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 Decade: 2010-2019
 Collection: Congressional Research Service Reports
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/
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 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/
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/
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/
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/
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/
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 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/
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/
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/
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/
Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis
This report discusses the Patient Protection and Affordable Care Act (ACA), P.L. 111-148, as amended, Congress enacted a “minimum coverage provision,” which compels certain individuals to have a minimum level of health insurance. This report provides an analysis of the constitutionality of this provision requiring individuals to obtain health insurance. digital.library.unt.edu/ark:/67531/metadc821696/
Medicare Physician Payment Updates and the Sustainable Growth Rate (SGR) System
This report provides a background on the Medicare fee schedule, the Sustainable Growth Rate (SGR) system, and the annual updates and discusses recent proposals to address this issue. digital.library.unt.edu/ark:/67531/metadc822555/
Medicare Physician Payment Updates and the Sustainable Growth Rate (SGR) System
This report provides a background on the Medicare fee schedule, the Sustainable Growth Rate (SGR) system and the annual updates, and discusses recent proposal to address this issue. digital.library.unt.edu/ark:/67531/metadc821668/
Public Health, Workforce, Quality, and Related Provisions in H.R. 3590, as Passed by the Senate
This report summarizes the workforce, prevention, quality, and related provisions in H.R. 3590, as passed by the Senate. It begins with some background on health care delivery reform, followed by an overview of the report’s content and organization digital.library.unt.edu/ark:/67531/metadc821682/
Medicaid and CHIP Maintenance of Effort (MOE): Requirements and Responses
This report summarizes the MOE requirements enacted under American Recovery and Reinvestment Act of 2009 and the Patient Protection and Affordable Care Act as modified by the Health Care and Education Reconciliation Act of 2010 and what these requirements have meant for states in terms of their actions to restrict Medicaid and/or CHIP eligibility. It also summarizes recent legislative activity to repeal the MOE requirements. digital.library.unt.edu/ark:/67531/metadc822572/
Self-Insured Health Insurance Coverage
This report provides background information on private health insurance coverage, state and federal regulation of private coverage, and self-insured health plans. It includes data on the prevalence of self-insurance and discusses the employer decision to self-insure. Lastly, it describes selected private health insurance provisions under federal health reform, and application of such provisions on self-insured plans. digital.library.unt.edu/ark:/67531/metadc812033/
Self-Insured Health Insurance Coverage
This report provides background information on private health insurance coverage, state and federal regulation of private coverage, and self-insured health plans. It includes data on the prevalence of self-insurance and discusses the employer decision to self-insure. Lastly, it describes selected private health insurance provisions under federal health reform, and application of such provisions on self-insured plans. digital.library.unt.edu/ark:/67531/metadc822356/
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/
Health Savings Accounts: Overview of Rules for 2012
This report provides a summary of the principal rules governing Health Savings Accounts (HSAs), covering such matters as eligibility, qualifying health insurance, contributions, and withdrawals. digital.library.unt.edu/ark:/67531/metadc822646/
Mental Health Parity and the Patient Protection and Affordable Care Act of 2010
This report provides a brief background on mental health parity and the policy discussion around parity in health insurance coverage; an overview of federal mental health parity law prior to the enactment of the ACA; and an analysis of the impact of the ACA. digital.library.unt.edu/ark:/67531/metadc810015/
Mental Health Parity and the Patient Protection and Affordable Care Act of 2010
This report provides a brief background on mental health parity and the policy discussion around parity in health insurance coverage; an overview of federal mental health parity law prior to the enactment of the ACA; and an analysis of the impact of the ACA. digital.library.unt.edu/ark:/67531/metadc822647/
Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis
This report first analyzes the authority of Congress to enact the minimum essential coverage requirement contained in Patient Protection and Affordable Care Act (PPACA), as well as how a court might analyze this provision if challenged based on various provisions of the Fifth and Tenth Amendments. This report discusses whether there must be exceptions to a requirement to purchase health insurance based on First Amendment freedom of religion, and finally, discusses some of the legal challenges to this federal requirement. digital.library.unt.edu/ark:/67531/metadc806315/
Community Living Assistance Services and Supports (CLASS) Provisions in the Patient Protection and Affordable Care Act (PPACA)
This report first discusses the cost and financing for long-term care (LTC) services as well as the current market for private LTC insurance. It then details those CLASS program requirements for enrollment, premiums, eligibility, benefits, administration, and oversight. The report also discusses federal budget implications, as estimated by the Congressional Budget Office (CBO) and the Centers for Medicare and Medicaid Services (CMS). Finally, the report provides a timeline of the CLASS program provisions enacted under PPACA. digital.library.unt.edu/ark:/67531/metadc822373/
Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis
This report first analyzes the authority of Congress to enact the minimum essential coverage requirement contained in the Patient Protection and Affordable Care Act (PPACA), as well as how a court might analyze this provision if challenged based on various provisions of the Fifth and Tenth Amendments. This report discusses whether there must be exceptions to a requirement to purchase health insurance based on First Amendment freedom of religion, and finally, discusses some of the legal challenges to this federal requirement. digital.library.unt.edu/ark:/67531/metadc815463/
Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis
This report first analyzes the authority of Congress to pass a law of this nature, as well as how a court could analyze this provision in light of a constitutional challenge based on various provisions of the Fifth and Tenth Amendments. Finally, this report discusses whether the exceptions to the individual responsibility requirement to purchase health insurance satisfy First Amendment freedom of religion protections. digital.library.unt.edu/ark:/67531/metadc820533/
Long-Term Care (LTC): Financing Overview and Issues for Congress
This report provides an overview of long-term care (LTC) and an explanation of the nation’s complex financing system of public and private payers. It also describes some of the major challenges facing Congress as it contemplates LTC reform and whether and how to include LTC in health reform legislation. digital.library.unt.edu/ark:/67531/metadc820874/
Medicare Primer
This report provides an overview of Medicare, the nation's federal insurance program, which pays for covered health care services of qualified beneficiaries. digital.library.unt.edu/ark:/67531/metadc820963/
Medicare Home Health Benefit Primer: Benefit Basics and Issues
This report describes home health eligibility criteria, home health services, characteristics of Medicare beneficiaries who use home health services, and home health providers. Further, this report describes in detail the Medicare home health prospective payment system (HH PPS), provides an overview of Medicare home health payments, and discusses issues for Congress related to the Medicare home health benefit. digital.library.unt.edu/ark:/67531/metadc808302/
Medicare Home Health Benefit Primer: Benefit Basics and Issues
This report describes home health eligibility criteria, home health services, characteristics of Medicare beneficiaries who use home health services, and home health providers. Further, this report describes in detail the Medicare home health prospective payment system (HH PPS), provides an overview of Medicare home health payments, and discusses issues for Congress related to the Medicare home health benefit. digital.library.unt.edu/ark:/67531/metadc820974/
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/
Medicare Primer
This report provides an overview of Medicare, the nation's federal insurance program, which pays for covered health care services of qualified beneficiaries. digital.library.unt.edu/ark:/67531/metadc821635/
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/
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/
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/
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/
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/
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/
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 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/
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/
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/
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/
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/
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/
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