mes-
12
sages.
13
(vii) Information about household
14
composition that—
15
(I) may affect eligibility for an
16
insurance affordability program, and
17
(II) is not otherwise included on
18
the return of tax.
19
(viii) Such other information as the
20
Secretary, in consultation with the Sec-
21
retary of Health and Human Services, may
22
require, including information requested on
23
the single, streamlined application.
24
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•S 423 IS
(B) LIMITATIONS.—The information ob-
1
tained through the form described in subpara-
2
graph (A) may not include any request for in-
3
formation with respect to citizenship, immigra-
4
tion status, or health status of any household
5
member.
6
(C)
ADDITIONAL
INFORMATION.—The
7
form described in subparagraph (A) and the ac-
8
companying tax instructions may provide the
9
taxpayer with additional information about in-
10
surance affordability programs, including infor-
11
mation provided to applicants on the single,
12
streamlined application.
13
(D) ACCESSIBILITY.—
14
(i) IN GENERAL.—The Secretary shall
15
ensure that the form described in subpara-
16
graph (A) is made available to all tax-
17
payers without discrimination based on
18
language, disability, literacy, or internet
19
access.
20
(ii) RULE OF CONSTRUCTION.—Noth-
21
ing in clause (i) shall be construed as di-
22
minishing, reducing, or otherwise limiting
23
any other legal obligation for the Secretary
24
to avoid or to prevent discrimination.
25
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•S 423 IS
(4) RETURN
LANGUAGE.—The Secretary, in
1
consultation with the Secretary of Health and
2
Human Services, shall, with respect to any items de-
3
scribed in this subsection which are to be included
4
in a taxpayer’s return of tax, develop language for
5
such items which is as simple and clear as possible
6
(such as referring to ‘‘insurance affordability pro-
7
grams’’ as ‘‘free or low-cost health insurance’’).
8
(c) TAX RETURN PREPARERS.—
9
[Text truncated for display. Full text available on Congress.gov.]