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 Resource Type: Report
 Collection: Congressional Research Service Reports
The Affordable Care Act's (ACA) Employer Shared Responsibility Determination and the Potential Employer Penalty
This report describes potential employer penalties as well as regulations to implement the ACA employer provisions. The regulations address insurance coverage requirements, methodologies for determining whether a worker is considered full time, provisions relating to seasonal workers and corporate franchises, and other reporting requirements. digital.library.unt.edu/ark:/67531/metadc847595/
Medicare Primer
This report provides a general overview of the Medicare program including descriptions of the program's history, eligibility criteria, covered services, provider payment systems, and program administration and financing. digital.library.unt.edu/ark:/67531/metadc847725/
Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief
This report provides an overview of the excise tax. The report includes cost estimates for the excise tax and explores the excise tax's relationship with the tax advantages for employer-sponsored health coverage. The information in this report is based on statute and two notices issued by the Department of the Treasury (Treasury) and the Internal Revenue Service (IRS). digital.library.unt.edu/ark:/67531/metadc847499/
Eligibility and Determination of Health Insurance Premium Tax Credits and Cost-Sharing Subsidies: In Brief
Certain individuals without access to subsidized health insurance coverage may be eligible for premium tax credits, as established under the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended). This report examines these tax credits and their eligibility requirements, as well as cost-sharing subsidies. digital.library.unt.edu/ark:/67531/metadc847648/
Consumer Operated and Oriented Plan (CO-OP) Program: Frequently Asked Questions
This report addresses frequently asked questions regarding the Consumer Operated and Oriented Plan (CO-OP) program, which was established under the Patient Protection and Affordable Care Act and aims to foster the creation of CO-OPs--nonprofit, member-run health insurance issuers that sell health plans in states in which they are licensed. digital.library.unt.edu/ark:/67531/metadc847682/
The Use of Modified Adjusted Gross Income (MAGI) in Federal Health Programs
This report explores how modified adjusted gross income (MAGI) is defined differently across health programs such as Medicare, the health insurance exchanges under the Affordable Care Act (ACA), and Medicaid. It also discusses why MAGI is used, and how it is applied, specific to each program. The report covers that MAGI is used to determine (1) penalty amounts owed if a person does not comply with the individual mandate or whether an individual is exempt from the individual mandate; (2) eligibility for and the amount of a premium credit to purchase coverage through a health insurance exchange; and (3) Medicaid income eligibility for certain populations. digital.library.unt.edu/ark:/67531/metadc824590/
The Health Coverage Tax Credit (HCTC): In Brief
This report describes the eligibility criteria for the Health Coverage Tax Credit (HCTC) and the types of health insurance to which the tax credit may be applied. The tax credit's purpose is to make the purchase of health insurance more affordable for eligible individuals. The HCTC has a sunset date of January 1, 2020. The report also briefly describes the administration of the HCTC program and receipt of the credit by eligible taxpayers; it concludes with a summary of the HCTC's statutory history. digital.library.unt.edu/ark:/67531/metadc824691/
Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA)
This report provides background information about the private health insurance market, including market segments and regulation. It then describes each ACA market reform, grouped under the following categories: obtaining coverage, keeping coverage, cost of purchasing coverage, covered services, cost-sharing limits, consumer assistance and other health care protections, and plan requirements related to health care providers. digital.library.unt.edu/ark:/67531/metadc847515/
Puerto Rico and Health Care Finance: Frequently Asked Questions
This report provides answers to frequently asked questions (FAQs) about how federal health care programs and requirements are implemented in Puerto Rico, including information about eligibility, coverage, program requirements, and payment rules. Examples provided in the FAQs illustrate that in many circumstances, some health programs in Puerto Rico differ from programs in the US, while in other circumstances, Puerto Rico is treated the same as the states. As such, these questions and answers should be viewed as a discussion of the complexity of health care financing as it relates to Puerto Rico under current law. digital.library.unt.edu/ark:/67531/metadc824672/
Provisions of the Senate Amendment to H.R. 3762
This report includes a table listing all provisions in H.R. 3762 and the Senate amendment to H.R. 3762 that would amend or repeal Affordable Care Act (ACA) provisions. It also provides a brief explanation of the provisions included in the Senate Amendment to H.R. 3762. digital.library.unt.edu/ark:/67531/metadc824795/
Discretionary Spending Under the Affordable Care Act (ACA)
This report examines the Affordable Care Act's (ACA's) effects on discretionary spending. It first discusses all the ACA authorizations (and reauthorizations) of appropriations for grant and other programs; this information, along with actual funding amounts, is summarized in a series of tables. The report then reviews the ACA administrative costs borne by CMS and the IRS. digital.library.unt.edu/ark:/67531/metadc824419/
Health-Related Tax Expenditures: Overview and Analysis
This report analyzes health-related tax expenditures together at the budget function level, rather than focusing on the size of any single provision. To provide some insights into common questions about health-related expenditures, this report analyzes historical data on health-related tax expenditure estimates published by the Joint Committee on Taxation (JCT). digital.library.unt.edu/ark:/67531/metadc824709/
Use of the Annual Appropriations Process to Block Implementation of the Affordable Care Act (FY2011-FY2016)
This report summarizes the language related to the Affordable Care (ACA) that was added to annual appropriations legislation by congressional appropriators since the ACA was signed into law. The information is presented in a table. While a detailed examination of the ACA itself is beyond the scope of this report, a brief overview of the ACA's core provisions and its impact on federal spending is provided as context for the material in the table. Congress remains deeply divided over implementation of the Affordable Care Act (ACA), which President Obama signed into law in March 2010. digital.library.unt.edu/ark:/67531/metadc824565/
The Ryan White HIV/AIDS Program: Overview and Impact of the Affordable Care Act
This report discusses the impact of the Affordable Care Act on the Ryan White HIV/AIDS Program, which makes federal funds available to metropolitan areas and states to that provide a number of health care services for HIV/AIDS patients. digital.library.unt.edu/ark:/67531/metadc795903/
Puerto Rico and Health Care Finance: Frequently Asked Questions
This report provides answers to frequently asked questions (FAQs) about Puerto Rico's health care system, including how federal health care programs (Medicare, Medicaid, and the State Children's Health Insurance Program [CHIP]) and private health insurance requirements apply to Puerto Rico. digital.library.unt.edu/ark:/67531/metadc795577/
The Independent Payment Advisory Board (IPAB): Frequently Asked Questions
This report responds to frequently asked questions about the Independent Payment Advisory Board (IPAB), including the board's background, current status, controversial issues including legal challenges, and recent legislative efforts to repeal the IPAB. digital.library.unt.edu/ark:/67531/metadc795587/
Potential Policy Implications of the House Reconciliation Bill (H.R. 3762)
This report provides background on the reconciliation process and summarizes the provisions in the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 (H.R. 3762), including their projected budgetary impact. It then briefly examines some of the bill's policy implications. digital.library.unt.edu/ark:/67531/metadc795707/
Potential Impact of No Social Security COLA on Medicare Part B Premiums in 2016
This report provides an overview of Medicare Part B premiums, the relationship between the Social Security cost-of-living increase (COLA) and Part B premiums, and the potential impact of a projected 0% Social Security COLA in 2016 on Medicare premiums, based on recent projections by the Medicare Trustees. digital.library.unt.edu/ark:/67531/metadc795920/
Public Health Service Agencies: Overview and Funding (FY2010-FY2016)
This report gives a brief overview of the eight agencies within the Department of Health and Human Services (HHS) which are designated components of the U.S. Public Health Services (PHS), and summarizes its funding for FY2010 through FY2016. digital.library.unt.edu/ark:/67531/metadc795421/
Use of the Annual Appropriations Process to Block Implementation of the Affordable Care Act (FY2011-FY2016)
This report summarizes the Patient Protection and Affordable Care act (ACA)-related language added to annual appropriations legislation by congressional appropriators since the ACA was signed into law. digital.library.unt.edu/ark:/67531/metadc795341/
The Affordable Care Act's (ACA) Employer Shared Responsibility Determination and the Potential ACA Employer Penalty
This report describes the potential employer penalties related to the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) as well as regulations to implement the ACA employer provisions. The regulations address insurance coverage requirements, methodologies for determining whether a worker is considered full time, provisions relating to seasonal workers and corporate franchises, and other reporting requirements. digital.library.unt.edu/ark:/67531/metadc743623/
The Patient Protection and Affordable Care Act's Essential Health Benefits (EHB)
This report provides an overview of the first component of the essential health benefits (EHB) package--a core package of health care services required by the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) for non-group and small-group private health insurance markets. The report examines how the EHB are defined, regulations related to the EHB, state variation in the EHB, applicability of the EHB to health plans, and how the EHB interact with other ACA provisions. digital.library.unt.edu/ark:/67531/metadc770537/
Health Insurance: Small is the New Large
This report discusses aspects of the Patient Protection and Affordable Care Act that expand the definition of small employer to include employers with 100 or fewer employees. States must implement the expanded definition for plan years beginning in 2016, but have the option of implementing the expanded definition prior to the deadline. digital.library.unt.edu/ark:/67531/metadc743516/
Medicare Financial Status: In Brief
This report provides an overview on Medicare, discussing its various components and sources of funding. The report also examines projections for spending within the program. digital.library.unt.edu/ark:/67531/metadc743416/
Centers for Medicare & Medicaid Services (CMS) Proposed Rule on Medicaid Managed Care: Frequently Asked Questions
This report responds to a series of frequently asked questions (FAQs) identified to address some of the major updates included in the proposed rule. The FAQs summarize provisions such as the introduction of a minimum medical loss ratio (MLR), guidance on enrolling the long-term services and supports (LTSS) population in managed care, and network adequacy. digital.library.unt.edu/ark:/67531/metadc822604/
Use of the Annual Appropriations Process to Block Implementation of the Affordable Care Act (FY2011-FY2016)
Congress remains deeply divided over implementation of the Patient Protection and Affordable Care Act (ACA), the health reform law enacted in March 2010. Since the ACA's enactment, lawmakers opposed to specific provisions in the ACA or the entire law have repeatedly debated its implementation and considered bills to repeal, defund, delay, or otherwise amend the law. This report summarizes the ACA-related language added to annual appropriations legislation by congressional appropriators since the ACA was signed into law. digital.library.unt.edu/ark:/67531/metadc700680/
H.R. 6: The 21st Century Cures Act
Report about H.R. 6, the 21st Century Cures Act, which would reauthorize the National Institutes of Health (NIH) through FY2018 and provide other funding to the agency through FY2020. digital.library.unt.edu/ark:/67531/metadc700571/
Timeline Related to Health Insurance and Exchange Rules: Backdrop to King v. Burwell
This report provides a timeline that identifies selected 2015 dates related to exchange establishment and operation, legislative calendars, and regulation of the individual health insurance market, among other issues. digital.library.unt.edu/ark:/67531/metadc700894/
Maps of 2015 Individual Exchange Enrollment by Zip Code
This report presents a tool to examine exchange enrollment information by zip code with additional geographic boundaries. digital.library.unt.edu/ark:/67531/metadc689339/
An Introduction to Health Insurance: What Should a Consumer Know?
This report provides an overview of private-sector (as opposed to government-provided) health insurance. It serves as an introduction to health insurance from the point of view of many consumers under the age of 65. No background in health insurance is assumed, and all terms are defined in the body of the report. digital.library.unt.edu/ark:/67531/metadc626977/
Health Coverage Tax Credit
The report describes the expired eligibility criteria, as well as the types of health insurance to which the tax credit may have been applied. It discusses past federal and state roles in administering the HCTC program, and it summarizes analyses on the credit's effectiveness in reaching targeted populations and related equity and efficiency issues. In addition, the report includes a short discussion of relevant current law and summarizes statutory history of the HCTC program. digital.library.unt.edu/ark:/67531/metadc505481/
Health Care-Related Expiring Provisions, First Session of the 114th Congress
This report provides a list of selected health-related programs and activities under specified titles of the Social Security Act (SSA). digital.library.unt.edu/ark:/67531/metadc627239/
Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA) in 2015
This report describes the eligibility criteria applicable to the premium tax credits and cost-sharing subsidies, and the calculation method for the credit and subsidy amounts. It also highlights selected issues addressed in the final regulation and guidance on premium credits and indicates the status of implementation, where relevant data is available. digital.library.unt.edu/ark:/67531/metadc503513/
Appropriations and Fund Transfers in the Affordable Care Act (ACA)
This report summarizes all the mandatory appropriations and Medicare trust fund transfers in the ACA and provides details on the status of obligation of these funds. The information is presented in two tables. The report also includes a brief discussion of the impact that sequestration is having on ACA mandatory spending. This report is periodically revised and updated to reflect important legislative and other developments. digital.library.unt.edu/ark:/67531/metadc503381/
Medicare Advantage (MA)--Proposed Benchmark Update and Other Adjustments for CY2016: In Brief
This report provides a brief background on how Medicare Advantage (Part C or MA) payments are determined through a comparison of a plan's estimated cost (bid) and the maximum amount Medicare will pay a plan (benchmark). digital.library.unt.edu/ark:/67531/metadc503456/
The Community Health Center Fund: In Brief
This report provides information on the Community Health Center Fund (CHCF) that may be useful for discussions about the fund's future. Specifically, it includes information on: the types of grants awarded, total funds disbursed, and the amount of CHCF funds that facilities in each state and territory received. digital.library.unt.edu/ark:/67531/metadc503374/
The Affordable Care Act and Small Business: Economic Issues
This report explains how employer-sponsored insurance can be used to address concerns about health insurance coverage and cost. Then, it summarizes the three Affordable Care Act (ACA) provisions most relevant to small businesses. Also, it analyzes these provisions for their potential effects on small businesses. Last, this report presents several approaches that could address some concerns associated with these provisions (particularly the employer penalty). digital.library.unt.edu/ark:/67531/metadc501935/
The ACA Medicaid Expansion
This report provides an overview of the ACA Medicaid expansion, and the impact of the Supreme Court decision on the ACA Medicaid expansion. Then, the report describes who is covered under the expansion, the expansion rules, and how the expansion is financed. In addition, enrollment and expenditure estimates for the ACA Medicaid expansion are provided. Finally, the report reviews state decisions whether or not to implement the ACA Medicaid expansion, and the implications of those decisions on certain individuals, employers, and hospitals. digital.library.unt.edu/ark:/67531/metadc821147/
Premium Tax Credits and Federal Health Insurance Exchanges: Questions and Answers
Legal challenges that may have a substantial impact on the implementation and operation of the Patient Protection and Affordable Care Act (ACA) concern whether premium tax credits are available for millions of individuals participating in federally administered health insurance exchanges. The Supreme Court has decided to weigh in on this issue in King v. Burwell. This report provides background on provisions of ACA relevant to this issue. It then answers questions concerning the legal challenges and potential implications of the Court's decision in King. digital.library.unt.edu/ark:/67531/metadc501694/
Ebola: Selected Legal Issues
Several West African countries are currently grappling with an unprecedented outbreak of Ebola virus disease (EVD). Here in the United States, where Ebola is not endemic, a handful of EVD cases have been diagnosed, and domestic transmission of the virus has occurred in only two cases to date. This report provides a brief overview of selected legal issues regarding measures to prevent transmission of Ebola virus and the civil rights of individuals affected by the disease. digital.library.unt.edu/ark:/67531/metadc501695/
Hospital-Based Emergency Departments: Background and Policy Considerations
This report describes Emergency departments (EDs), the role they play in the health care delivery system, and current federal involvement in supporting EDs. It then discusses the causes and consequences of three commonly identified and interrelated challenges that EDs face: (1) crowding, (2) providing repeat care to a subset of patients who are frequent users, and (3) providing care to a large population who have behavioral health conditions when an ED lacks the appropriate resources to provide such treatment. The report concludes with policy options that Congress may consider to potentially improve ED functioning and reduce payer costs. digital.library.unt.edu/ark:/67531/metadc490866/
Preventing the Introduction and Spread of Ebola in the United States: Frequently Asked Questions
This report answers common legal and policy questions about the potential introduction and spread of Ebola Virus Disease in the United States. digital.library.unt.edu/ark:/67531/metadc491094/
Congress Faces Calls to Address Expiring ACA Appropriations
This report discusses the Affordable Care Act (ACA), enacted in March 2010, which appropriated billions of dollars of mandatory funds to support grant programs and other activities authorized by the law. digital.library.unt.edu/ark:/67531/metadc491500/
A Federal Pause in Potentially Risky Influenza Research
This report briefly discusses a recently implemented federal research moratorium that has highlighted concerns about the general appropriateness of research on biological pathogens and the sufficiency of certain biosecurity efforts. digital.library.unt.edu/ark:/67531/metadc490863/
Treating Ebola Patients in the United States: Health Care Delivery Implications
This report discusses the recent response to Ebola patients in the United States. While the U.S. health care system has the resources to effectively identify and treat Ebola cases, a situation that is novel, emergent, and resource-intensive may test the system's ability to effectively mobilize those resources. digital.library.unt.edu/ark:/67531/metadc491297/
U.S. and International Health Responses to the Ebola Outbreak in West Africa
In March 2014, an Ebola Virus Disease (EVD) outbreak was reported in Guinea, West Africa. The outbreak is the first in West Africa and has caused an unprecedented number of cases and deaths. The outbreak is continuing to spread in Guinea, Sierra Leone, and Liberia (the "affected countries"); it has been contained in Nigeria and Senegal, and has been detected in Mali. As of October 22, 2014, more than 10,000 people have contracted EVD, more than half of whom have died. This report focuses on the health impacts of the outbreak and discusses U.S. and international responses to those health challenges. digital.library.unt.edu/ark:/67531/metadc491179/
Discretionary Spending Under the Affordable Care Act (ACA)
The Patient Protection and Affordable Care Act (Affordable Care Act, or ACA) reauthorized funding for numerous existing discretionary grant programs administered by the Department of Health and Human Services (HHS). The ACA also created many new discretionary grant programs and provided for each an authorization of appropriations. Generally, the law authorized (or reauthorized) appropriations through FY2014 or FY2015. This report summarizes all the discretionary spending provisions in the ACA. digital.library.unt.edu/ark:/67531/metadc491520/
The Ebola Outbreak: Quarantine and Isolation Authority
This legal sidebar discusses recent quarantine policies announced by several states, including New York and New Jersey, for travelers arriving from areas affected by the outbreak of Ebola Virus Disease, which have raised legal and constitutional questions about federal and state authority to order quarantine and isolation measures. digital.library.unt.edu/ark:/67531/metadc824427/
Beverage Industry Pledges to Reduce Americans' Drink Calories
This report briefly covers recent initiatives by leading beverage companies to curb the obesity epidemic. digital.library.unt.edu/ark:/67531/metadc461921/
Medicare: Insolvency Projections
This report focuses on the two separate trust funds that fund Medicare, the Hospital Insurance (HI) trust fund and Supplementary Medical Insurance (SMI) trust fund. Almost from its inception, the HI trust fund has faced a projected shortfall and eventual insolvency. Because of the way it is financed, the SMI trust fund cannot become insolvent; however, the Medicare Trustees continue to express concerns about the rapid growth in SMI costs. digital.library.unt.edu/ark:/67531/metadc462915/
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