What This Bill Does
This bill creates a system that lets people apply for health insurance through federal income tax returns. When filing taxes, people who don't have health insurance can consent to share tax information with health insurance programs to check if they qualify for free or low-cost coverage. If eligible and consent is given, the person gets automatically enrolled in a zero net premium plan (a plan with no monthly premium cost).
##
Who It Affects
- Taxpayers without health insurance who file federal income tax returns
- Family members of taxpayers who lack health insurance
- State Medicaid programs
- State Children's Health Insurance Programs (CHIP)
- Health insurance exchanges (the marketplaces where people buy insurance)
- Tax return preparers
- The Internal Revenue Service
- Department of Health and Human Services
- State agencies administering insurance affordability programs
##
Key Provisions
- The Secretary of the Treasury must establish a program by January 1, 2026, allowing uninsured taxpayers to consent to sharing tax information with insurance exchanges to check eligibility for free or low-cost health insurance (Sec. 3(a))
- Taxpayers can provide a supplemental form with additional information needed to determine eligibility, including state of residence, date of birth, employment status, and preferred contact methods, but the form cannot ask about citizenship, immigration status, or health status (Sec. 3(b)(3))
- Tax return preparers are not required to verify the accuracy of information submitted solely for this enrollment program (Sec. 3(c)(1))
- Exchanges receiving tax information must minimize the amount of additional paperwork needed and use data from reliable third-party sources to confirm eligibility (Sec. 4(a))
- If an uninsured person qualifies for Medicaid or CHIP, the state must automatically enroll them unless the person must pay a premium they have not agreed to pay (Sec. 4(b)(2)(A))
- If a person does not qualify for Medicaid or CHIP but qualifies for exchange coverage, the exchange must select a default zero net premium health plan and enroll the person unless they choose a different plan or opt out during a special enrollment period (Sec. 4(c)(2))
- States must allow Medicaid eligibility determinations for people applying in January through April based on income from the previous calendar year (Sec. 5(a))
- Insurance affordability programs can access employment and wage information from the National Directory of New Hires to verify eligibility (Sec. 6(a))
##
What Changes
If this becomes law, uninsured people filing federal income taxes will have a new option to apply for health insurance without filling out separate applications. Tax filers can consent to let the IRS share their tax information with health insurance programs. Exchanges and state Medicaid/CHIP programs will automatically enroll eligible people in zero net premium plans unless the person declines. States will be required to allow Medicaid eligibility determinations based on previous year income for early calendar year applicants. Insurance programs will have new access to employment data from the National Directory of New Hires to verify eligibility. The Treasury and health agencies will develop systems to securely transfer tax information to insurance exchanges.
##
Important Definitions
- **Insurance affordability program**: Medicaid, CHIP, health plans sold through insurance exchanges (including premium tax credits and cost-sharing reductions), state basic health programs, and other federal, state, or local programs that help pay for health insurance based on income
- **Minimum essential coverage**: Health insurance that meets minimum federal standards
- **Zero net premium**: A health plan with a monthly premium cost of $0.00 after all available subsidies (discounts and tax credits) are applied
- **Net premium**: The amount a person must pay for health insurance after all available help from government programs is subtracted
- **Household member**: A taxpayer, their spouse, and any person the taxpayer claims as a dependent
- **Relevant return information**: Tax return information that may help determine eligibility for health insurance programs or help enroll someone in coverage
- **Single, streamlined application**: The standard health insurance application form used by insurance exchanges
- **Modified adjusted gross income**: A calculation of income used to determine eligibility for health insurance help (defined in federal tax law)
- **Applicable taxable year**: For coverage in January-May, the most recent tax year that ended at least 12 months before January 1 of the plan year; for other coverage months, the most recent tax year that ended before January 1 of the plan year
##
Effective Date
The program allowing tax-based enrollment must be established by January 1, 2026 (Sec. 3(a)). People can use this program starting with tax returns filed for taxable years beginning after December 31, 2024. Changes to income eligibility rules for Medicaid and CHIP take effect January 1, 2025 (Sec. 5(a)(3)). Changes to how exchanges determine eligibility for premium tax credits take effect January 1, 2026, and continue through December 31, 2032 (Sec. 5(b)(3)).
I
118TH CONGRESS
1ST SESSION H. R. 1113
To streamline enrollment in health insurance affordability programs and
minimum essential coverage, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 21, 2023
Mr. BERA introduced the following bill; which was referred to the Committee
on Energy and Commerce, and in addition to the Committee on Ways
and Means, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned
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
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(1) CHIP PROGRAM.—The term ‘‘CHIP pro-
1
gram’’ means a State plan for child health assist-
2
ance under title XXI of the Social Security Act (42
3
U.S.C. 1397aa et seq.), including any waiver of such
4
a plan.
5
(2) EXCHANGE.—The term ‘‘Exchange’’ means
6
an American Health Benefit Exchange established
7
under subtitle D of title I of the Patient Protection
8
and Affordable Care Act (42 U.S.C. 18021 et seq.).
9
(3) FAMILY SIZE.—The term ‘‘family size’’ has
10
the meaning given such term in section 36B(d) of
11
the Internal Revenue Code of 1986.
12
(4) GROUP HEALTH PLAN.—The term ‘‘group
13
health plan’’ has the meaning given such term in
14
section 5000(b)(1) of the Internal Revenue Code of
15
1986.
16
(5) HOUSEHOLD INCOME.—The term ‘‘house-
17
hold income’’ has the meaning given such term in
18
section 36B(d) of the Internal Revenue Code of
19
1986.
20
(6) HOUSEHOLD MEMBER.—The term ‘‘house-
21
hold member’’ means the taxpayer, the taxpayer’s
22
spouse, and any dependent of the taxpayer.
23
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(7) INSURANCE
AFFORDABILITY
PROGRAM.—
1
The term ‘‘insurance affordability program’’ means
2
any of the following:
3
(A) A Medicaid program.
4
(B) A CHIP program.
5
(C) The program under title I of the Pa-
6
tient Protection and Affordable Care Act (42
7
U.S.C. 18001 et seq.) for the enrollment in
8
qualified health plans offered through an Ex-
9
change, including the premium tax credits
10
under section 36B of the Internal Revenue
11
Code of 1986, cost-sharing reductions under
12
section 1402 of the Patient Protection and Af-
13
fordable Care Act (42 U.S.C. 18071), and the
14
advance payment of such credits and reductions
15
under section 1412(a)(3) of the Patient Protec-
16
tion and Affordable Care Act (42 U.S.C.
17
18082(a)(3)).
18
(D) A State basic health program under
19
section 1331 of the Patient Protection and Af-
20
fordable Care Act (42 U.S.C. 18051).
21
(E) Any other Federal, State, or local pro-
22
gram that provides assistance for some or all of
23
the cost of minimum essential coverage and re-
24
quires eligibility for such program to be based
25
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•HR 1113 IH
in whole or in part on income, including such
1
a program carried out through a waiver under
2
section 1332 of the Patient Protection and Af-
3
fordable Care Act (42 U.S.C. 18052) or a State
4
program supplementing the advanced payment
5
of tax credits and cost-sharing reductions under
6
section 1412(a)(3) of such Act.
7
(8) MEDICAID PROGRAM.—The term ‘‘Medicaid
8
program’’ means a State plan for medical assistance
9
under title XIX of the Social Security Act (42
10
U.S.C. 1396 et seq.), including any waiver of such
11
a plan.
12
(9) MINIMUM
ESSENTIAL
COVERAGE.—The
13
term ‘‘minimum essential coverage’’ has the meaning
14
given such term in section 5000A(f) of the Internal
15
Revenue Code of 1986.
16
(10) MODIFIED
ADJUSTED
GROSS
INCOME.—
17
The term ‘‘modified adjusted gross income’’ has the
18
meaning given such term in section 36B(d)(2)(B) of
19
the Internal Revenue Code of 1986.
20
(11) NET
PREMIUM.—The term ‘‘net pre-
21
mium’’, with respect to a health plan or other form
22
of minimum essential coverage—
23
(A) except as provided in subparagraph
24
(B), means the payment from or on behalf of
25
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•HR 1113 IH
an individual required to enroll in such plan or
1
coverage, after application of the premium tax
2
credit under section 36B of the Internal Rev-
3
enue Code of 1986, the advance payment of
4
such credit under section 1412(a)(3) of the Pa-
5
tient Protection and Affordable Care Act (42
6
U.S.C. 18082(a)(3)), and any other assistance
7
provided by an insurance affordability program;
8
and
9
(B) does not include any amounts de-
10
scribed in section 36B(b)(3)(D) of the Internal
11
Revenue Code of 1986 or section 1303(b)(2) of
12
the Patient Protection and Affordable Care Act
13
(42 U.S.C. 18023(b)(2)).
14
(12) POVERTY LINE.—The term ‘‘poverty line’’
15
has the meaning given such term in section
16
36B(d)(3) of the Internal Revenue Code of 1986.
17
(13) QUALIFIED
HEALTH
PLAN.—The term
18
‘‘qualified health plan’’ has the meaning given such
19
term in section 1301(a) of the Patient Protection
20
and Affordable Care Act (42 U.S.C. 18021(a)).
21
(14) RELEVANT RETURN INFORMATION.—The
22
term ‘‘relevant return information’’ means, with re-
23
spect to a taxpayer, any return information, as de-
24
fined in section 6103(b)(2) of the Internal Revenue
25
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•HR 1113 IH
Code of 1986, which may be relevant, as determined
1
by the Secretary of the Treasury in consultation
2
with the Secretary of Health and Human Services,
3
with respect to—
4
(A) determining, or facilitating determina-
5
tion of, the eligibility of any household member
6
of the taxpayer for any insurance affordability
7
program, either directly or through enabling ac-
8
cess to additional information potentially rel-
9
evant to such eligibility; or
10
(B) enrolling, or facilitating the enrollment
11
of, such individual in minimum essential cov-
12
erage.
13
(15) SINGLE, STREAMLINED
APPLICATION.—
14
The term ‘‘single, streamlined application’’ means
15
the form described in section 1413(b)(1)(A) of the
16
Patient Protection and Affordable Care Act (42
17
U.S.C. 18083(b)(1)(A)).
18
(16) TAX RETURN PREPARER.—The term ‘‘tax
19
return preparer’’ has the meaning given such term
20
in section 7701(a)(36) of the Internal Revenue Code
21
of 1986.
22
(17) ZERO NET PREMIUM.—The term ‘‘zero net
23
premium’’, with respect to a health plan or other
24
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•HR 1113 IH
form of minimum essential coverage, means a net
1
premium of $0.00 for such plan or coverage.
2
SEC. 3. FEDERAL INCOME TAX RETURNS USED TO FACILI-
3
TATE ENROLLMENT INTO INSURANCE AF-
4
FORDABILITY PROGRAMS.
5
(a) IN GENERAL.—Not later than January 1, 2026,
6
the Secretary shall establish a program which allows any
7
taxpayer who is not covered under minimum essential cov-
8
erage at the time their return of tax for the taxable year
9
is filed, as well as any other household member who is
10
not covered under such coverage, to, in conjunction with
11
the filing of their return of tax for any taxable year which
12
begins after December 31, 2024, elect to—
13
(1) have a determination made as to whether
14
the household member who is not covered under
15
such coverage is eligible for an insurance afford-
16
ability program; and
17
(2) have such household member enrolled into
18
minimum essential coverage, provided that—
19
(A) such coverage is provided through a
20
zero-net-premium plan, and
21
(B) the taxpayer does not—
22
(i) opt out of coverage through the
23
zero-net-premium plan, or
24
(ii) select a different plan.
25
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•HR 1113 IH
(b) TAXPAYER REQUIREMENTS AND CONSENT.—
1
(1) IN GENERAL.—Pursuant to the program es-
2
tablished under subsection (a), the taxpayer may, in
3
conjunction with the filing of their return of tax for
4
the taxable year—
5
(A) identify any household member who is
6
not covered under minimum essential coverage
7
at the time of such filing; and
8
(B) with respect to each household member
9
identified under subparagraph (A), elect wheth-
10
er to—
11
(i)
in
accordance
with
section
12
6103(l)(23) of the Internal Revenue Code
13
of 1986 (as added by subsection (f)), con-
14
sent to the disclosure and transfer to the
15
applicable Exchange of any relevant return
16
information for purposes of determining
17
whether such household member may be el-
18
igible for any insurance affordability pro-
19
gram and facilitating enrollment into such
20
program and minimum essential coverage,
21
including any further disclosure and trans-
22
fer by the Exchange to any other entity as
23
is deemed necessary to accomplish such
24
purposes; and
25
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•HR 1113 IH
(ii) in the case consent is provided
1
under clause (i) with respect to such
2
household member, enroll such household
3
member in any minimum essential cov-
4
erage that is available with a zero net pre-
5
mium, if—
6
(I) the member is eligible for
7
such coverage through an insurance
8
affordability program; and
9
(II) the member does not, by the
10
end of the special enrollment period
11
described in section 4(c)(1)(A)—
12
(aa) select a different plan
13
offering minimum essential cov-
14
erage; or
15
(bb) opt out of such cov-
16
erage that is available with a zero
17
net premium.
18
(2) ESTABLISHMENT
OF
OPTIONS
FOR
TAX-
19
PAYER CONSENT AND ELECTION.—For purposes of
20
paragraph (1)(B), the Secretary, in consultation
21
with the Secretary of Health and Human Services,
22
may provide the elections under such paragraph as
23
a single election or as 2 elections.
24
(3) SUPPLEMENTAL FORM.—
25
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•HR 1113 IH
(A) IN GENERAL.—In the case of a tax-
1
payer who has consented to disclosure and
2
transfer of relevant return information pursu-
3
ant to paragraph (1)(B)(i), such taxpayer shall
4
be enrolled in the insurance affordability pro-
5
gram only if the taxpayer submits a supple-
6
mental form which is designed to collect addi-
7
tional information necessary (as determined by
8
the Secretary of Health and Human Services)
9
to establish eligibility for and enrollment in an
10
insurance affordability program, which may in-
11
clude (except as provided in subparagraph (B)),
12
with respect to each individual described in
13
paragraph (1)(A), the following:
14
(i) State of residence.
15
(ii) Date of birth.
16
(iii) Employment and the availability
17
of benefits under a group health plan at
18
the time the return of tax is filed.
19
(iv) Any changed circumstances de-
20
scribed in section 1412(b)(2) of the Pa-
21
tient Protection and Affordable Care Act;
22
(42 U.S.C. 18082(b)(2)).
23
(v) Solely for the purpose of facili-
24
tating automatic renewal of coverage and
25
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•HR 1113 IH
eligibility redeterminations under section
1
1413(c)(3)(A) of such Act (42 U.S.C.
2
18083(c)(3)(A)), authorization for the Sec-
3
retary to disclose relevant return informa-
4
tion for subsequent taxable years to insur-
5
ance affordability programs.
6
(vi) Any methods preferred by the
7
taxpayer or household member for the pur-
8
pose of being contacted by the applicable
9
Exchange or insurance affordability pro-
10
gram with respect to any eligibility deter-
11
mination for, or enrollment in, an insur-
12
ance affordability program or minimum es-
13
sential coverage, such as an email address
14
or a phone number for calls or text mes-
15
sages.
16
(vii) Information about household
17
composition that—
18
(I) may affect eligibility for an
19
insurance affordability program; and
20
(II) is not otherwise included on
21
the return of tax.
22
(viii) Such other information as the
23
Secretary, in consultation with the Sec-
24
retary of Health and Human Services, may
25
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•HR 1113 IH
require, including information requested on
1
the single, streamlined application.
2
(B) LIMITATIONS.—The information ob-
3
tained through the form described in subpara-
4
graph (A) may not include any request for in-
5
formation with respect to citizenship, immigra-
6
tion status, or health status of any household
7
member.
8
(C)
ADDITIONAL
INFORMATION.—The
9
form described in subparagraph (A) and the ac-
10
companying tax instructions may provide the
11
taxpayer with additional information about in-
12
surance affordability programs, including infor-
13
mation provided to applicants on the single,
14
streamlined application.
15
(D) ACCESSIBILITY.—
16
(i) IN GENERAL.—The Secretary shall
17
ensure that the form described in subpara-
18
graph (A) is made available to all tax-
19
payers without discrimination based on
20
language, disability, literacy, or internet
21
access.
22
(ii) RULE OF CONSTRUCTION.—Noth-
23
ing in clause (i) shall be construed as di-
24
minishing, reducing, or otherwise limiting
25
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•HR 1113 IH
any other legal obligation for the Secretary
1
to avoid or to prevent discrimination.
2
(4) RETURN
LANGUAGE.—The Secretary, in
3
consultation with the Secretary of Health and
4
Human Services, shall, with respect to any items de-
5
scribed in this subsection which are to b
[Text truncated for display. Full text available on Congress.gov.]