; and (B) in paragraph (2), in the matter preceding subparagraph (A), by striking (as so defined) . (3) Exemption from penalty for not maintaining minimum essential coverage Section 5000A(e) of the Internal Revenue Code of 1986 is amended by striking paragraph (3) and inserting the following: (3) Indians Any applicable individual who is an Indian (as defined in section 1304(f) of the Patient Protection and Affordable Care Act). . 425. Study of DSH payments to ensure hospital access for low-income patients (a) In general Not later than January 1, 2019, the Comptroller General of the United States shall conduct a study on how amendments made by the Patient Protection and Affordable Care Act ( Public Law 111–148 ) and the Health Care and Education Reconciliation Act of 2010 ( Public Law 111–152 ) to titles XVIII and XIX of the Social Security Act ( 42 U.S.C. 1395 et seq., 1396 et seq.) relating to disproportionate share hospital adjustment payments under Medicare and Medicaid (and subsequent amendments made with respect to such payments) affect the timely access to health care services for low-income patients. Such study shall— (1) evaluate and examine whether States electing to make medical assistance available under section 1902(a)(10)(A)(i)(VIII) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(A)(i)(VIII) ) (including States making such an election through a waiver of the State plan) to individuals described in such section mitigate the need for payments to disproportionate share hospitals under section 1886(d)(5)(F) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(F) ) and section 1923 of such Act ( 42 U.S.C. 1396r–4 ), including the impact of such States electing to make medical assistance available to such individuals on— (A) the number of individuals in the United States who are without health insurance and the distribution of such individuals in relation to areas primarily served by disproportionate share hospitals