124 STAT. 907 PUBLIC LAW 111–148—MAR. 23, 2010 (4) Section 1421(f) of this Act is amended by striking ‘‘2010’’ both places it appears and inserting ‘‘2009’’. (5) The amendments made by this subsection shall take effect as if included in the enactment of section 1421 of this Act. (f) Part I of subtitle E of title I of this Act is amended by adding at the end of subpart B, the following: ‘‘SEC. 1416. STUDY OF GEOGRAPHIC VARIATION IN APPLICATION OF FPL. ‘‘(a) IN GENERAL.—The Secretary shall conduct a study to examine the feasibility and implication of adjusting the application of the Federal poverty level under this subtitle (and the amend- ments made by this subtitle) for different geographic areas so as to reflect the variations in cost-of-living among different areas within the United States. If the Secretary determines that an adjustment is feasible, the study should include a methodology to make such an adjustment. Not later than January 1, 2013, the Secretary shall submit to Congress a report on such study and shall include such recommendations as the Secretary deter- mines appropriate. ‘‘(b) INCLUSION OF TERRITORIES.— ‘‘(1) IN GENERAL.—The Secretary shall ensure that the study under subsection (a) covers the territories of the United States and that special attention is paid to the disparity that exists among poverty levels and the cost of living in such territories and to the impact of such disparity on efforts to expand health coverage and ensure health care. ‘‘(2) TERRITORIES DEFINED.—In this subsection, the term ‘territories of the United States’ includes the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands, and any other territory or possession of the United States.’’. SEC. 10106. AMENDMENTS TO SUBTITLE F. (a) Section 1501(a)(2) of this Act is amended to read as follows: ‘‘(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 commer- cial 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 eco- nomic and financial decision to forego health insurance coverage and attempt to self-insure, which increases finan- cial 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 insur- ance is sold by national or regional health insurance compa- nies, health insurance is sold in interstate commerce and claims payments flow through interstate commerce. 42 USC 18091. Deadline. Reports. Recommenda- tions. Determination. 26 USC 45R note. 26 USC 38 note.
