The Obamacare Surveillance System


June 12, 2013


There is an Obamacare surveillance system. Surveillance is national news today...except in health care. That needs to change. The National Security Administration (NSA) is not the only agency spying on citizens without their consent or knowledge. And the problem is going to get worse under the federal reform law, empowering the IRS in ways we've never seen before.

In fact, 700 pages of the 2,700-page Obamacare law were a rewrite of IRS code, according to expert testimony at the Minnesota legislature, giving the IRS 47 new tax provisions to administer and essentially establishing the IRS as a police force for implementing and imposing Obamacare.

The health insurance exchange system will build it. It begins with the state-based websites (e.g., It continues with the computerized information technology network that stretches from each website into the Federal Data Services Hub. The Hub then uses this vast national IT infrastructure to reach into the databases of state government agencies and federal government agencies to grab data on individuals and employers applying for Exchange coverage. All that private data is captured and sent to a new Federal System of Records called the "Health Insurance Exchanges Program."

The IRS and other federal and state agencies will use the data in this new centralized surveillance system to monitor compliance with Obamacare and police the Obamacare mandate that requires everyone to purchase private insurance, enroll in government coverage or pay a penalty-tax.

Data gathering will be extensive. Individuals, employers, employees, various entities, and government contractors will all be included. According to the federal document announcing the new centralized federal surveillance system there are SEVEN categories of individuals whose data will be stored:

"The system will contain personally identifiable information (PII) about the following categories of individuals who participate in or are involved with the CMS Health Insurance Exchanges Program: (1) Any applicant/enrollee who applies, or on whose behalf an application is filed, for an eligibility determination for a qualified health plan (QHP) through an Exchange, insurance affordability program, or for a certification of exemption; (2) Navigators, Agents, Brokers, individuals or entities that are required to register with an Exchange prior to assisting qualified individuals to enroll in QHPs through the Exchange; (3) officers, employees and contractors of the Exchange; (4) employees and contractors of CMS (e.g. marketplace assisters, appeals staff); (5) contact information and business identifying information of QHPs seeking certification; (6) persons employed by or contracted with an Exchange organization who provide home or personal contact information; and (7) any qualified employer and the qualified employees whose enrollment in a QHP is facilitated through a Small Business Health Options Program (SHOP). [Emphasis added.]

What kind of information will be stored? The February 6 announcement of the new surveillance system provides the answer. The following list is not inclusive about the data to be collected and stored, but it is indicative of the extensive surveillance system being built:

  • Applicant’s first names, last name, middle initial

  • Mailing address or permanent residential address

  • Social Security Number

  • Taxpayer status

  • Gender

  • Ethnicity

  • Residency

  • Email address

  • Telephone number

  • Information that will verify the information provided by the individual/enrollee…that will enable a decision about an applicant’s eligibility

  • Citizenship or immigration status

  • Enrollment in Federally funded minimum essential health coverage (e.g. Medicare, Medicaid, Federal Employees Health Benefit Program (FEHBP), Veterans Health Administration (Champ VA), Children’s Health Insurance Program (CHIP), Department of Defense (TRICARE), Peace Corps)

  • Incarceration status

  • Indian status

  • Enrollment in employer-sponsored coverage

  • Requests for and accompanying documentation to justify receipt of individual responsibility exemptions, including membership in a certain type of recognized religious sect or health care sharing ministry

  • Employer information

  • Status as a veteran

  • Limited health status information (pregnancy status, blindness, disability status)

  • Household income, including tax return information from the IRS, income information from the Social Security Administration, and financial information from other third party sources.

  • Applicant’s enrollment in a qualified health plan (QHP)

  • Premium amounts and payment history

  • Name and address of the employer who uses the SHOP exchange

  • Number of employees of the employer who uses the SHOP exchange

  • Employer identification number

  • List of qualified employees

  • Tax ID numbers of qualified employees.

Almost nobody knows about the Obamacare surveillance system. The system of records became effective on March 6, 2013, just 30 days after the notice was released. I have contacted the Department directly and discovered that during those 30 days, not one person, not one company, not one organization made a public comment. It is likely that few people even saw the notice. Or like us, when we discovered it, there was no more time to comment.

Access to the data is extensive. There are nine broad types of entities who can have access to all this data under what is called “Routine Use.” As an example, the routine use section includes the following use:

“To disclose information to another Federal agency, agency of a State government, a non-profit entity operating an Exchange for a State, an agency established by State law, or its fiscal agent to (A) make eligibility determinations for enrollment in a QHP through an Exchange, insurance affordability programs, and certifications of exemption from the individual responsibility requirement, (B) to carry out the HIX Program, and (C) to perform functions of an Exchange described in 45 CFR 155.200, including notices to employers under section 1411(f) of the Affordable Care Act.

This new federal surveillance system will be used to enforce Obamacare and monitor individual and employer implementation. It will allow the IRS to profile individuals, to identify and find the non-compliant individuals and employers, and to find and penalize anyone who refuses to conform to the Obamacare mandate that everyone buy a private policy, buy government Exchange coverage, or submit to being enrolled in government-approved coverage.

Twila Brase, R.N., PHN
President and Co-founder