,,ii #aadth ,,congress #ast ,session ,s4 #acfh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ai1 #bjae,mr4 ,roberts 7for himself and ,mr4 ,portman7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to establish the ,office of the ,special ,inspector ,general for ,monitoring the ,affordable ,care ,act1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,special ,inspector ,general for ,monitoring the ,,aca ,act of #bjae or the ,,sigma ,act of #bjae4 #b4 ,findings ,the ,congress finds the following3 7#a7 ,the writing1 passage1 and implementation of the ,affordable ,care ,act has utterly lacked transparency4 7#b7 ,presidential candidate ,barack ,obama repeatedly promised that if elected ,president1 he would hold open1 public negotiations on health care reform among public and private stakeholders1 including at a ,democratic ,presidential debate on ,january #ca1 #bjjh1 when he said1 ,that's what ,i will do in bringing all parties together1 not negotiating behind closed doors1 but bringing all parties together1 and broadcasting those negotiations on ,c-,,span so that the ,american people can see what the choices are1 because part of what we have to do is enlist the ,american people in this process44 7#c7 ,then-,senator ,obama repeated this promise multiple times1 including at an ,ohio town hall on ,march #a1 #bjjh1 when he said1 ,but here's the thing3 we're gonna do all these negotiations on ,c-,,span4 ,so the ,american people will be able to watch these negotiations44 7#d7 ,then-,senator ,obama also repeated this promise at a ,virginia town hall on ,august #ba1 #bjjh1 when he said1 ,i'm going to have all the negotiations around a big table4 ,we'll have doctors and nurses and hospital administrators4 ,insurance companies1 drug companies--they'll get a seat at the table ''' ,but what we will do is1 we'll have the negotiations televised on ,c-,,span1 so that people can see who is making arguments on behalf of their constituents1 and who are making arguments on behalf of the drug companies or the insurance companies4 ,and so1 that approach1 ,i think is what is going to allow people to stay involved in this process44 7#e7 ,in a ,september #bf1 #bjaa1 interview1 ,brian ,lamb1 the ,,ceo of ,c-,,span confirmed the negotiations of the health reform law had not been broadcast publicly1 noting1 ,the ,president said that they were all going to be on ,c-,,span4 ,he never asked us44 7#f7 ,president ,obama1 in leading the national health reform debate1 broke his promise1 admitting in a ,january #be1 #bjaj1 interview with ,,abc ,news that locking the public out of key health reform discussions was a mistake and explaining1 ,we had to make so many decisions quickly in a very difficult set of circumstances that after awhile1 we started worrying more about getting the policy right than getting the process right4 ,but ,i had campaigned on process--part of what ,i had campaigned on was changing how ,washington works1 opening up1 transparency and ,i think it is--,i think the health care debate as it unfolded legitimately raised concerns not just among my opponents1 but also amongst supporters that we just don't know what's going on4 ,and it's an ugly process and it looks like there are a bunch of backroom deals44 7#g7 ,on ,march #i1 #bjaj1 then-,speaker of the ,house ,nancy ,pelosi said of what would become the ,affordable ,care ,act1 ,we have to pass the bill so that you can find out what is in it44 7#h7 ,dr4 ,jonathan ,gruber1 a professor of economics at the ,massachusetts ,institute of ,technology1 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 policies4 7#i7 ,dr4 ,gruber described himself as a health reform architect who contributed to the crafting of the ,affordable ,care ,act in a #bjab opinion editorial1 noting1 ,several of the architects of ,massachusetts reform1 including myself1 worked closely with the ,administration and ,congress to translate the lessons from ,massachusetts onto the national stage44 7#aj7 ,dr4 ,gruber's ,,mit biography has described him as a key architect of the ,massachusetts health reform effort and a #bjji and #bjaj technical consultant who worked with both the ,administration and ,congress to help craft the ,patient ,protection and ,affordable ,care ,act44 7#aa7 ,an ,october #aa1 #bjaa1 report by ,,nbc ,news described ,white ,house visitor logs that show ,dr4 ,gruber had at least five meetings at the ,white ,house in #bjji in the lead up to the passage of the ,affordable ,care ,act1 including a meeting in the ,oval ,office with ,president ,obama to evaluate options for national health reform4 7#ab7 ,in a video posted ,april #ab1 #bjab1 by the ,obama ,presidential campaign to ,you,tube1 ,dr4 ,gruber states that he went down to ,washington to help ,president ,obama develop his national version of that law44 7#ac7 ,a ,march #bh1 #bjab1 article in the ,new ,york ,times reports that ,after ,mr4 ,gruber helped the administration put together the basic principles of the proposal1 the ,white ,house lent him to ,capitol ,hill to help congressional staff members draft the specifics of the legislation44 7#ad7 ,in a ,january #ah1 #bjab1 lecture on the structure of the ,affordable ,care ,act1 ,dr4 ,gruber refers to the law's small business tax credits as a portion of the bill that he actually wrote44 7#ae7 ,dr4 ,gruber's initial contract with the ,department of ,health and ,human ,services 7,,hhs7 was for #big1jjj1 and later a ,federal grant of #ie1jjj brought his total ,federal compensation for work on the ,affordable ,care ,act to at least #cib1jjj4 7#af7 ,in #bjji1 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 #agb1bjj1 including the ,white ,house ,chief of ,staff1 senior advisers1 ,white ,house ,counsel1 and ,national ,security ,adviser4 7#ag7 ,in #bjaj1 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 #agb1bjj1 again including the ,president's top management1 policy1 communications1 and security advisers4 7#ah7 ,in #bjji and #bjaj1 each of ,president ,obama's most senior ,white ,house staff received less compensation than ,dr4 ,gruber4 7#ai7 ,in a ,november #e1 #bjab1 speech at the ,university of ,rhode ,island1 ,dr4 ,gruber described the mechanism of the ,affordable ,care ,act1 stating1 ,it's a very clever1 you know1 basic exploitation of the lack of economic understanding of the ,american voter44 7#bj7 ,at an ,october #ag1 #bjac1 panel at the ,university of ,pennsylvania1 ,dr4 ,gruber described the ,affordable ,care ,act1 stating1 ,this bill was written in a tortured way to make sure ,,cbo did not score the mandate as taxes4 ,if ,,cbo scored the mandate as taxes1 the bill dies4 ,okay1 so it's written to do that44 7#ba7 ,in the same speech1 ,dr4 ,gruber stated that1 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 money1 it would not have passed44 7#bb7 ,dr4 ,gruber went on to claim1 ,lack of transparency is a huge political advantage4 ,and basically1 call it the stupidity of the ,american voter or whatever1 but basically that was really1 really critical for the thing to pass44 7#bc7 ,since the passage of the ,affordable ,care ,act1 ,president ,obama called for a new1 more transparent approach to the health reform law moving forward1 saying in a ,january #be1 #bjaj1 ,,abc ,news interview1 ,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 more44 7#bd7 ,the ,obama ,administration's implementation of the ,affordable ,care ,act has been marked by ,executive overreach4 7#be7 ,on at least #bh occasions1 ,president ,obama and his administration have unilaterally delayed1 extended1 or changed provisions of the ,affordable ,care ,act1 including in contravention of the law and the ,constitution of the ,united ,states4 7#bf7 ,section #aeac of the ,patient ,protection and ,affordable ,care ,act 7#bf ,u4,s4,c4 #dihj;h note7 requires applicable large employers with more than #ej full-time employees to provide qualifying health insurance to their employees or pay a fine1 and the effective date under such section specified the amendments made by such section applied to months beginning after ,december #ca1 #bjac4 7#bg7 ,contrary to the plain meaning of the statutory requirement1 and acting without authority provided by law1 the ,internal ,revenue ,service published in the ,federal ,register ,notice #bjac-de to change the effective date of the employer mandate requirement1 stating1 ,section #aeac7;d7 of the ,affordable ,care ,act provides that section #dihj;,h applies to months after ,december #ca1 #bjac2 however ,notice #bjac-de1 issued on ,july #i1 #bjac1 provides as transition relief that no assessable payments under section #dihj;,h will apply for #bjad44 7#bh7 ,on ,july #ab1 #bjac1 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 territories1 writing to the ,secretary of ,commerce for the ,commonwealth of the ,northern ,mariana ,islands1 ,however meritorious your request might be1 the ,department of ,health and ,human ,services is not authorized to choose which provisions of the ,affordable ,care ,act ''' might apply to the territories44 7#bi7 ,a year later1 on ,july #af1 #bjad1 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 ,act1 despite the previous explanation from ,,cms that ,,cms does not have the legal authority to provide such an exemption4 ,as the ,,cms ,administrator now rationalized1 ,currently1 the ,department uses the existing ,public ,health ,service ,act 7,,phs ,act7 definition of ,state for new ,,phs ,act requirements and funding opportunities included in title ,i of the ,affordable ,care ,act4 ,under this definition1 the new market reforms in the ,,phs ,act apply to the territories4 ,we have been informed by representatives of the territories that this interpretation is undermining the stability of the territories' health insurance markets4 ,after a careful review of this situation and the relevant statutory language1 ,,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 title1 and therefore that these new provisions do not apply to the territories44 7#cj7 ,the ,obama ,administration has claimed that the ,affordable ,care ,act will save money and improve the economy1 with ,white,house4gov stating1 ,in keeping with the ,president's pledge that reform must fix our health care system without adding to the deficit1 the ,affordable ,care ,act reduces the deficit1 saving over #bjj billion over #aj years and more than #a trillion in the second decade4 ,the law reduces health care costs ''' and is improving our economic competitiveness44 7#ca7 #gj4b billion of the ,white ,house's estimated savings was to come from the ,community ,living ,assistance ,services and ,supports 7,,class7 ,act provisions of the ,affordable ,care ,act1 a program that was deemed actuarially unsound and never implemented by the ,obama ,administration4 7#cb7 ,an ,april #bjaj 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 hospitals1 skilled nursing facilities1 and home health centers4 ,these cuts have been delayed and may never materialize4 ,even if implemented1 the projected savings may never accrue as the ,,cms ,actuary's report concludes that such cuts will cause about #ae percent of hospitals and post-acute care facilities like nursing homes to go out of business4 7#cc7 #eb 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 insurance1 a requirement that the ,obama ,administration has repeatedly delayed and modified1 causing penalties and associated savings to not accrue4 7#cd7 ,initial estimates of savings under the ,affordable ,care ,act projected at least #ae4e billion in savings over the next decade attributable to ,medicare cuts through the ,independent ,payment ,advisory ,board1 which has not yet been appointed and through which no cuts or savings have been realized4 7#ce7 ,on ,september #i1 #bjji1 ,president ,obama pledged to a joint session of ,congress1 ,i will not sign a health care reform plan that adds one dime to our deficits--either now or in the future44 7#cf7 ,the ,congressional ,budget ,office estimated in ,february #bjad that health insurance subsidies under the ,affordable ,care ,act would cost the ,federal ,government #dg billion in fiscal year #bjae and #a4aig trillion over fiscal years #bjae-bjbd4 7#cg7 ,the ,committees on ,finance and ,health1 ,education1 ,labor1 and ,pensions of the ,senate estimated in ,september #bjad that the ,affordable ,care ,act will add at least #cdj billion to ,federal budget deficits4 7#ch7 ,dr4 ,gruber stated1 ,the ,affordable ,care ,act isn't designed to save money44 7#ci7 ,on at least #cg occasions1 ,president ,obama or a top official in the executive branch repeated the promise that ,if you like the health insurance plan you have1 you can keep it4 ,if you like the doctor you have1 you can keep your doctor44 7#dj7 ,the ,associated ,press calculated at least #d4g million ,americans had their health insurance cancelled for #bjad and later1 when the ,president issued a last-minute fix to try to prevent these cancellations as required by the ,affordable ,care ,act1 the changes came too late for approximately #b4d million ,americans to keep the plans they had and liked4 7#da7 ,the nonpartisan1 fact-checking publication ,politifact rated ,if you like your health care plan1 you can keep it4 as the ,lie of the ,year for #bjac4 7#db7 ,then-,presidential candidate ,barack ,obama repeatedly promised that1 if elected ,president1 his national health care reforms would1 cut the cost of a typical family's premium by up to #b1ejj a year44 7#dc7 ,a ,november #bjac analysis by the ,manhattan ,institute calculates that the ,affordable ,care ,act would increase individual marketplace health insurance premiums by #da percent nationwide between #bjac and #bjad4 7#dd7 ,a ,december #bjac study by ,health ,pocket1 ,inc41 found that the average individual deductible for a ,bronze plan was #e1jha a year1 a #db-percent increase from the average plan purchased by an individual in #bjac4 7#de7 ,a ,february #bjac study by ,health ,pocket ,inc41 found that exchange plans under the ,affordable ,care ,act averaged a #cd-percent increase in drug-cost sharing compared to copayment and coinsurance rates in the pre-,affordable ,care ,act market4 ,for the sickest patients needing specialty drugs1 the study found copayments increased by #bbf percent under a ,bronze plan via the ,affordable ,care ,act4 7#df7 ,a ,december #bjac study by ,mc,kinsey and ,company found that insurers offered almost three times as many narrow or ultranarrow network plans in #bjad compared to #bjac4 ,fully #gj percent of ,affordable ,care ,act plans analyzed had narrow or ultranarrow network coverage1 meaning coverage for fewer doctors and hospitals than plans sold on the individual market before the law took effect4 7#dg7 ,details consumers require to make informed decisions about their health care plan coverage under the ,affordable ,care ,act have been withheld or lacked transparency4 7#dh7 ,on ,september #bf1 #bjac1 ,president ,obama said1 ,it will say clearly what each plan covers1 what each plan costs4 ,the price will be right there4 ,it will be fully transparent ''' ,and so if you've ever tried to buy insurance on your own1 ,i promise you this is a lot easier4 ,it's like booking a hotel or a plane ticket44 7#di7 ,health,care4gov was established as the website to implement the ,federal exchange portion of the ,act at a cost of as much as #hdj million1 including more than #aej million in cost overruns1 according to the ,government ,accountability ,office in ,march #bjad4 7#ej7 ,on ,october #a1 #bjac1 ,health,care4gov launched without adequate security testing1 leaving the approximately #bej1jjj unique users it drew not only vulnerable to identity theft by hackers1 but unable to even use the site1 as the website was demonstrably unable to handle even #a1ajj simultaneous users4 7#ea7 ,for the subsequent months after its launch1 ,health,care4gov continued to be plagued by crippling malfunctions1 and the dismal performance of the website led only to problems and frustration for millions of ,americans4 7#eb7 ,a ,june #bjac study by the ,department of ,health and ,human ,services' ,office of ,inspector ,general revealed that software designed by a principal ,health,care4gov vendor was highly insecure and put the information of more than #f million ,medicare beneficiaries at greater risk from malware1 inappropriate access or theft4 7#ec7 ,an ,april #bjad study by ,avalere ,health determined that #ch percent of health insurance plans offered on the exchanges under the ,affordable ,care ,act had no information about drug coverage available4 ,avalere also found that nearly #a in #d plans offered insufficient information on which doctors and hospitals are covered4 7#ed7 ,in ,september #bjad1 the ,administrator of the ,centers for ,medicare and ,medicaid ,services reported to ,congress that #g4c million ,americans had enrolled in plans through exchanges under the ,affordable ,care ,act1 meeting enrollment targets estimated by the ,congressional ,budget ,office and held as a goal by the ,obama ,administration4 7#ee7 ,four months later1 ,,hhs ,secretary ,burwell stated that this enrollment data was a mistake that included some #djj1jjj dental insurance enrollments1 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 had1 but would not release to the public4 7#ef7 ,since implementation of the ,,aca began1 the ,,hhs ,secretary has granted over #a billion in ,federal taxpayer dollars to ,states to help build websites for their own ,state-based exchanges1 yet development and usability issues on short timelines repeatedly caused these same ,states to seek different options for the #bjae open enrollment period1 including opting to revert to enrolling via the ,federal ,health,care4gov website4 7#eg7 ,the ,affordable ,care ,act provides opportunities for fraud within subsidy and tax credit issuance4 7#eh7 ,a ,september #bjac report by the ,treasury ,inspector ,general for ,tax ,administration concluded that1 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 refunds44 7#ei7 ,a ,july #bjad 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 #aa out of #ab cases4 7#fj7 ,the ,affordable ,care ,act has had a negative impact on the ,american economy4 7#fa7 ,a ,february #bjad calculation by the ,congressional ,budget ,office found the ,affordable ,care ,act will significantly harm the ,american economy1 reducing the number of hours worked by millions of full-time employees worth of hours4 ,the ,,cbo study noted1 ,the reduction in ,,cbo's projections of hours worked represents a decline in the number of full-time-equivalent workers of about #b million in #bjag1 rising to about #b4e million in #bjbd44 7#fb7 ,history has shown the ,special ,inspector ,general model to be successful at saving taxpayer dollars and rooting our waste1 fraud1 and abuse in large ,federal ,government programs4 7#fc7 ,congress and the ,president have enacted legislation creating ,special ,inspectors ,general on three occasions1 including to oversee ,federal spending and policy implementation for ,afghanistan reconstruction 7,,sigar71 ,iraq reconstruction 7,,sigir71 and the ,troubled ,asset ,relief ,program 7,,sigtarp74 7#fd7 ,,sigar1 ,,sigir1 and ,,sigtarp have successfully conducted audits and investigations saving the ,federal ,government billions in waste1 fraud1 and abuse1 and have helped to identify and prosecute theft and corruption4 7#fe7 ,as of an ,october #bjad report1 ,,sigar has produced #eg referrals for suspension and debarment of ,federal contractors and employees and produced over #ejj million in direct taxpayer savings4 7#ff7 ,according to its final report1 ,,sigir cost #bde million to operate1 but resulted in #fde million in direct savings to the ,federal ,government1 in addition to producing #aib million in seizures and court-ordered penalties1 as well as #ij criminal convictions4 7#fg7 ,as of an ,october #bjad report1 ,,sigtarp has produced #adf convictions and #g4ch billion in fines1 penalties1 and restitution to the ,government and victims4 7#fh7 ,on ,august #e1 #bjad1 the ,associated ,press reported that #dg ,federal inspectors general sent an unprecedented joint letter to ,congress to decry1 ,obama administration efforts to delay or stall their investigations1 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 law4 7#fi7 ,the letter from more than half of the ,federal ,government's independent inspectors general correctly states1 ,section #f7;a77#a7 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 activities4 ,the constricted interpretations of ,section #f7;a77#a7 by these and other agencies conflict with the actual language and ,congressional intent4 ,the ,,ig ,act is clear3 no law restricting access to records applies to ,inspectors ,general unless that law expressly so states1 and that unrestricted access extends to all records available to the agency1 regardless of location or form44 7#gj7 ,congress has a responsibility to exercise prudent stewardship of public dollars1 to ensure that laws are well and faithfully executed by the executive branch1 to provide for efficacious services for the ,american people1 and to ensure that those who cheat1 steal from1 or defraud the ,federal ,government are held to account4 #c4 ,special ,inspector ,general for ,monitoring the ,affordable ,care ,act 7a7 ,office of ,special ,inspector ,general ,there is hereby established the ,office of the ,special ,inspector ,general for ,monitoring the ,affordable ,care ,act 7in this section1 referred to as the ,office7 to carry out the duties described under subsection 7e74 7b7 ,appointment of ,inspector ,general2 removal 7#a7 ,appointment ,the head of the ,office is the ,special ,inspector ,general for ,monitoring the ,affordable ,care ,act 7in this section referred to as the ,special ,inspector ,general71 who shall be appointed by the ,president1 by and with the advice and consent of the ,senate4 7#b7 ,qualifications ,the appointment of the ,special ,inspector ,general shall be made solely on the basis of integrity and demonstrated ability in accounting1 auditing1 financial analysis1 law1 management analysis1 health care expertise and financing1 public administration1 or investigations4 7#c7 ,deadline for appointment ,the appointment of an individual as the ,special ,inspector ,general shall be made not later than #cj days after the date of the enactment of this ,act4 7#d7 ,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 #ecae of title #e1 ,united ,states ,code4 7#e7 ,prohibition on political activities ,for purposes of section #gcbd of title #e1 ,united ,states ,code1 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 law4 7#f7 ,removal ,the ,special ,inspector ,general shall be removable from office in accordance with the provisions of section #c7;b7 of the ,inspector ,general ,act of #aigh 7#e ,u4,s4,c4 ,app474 7c7 ,assistant ,inspectors ,general ,the ,special ,inspector ,general shall1 in accordance with applicable laws and regulations governing the civil service-- 7#a7 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 7e72 and 7#b7 appoint an ,assistant ,inspector ,general for ,investigations who shall have the responsibility for supervising the performance of investigative activities relating to such duties4 7d7 ,supervision 7#a7 ,in general ,except as provided under paragraph 7#b71 the ,special ,inspector ,general shall report directly to1 and be under the general supervision of1 the ,secretary of ,health and ,human ,services4 7#b7 ,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 initiating1 carrying out1 or completing any audit or investigation related to the duties described under subsection 7e7 or from issuing any subpoena during the course of any such audit or investigation3 7,a7 ,the ,executive ,office of the ,president and the ,office of ,personnel ,management4 7,b7 ,the ,department of ,health and ,human ,services4 7,c7 ,the ,department of the ,treasury4 7,d7 ,the ,social ,security ,administration1 the ,department of ,homeland ,security1 the ,department of ,veterans ,affairs1 the ,department of ,defense1 the ,department of ,labor1 and the ,peace ,corps4 7,e7 ,any other ,federal agency involved in implementing or administering the ,affordable ,care ,act4 7e7 ,duties 7#a7 ,oversight of the implementation and administration of the affordable care act ,it shall be the duty of the ,special ,inspector ,general to conduct1 supervise1 and coordinate audits and investigations of the implementation and administration of programs and activities established under1 and payment system changes made by1 the ,affordable ,care ,act1 including by collecting and summarizing the following3 7,a7 ,a description of the individual mandate requirement for applicable individuals to maintain minimum essential coverage or pay a penalty under section #ejjj;,a of the ,internal ,revenue ,code of #aihf1 including a description of the number of individuals maintaining such coverage and the number of individuals paying such penalties4 7,b7 ,a description of any increases or decreases in-- 7i7 premiums for qualified health plans 7as defined in section #acja of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba772 7ii7 deductibles under qualified health plans2 and 7iii7 cost-sharing under qualified health plans1 including by copayments and coinsurance1 affecting individuals enrolling in coverage under such plans through an exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act 7including a ,state-run exchange1 a federally administered exchange1 and a ,small ,business ,health ,options ,program74 7,c7 ,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 exchange1 a federally administered exchange1 and a ,small ,business ,health ,options ,program4 7,d7 ,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 exchange1 a federally administered exchange1 and a ,small ,business ,health ,options ,program4 7,e7 ,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 7as defined in section #abea7;e7 of such ,act 7#db ,u4,s4,c4 #ahjaa7;e7774 7,f7 ,a description of any credits under section #cf;,b of the ,internal ,revenue ,code of #aihf 7and the amount 7if any7 of the advance payment of the credit under section #adab of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhb77 and any cost-sharing reduction under section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 7and the amount 7if any7 of the advance payment of the reduction under section #adab of such ,act 7#db ,u4,s4,c4 #ahjhb77 provided to individuals enrolling under qualified health plans through an exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act4 7,g7 ,a description of any projections1 estimates1 analysis1 goals1 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 ,act4 7,h7 ,a description of the employer mandate requirement that applicable large employers provide eligible employees with minimum essential coverage or pay a fine under section #dihj;,h of the ,internal ,revenue ,code of #aihf1 including a description of the type and number of employers providing such coverage and the type and number of employers paying such fines4 7,i7 ,a description of any projections1 estimates1 analyses1 goals1 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 employees4 7,j7 ,a description of any reports1 meetings1 discussions1 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 7,h74 7,k7 ,a description of any reports1 meetings1 discussions1 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 #ej 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 7,h74 7,l7 ,a description of any reports1 meetings1 discussions1 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 employees1 or employees' spouses or dependents1 for the purposes of avoiding the requirement to provide minimum essential coverage or pay a fine under the employer mandate requirement described in subparagraph 7,h74 7,m7 ,a description of the transitional reinsurance program established under section #acda of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjfa71 including a description of reinsurance contributions collected or required to be collected under such program1 a description of any reinsurance payments made or required to be made to health insurance issuers under such program1 a description of the health insurance coverage and related costs for high-cost individuals for plans related to such program1 an explanation of the impact of such reinsurance program on adverse selection in the marketplace1 and an explanation of any premium-stabilizing effects of such program4 7,n7 ,a description of the temporary risk corridors for qualified health plans established under section #acdb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjfb71 including a description of participating plans and the allowable costs and target amounts of such plans1 a description of risk corridor ratios of such plans1 and a description of payment adjustments made under such program4 7,o7 ,a description of the permanent risk adjustment program established under section #acdc of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjfc71 including a description of any plans participating in such program1 a description of any risk adjustment payments made or required to be made under such program1 a description of the health insurance coverage and related costs for high-cost individuals for plans related to such program1 an explanation of the impact of such program on adverse selection in the marketplace1 and an explanation of any premium-stabilizing effects of such program4 7,p7 ,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 ,act4 7,q7 ,a description of the development of the health insurance marketplace for the ,internet portal established under section #aajc of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjjc71 including a description of the design1 features1 and security systems of such web portal and a description of all costs associated with such development4 7,r7 ,a description of any threats1 risks1 problems1 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 #a1 #bjac4 7,s7 ,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 threats1 risks1 problems1 or functionality issues4 7,t7 ,a description of the systems 7on the ,federal and ,state levels7 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 ,act1 including that data verification and validation can occur with respect to information provided or stored by individuals1 the ,department of ,health and ,human ,services1 the qualified health plans1 ,states1 and other applicable ,federal agencies1 including for purposes of credits under section #cf;,b of the ,internal ,revenue ,code of #aihf 7and the amount 7if any7 of the advance payment of the credit under section #adab of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhb77 and any cost-sharing reduction under section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 7and the amount 7if any7 of the advance payment of the reduction under section #adab of such ,act 7#db ,u4,s4,c4 #ahjhb774 7,u7 ,a description of the development of the ,federal ,data ,services ,hub1 including its design1 features1 and security systems1 and a description of the type of data accessed through such data hub1 and a description of the actual storage location of such data accessed through such data hub4 7,v7 ,a list of the duties and responsibilities assigned to the ,internal ,revenue ,service as a result of the enactment of the ,affordable ,care ,act1 a description of any plans of the ,internal ,revenue ,service for how to carry out such duties1 and an explanation of the resources and personnel required to carry out such duties1 including a description of any new resources or personnel required to carry out such duties not already available to the ,internal ,revenue ,service4 7,w7 ,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 #cf;,b of the ,internal ,revenue ,code of #aihf 7and the amount 7if any7 of the advance payment of the credit under section #adab of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhb77 and any cost-sharing reduction under section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 7and the amount 7if any7 of the advance payment of the reduction under section #adab of such ,act 7#db ,u4,s4,c4 #ahjhb771 including a description of any such verification completed and a description of any such individuals determined to be ineligible4 7,x7 ,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 ineligible1 including a description of any such calculations completed4 7,y7 ,a description of any plans by the ,internal ,revenue ,service to notify individuals determined to be ineligible for such credits or reductions1 including a description of such notifications completed4 7,z7 ,a description of any plans by the ,internal ,revenue ,service to recapture such overpayments of such credits and reductions for individuals determined to be ineligible1 including a description of such recapturing completed4 7,,aa7 ,a description of the impact of the ,affordable ,care ,act on the right of conscience1 including on-- 7i7 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 contraceptives2 7ii7 individuals2 and 7iii7 medical professionals4 7,,bb7 ,a description of abortion coverage offered under qualified health plans purchased through ,state-run exchanges1 federally administered exchanges1 and ,small ,business ,health ,options ,programs1 including costs associated with such coverage4 7,,cc7 ,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 ,act1 including an explanation from the head of such ,department or ,agency of the specific authority used to implement such a modification or delay4 7,,dd7 ,a description of the ,independent ,payment ,advisory ,board under section #ahii;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #aciekkk7 and any actions taken to alter or reduce the use of medical products1 treatments or procedures1 including an explanation from the ,independent ,payment ,advisory ,board of the reasons for taking such actions1 whether such actions could be expected to result in worsened medical outcomes for individuals affected by such alterations or reductions1 and an explanation of the medical information used to determine whether such alterations or reductions could be expected to result in such worsened outcomes4 7,,ee7 ,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 ,act1 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 individuals4 7,,ff7 ,any additional topic related to the implementation and administration of the ,affordable ,care ,act1 the inclusion of which helps to provide the public a full and objective accounting of such law4 7#b7 ,data to be included ,in carrying out the duties described under paragraph 7#a71 the ,special ,inspector ,general shall1 to the greatest extent possible1 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 ,act4 7#c7 ,other duties related to oversight ,the ,special ,inspector ,general shall establish1 maintain1 and oversee such systems1 procedures1 and controls as the ,special ,inspector ,general considers appropriate to discharge the duties described under paragraph 7#a74 7#d7 ,duties and responsibilities under the ,inspector ,general ,act of #aigh ,in addition to the duties described under paragraphs 7#a7 and 7#b71 the ,special ,inspector ,general shall also have the duties and responsibilities of inspectors general under the ,inspector ,general ,act of #aigh 7#e ,u4,s4,c4 ,app474 7f7 ,coordination of efforts ,in carrying out the duties1 responsibilities1 and authorities of the ,special ,inspector ,general under this section1 the ,special ,inspector ,general shall coordinate with1 and receive the cooperation of each of the following3 7#a7 ,the ,inspector ,general of the ,department of ,health and ,human ,services4 7#b7 ,the ,inspector ,general of the ,department of the ,treasury4 7#c7 ,the ,inspectors ,general of the ,social ,security ,administration1 the ,department of ,homeland ,security1 the ,department of ,veterans ,affairs1 the ,department of ,defense1 the ,department of ,labor1 and the ,peace ,corps4 7#d7 ,the inspector general of any other ,federal entity1 as determined by the ,special ,inspector ,general4 7g7 ,powers and authorities 7#a7 ,authority to access materials1 request information1 compel response1 and other authorities under the ,inspector ,general ,act of #aigh ,in carrying out the duties described under subsection 7e71 the ,special ,inspector ,general shall have all of the authorities provided under section #f of the ,inspector ,general ,act of #aigh 7#e ,u4,s4,c4 ,app474 7#b7 ,exemption from requirement for initial determination by ,attorney ,general ,for purposes of section #f7;e7 of the ,inspector ,general ,act of #aigh 7#e ,u4,s4,c4 ,app471 the ,special ,inspector ,general shall be considered exempt from the requirement of an initial determination of eligibility by the ,attorney ,general under paragraph 7#b7 of such section4 7#c7 ,audit standards ,the ,special ,inspector ,general shall carry out the duties specified under subsection 7e77#a7 in accordance with section #d7;b77#a7 of the ,inspector ,general ,act of #aigh 7#e ,u4,s4,c4 ,app474 7h7 ,personnel1 facilities1 and other resources 7#a7 ,personnel ,the ,special ,inspector ,general may select1 appoint1 and employ such officers and employees as may be necessary for carrying out the duties of the ,special ,inspector ,general1 subject to the provisions of title #e1 ,united ,states ,code1 governing appointments in the competitive service1 and the provisions of chapter #ea and subchapter ,,iii of chapter #ec of such title1 relating to classification and ,general ,schedule pay rates4 7#b7 ,employment of experts and consultants ,the ,special ,inspector ,general may obtain services as authorized by section #caji of title #e1 ,united ,states ,code1 at daily rates not to exceed the equivalent rate prescribed for grade ,,gs-#ae of the ,general ,schedule by section #eccb of such title4 7#c7 ,contracting authority ,to the extent and in such amounts as may be provided in advance by appropriations ,acts1 the ,special ,inspector ,general may enter into contracts and other arrangements for audits1 studies1 analyses1 and other services with public agencies and with private persons1 and make such payments as may be necessary to carry out the duties of the ,special ,inspector ,general4 7#d7 ,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 equipment1 office supplies1 and communications facilities and services as may be necessary for the operation of such offices1 and shall provide necessary maintenance services for such offices and the equipment and facilities located therein4 7#e7 ,assistance from ,federal agencies 7,a7 ,in general ,upon request of the ,special ,inspector ,general for information or assistance from any ,department1 ,agency1 or other entity of the ,federal ,government 7including any entity listed under subsection 7d77#b771 the head of such entity shall1 insofar as is practicable and not in contravention of any existing law1 furnish such information or assistance to the ,special ,inspector ,general1 or an authorized designee4 7,b7 ,reporting of refused assistance 7i7 ,reporting to ,health and ,human ,services and ,congress ,in accordance with clause 7ii71 as the case may be1 whenever information or assistance requested by the ,special ,inspector ,general is1 in the judgment of the ,special ,inspector ,general1 unreasonably refused or not provided1 the ,special ,inspector ,general shall report the circumstances to the ,secretary of ,health and ,human ,services and to the appropriate congressional committees without delay4 7ii7 ,reporting to the public on refusal or noncooperation in transparency ,whenever any information described in clause 7i7 is requested by the ,special ,inspector ,general and unreasonably refused or not provided1 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 delay4 7#f7 ,use of personnel1 facilities1 and other resources of the ,office ,upon the request of the ,special ,inspector ,general1 an ,inspector ,general-- 7,a7 may detail1 on a reimbursable basis1 to the ,office any of the personnel of such ,inspector ,general's office for the purpose of carrying out this section2 and 7,b7 may provide1 on a reimbursable basis1 any of the facilities or other resources of the ,office for the purpose of carrying out this section4 7i7 ,reports 7#a7 ,initial report ,not later than #ij days after the date of the enactment of this ,act1 the ,special ,inspector ,general shall submit to the appropriate congressional committees and the ,secretary of ,health and ,human ,services a report summarizing1 for the period beginning on the date of the enactment of the ,health ,care and ,education ,reconciliation ,act of #bjaj and ending on the completion of a fiscal year quarter after the date of enactment of this ,act1 the activities during such period of the ,special ,inspector ,general required under subsection 7e74 7#b7 ,quarterly reports ,beginning with the first full fiscal year quarter after the date of the enactment of this ,act1 not later than #cj days after the end of each fiscal year quarter1 during which the ,affordable ,care ,act is in effect1 the ,special ,inspector ,general shall submit to the appropriate congressional committees and the ,secretary of ,health and ,human ,services a report summarizing1 for the period of that quarter and1 to the extent possible1 the period from the end of such quarter to the time of the submission of the report1 the activities during such period of the ,special ,inspector ,general required under subsection 7e74 7#c7 ,comments on report ,not later than #cj days after receipt of a report under this subsection1 the ,secretary of ,health and ,human ,services shall submit to the appropriate congressional committees any comments on the matters covered by the report4 7#d7 ,public availability2 recordkeeping 7,a7 ,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 7#c74 7,b7 ,requirement to index ,except as provided in subparagraph 7,c71 the ,special ,inspector ,general shall1 to the greatest extent possible1 index and publish on the publicly available website information for each source used in each report described under this subsection1 including whenever applicable the document name1 author1 and owner4 7,c7 ,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 7,b7 that the ,special ,inspector ,general determines is-- 7i7 necessary to protect an individual that provided the information2 or 7ii7 classified4 7,d7 ,recordkeeping requirement ,all source material and information used to create a report described under this subsection1 including information excepted under subparagraph 7,c71 shall be identified1 indexed 7in a classified annex1 if necessary71 and maintained 7including any written note of exclusion7 by the ,special ,inspector ,general4 7#e7 ,protected information ,to the extent possible1 information submitted in any report required under this subsection shall be in a form that is not prohibited from disclosure under section #eeb;a of title #e1 ,united ,states ,code 7commonly known as the ,privacy ,act of #aigd74 7#f7 ,aggregated information ,the ,special ,inspector ,general shall1 to the maximum extent possible1 aggregate any personally identifiable information submitted in a report required under this subsection4 7j7 ,amendment to the ,inspector ,general ,act ,section #h;,d of the ,inspector ,general ,act 7#e ,u4,s4,c4 ,app47 is amended in subsections 7e7 and 7f7 by inserting after for ,tax ,administration1 each place it appears1 the following3 and the ,special ,inspector ,general for ,monitoring the ,affordable ,care ,act4 7k7 ,termination ,the ,office of the ,special ,inspector ,general shall terminate the earlier of-- 7#a7 ,january #a1 #bjbe2 or 7#b7 the date on which the final report required by subsection 7h7 is submitted for the last year the ,affordable ,care ,act is in effect4 7l7 ,definitions ,in this section3 7#a7 ,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 #bjaj4 7#b7 ,appropriate congressional committees ,the term appropriate congressional committees means-- 7,a7 the ,committees on ,appropriations2 the ,budget2 ,education and the ,workforce2 ,energy and ,commerce2 ,homeland ,security2 the ,judiciary2 ,oversight and ,government ,reform2 ,small ,business2 and ,ways and ,means of the ,house of ,representatives2 and 7,b7 the ,committees on ,appropriations2 the ,budget2 ,commerce1 ,science1 and ,transportation2 ,finance2 ,health1 ,education1 ,labor1 and ,pensions2 ,homeland ,security and ,governmental ,affairs2 the ,judiciary2 and ,small ,business and ,entrepreneurship of the ,senate4