,,ii  #aad? ,,congress  #a/ ,session    
,s4 #acfh  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #ai1 #bjae,mr4    
,rob]ts 7= himself & ,mr4 ,portman7     
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to e/abli% ! ,(fice ( !     
,special ,inspector ,g5]al = ,monitor+ !
 ,af=dable ,c>e ,act1 & = o!r purposes4 
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,special ,inspector ,g5]al = ,monitor+
 ! ,,aca ,act ( #bjae or ! ,,sigma ,act 
( #bjae4  #b4 ,f9d+s ,! ,congress f9ds !
 foll[+3  7#a7 ,! writ+1 passage1 &     
implem5tation ( ! ,af=dable ,c>e ,act   
has utt]ly lack$ transp>5cy4  7#b7      
,presid5tial c&idate ,b>ack ,obama      
repeat$ly promis$ t if elect$ ,presid5t1
 he w\ld hold op51 public negotiations  
on heal? c>e re=m among public & private
 /akehold]s1 includ+ at a ,democratic   
,presid5tial debate on ,janu>y #ca1     
#bjjh1 :5 he said1 ,t's :at ,i w d 9    
br++ all p>ties toge!r1 n negotiat+     

beh9d clos$ doors1 b br++ all p>ties    
toge!r1 & broadca/+ ^? negotiations on  
,c-,,span s t ! ,am]ican p c see :at !  
*oices are1 because "p ( :at we h to d  
is enli/ ! ,am]ican p 9 ?is process44   
7#c7 ,!n-,s5ator ,obama repeat$ ?is     
promise multiple times1 includ+ at an   
,ohio t[n hall on ,m>* #a1 #bjjh1 :5 he 
said1 ,b "h's ! ?+3 we're gonna d all ^!
 negotiations on ,c-,,span4 ,s !        
,am]ican p w be able to wat* ^!         
negotiations44  7#d7 ,!n-,s5ator ,obama 
also repeat$ ?is promise at a ,virg9ia  
t[n hall on ,augu/ #ba1 #bjjh1 :5 he    
said1 ,i'm go+ to h all ! negotiations  
ar\nd a big table4 ,we'll h doctors &   
nurses & hospital adm9i/rators4         
,insurance companies1 drug              
companies--!y'll get a seat at ! table  
''' ,b :at we w d is1 we'll h !         
negotiations televis$ on ,c-,,span1 s t 
p c see :o is mak+ argum5ts on behalf ( 
_! con/itu5ts1 & :o are mak+ argum5ts on
 behalf ( ! drug companies or !         
insurance companies4 ,& s1 t approa*1 ,i

 ?9k is :at is go+ to all[ p to /ay     
involv$ 9 ?is process44  7#e7 ,9 a      
,septemb] #bf1 #bjaa1 int]view1 ,brian  
,lamb1 ! ,,ceo ( ,c-,,span confirm$ !   
negotiations ( ! heal? re=m law _h n be5
 broadca/ publicly1 not+1 ,! ,presid5t  
said t !y 7 all go+ to be on ,c-,,span4 
,he nev] ask$ u44  7#f7 ,presid5t       
,obama1 9 lead+ ! national heal? re=m   
debate1 broke 8 promise1 admitt+ 9 a    
,janu>y #be1 #bjaj1 int]view ) ,,abc    
,news t lock+ ! public out ( key heal?  
re=m discussions 0 a mi/ake & expla9+1  
,we _h to make s _m decisions quickly 9 
a v difficult set ( circum/ances t aft] 
a:ile1 we />t$ worry+ m ab\t gett+ !    
policy "r ?an gett+ ! process "r4 ,b ,i 
_h campaign$ on process--"p ( :at ,i _h 
campaign$ on 0 *ang+ h[ ,wa%+ton works1 
op5+ up1 transp>5cy & ,i ?9k x is--,i   
?9k ! heal? c>e debate z x unfold$      
legitimately rais$ conc]ns n j among my 
oppon5ts1 b also among/ support]s t we j
 don't "k :at's go+ on4 ,& x's an ugly  
process & x looks l !re are a bun* (    

backroom deals44  7#g7 ,on ,m>* #i1     
#bjaj1 !n-,speak] ( ! ,h\se ,nancy      
,pelosi said ( :at w\ld become !        
,af=dable ,c>e ,act1 ,we h to pass !    
bill s t y c f9d out :at is 9 x44  7#h7 
,dr4 ,jona?an ,grub]1 a pr(essor (      
economics at ! ,massa*usetts ,in/itute (
 ,te*nology1 0 aw>d$ a contract by !    
,dep>tm5t ( ,heal? & ,human ,s]vices to 
provide te*nical assi/ance 9 evaluat+   
options = national heal?c>e re=m due to 
8 propriet>y /ati/ically sophi/icat$    
micro-simulation model :i* c\ld assess !
 impact ( *anges 9 ,f$]al heal? c>e     
policies4  7#i7 ,dr4 ,grub] describ$    
himself z a heal? re=m ar*itect :o      
contribut$ to ! craft+ ( ! ,af=dable    
,c>e ,act 9 a #bjab op9ion editorial1   
not+1 ,sev]al ( ! ar*itects (           
,massa*usetts re=m1 includ+ myself1     
work$ closely ) ! ,adm9i/ration &       
,congress to translate ! lessons f      
,massa*usetts onto ! national /age44    
7#aj7 ,dr4 ,grub]'s ,,mit biography has 
describ$ him z a key ar*itect ( !       

,massa*usetts heal? re=m ef=t & a #bjji 
& #bjaj te*nical consultant :o work$ )  
bo? ! ,adm9i/ration & ,congress to help 
craft ! ,pati5t ,protection & ,af=dable 
,c>e ,act44  7#aa7 ,an ,octob] #aa1     
#bjaa1 report by ,,nbc ,news describ$   
,:ite ,h\se visitor logs t %[ ,dr4      
,grub] _h at lea/ five meet+s at ! ,:ite
 ,h\se 9 #bjji 9 ! lead up to ! passage 
( ! ,af=dable ,c>e ,act1 includ+ a meet+
 9 ! ,oval ,(fice ) ,presid5t ,obama to 
evaluate options = national heal? re=m4 
7#ab7 ,9 a video po/$ ,april #ab1 #bjab1
 by ! ,obama ,presid5tial campaign to   
,you,tube1 ,dr4 ,grub] /ates t he w5t   
d[n to ,wa%+ton to help ,presid5t ,obama
 develop 8 national v]sion ( t law44    
7#ac7 ,a ,m>* #bh1 #bjab1 article 9 !   
,new ,york ,times reports t ,aft] ,mr4  
,grub] help$ ! adm9i/ration put toge!r !
 basic pr9ciples ( ! proposal1 ! ,:ite  
,h\se l5t him to ,capitol ,hill to help 
congressional /aff memb]s draft !       
specifics ( ! legislation44  7#ad7 ,9 a 
,janu>y #ah1 #bjab1 lecture on !        

/ructure ( ! ,af=dable ,c>e ,act1 ,dr4  
,grub] ref]s to ! law's small bus9ess   
tax cr$its z a portion ( ! bill t he    
actually wrote44  7#ae7 ,dr4 ,grub]'s   
initial contract ) ! ,dep>tm5t ( ,heal? 
& ,human ,s]vices 7,,hhs7 0 = #big1jjj1 
& lat] a ,f$]al grant ( #ie1jjj br\ght 8
 total ,f$]al comp5sation = "w on !     
,af=dable ,c>e ,act to at lea/ #cib1jjj4
  7#af7 ,9 #bjji1 ! ,:ite ,h\se annual  
report to ,congress on ,presid5tial /aff
 sal>ies li/s t tw5ty-two ,:ite ,h\se   
/aff]s made ! highe/ ,presid5tial /aff  
sal>y rate ( #agb1bjj1 includ+ ! ,:ite  
,h\se ,*ief ( ,/aff1 s5ior advis]s1     
,:ite ,h\se ,c\nsel1 & ,national        
,security ,advis]4  7#ag7 ,9 #bjaj1 !   
,:ite ,h\se annual report to ,congress  
on ,presid5tial /aff sal>ies li/s t     
tw5ty-?ree ,:ite ,h\se /aff]s made !    
highe/ ,presid5tial /aff sal>y rate (   
#agb1bjj1 aga9 includ+ ! ,presid5t's top
 managem5t1 policy1 communications1 &   
security advis]s4  7#ah7 ,9 #bjji &     
#bjaj1 ea* ( ,presid5t ,obama's mo/     

s5ior ,:ite ,h\se /aff receiv$ less     
comp5sation ?an ,dr4 ,grub]4  7#ai7 ,9 a
 ,novemb] #e1 #bjab1 spee* at !         
,univ]sity ( ,rhode ,isl&1 ,dr4 ,grub]  
describ$ ! me*anism ( ! ,af=dable ,c>e  
,act1 /at+1 ,x's a v clev]1 y "k1 basic 
exploitation ( ! lack ( economic und]/&+
 ( ! ,am]ican vot]44  7#bj7 ,at an      
,octob] #ag1 #bjac1 panel at !          
,univ]sity ( ,p5nsylvania1 ,dr4 ,grub]  
describ$ ! ,af=dable ,c>e ,act1 /at+1   
,?is bill 0 writt5 9 a tortur$ way to   
make sure ,,cbo did n score ! m&ate z   
taxes4 ,if ,,cbo scor$ ! m&ate z taxes1 
! bill dies4 ,okay1 s x's writt5 to d   
t44  7#ba7 ,9 ! same spee*1 ,dr4 ,grub] 
/at$ t1 if y _h a law :i* said t heal?y 
p are go+ to pay 9 y made explicit      
heal?y p pay 9 & sick p get money1 x    
w\ld n h pass$44  7#bb7 ,dr4 ,grub] w5t 
on to claim1 ,lack ( transp>5cy is a    
huge political advantage4 ,& basically1 
call x ! /upidity ( ! ,am]ican vot] or  
:atev]1 b basically t 0 really1 really  
critical = ! ?+ to pass44  7#bc7 ,s9ce !

 passage ( ! ,af=dable ,c>e ,act1       
,presid5t ,obama call$ = a new1 m       
transp>5t approa* to ! heal? re=m law   
mov+ =w>d1 say+ 9 a ,janu>y #be1 #bjaj1 
,,abc ,news int]view1 ,! process didn't 
run ! way ,i ideally w\ld l x to & t we 
h to move =w>d 9 a way t recaptures t   
s5se ( op5+ ?+s up m44  7#bd7 ,! ,obama 
,adm9i/ration's implem5tation ( !       
,af=dable ,c>e ,act has be5 m>k$ by     
,executive ov]rea*4  7#be7 ,on at lea/  
#bh occasions1 ,presid5t ,obama & 8     
adm9i/ration h unilat]ally delay$1      
ext5d$1 or *ang$ provisions ( !         
,af=dable ,c>e ,act1 includ+ 9          
contrav5tion ( ! law & ! ,con/itution ( 
! ,unit$ ,/ates4  7#bf7 ,section #aeac (
 ! ,pati5t ,protection & ,af=dable ,c>e 
,act 7#bf ,u4,s4,c4 #dihj;h note7       
requires applicable l>ge employ]s ) m   
?an #ej full-"t employees to provide    
qualify+ heal? insurance to _! employees
 or pay a f9e1 & ! effective date "u su*
 section specifi$ ! am5dm5ts made by su*
 section appli$ to mon?s beg9n+ aft]    

,decemb] #ca1 #bjac4  7#bg7 ,contr>y to 
! pla9 mean+ ( ! /atutory requirem5t1 & 
act+ )\t au?ority provid$ by law1 !     
,int]nal ,rev5ue ,s]vice publi%$ 9 !    
,f$]al ,regi/] ,notice #bjac-de to *ange
 ! effective date ( ! employ] m&ate     
requirem5t1 /at+1 ,section #aeac7;d7 ( !
 ,af=dable ,c>e ,act provides t section 
#dihj;,h applies to mon?s aft] ,decemb] 
#ca1 #bjac2 h[ev] ,notice #bjac-de1     
issu$ on ,july #i1 #bjac1 provides z    
transition relief t no assessable       
paym5ts "u section #dihj;,h w apply =   
#bjad44  7#bh7 ,on ,july #ab1 #bjac1 !  
,director = ! ,c5t] = ,consum]          
,in=mation & ,insurance ,ov]sight at !  
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices d5i$
 ! reque/ = exemption f c]ta9 ,af=dable 
,c>e ,act requirem5ts made by           
repres5tatives ( ! ,unit$ ,/ates        
t]ritories1 writ+ to ! ,secret>y (      
,comm]ce = ! ,commonweal? ( ! ,nor!rn   
,m>iana ,isl&s1 ,h[ev] m]itori\s y\r    
reque/ might be1 ! ,dep>tm5t ( ,heal? & 
,human ,s]vices is n au?oriz$ to *oose  

:i* provisions ( ! ,af=dable ,c>e ,act  
''' might apply to ! t]ritories44  7#bi7
 ,a ye> lat]1 on ,july #af1 #bjad1 !    
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices notifi$ repres5tatives
 ( ! ,unit$ ,/ates t]ritories t !y w\ld 
9 fact receive an exemption f           
requirem5ts "u ! ,af=dable ,c>e ,act1   
despite ! previ\s explanation f ,,cms t 
,,cms does n h ! legal au?ority to      
provide su* an exemption4 ,z ! ,,cms    
,adm9i/rator n[ rationaliz$1 ,curr5tly1 
! ,dep>tm5t uses ! exi/+ ,public ,heal? 
,s]vice ,act 7,,phs ,act7 def9ition (   
,/ate = new ,,phs ,act requirem5ts &    
fund+ opportunities includ$ 9 title ,i (
 ! ,af=dable ,c>e ,act4 ,"u ?is         
def9ition1 ! new m>ket re=ms 9 ! ,,phs  
,act apply to ! t]ritories4 ,we h be5   
in=m$ by repres5tatives ( ! t]ritories t
 ?is int]pretation is und]m9+ ! /ability
 ( ! t]ritories' heal? insurance m>kets4
 ,aft] a c>eful review ( ?is situation &
 ! relevant /atutory language1 ,,hhs has
 det]m9$ t ! new provisions ( ! ,,phs   

,act enact$ 9 title ,i are appropriately
 gov]n$ by ! def9ition ( ,/ate set =? 9 
t title1 & !re=e t ^! new provisions d n
 apply to ! t]ritories44  7#cj7 ,!      
,obama ,adm9i/ration has claim$ t !     
,af=dable ,c>e ,act w save money &      
improve ! economy1 ) ,white,house4gov   
/at+1 ,9 keep+ ) ! ,presid5t's pl$ge t  
re=m mu/ fix our heal? c>e sy/em )\t    
add+ to ! deficit1 ! ,af=dable ,c>e ,act
 r$uces ! deficit1 sav+ ov] #bjj billion
 ov] #aj ye>s & m ?an #a trillion 9 !   
second decade4 ,! law r$uces heal? c>e  
co/s ''' & is improv+ our economic      
competitiv5ess44  7#ca7 #gj4b billion ( 
! ,:ite ,h\se's e/imat$ sav+s 0 to come 
f ! ,community ,liv+ ,assi/ance ,s]vices
 & ,supports 7,,class7 ,act provisions (
 ! ,af=dable ,c>e ,act1 a program t 0   
deem$ actu>ially uns\nd & nev] implem5t$
 by ! ,obama ,adm9i/ration4  7#cb7 ,an  
,april #bjaj report f ! ,(fice ( !      
,actu>y = ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices describes t additional sav+s "u
 ! ,af=dable ,c>e ,act 7 to be paid = ) 

,m$ic>e ,fee-=-,s]vice & ,m$ic>e        
,advantage cuts & r$uctions 9 paym5ts to
 hospitals1 skill$ nurs+ facilities1 &  
home heal? c5t]s4 ,^! cuts h be5 delay$ 
& may nev] mat]ialize4 ,ev5 if          
implem5t$1 ! project$ sav+s may nev]    
accrue z ! ,,cms ,actu>y's report       
concludes t su* cuts w cause ab\t #ae   
p]c5t ( hospitals & po/-acute c>e       
facilities l nurs+ homes to g out (     
bus9ess4  7#cc7 #eb billion 9 deficit   
r$uction sav+s 0 project$ to come f     
employ] p5alties paid to ! ,gov]nm5t =  
failure to comply ) ! employ] m&ate     
requirem5t to provide employees heal?   
insurance1 a requirem5t t ! ,obama      
,adm9i/ration has repeat$ly delay$ &    
modifi$1 caus+ p5alties & associat$     
sav+s to n accrue4  7#cd7 ,initial      
e/imates ( sav+s "u ! ,af=dable ,c>e    
,act project$ at lea/ #ae4e billion 9   
sav+s ov] ! next decade attributable to 
,m$ic>e cuts ?r\gh ! ,indep5d5t ,paym5t 
,advisory ,bo>d1 :i* has n yet be5      
appo9t$ & ?r\gh :i* no cuts or sav+s h  

be5 realiz$4  7#ce7 ,on ,septemb] #i1   
#bjji1 ,presid5t ,obama pl$g$ to a jo9t 
session ( ,congress1 ,i w n sign a heal?
 c>e re=m plan t adds "o dime to our    
deficits--ei!r n[ or 9 ! future44  7#cf7
 ,! ,congressional ,budget ,(fice       
e/imat$ 9 ,febru>y #bjad t heal?        
insurance subsidies "u ! ,af=dable ,c>e 
,act w\ld co/ ! ,f$]al ,gov]nm5t #dg    
billion 9 fiscal ye> #bjae & #a4aig     
trillion ov] fiscal ye>s #bjae-bjbd4    
7#cg7 ,! ,committees on ,f9ance &       
,heal?1 ,education1 ,labor1 & ,p5sions (
 ! ,s5ate e/imat$ 9 ,septemb] #bjad t ! 
,af=dable ,c>e ,act w add at lea/ #cdj  
billion to ,f$]al budget deficits4      
7#ch7 ,dr4 ,grub] /at$1 ,! ,af=dable    
,c>e ,act isn't design$ to save money44 
7#ci7 ,on at lea/ #cg occasions1        
,presid5t ,obama or a top (ficial 9 !   
executive bran* repeat$ ! promise t ,if 
y l ! heal? insurance plan y h1 y c keep
 x4 ,if y l ! doctor y h1 y c keep y\r  
doctor44  7#dj7 ,! ,associat$ ,press    
calculat$ at lea/ #d4g million ,am]icans

 _h _! heal? insurance cancell$ = #bjad 
& lat]1 :5 ! ,presid5t issu$ a la/-m9ute
 fix to try to prev5t ^! cancellations z
 requir$ by ! ,af=dable ,c>e ,act1 !    
*anges came too late = approximately    
#b4d million ,am]icans to keep ! plans  
!y _h & lik$4  7#da7 ,! nonp>tisan1     
fact-*eck+ publication ,politifact rat$ 
,if y l y\r heal? c>e plan1 y c keep x4 
z ! ,lie ( ! ,ye> = #bjac4  7#db7       
,!n-,presid5tial c&idate ,b>ack ,obama  
repeat$ly promis$ t1 if elect$          
,presid5t1 8 national heal? c>e re=ms   
w\ld1 cut ! co/ ( a typical family's    
premium by up to #b1ejj a ye>44  7#dc7  
,a ,novemb] #bjac analysis by !         
,manhattan ,in/itute calculates t !     
,af=dable ,c>e ,act w\ld increase       
individual m>ketplace heal? insurance   
premiums by #da p]c5t nationwide betwe5 
#bjac & #bjad4  7#dd7 ,a ,decemb] #bjac 
/udy by ,heal? ,pocket1 ,inc41 f\nd t ! 
av]age individual d$uctible = a ,bronze 
plan 0 #e1jha a ye>1 a #db-p]c5t        
increase f ! av]age plan pur*as$ by an  

individual 9 #bjac4  7#de7 ,a ,febru>y  
#bjac /udy by ,heal? ,pocket ,inc41 f\nd
 t ex*ange plans "u ! ,af=dable ,c>e    
,act av]ag$ a #cd-p]c5t increase 9      
drug-co/ %>+ comp>$ to copaym5t &       
co9surance rates 9 ! pre-,af=dable ,c>e 
,act m>ket4 ,= ! sicke/ pati5ts ne$+    
specialty drugs1 ! /udy f\nd copaym5ts  
increas$ by #bbf p]c5t "u a ,bronze plan
 via ! ,af=dable ,c>e ,act4  7#df7 ,a   
,decemb] #bjac /udy by ,mc,kinsey &     
,company f\nd t insur]s (f]$ almo/ ?ree 
times z _m n>r[ or ultran>r[ network    
plans 9 #bjad comp>$ to #bjac4 ,fully   
#gj p]c5t ( ,af=dable ,c>e ,act plans   
analyz$ _h n>r[ or ultran>r[ network    
cov]age1 mean+ cov]age = few] doctors & 
hospitals ?an plans sold on ! individual
 m>ket be=e ! law took effect4  7#dg7   
,details consum]s require to make in=m$ 
decisions ab\t _! heal? c>e plan cov]age
 "u ! ,af=dable ,c>e ,act h be5 )held or
 lack$ transp>5cy4  7#dh7 ,on ,septemb] 
#bf1 #bjac1 ,presid5t ,obama said1 ,x w 
say cle>ly :at ea* plan cov]s1 :at ea*  

plan co/s4 ,! price w be "r !re4 ,x w be
 fully transp>5t ''' ,& s if y've ev]   
tri$ to buy insurance on y\r own1 ,i    
promise y ?is is a lot easi]4 ,x's l    
book+ a hotel or a plane ticket44  7#di7
 ,health,care4gov 0 e/abli%$ z ! website
 to implem5t ! ,f$]al ex*ange portion ( 
! ,act at a co/ ( z mu* z #hdj million1 
includ+ m ?an #aej million 9 co/        
ov]runs1 accord+ to ! ,gov]nm5t         
,acc\ntability ,(fice 9 ,m>* #bjad4     
7#ej7 ,on ,octob] #a1 #bjac1            
,health,care4gov laun*$ )\t adequate    
security te/+1 leav+ ! approximately    
#bej1jjj unique us]s x drew n only      
vuln]able to id5tity !ft by hack]s1 b   
unable to ev5 use ! site1 z ! website 0 
demon/rably unable to h&le ev5 #a1ajj   
simultane\s us]s4  7#ea7 ,= ! subsequ5t 
mon?s aft] its laun*1 ,health,care4gov  
cont9u$ to be plagu$ by crippl+         
malfunctions1 & ! dismal p]=mance ( !   
website l$ only to problems & fru/ration
 = millions ( ,am]icans4  7#eb7 ,a ,june
 #bjac /udy by ! ,dep>tm5t ( ,heal? &   

,human ,s]vices' ,(fice ( ,inspector    
,g5]al reveal$ t s(tw>e design$ by a    
pr9cipal ,health,care4gov v5dor 0 highly
 insecure & put ! in=mation ( m ?an #f  
million ,m$ic>e b5efici>ies at great]   
risk f malw>e1 inappropriate access or  
!ft4  7#ec7 ,an ,april #bjad /udy by    
,aval]e ,heal? det]m9$ t #ch p]c5t (    
heal? insurance plans (f]$ on ! ex*anges
 "u ! ,af=dable ,c>e ,act _h no         
in=mation ab\t drug cov]age available4  
,aval]e also f\nd t ne>ly #a 9 #d plans 
(f]$ insuffici5t in=mation on :i*       
doctors & hospitals are cov]$4  7#ed7 ,9
 ,septemb] #bjad1 ! ,adm9i/rator ( !    
,c5t]s = ,m$ic>e & ,m$icaid ,s]vices    
report$ to ,congress t #g4c million     
,am]icans _h enroll$ 9 plans ?r\gh      
ex*anges "u ! ,af=dable ,c>e ,act1 meet+
 enrollm5t t>gets e/imat$ by !          
,congressional ,budget ,(fice & held z a
 goal by ! ,obama ,adm9i/ration4  7#ee7 
,f\r mon?s lat]1 ,,hhs ,secret>y        
,burwell /at$ t ?is enrollm5t data 0 a  
mi/ake t includ$ "s #djj1jjj d5tal      

insurance enrollm5ts1 ! inclusion ( :i* 
all[$ ! adm9i/ration to claim = mon?s t 
! ,af=dable ,c>e ,act 0 p]=m+ z         
anticipat$ :i* 0 n 9 fact a true or     
accurate repres5tation ( ! data !y _h1 b
 w\ld n release to ! public4  7#ef7     
,s9ce implem5tation ( ! ,,aca began1 !  
,,hhs ,secret>y has grant$ ov] #a       
billion 9 ,f$]al taxpay] doll>s to      
,/ates to help build websites = _! own  
,/ate-bas$ ex*anges1 yet developm5t &   
usability issues on %ort timel9es       
repeat$ly caus$ ^! same ,/ates to seek  
diff]5t options = ! #bjae op5 enrollm5t 
p]iod1 includ+ opt+ to rev]t to enroll+ 
via ! ,f$]al ,health,care4gov website4  
7#eg7 ,! ,af=dable ,c>e ,act provides   
opportunities = fraud )9 subsidy & tax  
cr$it issuance4  7#eh7 ,a ,septemb]     
#bjac report by ! ,treasury ,inspector  
,g5]al = ,tax ,adm9i/ration conclud$ t1 
! ,,irs's exi/+ fraud detection sy/em   
may n be capable ( id5tify+ ,,aca refund
 fraud or s*emes prior to ! issuance (  
tax return refunds44  7#ei7 ,a ,july    

#bjad und]cov] /udy by ! ,gov]nm5t      
,acc\ntability ,(fice det]m9$ t         
fictiti\s applicants 7 able to obta9    
heal? insurance cov]age & taxpay]-fund$ 
subsidies on ! ,f$]al ex*anges us+      
falsifi$ docum5ts 9 #aa out ( #ab cases4
  7#fj7 ,! ,af=dable ,c>e ,act has _h a 
negative impact on ! ,am]ican economy4  
7#fa7 ,a ,febru>y #bjad calculation by !
 ,congressional ,budget ,(fice f\nd !   
,af=dable ,c>e ,act w significantly h>m 
! ,am]ican economy1 r$uc+ ! numb] ( h\rs
 work$ by millions ( full-"t employees  
wor? ( h\rs4 ,! ,,cbo /udy not$1 ,!     
r$uction 9 ,,cbo's projections ( h\rs   
work$ repres5ts a decl9e 9 ! numb] (    
full-"t-equival5t work]s ( ab\t #b      
million 9 #bjag1 ris+ to ab\t #b4e      
million 9 #bjbd44  7#fb7 ,hi/ory has %[n
 ! ,special ,inspector ,g5]al model to  
be successful at sav+ taxpay] doll>s &  
root+ our wa/e1 fraud1 & abuse 9 l>ge   
,f$]al ,gov]nm5t programs4  7#fc7       
,congress & ! ,presid5t h enact$        
legislation creat+ ,special ,inspectors 

,g5]al on ?ree occasions1 includ+ to    
ov]see ,f$]al sp5d+ & policy            
implem5tation = ,afghani/an             
recon/ruction 7,,sig>71 ,iraq           
recon/ruction 7,,sigir71 & ! ,tr\bl$    
,asset ,relief ,program 7,,sigt>p74     
7#fd7 ,,sig>1 ,,sigir1 & ,,sigt>p h     
successfully conduct$ audits &          
inve/igations sav+ ! ,f$]al ,gov]nm5t   
billions 9 wa/e1 fraud1 & abuse1 & h    
help$ to id5tify & prosecute !ft &      
corruption4  7#fe7 ,z ( an ,octob] #bjad
 report1 ,,sig> has produc$ #eg ref]rals
 = susp5sion & deb>m5t ( ,f$]al         
contractors & employees & produc$ ov]   
#ejj million 9 direct taxpay] sav+s4    
7#ff7 ,accord+ to its f9al report1      
,,sigir co/ #bde million to op]ate1 b   
result$ 9 #fde million 9 direct sav+s to
 ! ,f$]al ,gov]nm5t1 9 addition to      
produc+ #aib million 9 seizures &       
c\rt-ord]$ p5alties1 z well z #ij       
crim9al convictions4  7#fg7 ,z ( an     
,octob] #bjad report1 ,,sigt>p has      
produc$ #adf convictions & #g4ch billion

 9 f9es1 p5alties1 & re/itution to !    
,gov]nm5t & victims4  7#fh7 ,on ,augu/  
#e1 #bjad1 ! ,associat$ ,press report$ t
 #dg ,f$]al inspectors g5]al s5t an     
unprec$5t$ jo9t lett] to ,congress to   
decry1 ,obama adm9i/ration ef=ts to     
delay or /all _! inve/igations1 cit+    
?ree examples :]e ,f$]al ag5cies h h9d]$
 sub/antive inspector g5]al ov]sight "w 
by refus+ to provide in=mation or       
docum5ts !y are entitl$ to "u ! law4    
7#fi7 ,! lett] f m ?an half ( ! ,f$]al  
,gov]nm5t's indep5d5t inspectors g5]al  
correctly /ates1 ,section #f7;a77#a7 ( !
 ,,ig ,act reflects ! cle> int5t (      
,congress t an ,inspector ,g5]al is     
entitl$ to timely & unimp$$ access to   
all records available to an ag5cy t     
relate to t ,inspector ,g5]al's ov]sight
 activities4 ,! con/rict$ int]pretations
 ( ,section #f7;a77#a7 by ^! & o!r      
ag5cies conflict ) ! actual language &  
,congressional int5t4 ,! ,,ig ,act is   
cle>3 no law re/rict+ access to records 
applies to ,inspectors ,g5]al unless t  

law expressly s /ates1 & t unre/rict$   
access ext5ds to all records available  
to ! ag5cy1 reg>dless ( location or =m44
  7#gj7 ,congress has a responsibility  
to ex]cise prud5t /ew>d%ip ( public     
doll>s1 to ensure t laws are well &     
fai?fully execut$ by ! executive bran*1 
to provide = efficaci\s s]vices = !     
,am]ican p1 & to ensure t ^? :o *eat1   
/eal f1 or defraud ! ,f$]al ,gov]nm5t   
are held to acc\nt4  #c4 ,special       
,inspector ,g5]al = ,monitor+ !         
,af=dable ,c>e ,act  7a7 ,(fice (       
,special ,inspector ,g5]al ,!re is h]eby
 e/abli%$ ! ,(fice ( ! ,special         
,inspector ,g5]al = ,monitor+ !         
,af=dable ,c>e ,act 79 ?is section1     
ref]r$ to z ! ,(fice7 to c>ry out !     
duties describ$ "u subsection 7e74  7b7 
,appo9tm5t ( ,inspector ,g5]al2 removal 
7#a7 ,appo9tm5t ,! head ( ! ,(fice is ! 
,special ,inspector ,g5]al = ,monitor+ !
 ,af=dable ,c>e ,act 79 ?is section     
ref]r$ to z ! ,special ,inspector       
,g5]al71 :o %all be appo9t$ by !        

,presid5t1 by & ) ! advice & cons5t ( ! 
,s5ate4  7#b7 ,qualifications ,!        
appo9tm5t ( ! ,special ,inspector ,g5]al
 %all be made solely on ! basis (       
integrity & demon/rat$ ability 9        
acc\nt+1 audit+1 f9ancial analysis1 law1
 managem5t analysis1 heal? c>e exp]tise 
& f9anc+1 public adm9i/ration1 or       
inve/igations4  7#c7 ,deadl9e =         
appo9tm5t ,! appo9tm5t ( an individual z
 ! ,special ,inspector ,g5]al %all be   
made n lat] ?an #cj days aft] ! date ( !
 enactm5t ( ?is ,act4  7#d7 ,comp5sation
 ,! annual rate ( basic pay ( ! ,special
 ,inspector ,g5]al %all be ! annual rate
 ( basic pay provid$ = positions at     
level ,,iv ( ! ,executive ,s*$ule "u    
section #ecae ( title #e1 ,unit$ ,/ates 
,code4  7#e7 ,prohibition on political  
activities ,= purposes ( section #gcbd (
 title #e1 ,unit$ ,/ates ,code1 !       
,special ,inspector ,g5]al %all n be    
consid]$ an employee :o det]m9es        
policies to be pursu$ by ! ,unit$ ,/ates
 9 ! nationwide adm9i/ration ( ,f$]al   

law4  7#f7 ,removal ,! ,special         
,inspector ,g5]al %all be removable f   
(fice 9 accordance ) ! provisions (     
section #c7;b7 ( ! ,inspector ,g5]al    
,act ( #aigh 7#e ,u4,s4,c4 ,app474  7c7 
,assi/ant ,inspectors ,g5]al ,! ,special
 ,inspector ,g5]al %all1 9 accordance ) 
applicable laws & regulations gov]n+ !  
civil s]vice--  7#a7 appo9t an ,assi/ant
 ,inspector ,g5]al = ,audit+ :o %all h !
 responsibility = sup]vis+ ! p]=mance ( 
audit+ activities relat+ to ! duties    
describ$ "u subsection 7e72 &  7#b7     
appo9t an ,assi/ant ,inspector ,g5]al = 
,inve/igations :o %all h !              
responsibility = sup]vis+ ! p]=mance (  
inve/igative activities relat+ to su*   
duties4  7d7 ,sup]vision  7#a7 ,9 g5]al 
,except z provid$ "u p>agraph 7#b71 !   
,special ,inspector ,g5]al %all report  
directly to1 & be "u ! g5]al sup]vision 
(1 ! ,secret>y ( ,heal? & ,human        
,s]vices4  7#b7 ,indep5d5ce to conduct  
inve/igations & audits ,no employee or  
(fic] ( any ( ! foll[+ entities %all    

prev5t or prohibit ! ,special ,inspector
 ,g5]al f initiat+1 c>ry+ out1 or       
complet+ any audit or inve/igation      
relat$ to ! duties describ$ "u          
subsection 7e7 or f issu+ any subpo5a   
dur+ ! c\rse ( any su* audit or         
inve/igation3  7,a7 ,! ,executive ,(fice
 ( ! ,presid5t & ! ,(fice ( ,p]sonnel   
,managem5t4  7,b7 ,! ,dep>tm5t ( ,heal? 
& ,human ,s]vices4  7,c7 ,! ,dep>tm5t ( 
! ,treasury4  7,d7 ,! ,social ,security 
,adm9i/ration1 ! ,dep>tm5t ( ,homel&    
,security1 ! ,dep>tm5t ( ,vet]ans       
,affairs1 ! ,dep>tm5t ( ,def5se1 !      
,dep>tm5t ( ,labor1 & ! ,peace ,corps4  
7,e7 ,any o!r ,f$]al ag5cy involv$ 9    
implem5t+ or adm9i/]+ ! ,af=dable ,c>e  
,act4  7e7 ,duties  7#a7 ,ov]sight ( !  
implem5tation & adm9i/ration ( !        
af=dable c>e act ,x %all be ! duty ( !  
,special ,inspector ,g5]al to conduct1  
sup]vise1 & coord9ate audits &          
inve/igations ( ! implem5tation &       
adm9i/ration ( programs & activities    
e/abli%$ "u1 & paym5t sy/em *anges made 

by1 ! ,af=dable ,c>e ,act1 includ+ by   
collect+ & summ>iz+ ! foll[+3  7,a7 ,a  
description ( ! individual m&ate        
requirem5t = applicable individuals to  
ma9ta9 m9imum ess5tial cov]age or pay a 
p5alty "u section #ejjj;,a ( ! ,int]nal 
,rev5ue ,code ( #aihf1 includ+ a        
description ( ! numb] ( individuals     
ma9ta9+ su* cov]age & ! numb] (         
individuals pay+ su* p5alties4  7,b7 ,a 
description ( any increases or decreases
 9-- 7i7 premiums = qualifi$ heal? plans
 7z def9$ 9 section #acja ( ! ,pati5t   
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjba772  7ii7 d$uctibles "u 
qualifi$ heal? plans2 &  7iii7 co/-%>+  
"u qualifi$ heal? plans1 includ+ by     
copaym5ts & co9surance1  affect+        
individuals enroll+ 9 cov]age "u su*    
plans ?r\gh an ex*ange e/abli%$ "u title
 ,i ( ! ,pati5t ,protection & ,af=dable 
,c>e ,act 7includ+ a ,/ate-run ex*ange1 
a f$]ally adm9i/]$ ex*ange1 & a ,small  
,bus9ess ,heal? ,options ,program74     
7,c7 ,a description ( any increases or  

decreases 9 ! maximum out-(-pocket co/s 
affect+ individuals enroll+ 9 qualifi$  
heal? plans ?r\gh su* a ,/ate-run       
ex*ange1 a f$]ally adm9i/]$ ex*ange1 & a
 ,small ,bus9ess ,heal? ,options        
,program4  7,d7 ,a description ( any    
increases or decreases 9 ! size (       
physician & o!r heal? c>e provid]       
networks affect+ individuals enroll+ 9  
qualifi$ heal? plans ?r\gh su* a        
,/ate-run ex*ange1 a f$]ally adm9i/]$   
ex*ange1 & a ,small ,bus9ess ,heal?     
,options ,program4  7,e7 ,a description 
( any type ( heal? insurance cov]age lo/
 because ( ! treatm5t "u title ,i ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act ( gr&fa!r$ heal? plans 7z def9$ 9  
section #abea7;e7 ( su* ,act 7#db       
,u4,s4,c4 #ahjaa7;e7774  7,f7 ,a        
description ( any cr$its "u section     
#cf;,b ( ! ,int]nal ,rev5ue ,code (     
#aihf 7& ! am\nt 7if any7 ( ! advance   
paym5t ( ! cr$it "u section #adab ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjhb77 & any      

co/-%>+ r$uction "u section #adjb ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjga7 7& ! am\nt  
7if any7 ( ! advance paym5t ( ! r$uction
 "u section #adab ( su* ,act 7#db       
,u4,s4,c4 #ahjhb77 provid$ to           
individuals enroll+ "u qualifi$ heal?   
plans ?r\gh an ex*ange e/abli%$ "u title
 ,i ( ! ,pati5t ,protection & ,af=dable 
,c>e ,act4  7,g7 ,a description ( any   
projections1 e/imates1 analysis1 goals1 
or t>gets made by any employee ( !      
,f$]al ,gov]nm5t or any contractor ( !  
,f$]al ,gov]nm5t 9 c>ry+ out duties     
associat$ ) ! ,pati5t ,protection &     
,af=dable ,c>e ,act ) respect to !      
enrollm5t ( individuals 9 a qualifi$    
heal? plan ?r\gh an ex*ange e/abli%$ "u 
title ,i ( ! ,pati5t ,protection &      
,af=dable ,c>e ,act4  7,h7 ,a           
description ( ! employ] m&ate requirem5t
 t applicable l>ge employ]s provide     
eligible employees ) m9imum ess5tial    
cov]age or pay a f9e "u section #dihj;,h
 ( ! ,int]nal ,rev5ue ,code ( #aihf1    

includ+ a description ( ! type & numb] (
 employ]s provid+ su* cov]age & ! type &
 numb] ( employ]s pay+ su* f9es4  7,i7  
,a description ( any projections1       
e/imates1 analyses1 goals1 or t>gets    
made by any employee ( ! ,f$]al         
,gov]nm5t or any contractor ( ! ,f$]al  
,gov]nm5t 9 c>ry+ out duties associat$ )
 ! ,pati5t ,protection & ,af=dable ,c>e 
,act ) respect to employ]s provid+      
m9imum ess5tial cov]age to applicable   
employees4  7,j7 ,a description ( any   
reports1 meet+s1 discussions1 or        
mat]ials ( any employee ( ! ,f$]al      
,gov]nm5t or any contractor ( ! ,f$]al  
,gov]nm5t 9 c>ry+ out duties associat$ )
 ! ,pati5t ,protection & ,af=dable ,c>e 
,act relat+ to any employ]s conv]t+     
full-"t employees to "p-"t employees or 
hir+ new "p-"t employees in/ead (       
full-"t employees = ! purposes ( avoid+ 
! f9es provid$ = "u ! employ] m&ate     
requirem5t describ$ 9 subp>agraph 7,h74 
7,k7 ,a description ( any reports1      
meet+s1 discussions1 or mat]ials ( any  

employee ( ! ,f$]al ,gov]nm5t or any    
contractor ( ! ,f$]al ,gov]nm5t 9 c>ry+ 
out duties associat$ ) ! ,pati5t        
,protection & ,af=dable ,c>e ,act relat+
 to any employ]s hir+ no m ?an #ej      
employees = ! purposes ( avoid+ !       
requirem5t to provide m9imum ess5tial   
cov]age or pay a f9e "u ! employ] m&ate 
requirem5t describ$ 9 subp>agraph 7,h74 
7,l7 ,a description ( any reports1      
meet+s1 discussions1 or mat]ials ( any  
employee ( ! ,f$]al ,gov]nm5t or any    
contractor ( ! ,f$]al ,gov]nm5t 9 c>ry+ 
out duties associat$ ) ! ,pati5t        
,protection & ,af=dable ,c>e ,act relat+
 to any employ]s dropp+ ! heal?         
insurance cov]age (f]$ to _! employees1 
or employees' sp\ses or dep5d5ts1 = !   
purposes ( avoid+ ! requirem5t to       
provide m9imum ess5tial cov]age or pay a
 f9e "u ! employ] m&ate requirem5t      
describ$ 9 subp>agraph 7,h74  7,m7 ,a   
description ( ! transitional re9surance 
program e/abli%$ "u section #acda ( !   
,pati5t ,protection & ,af=dable ,c>e    

,act 7#db ,u4,s4,c4 #ahjfa71 includ+ a  
description ( re9surance contributions  
collect$ or requir$ to be collect$ "u   
su* program1 a description ( any        
re9surance paym5ts made or requir$ to be
 made to heal? insurance issu]s "u su*  
program1 a description ( ! heal?        
insurance cov]age & relat$ co/s =       
high-co/ individuals = plans relat$ to  
su* program1 an explanation ( ! impact (
 su* re9surance program on adv]se       
selection 9 ! m>ketplace1 & an          
explanation ( any premium-/abiliz+      
effects ( su* program4  7,n7 ,a         
description ( ! tempor>y risk corridors 
= qualifi$ heal? plans e/abli%$ "u      
section #acdb ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjfb71 includ+ a description (        
p>ticipat+ plans & ! all[able co/s &    
t>get am\nts ( su* plans1 a description 
( risk corridor ratios ( su* plans1 & a 
description ( paym5t adju/m5ts made "u  
su* program4  7,o7 ,a description ( !   
p]man5t risk adju/m5t program e/abli%$  

"u section #acdc ( ! ,pati5t ,protection
 & ,af=dable ,c>e ,act 7#db ,u4,s4,c4   
#ahjfc71 includ+ a description ( any    
plans p>ticipat+ 9 su* program1 a       
description ( any risk adju/m5t paym5ts 
made or requir$ to be made "u su*       
program1 a description ( ! heal?        
insurance cov]age & relat$ co/s =       
high-co/ individuals = plans relat$ to  
su* program1 an explanation ( ! impact (
 su* program on adv]se selection 9 !    
m>ketplace1 & an explanation ( any      
premium-/abiliz+ effects ( su* program4 
7,p7 ,a li/ ( all contracts aw>d$ "u !  
,af=dable ,c>e ,act & an analysis ( :e!r
 ,f$]al contract+ proc$ures 7 foll[$ :5 
aw>d+ any contract associat$ ) su* ,act4
  7,q7 ,a description ( ! developm5t ( !
 heal? insurance m>ketplace = ! ,int]net
 portal e/abli%$ "u section #aajc ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjjc71 includ+ a  
description ( ! design1 features1 &     
security sy/ems ( su* web portal & a    
description ( all co/s associat$ ) su*  

developm5t4  7,r7 ,a description ( any  
?reats1 risks1 problems1 or             
functionality issues id5tifi$ by any    
employee ( ! ,f$]al ,gov]nm5t or any    
contractor ( ! ,f$]al ,gov]nm5t 9 c>ry+ 
out duties associat$ ) ! ,pati5t        
,protection & ,af=dable ,c>e ,act prior 
to ! laun* ( su* web portal on ,octob]  
#a1 #bjac4  7,s7 ,a description ( any   
decisionmak+ or activities by any       
employee ( ! ,f$]al ,gov]nm5t or any    
contractor ( ! ,f$]al ,gov]nm5t 9 c>ry+ 
out duties associat$ ) ! ,pati5t        
,protection & ,af=dable ,c>e ,act 9     
response to su* ?reats1 risks1 problems1
 or functionality issues4  7,t7 ,a      
description ( ! sy/ems 7on ! ,f$]al &   
,/ate levels7 9 place or 9 developm5t to
 all[ heal? insurance issu]s & plans &  
gov]nm5t entities to v]ify in=mation is 
accurate = purposes ( enrollm5ts 9      
qualifi$ heal? plans ?r\gh ex*anges     
e/abli%$ "u title ,i ( ! ,pati5t        
,protection & ,af=dable ,c>e ,act1      
includ+ t data v]ification & validation 

c occur ) respect to in=mation provid$  
or /or$ by individuals1 ! ,dep>tm5t (   
,heal? & ,human ,s]vices1 ! qualifi$    
heal? plans1 ,/ates1 & o!r applicable   
,f$]al ag5cies1 includ+ = purposes (    
cr$its "u section #cf;,b ( ! ,int]nal   
,rev5ue ,code ( #aihf 7& ! am\nt 7if    
any7 ( ! advance paym5t ( ! cr$it "u    
section #adab ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjhb77 & any co/-%>+ r$uction "u      
section #adjb ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjga7 7& ! am\nt 7if any7 ( ! advance 
paym5t ( ! r$uction "u section #adab (  
su* ,act 7#db ,u4,s4,c4 #ahjhb774  7,u7 
,a description ( ! developm5t ( ! ,f$]al
 ,data ,s]vices ,hub1 includ+ its       
design1 features1 & security sy/ems1 & a
 description ( ! type ( data access$    
?r\gh su* data hub1 & a description ( ! 
actual /orage location ( su* data       
access$ ?r\gh su* data hub4  7,v7 ,a li/
 ( ! duties & responsibilities assign$  
to ! ,int]nal ,rev5ue ,s]vice z a result

 ( ! enactm5t ( ! ,af=dable ,c>e ,act1 a
 description ( any plans ( ! ,int]nal   
,rev5ue ,s]vice = h[ to c>ry out su*    
duties1 & an explanation ( ! res\rces & 
p]sonnel requir$ to c>ry out su* duties1
 includ+ a description ( any new        
res\rces or p]sonnel requir$ to c>ry out
 su* duties n already available to !    
,int]nal ,rev5ue ,s]vice4  7,w7 ,a      
description ( any plans ( ! ,int]nal    
,rev5ue ,s]vice to v]ify ! eligibility (
 individuals enroll+ 9 qualifi$ heal?   
plans = any cr$its "u section #cf;,b ( !
 ,int]nal ,rev5ue ,code ( #aihf 7& !    
am\nt 7if any7 ( ! advance paym5t ( !   
cr$it "u section #adab ( ! ,pati5t      
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjhb77 & any co/-%>+        
r$uction "u section #adjb ( ! ,pati5t   
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjga7 7& ! am\nt 7if any7 ( 
! advance paym5t ( ! r$uction "u section
 #adab ( su* ,act 7#db ,u4,s4,c4        
#ahjhb771 includ+ a description ( any   
su* v]ification complet$ & a description

 ( any su* individuals det]m9$ to be    
ineligible4  7,x7 ,a description ( any  
plans by ! ,int]nal ,rev5ue ,s]vice to  
calculate ! am\nt ( ov]paym5t ( any su* 
cr$it or r$uction = :i* an individual   
enroll$ 9 a qualifi$ heal? plan 0       
det]m9$ to be ineligible1 includ+ a     
description ( any su* calculations      
complet$4  7,y7 ,a description ( any    
plans by ! ,int]nal ,rev5ue ,s]vice to  
notify individuals det]m9$ to be        
ineligible = su* cr$its or r$uctions1   
includ+ a description ( su*             
notifications complet$4  7,z7 ,a        
description ( any plans by ! ,int]nal   
,rev5ue ,s]vice to recapture su*        
ov]paym5ts ( su* cr$its & r$uctions =   
individuals det]m9$ to be ineligible1   
includ+ a description ( su* recaptur+   
complet$4  7,,aa7 ,a description ( !    
impact ( ! ,af=dable ,c>e ,act on ! "r (
 consci5ce1 includ+ on-- 7i7 religi\s   
employ]s & in/itutions t 7 n exempt$ f !
 m&ate issu$ by ! ,dep>tm5t ( ,heal? &  
,human ,s]vices requir+ individual &    

gr\p heal? plans to cov] /]ilization &  
,food & ,drug ,adm9i/ration approv$     
contraceptives2  7ii7 individuals2 &    
7iii7 m$ical pr(essionals4  7,,bb7 ,a   
description ( abortion cov]age (f]$ "u  
qualifi$ heal? plans pur*as$ ?r\gh      
,/ate-run ex*anges1 f$]ally adm9i/]$    
ex*anges1 & ,small ,bus9ess ,heal?      
,options ,programs1 includ+ co/s        
associat$ ) su* cov]age4  7,,cc7 ,a     
description ( any actions by ,dep>tm5ts 
or ,ag5cies ( ! ,f$]al ,gov]nm5t to     
modify or delay ! programs or activities
 au?oriz$ by ! ,af=dable ,c>e ,act1     
includ+ an explanation f ! head ( su*   
,dep>tm5t or ,ag5cy ( ! specific        
au?ority us$ to implem5t su* a          
modification or delay4  7,,dd7 ,a       
description ( ! ,indep5d5t ,paym5t      
,advisory ,bo>d "u section #ahii;,a ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciekkk7 & any actions tak5 to alt] or 
r$uce ! use ( m$ical products1 treatm5ts
 or proc$ures1 includ+ an explanation f 
! ,indep5d5t ,paym5t ,advisory ,bo>d ( !

 reasons = tak+ su* actions1 :e!r su*   
actions c\ld be expect$ to result 9     
wors5$ m$ical outcomes = individuals    
affect$ by su* alt]ations or r$uctions1 
& an explanation ( ! m$ical in=mation   
us$ to det]m9e :e!r su* alt]ations or   
r$uctions c\ld be expect$ to result 9   
su* wors5$ outcomes4  7,,ee7 ,a         
description ( individuals enroll$ 9 !   
,m$icaid program "u title ,,xix ( !     
,social ,security ,act ?r\gh an ex*ange 
e/abli%$ "u title ,i ( ! ,pati5t        
,protection & ,af=dable ,c>e ,act1      
includ+ a description ( ! co/ ( heal?   
c>e s]vices utiliz$ by su* individuals &
 a description ( ! co/ to ,/ates & ! co/
 to ! ,f$]al ,gov]nm5t to provide heal? 
c>e s]vices to su* individuals4  7,,ff7 
,any additional topic relat$ to !       
implem5tation & adm9i/ration ( !        
,af=dable ,c>e ,act1 ! inclusion ( :i*  
helps to provide ! public a full &      
objective acc\nt+ ( su* law4  7#b7 ,data
 to be includ$ ,9 c>ry+ out ! duties    
describ$ "u p>agraph 7#a71 ! ,special   

,inspector ,g5]al %all1 to ! greate/    
ext5t possible1 collect & summ>ize data 
describ$ "u su* p>agraph accord+ to ea* 
type ( insurance m>ketplace & accord+ to
 ! age & g5d] ( individuals enroll+ 9   
cov]age "u qualifi$ heal? plans ?r\gh an
 ex*ange e/abli%$ "u title ,i ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act4  7#c7 ,o!r duties relat$ to       
ov]sight ,! ,special ,inspector ,g5]al  
%all e/abli%1 ma9ta91 & ov]see su*      
sy/ems1 proc$ures1 & controls z !       
,special ,inspector ,g5]al consid]s     
appropriate to dis*>ge ! duties describ$
 "u p>agraph 7#a74  7#d7 ,duties &      
responsibilities "u ! ,inspector ,g5]al 
,act ( #aigh ,9 addition to ! duties    
describ$ "u p>agraphs 7#a7 & 7#b71 !    
,special ,inspector ,g5]al %all also h !
 duties & responsibilities ( inspectors 
g5]al "u ! ,inspector ,g5]al ,act (     
#aigh 7#e ,u4,s4,c4 ,app474  7f7        
,coord9ation ( ef=ts ,9 c>ry+ out !     
duties1 responsibilities1 & au?orities (
 ! ,special ,inspector ,g5]al "u ?is    

section1 ! ,special ,inspector ,g5]al   
%all coord9ate )1 & receive ! coop]ation
 ( ea* ( ! foll[+3  7#a7 ,! ,inspector  
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices4  7#b7 ,! ,inspector ,g5]al ( !
 ,dep>tm5t ( ! ,treasury4  7#c7 ,!      
,inspectors ,g5]al ( ! ,social ,security
 ,adm9i/ration1 ! ,dep>tm5t ( ,homel&   
,security1 ! ,dep>tm5t ( ,vet]ans       
,affairs1 ! ,dep>tm5t ( ,def5se1 !      
,dep>tm5t ( ,labor1 & ! ,peace ,corps4  
7#d7 ,! inspector g5]al ( any o!r ,f$]al
 entity1 z det]m9$ by ! ,special        
,inspector ,g5]al4  7g7 ,p[]s &         
au?orities  7#a7 ,au?ority to access    
mat]ials1 reque/ in=mation1 compel      
response1 & o!r au?orities "u !         
,inspector ,g5]al ,act ( #aigh ,9 c>ry+ 
out ! duties describ$ "u subsection 7e71
 ! ,special ,inspector ,g5]al %all h all
 ( ! au?orities provid$ "u section #f ( 
! ,inspector ,g5]al ,act ( #aigh 7#e    
,u4,s4,c4 ,app474  7#b7 ,exemption f    
requirem5t = initial det]m9ation by     
,attorney ,g5]al ,= purposes ( section  

#f7;e7 ( ! ,inspector ,g5]al ,act (     
#aigh 7#e ,u4,s4,c4 ,app471 ! ,special  
,inspector ,g5]al %all be consid]$      
exempt f ! requirem5t ( an initial      
det]m9ation ( eligibility by ! ,attorney
 ,g5]al "u p>agraph 7#b7 ( su* section4 
7#c7 ,audit /&>ds ,! ,special ,inspector
 ,g5]al %all c>ry out ! duties specifi$ 
"u subsection 7e77#a7 9 accordance )    
section #d7;b77#a7 ( ! ,inspector ,g5]al
 ,act ( #aigh 7#e ,u4,s4,c4 ,app474  7h7
 ,p]sonnel1 facilities1 & o!r res\rces  
7#a7 ,p]sonnel ,! ,special ,inspector   
,g5]al may select1 appo9t1 & employ su* 
(fic]s & employees z may be necess>y =  
c>ry+ out ! duties ( ! ,special         
,inspector ,g5]al1 subject to !         
provisions ( title #e1 ,unit$ ,/ates    
,code1 gov]n+ appo9tm5ts 9 ! competitive
 s]vice1 & ! provisions ( *apt] #ea &   
sub*apt] ,,iii ( *apt] #ec ( su* title1 
relat+ to classification & ,g5]al       
,s*$ule pay rates4  7#b7 ,employm5t (   
exp]ts & consultants ,! ,special        
,inspector ,g5]al may obta9 s]vices z   

au?oriz$ by section #caji ( title #e1   
,unit$ ,/ates ,code1 at daily rates n to
 exce$ ! equival5t rate prescrib$ =     
grade ,,gs-#ae ( ! ,g5]al ,s*$ule by    
section #eccb ( su* title4  7#c7        
,contract+ au?ority ,to ! ext5t & 9 su* 
am\nts z may be provid$ 9 advance by    
appropriations ,acts1 ! ,special        
,inspector ,g5]al may ent] into         
contracts & o!r arrangem5ts = audits1   
/udies1 analyses1 & o!r s]vices ) public
 ag5cies & ) private p]sons1 & make su* 
paym5ts z may be necess>y to c>ry out ! 
duties ( ! ,special ,inspector ,g5]al4  
7#d7 ,res\rces ,! ,secret>y ( ,heal? &  
,human ,s]vices %all provide ! ,special 
,inspector ,g5]al ) appropriate &       
adequate (fice space at appropriate     
locations ( ! ,dep>tm5t ( ,heal? &      
,human ,s]vices toge!r ) su* equipm5t1  
(fice supplies1 & communications        
facilities & s]vices z may be necess>y =
 ! op]ation ( su* (fices1 & %all provide
 necess>y ma9t5ance s]vices = su* (fices
 & ! equipm5t & facilities locat$ !re94 

7#e7 ,assi/ance f ,f$]al ag5cies  7,a7  
,9 g5]al ,^u reque/ ( ! ,special        
,inspector ,g5]al = in=mation or        
assi/ance f any ,dep>tm5t1 ,ag5cy1 or   
o!r entity ( ! ,f$]al ,gov]nm5t 7includ+
 any entity li/$ "u subsection 7d77#b771
 ! head ( su* entity %all1 ins(> z is   
practicable & n 9 contrav5tion ( any    
exi/+ law1 furni% su* in=mation or      
assi/ance to ! ,special ,inspector      
,g5]al1 or an au?oriz$ designee4  7,b7  
,report+ ( refus$ assi/ance  7i7        
,report+ to ,heal? & ,human ,s]vices &  
,congress ,9 accordance ) clause 7ii71 z
 ! case may be1 :5ev] in=mation or      
assi/ance reque/$ by ! ,special         
,inspector ,g5]al is1 9 ! judgm5t ( !   
,special ,inspector ,g5]al1 unreasonably
 refus$ or n provid$1 ! ,special        
,inspector ,g5]al %all report !         
circum/ances to ! ,secret>y ( ,heal? &  
,human ,s]vices & to ! appropriate      
congressional committees )\t delay4     
7ii7 ,report+ to ! public on refusal or 
noncoop]ation 9 transp>5cy ,:5ev] any   

in=mation describ$ 9 clause 7i7 is      
reque/$ by ! ,special ,inspector ,g5]al 
& unreasonably refus$ or n provid$1 !   
report to ! ,secret>y ( ,heal? & ,human 
,s]vices & ! appropriate congressional  
committees %all be titl$ ,notice (      
,refusal or ,noncoop]ation 9 ,transp>5cy
 & %all be publi%$ on a publicly        
available website 9 an accessible =mat  
)\t delay4  7#f7 ,use ( p]sonnel1       
facilities1 & o!r res\rces ( ! ,(fice   
,^u ! reque/ ( ! ,special ,inspector    
,g5]al1 an ,inspector ,g5]al-- 7,a7 may 
detail1 on a reimbursable basis1 to !   
,(fice any ( ! p]sonnel ( su* ,inspector
 ,g5]al's (fice = ! purpose ( c>ry+ out 
?is section2 &  7,b7 may provide1 on a  
reimbursable basis1 any ( ! facilities  
or o!r res\rces ( ! ,(fice = ! purpose (
 c>ry+ out ?is section4  7i7 ,reports   
7#a7 ,initial report ,n lat] ?an #ij    
days aft] ! date ( ! enactm5t ( ?is     
,act1 ! ,special ,inspector ,g5]al %all 
submit to ! appropriate congressional   
committees & ! ,secret>y ( ,heal? &     

,human ,s]vices a report summ>iz+1 = !  
p]iod beg9n+ on ! date ( ! enactm5t ( ! 
,heal? ,c>e & ,education ,reconciliation
 ,act ( #bjaj & end+ on ! completion ( a
 fiscal ye> qu>t] aft] ! date ( enactm5t
 ( ?is ,act1 ! activities dur+ su* p]iod
 ( ! ,special ,inspector ,g5]al requir$ 
"u subsection 7e74  7#b7 ,qu>t]ly       
reports ,beg9n+ ) ! fir/ full fiscal ye>
 qu>t] aft] ! date ( ! enactm5t ( ?is   
,act1 n lat] ?an #cj days aft] ! end (  
ea* fiscal ye> qu>t]1 dur+ :i* !        
,af=dable ,c>e ,act is 9 effect1 !      
,special ,inspector ,g5]al %all submit  
to ! appropriate congressional          
committees & ! ,secret>y ( ,heal? &     
,human ,s]vices a report summ>iz+1 = !  
p]iod ( t qu>t] &1 to ! ext5t possible1 
! p]iod f ! end ( su* qu>t] to ! "t ( ! 
submission ( ! report1 ! activities dur+
 su* p]iod ( ! ,special ,inspector      
,g5]al requir$ "u subsection 7e74  7#c7 
,comm5ts on report ,n lat] ?an #cj days 
aft] receipt ( a report "u ?is          
subsection1 ! ,secret>y ( ,heal? &      

,human ,s]vices %all submit to !        
appropriate congressional committees any
 comm5ts on ! matt]s cov]$ by ! report4 
7#d7 ,public availability2 recordkeep+  
7,a7 ,9 g5]al ,! ,special ,inspector    
,g5]al %all publi% on a publicly        
available website ea* report describ$ "u
 ?is subsection & any comm5ts on !      
matt]s cov]$ by ! report submitt$       
pursuant to p>agraph 7#c74  7,b7        
,requirem5t to index ,except z provid$ 9
 subp>agraph 7,c71 ! ,special ,inspector
 ,g5]al %all1 to ! greate/ ext5t        
possible1 index & publi% on ! publicly  
available website in=mation = ea* s\rce 
us$ 9 ea* report describ$ "u ?is        
subsection1 includ+ :5ev] applicable !  
docum5t "n1 au?or1 & own]4  7,c7        
,exception to index requirem5t ,!       
,special ,inspector ,g5]al may except ) 
a writt5 note ( exclusion c]ta9         
in=mation requir$ to be publi%$ pursuant
 to subp>agraph 7,b7 t ! ,special       
,inspector ,g5]al det]m9es is--  7i7    
necess>y to protect an individual t     

provid$ ! in=mation2 or  7ii7 classifi$4
  7,d7 ,recordkeep+ requirem5t ,all     
s\rce mat]ial & in=mation us$ to create 
a report describ$ "u ?is subsection1    
includ+ in=mation except$ "u subp>agraph
 7,c71 %all be id5tifi$1 index$ 79 a    
classifi$ annex1 if necess>y71 & ma9ta9$
 7includ+ any writt5 note ( exclusion7  
by ! ,special ,inspector ,g5]al4  7#e7  
,protect$ in=mation ,to ! ext5t         
possible1 in=mation submitt$ 9 any      
report requir$ "u ?is subsection %all be
 9 a =m t is n prohibit$ f disclosure "u
 section #eeb;a ( title #e1 ,unit$      
,/ates ,code 7commonly kn[n z ! ,privacy
 ,act ( #aigd74  7#f7 ,aggregat$        
in=mation ,! ,special ,inspector ,g5]al 
%all1 to ! maximum ext5t possible1      
aggregate any p]sonally id5tifiable     
in=mation submitt$ 9 a report requir$ "u
 ?is subsection4  7j7 ,am5dm5t to !     
,inspector ,g5]al ,act ,section #h;,d ( 
! ,inspector ,g5]al ,act 7#e ,u4,s4,c4  
,app47 is am5d$ 9 subsections 7e7 & 7f7 
by ins]t+ aft] = ,tax ,adm9i/ration1 ea*

 place x appe>s1 ! foll[+3 & ! ,special 
,inspector ,g5]al = ,monitor+ !         
,af=dable ,c>e ,act4  7k7 ,t]m9ation ,! 
,(fice ( ! ,special ,inspector ,g5]al   
%all t]m9ate ! e>li] (-- 7#a7 ,janu>y   
#a1 #bjbe2 or  7#b7 ! date on :i* ! f9al
 report requir$ by subsection 7h7 is    
submitt$ = ! la/ ye> ! ,af=dable ,c>e   
,act is 9 effect4  7l7 ,def9itions ,9   
?is section3 7#a7 ,af=dable ,c>e ,act ,!
 t]m ,af=dable ,c>e ,act means ! ,pati5t
 ,protection & ,af=dable ,c>e ,act &    
title ,i & subtitle ,b ( title ,,ii ( ! 
,heal? ,c>e & ,education ,reconciliation
 ,act ( #bjaj4  7#b7 ,appropriate       
congressional committees ,! t]m         
appropriate congressional committees    
means-- 7,a7 ! ,committees on           
,appropriations2 ! ,budget2 ,education &
 ! ,work=ce2 ,en]gy & ,comm]ce2 ,homel& 
,security2 ! ,judici>y2 ,ov]sight &     
,gov]nm5t ,re=m2 ,small ,bus9ess2 &     
,ways & ,means ( ! ,h\se (              
,repres5tatives2 &  7,b7 ! ,committees  
on ,appropriations2 ! ,budget2 ,comm]ce1

 ,sci5ce1 & ,transportation2 ,f9ance2   
,heal?1 ,education1 ,labor1 & ,p5sions2 
,homel& ,security & ,gov]nm5tal         
,affairs2 ! ,judici>y2 & ,small ,bus9ess
 & ,entrepr5eur%ip ( ! ,s5ate4