HR 3947119th CongressIn Committee

Easy Enrollment in Health Care Act

Introduced: Jun 12, 2025

Healthcare

Standard Summary

Comprehensive overview in 1-2 paragraphs

The Easy Enrollment in Health Care Act aims to make it much easier for individuals and families to enroll in health coverage and the programs that subsidize it (Medicaid, CHIP, and ACA marketplace plans with premium credits and cost-sharing reductions). The core idea is to use information from a taxpayer’s federal tax return, with consent, to determine eligibility and enroll household members into insurance affordability programs, including options where the net premium is zero. The bill would create a federal program by January 1, 2028 to facilitate this process through a secure data interface between the Treasury and health exchanges, and it would allow automatic or semi-automatic enrollment unless the individual chooses to opt out. It also updates some eligibility processes (e.g., using SNAP/TANF data) and strengthens data protection and error-correction procedures. In short, the bill seeks to accelerate and simplify enrollment by tying health coverage eligibility to tax filing, while preserving important privacy protections, rights to notice and appeal, and opportunities to opt out or correct errors.

Key Points

1Tax-return–driven enrollment with zero net premium: By 2028, taxpayers not currently covered can elect to have determinations made about eligibility for insurance affordability programs and be enrolled in minimum essential coverage that has a zero net premium, provided they consent and do not opt out or choose a different plan.
2Consent mechanism and supplemental information: Taxpayers may identify household members not covered and, with consent, allow the disclosure and transfer of relevant return information to the appropriate Exchange to determine eligibility and facilitate enrollment. A supplemental form may collect additional information needed for eligibility, while protections prohibit requests for citizenship/immigration status or health status.
3Secure data interface and transfer: The Treasury will establish a secure electronic interface to transfer relevant return information to Exchanges, with data security standards and options for transfer by Treasury or the tax preparer if needed. The goal is to enable immediate determinations of eligibility and enrollment where possible.
4Exchange procedures for enrollment and default options: Exchanges will minimize additional data needs, determine eligibility for Medicaid/CHIP, and enroll eligible individuals in the appropriate program. If a zero net premium option is available, the Exchange may enroll the individual in a qualifying plan (with protections for opt-out, reconsideration, and notice). If the individual does not act, a default enrollment process can enroll them in a selected zero net premium plan, with a notice and a reconsideration window.
5Modernization of eligibility criteria: The act would adjust Medicaid/CHIP eligibility processes to incorporate other data sources (e.g., SNAP and TANF findings) and provide multiple options for verification procedures. States would have tailored rules and a default option if they do not select among provided verification sets.

Impact Areas

Primary group/area affected- Individuals and families eligible for Medicaid, CHIP, or ACA marketplace coverage who are currently underinsured or not enrolled. The bill also impacts taxpayers filing returns who may have household members eligible for coverage via automatic or streamlined enrollment facilitated by tax data.Secondary group/area affected- State Medicaid and CHIP programs, ACA Exchanges, and agents/navigators who process enrollments; Treasury (data handling and interface) and Health and Human Services (program eligibility and enrollment rules).Additional impacts- Data sharing and privacy: The proposal creates a structured, consent-based data transfer from tax returns to health eligibility systems, with safeguards and limited use, plus potential need for strong data security and compliance with existing privacy rules.- Administrative and cost considerations: Building and maintaining the secure interface, supplemental forms, and standardized enrollment processes would require interagency coordination and funding.- Access and equity: The act directs accessibility provisions for the consent form and ensures availability across language and disability barriers, but it also relies on taxpayer consent and touches on opt-out mechanics and notice requirements that could influence enrollment and awareness.- Tax administration and practice: Tax return preparers are not required to validate the information provided for enrollment, but they may be involved in transferring information; this changes the role of preparers in the insurance enrollment process.Zero net premium: The monthly cost to a covered individual after applying tax credits and other subsidies is $0.Exchange: The ACA marketplace entity that administers qualified health plans and enrollment subsidies in a given state.Insurance affordability programs: Includes Medicaid, CHIP, ACA marketplace plans with premium credits and/or cost-sharing reductions, and any state basic health programs.Special enrollment period: A defined window outside the usual open enrollment during which individuals can enroll in coverage.Relevant return information: Tax data that could help determine eligibility or enrollment, subject to privacy protections.Supplemental form: Additional information collected to establish eligibility (without requesting sensitive items like health status or immigration status).

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