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42 U.S.C. § 18091 — Requirement to maintain minimum essential coverage; findings
Federal law — U.S. Code and appendices · legal_authorities
Congress makes the following findings:
(1) **In general** — The individual responsibility requirement provided for in this section (in this section referred to as the “requirement”) is commercial and economic in nature, and substantially affects interstate commerce, as a result of the effects described in paragraph (2).
(2) **Effects on the national economy and interstate commerce** — The effects described in this paragraph are the following:
(A) The requirement regulates activity that is commercial and economic in nature: economic and financial decisions about how and when health care is paid for, and when health insurance is purchased. In the absence of the requirement, some individuals would make an economic and financial decision to forego health insurance coverage and attempt to self-insure, which increases financial risks to households and medical providers.
(B) Health insurance and health care services are a significant part of the national economy. National health spending is projected to increase from $2,500,000,000,000, or 17.6 percent of the economy, in 2009 to $4,700,000,000,000 in 2019. Private health insurance spending is projected to be $854,000,000,000 in 2009, and pays for medical supplies, drugs, and equipment that are shipped in interstate commerce. Since most health insurance is sold by national or regional health insurance companies, health insurance is sold in interstate commerce and claims payments flow through interstate commerce.
(C) The requirement, together with the other provisions of this Act, will add millions of new consumers to the health insurance market, increasing the supply of, and demand for, health care services, and will increase the number and share of Americans who are insured.
(D) The requirement achieves near-univ
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Source location: Title 42, Chapter 157, § 18091; chapter-157-quality-affordable-health-care-for-all-americans.md
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Congress makes the following findings:
(1) **In general** — The individual responsibility requirement provided for in this section (in this section referred to as the “requirement”) is commercial and economic in nature, and substantially affects interstate commerce, as a result of the effects described in paragraph (2).
(2) **Effects on the national economy and interstate commerce** — The effects described in this paragraph are the following:
(A) The requirement regulates activity that is commercial and economic in nature: economic and financial decisions about how and when health care is paid for, and when health insurance is purchased. In the absence of the requirement, some individuals would make an economic and financial decision to forego health insurance coverage and attempt to self-insure, which increases financial risks to households and medical providers.
(B) Health insurance and health care services are a significant part of the national economy. National health spending is projected to increase from $2,500,000,000,000, or 17.6 percent of the economy, in 2009 to $4,700,000,000,000 in 2019. Private health insurance spending is projected to be $854,000,000,000 in 2009, and pays for medical supplies, drugs, and equipment that are shipped in interstate commerce. Since most health insurance is sold by national or regional health insurance companies, health insurance is sold in interstate commerce and claims payments flow through interstate commerce.
(C) The requirement, together with the other provisions of this Act, will add millions of new consumers to the health insurance market, increasing the supply of, and demand for, health care services, and will increase the number and share of Americans who are insured.
(D) The requirement achieves near-universal coverage by building upon and strengthening the private employer-based health insurance system, which covers 176,000,000 Americans nationwide. In Massachusetts, a similar requirement has strengthened private employer-based coverage: despite the economic downturn, the number of workers offered employer-based coverage has actually increased.
(E) The economy loses up to $207,000,000,000 a year because of the poorer health and shorter lifespan of the uninsured. By significantly reducing the number of the uninsured, the requirement, together with the other provisions of this Act, will significantly reduce this economic cost.
(F) The cost of providing uncompensated care to the uninsured was $43,000,000,000 in 2008. To pay for this cost, health care providers pass on the cost to private insurers, which pass on the cost to families. This cost-shifting increases family premiums by on average over $1,000 a year. By significantly reducing the number of the uninsured, the requirement, together with the other provisions of this Act, will lower health insurance premiums.
(G) 62 percent of all personal bankruptcies are caused in part by medical expenses. By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will improve financial security for families.
(H) Under the Employee Retirement Income Security Act of 1974 ([29 U.S.C. 1001](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1001&num=0&edition=prelim) et seq.), the Public Health Service Act ([42 U.S.C. 201](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section201&num=0&edition=prelim) et seq.), and this Act, the Federal Government has a significant role in regulating health insurance. The requirement is an essential part of this larger regulation of economic activity, and the absence of the requirement would undercut Federal regulation of the health insurance market.
(I) Under sections 2704 and 2705 of the Public Health Service Act [[42 U.S.C. 300gg–3](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-3&num=0&edition=prelim), 300gg–4] (as added by section 1201 of this Act), if there were no requirement, many individuals would wait to purchase health insurance until they needed care. By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will lower health insurance premiums. The requirement is essential to creating effective health insurance markets in which improved health insurance products that are guaranteed issue and do not exclude coverage of pre-existing conditions can be sold.
(J) Administrative costs for private health insurance, which were $90,000,000,000 in 2006, are 26 to 30 percent of premiums in the current individual and small group markets. By significantly increasing health insurance coverage and the size of purchasing pools, which will increase economies of scale, the requirement, together with the other provisions of this Act, will significantly reduce administrative costs and lower health insurance premiums. The requirement is essential to creating effective health insurance markets that do not require underwriting and eliminate its associated administrative costs.
(3) **Supreme Court ruling** — In United States v. South-Eastern Underwriters Association (322 U.S. 533 (1944)), the Supreme Court of the United States ruled that insurance is interstate commerce subject to Federal regulation.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** Not later than 90 days after March 23, 2010, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014.
**(b) Administration**
(1) **In general** — The Secretary may carry out the program under this section directly or through contracts to eligible entities.
(2) **Eligible entities** — To be eligible for a contract under paragraph (1), an entity shall—
(A) be a State or nonprofit private entity;
(B) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; and
(C) agree to utilize contract funding to establish and administer a qualified high risk pool for eligible individuals.
(3) **Maintenance of effort** — To be eligible to enter into a contract with the Secretary under this subsection, a State shall agree not to reduce the annual amount the State expended for the operation of one or more State high risk pools during the year preceding the year in which such contract is entered into.
**(c) Qualified high risk pool**
(1) **In general** — Amounts made available under this section shall be used to establish a qualified high risk pool that meets the requirements of paragraph (2).
(2) **Requirements** — A qualified high risk pool meets the requirements of this paragraph if such pool—
(A) provides to all eligible individuals health insurance coverage that does not impose any preexisting condition exclusion with respect to such coverage;
(B) provides health insurance coverage—
(i) in which the issuer’s share of the total allowed costs of benefits provided under such co
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18001
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Benefit plans as affecting interstate commerce and the Federal taxing power** The Congress finds that the growth in size, scope, and numbers of employee benefit plans in recent years has been rapid and substantial; that the operational scope and economic impact of such plans is increasingly interstate; that the continued well-being and security of millions of employees and their dependents are directly affected by these plans; that they are affected with a national public interest; that they have become an important factor affecting the stability of employment and the successful development of industrial relations; that they have become an important factor in commerce because of the interstate character of their activities, and of the activities of their participants, and the employers, employee organizations, and other entities by which they are established or maintained; that a large volume of the activities of such plans are carried on by means of the mails and instrumentalities of interstate commerce; that owing to the lack of employee information and adequate safeguards concerning their operation, it is desirable in the interests of employees and their beneficiaries, and to provide for the general welfare and the free flow of commerce, that disclosure be made and safeguards be provided with respect to the establishment, operation, and administration of such plans; that they substantially affect the revenues of the United States because they are afforded preferential Federal tax treatment; that despite the enormous growth in such plans many employees with long years of employment are losing anticipated retirement benefits owing to the lack of vesting provisions in such plans; that owing to the inadequacy of current minimum standards, the soundness and stabilit
Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1001
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Federal law — U.S. Code and appendices · legal_authorities
Beginning with fiscal year 2010, the Secretary shall transfer from the Public Health and Social Services Emergency Fund such sums as may be necessary to carry out this part.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Requirement to maintain minimum essential coverage** An applicable individual shall for each month beginning after 2013 ensure that the individual, and any dependent of the individual who is an applicable individual, is covered under minimum essential coverage for such month.
**(b) Shared responsibility payment**
(1) **In general** — If a taxpayer who is an applicable individual, or an applicable individual for whom the taxpayer is liable under paragraph (3), fails to meet the requirement of subsection (a) for 1 or more months, then, except as provided in subsection (e), there is hereby imposed on the taxpayer a penalty with respect to such failures in the amount determined under subsection (c).
(2) **Inclusion with return** — Any penalty imposed by this section with respect to any month shall be included with a taxpayer’s return under chapter 1 for the taxable year which includes such month.
(3) **Payment of penalty** — If an individual with respect to whom a penalty is imposed by this section for any month—
(A) is a dependent (as defined in section 152) of another taxpayer for the other taxpayer’s taxable year including such month, such other taxpayer shall be liable for such penalty, or
(B) files a joint return for the taxable year including such month, such individual and the spouse of such individual shall be jointly liable for such penalty.
**(c) Amount of penalty**
(1) **In general** — The amount of the penalty imposed by this section on any taxpayer for any taxable year with respect to failures described in subsection (b)(1) shall be equal to the lesser of—
(A) the sum of the monthly penalty amounts determined under paragraph (2) for months in the taxable year during which 1 or more such failures occurred, or
(B) an amount equal to the na
Source: Supplied U.S. Code snapshot — release unconfirmed · 26 U.S.C. § 5000A
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Federal law — U.S. Code and appendices · legal_authorities
Page 353
TITLE 29—LABOR
§ 1001
Sec.
1365.
Annual report of plan administrator.
1366.
Annual notification to substantial employers.
1367.
Recovery of liability for plan termination.
1368.
Lien for liability.
1369.
Treatment of transactions to evade liability;
effect of corporate reorganization.
1370.
Enforcement authority relating to termi-
nations of single-employer plans.
1371.
Penalty for failure to timely provide required
information.
SUBTITLE E—SPECIAL PROVISIONS FOR MULTIEMPLOYER
PLANS
PART 1—EMPLOYER WITHDRAWALS
1381.
Withdrawal liability established; criteria and
definitions.
1382.
Determination and collection of liability; no-
tification of employer.
1383.
Complete withdrawal.
1384.
Sale of assets.
1385.
Partial withdrawals.
1386.
Adjustment for partial withdrawal; deter-
mination of amount; reduction for partial
withdrawal liability; procedures applicable.
1387.
Reduction or waiver of complete withdrawal
liability; procedures and standards applica-
ble.
1388.
Reduction of partial withdrawal liability.
1389.
De minimis rule.
1390.
Nonapplicability of withdrawal liability for
certain temporary contribution obligation
periods; exception.
1391.
Methods for computing withdrawal liability.
1392.
Obligation to contribute.
1393.
Actuarial assumptions.
1394.
Application of plan amendments; exception.
1395.
Plan notification to corporation of poten-
tially significant withdrawals.
1396.
Special rules for plans under section 404(c) of
title 26.
1397.
Application of part in case of certain pre-1980
withdrawals; adjustment of covered plan.
1398.
Withdrawal not to occur because of change in
business form or suspension of contribu-
tions during labor dispute.
1399.
Notice, collection, etc., of withdrawal liabil-
Source: Supplied 2024 U.S. Code historical extraction · 29 U.S.C. § 1001
Stored review status: historical_2024_not_currentness_verified. The source passage cites 29 U.S.C. § 1001. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
Page 9137
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 18091
3 See References in Text note below.
1 See References in Text note below.
matched and representatives of applicable
State health subsidy programs, promulgate
standards governing the timing, contents, and
procedures for data matching described in this
subsection. Such standards shall take into ac-
count administrative and other costs and the
value of data matching to the establishment,
verification, and updating of eligibility for ap-
plicable State health subsidy programs.
(d) Administrative authority
(1) Agreements
Subject to section 18081 of this title and sec-
tion 6103(l)(21) of title 26 and any other re-
quirement providing safeguards of privacy and
data integrity, the Secretary may establish
model agreements, and enter into agreements,
for the sharing of data under this section.
(2) Authority of exchange to contract out
Nothing in this section shall be construed
to—
(A)
prohibit
contractual
arrangements
through which a State medicaid agency de-
termines eligibility for all applicable State
health subsidy programs, but only if such
agency complies with the Secretary’s re-
quirements ensuring reduced administrative
costs, eligibility errors, and disruptions in
coverage; or
(B) change any requirement under title
XIX 1 that eligibility for participation in a
State’s medicaid program must be deter-
mined by a public agency.
(e) Applicable State health subsidy program
In this section, the term ‘‘applicable State
health subsidy program’’ means—
(1) the program under this title 3 for the en-
rollment in qualified health plans offered
through an Exchange, including the premium
tax credits under section 36B of title 26 and
cost-sharing reductions under section 18071 of
this title;
(
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 18091
Stored review status: historical_2024_not_currentness_verified. Same stored citation; legal effect and authority still require review.
Federal law — U.S. Code and appendices · legal_authorities
Page 35
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 201
1 See References in Text note below.
Sec.
300jj–34.
Competitive grants to States and Indian
tribes for the development of loan pro-
grams to facilitate the widespread
adoption of certified EHR technology.
300jj–35.
Demonstration program to integrate in-
formation
technology
into
clinical
education.
300jj–36.
Information technology professionals in
health care.
300jj–37.
General grant and loan provisions.
300jj–38.
Authorization for appropriations.
PART C—OTHER PROVISIONS
300jj–51.
Health information technology enroll-
ment standards and protocols.
300jj–52.
Information blocking.
SUBCHAPTER XXIX—DATA COLLECTION,
ANALYSIS, AND QUALITY
300kk.
Data collection, analysis, and quality.
SUBCHAPTER XXX—COMMUNITY LIVING
ASSISTANCE SERVICES AND SUPPORTS
300ll to 300ll–9. Repealed.
SUBCHAPTER XXXI—WORLD TRADE CENTER
HEALTH PROGRAM
PART A—ESTABLISHMENT OF PROGRAM; ADVISORY
COMMITTEE
300mm.
Establishment of World Trade Center
Health Program.
300mm–1.
WTC Health Program Scientific/Tech-
nical
Advisory
Committee;
WTC
Health Program Steering Committees.
300mm–2.
Education and outreach.
300mm–3.
Uniform data collection and analysis.
300mm–4.
Clinical Centers of Excellence and Data
Centers.
300mm–5.
Definitions.
PART B—PROGRAM OF MONITORING, INITIAL HEALTH
EVALUATIONS, AND TREATMENT
SUBPART 1—WTC RESPONDERS
300mm–21.
Identification of WTC responders and
provision of WTC-related monitoring
services.
300mm–22.
Treatment of enrolled WTC responders
for WTC-related health conditions.
300mm–23.
National arrangement for benefits for el-
igible individuals outside New York.
SUBPART 2—WTC SURVIVORS
300mm–31.
Identification and initial health evalua-
tion of screening-eligible and
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 201
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 201. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
**(a) 11 So in original. No subsec. (b) has been enacted. Prohibiting discriminatory premium rates**
(1) **In general** — With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market—
(A) such rate shall vary with respect to the particular plan or coverage involved only by—
(i) whether such plan or coverage covers an individual or family;
(ii) rating area, as established in accordance with paragraph (2);
(iii) age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with [section 300gg–6(c) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–6/c&num=0&edition=prelim)); and
(iv) tobacco use, except that such rate shall not vary by more than 1.5 to 1; and
(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).
(2) **Rating area**
(A) *In general* — Each State shall establish 1 or more rating areas within that State for purposes of applying the requirements of this subchapter.
(B) *Secretarial review* — The Secretary shall review the rating areas established by each State under subparagraph (A) to ensure the adequacy of such areas for purposes of carrying out the requirements of this subchapter. If the Secretary determines a State’s rating areas are not adequate, or that a State does not establish such areas, the Secretary may establish rating areas for that State.
(3) **Permissible age bands** — The Secretary, in consultation with the National Association of Insurance Commissioners, shall define the permissible age bands for rating purposes under paragraph (1)(A)(iii).
(4) **Application of variat
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 300gg
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Federal law — U.S. Code and appendices · legal_authorities
Page 1597
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 300gg
1 So in original.
1 So in original. No subsec. (b) has been enacted.
require the provision of data to public health
authorities.
(July 1, 1944, ch. 373, title XXVI, § 2695G, as added
Pub. L. 111–87, § 13, Oct. 30, 2009, 123 Stat. 2902.)
Statutory Notes and Related Subsidiaries
EFFECTIVE DATE
Section effective as if enacted on Sept. 30, 2009, see
section 2(a)(3)(B) of Pub. L. 111–87, set out as an Effec-
tive Date of 2009 Amendment; Revival of Section note
under section 300ff–11 of this title.
§ 300ff–139. Injunctions regarding violation of
prohibition
(a) In general
The Secretary may, in any court of competent
jurisdiction, commence a civil action for the
purpose of obtaining temporary or permanent
injunctive relief with respect to any violation of
this part.
(b) Facilitation of information on violations
The Secretary shall establish an administra-
tive process for encouraging emergency response
employees to provide information to the Sec-
retary regarding violations of this part. As ap-
propriate, the Secretary shall investigate al-
leged such 1 violations and seek appropriate in-
junctive relief.
(July 1, 1944, ch. 373, title XXVI, § 2695H, as added
Pub. L. 111–87, § 13, Oct. 30, 2009, 123 Stat. 2902.)
Statutory Notes and Related Subsidiaries
EFFECTIVE DATE
Section effective as if enacted on Sept. 30, 2009, see
section 2(a)(3)(B) of Pub. L. 111–87, set out as an Effec-
tive Date of 2009 Amendment; Revival of Section note
under section 300ff–11 of this title.
§ 300ff–140. Applicability of part
This part shall not apply in a State if the chief
executive officer of the State certifies to the
Secretary that the law of the State is substan-
tially consistent with this part.
(July 1, 19
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 300gg
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