42 U.S.C. § 18092 — Notification of nonenrollment

Page 9138 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 18092 jected 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 in- surance 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 re- gional 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 mil- lions of new consumers to the health insur- ance market, increasing the supply of, and demand for, health care services, and will in- crease the number and share of Americans who are insured. (D) The requirement achieves near-uni- versal coverage by building upon and strengthening the private employer-based health insurance system, which covers 176,000,000 Americans nationwide. In Massa- chusetts, a similar requirement has strengthened private employer-based cov- erage: 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 signifi- cantly reducing the number of the unin- sured, the requirement, together with the other provisions of this Act, will signifi- cantly 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 pro- viders 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 provi- sions 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 im- prove financial security for families. (H) Under the Employee Retirement In- come Security Act of 1974 (29 U.S.C. 1001 et seq.), the Public Health Service Act (42 U.S.C. 201 et seq.), and this Act, the Federal Government has a significant role in regu- lating health insurance. The requirement is an essential part of this larger regulation of economic activity, and the absence of the re- quirement would undercut Federal regula- tion of the health insurance market. (I) Under sections 2704 and 2705 of the Pub- lic Health Service Act [42 U.S.C. 300gg–3, 300gg–4] (as added by section 1201 of this Act), if there were no requirement, many in- dividuals would wait to purchase health in- surance until they needed care. By signifi- cantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will minimize this ad- verse selection and broaden the health insur- ance risk pool to include healthy individ- uals, which will lower health insurance pre- miums. The requirement is essential to cre- ating 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 cur- rent 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 provi- sions of this Act, will significantly reduce administrative costs and lower health insur- ance premiums. The requirement is essential to creating effective health insurance mar- kets that do not require underwriting and eliminate its associated administrative costs. (3) Supreme Court ruling In United States v. South-Eastern Under- writers Association (322 U.S. 533 (1944)), the Supreme Court of the United States ruled that insurance is interstate commerce subject to Federal regulation. (Pub. L. 111–148, title I, § 1501(a), title X, § 10106(a), Mar. 23, 2010, 124 Stat. 242, 907.) Editorial Notes REFERENCES IN TEXT This Act, referred to in par. (2)(C), (E) to (J), is Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 119, known as the Pa- tient Protection and Affordable Care Act. For complete classification of this Act to the Code, see Short Title note set out under section 18001 of this title and Tables. The Employee Retirement Income Security Act of 1974, referred to in par. (2)(H), is Pub. L. 93–406, Sept. 2, 1974, 88 Stat. 829, which is classified principally to chap- ter 18 (§ 1001 et seq.) of Title 29, Labor. For complete classification of this Act to the Code, see Short Title note set out under section 1001 of Title 29 and Tables. The Public Health Service Act, referred to in par. (2)(H), is act July 1, 1944, ch. 373, 58 Stat. 682, which is classified generally to chapter 6A (§ 201 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 201 of this title and Tables. AMENDMENTS 2010—Par. (2). Pub. L. 111–148, § 10106(a), amended par. (2) generally. Prior to amendment, par. (2) described ef- fects of the individual responsibility requirement on the national economy and interstate commerce. § 18092. Notification of nonenrollment Not later than June 30 of each year, the Sec- retary of the Treasury, acting through the In- ternal Revenue Service and in consultation with the Secretary of Health and Human Services, shall send a notification to each individual who files an individual income tax return and who is not enrolled in minimum essential coverage (as defined in section 5000A of title 26). Such notifi- cation shall contain information on the services available through the Exchange operating in the State in which such individual resides. Page 9139 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 18114 1 See References in Text note below. (Pub. L. 111–148, title I, § 1502(c), Mar. 23, 2010, 124 Stat. 251.) PART B—EMPLOYER RESPONSIBILITIES § 18101. Repealed. Pub. L. 112–10, div. B, title VIII, § 1858(a), Apr. 15, 2011, 125 Stat. 168 Section, Pub. L. 111–148, title X, § 10108(a)–(e), Mar. 23, 2010, 124 Stat. 912, 913, related to free choice vouchers. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF REPEAL Repeal by Pub. L. 112–10 effective as if included in the provisions of, and the amendments made by, the provi- sions of Pub. L. 111–148 to which it relates, see section 1858(d) of Pub. L. 112–10, set out as an Effective Date of 2011 Amendment note under section 36B of Title 26, In- ternal Revenue Code. SUBCHAPTER VI—MISCELLANEOUS PROVISIONS § 18111. Definitions Unless specifically provided for otherwise, the definitions contained in section 300gg–91 of this title shall apply with respect to this title.1 (Pub. L. 111–148, title I, § 1551, Mar. 23, 2010, 124 Stat. 258.) Editorial Notes REFERENCES IN TEXT This title, where footnoted in text, is title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted this chapter and enacted, amended, and transferred nu- merous other sections and notes in the Code. For com- plete classification of title I to the Code, see Tables. § 18112. Transparency in Government Not later than 30 days after March 23, 2010, the Secretary of Health and Human Services shall publish on the Internet website of the Depart- ment of Health and Human Services, a list of all of the authorities provided to the Secretary under this Act (and the amendments made by this Act). (Pub. L. 111–148, title I, § 1552, Mar. 23, 2010, 124 Stat. 258.) Editorial Notes REFERENCES IN TEXT This Act, referred to in text, is Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 119, known as the Patient Protection and Affordable Care Act. For complete classification of this Act to the Code, see Short Title note set out under section 18001 of this title and Tables. § 18113. Prohibition against discrimination on as- sisted suicide (a) In general The Federal Government, and any State or local government or health care provider that receives Federal financial assistance under this Act (or under an amendment made by this Act) or any health plan created under this Act (or under an amendment made by this Act), may not subject an individual or institutional health care entity to discrimination on the basis that the entity does not provide any health care item or service furnished for the purpose of causing, or for the purpose of assisting in causing, the death of any individual, such as by assisted sui- cide, euthanasia, or mercy killing. (b) Definition In this section, the term ‘‘health care entity’’ includes an individual physician or other health care professional, a hospital, a provider-spon- sored organization, a health maintenance orga- nization, a health insurance plan, or any other kind of health care facility, organization, or plan. (c) Construction and treatment of certain serv- ices Nothing in subsection (a) shall be construed to apply to, or to affect, any limitation relating to— (1) the withholding or withdrawing of med- ical treatment or medical care; (2) the withholding or withdrawing of nutri- tion or hydration; (3) abortion; or (4) the use of an item, good, benefit, or serv- ice furnished for the purpose of alleviating pain or discomfort, even if such use may in- crease the risk of death, so long as such item, good, benefit, or service is not also furnished for the purpose of causing, or the purpose of assisting in causing, death, for any reason. (d) Administration The Office for Civil Rights of the Department of Health and Human Services is designated to receive complaints of discrimination based on this section. (Pub. L. 111–148, title I, § 1553, Mar. 23, 2010, 124 Stat. 259.) Editorial Notes REFERENCES IN TEXT This Act, referred to in subsec. (a), is Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 119, known as the Patient Pro- tection and Affordable Care Act. For complete classi- fication of this Act to the Code, see Short Title note set out under section 18001 of this title and Tables. § 18114. Access to therapies Notwithstanding any other provision of this Act, the Secretary of Health and Human Serv- ices shall not promulgate any regulation that— (1) creates any unreasonable barriers to the ability of individuals to obtain appropriate medical care; (2) impedes timely access to health care services; (3) interferes with communications regard- ing a full range of treatment options between the patient and the provider; (4) restricts the ability of health care pro- viders to provide full disclosure of all relevant information to patients making health care decisions; (5) violates the principles of informed con- sent and the ethical standards of health care professionals; or (6) limits the availability of health care treatment for the full duration of a patient’s medical needs.