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 Decade: 2010-2019
 Collection: Congressional Research Service Reports
The Affordable Care Act's (ACA) Employer Shared Responsibility Determination and the Potential ACA Employer Penalty

The Affordable Care Act's (ACA) Employer Shared Responsibility Determination and the Potential ACA Employer Penalty

Date: September 1, 2015
Creator: Whittaker, Julie M.
Description: 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.
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Provisions of the Senate Amendment to H.R. 3762

Provisions of the Senate Amendment to H.R. 3762

Date: February 1, 2016
Creator: Mach, Annie L.
Description: 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.
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The Health Coverage Tax Credit (HCTC): In Brief

The Health Coverage Tax Credit (HCTC): In Brief

Date: February 18, 2016
Creator: Fernandez, Bernadette
Description: 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.
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The Use of Modified Adjusted Gross Income (MAGI) in Federal Health Programs

The Use of Modified Adjusted Gross Income (MAGI) in Federal Health Programs

Date: February 25, 2016
Creator: Baumrucker, Evelyne P.; Davis, Patricia A.; Fernandez, Bernadette; Mach, Annie L. & Pettit, Carol A.
Description: 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.
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Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Date: April 6, 2012
Creator: Staman, Jennifer; Brougher, Cynthia; Liu, Edward C.; Lunder, Erika K. & Thomas, Kenneth R.
Description: 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.
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Public Health, Workforce, Quality, and Related Provisions in H.R. 3590, as Passed by the Senate

Public Health, Workforce, Quality, and Related Provisions in H.R. 3590, as Passed by the Senate

Date: March 1, 2010
Creator: Redhead, C. Stephen & Williams, Erin D.
Description: 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
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Medicare Home Health Benefit Primer: Benefit Basics and Issues

Medicare Home Health Benefit Primer: Benefit Basics and Issues

Date: March 14, 2013
Creator: Talaga, Scott R.
Description: 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.
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Centers for Medicare & Medicaid Services (CMS) Proposed Rule on Medicaid Managed Care: Frequently Asked Questions

Centers for Medicare & Medicaid Services (CMS) Proposed Rule on Medicaid Managed Care: Frequently Asked Questions

Date: July 15, 2015
Creator: Blom, Kirstin B.
Description: 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.
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Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Date: February 1, 2011
Creator: Staman, Jennifer; Brougher, Cynthia; Liu, Edward C.; Lunder, Erika K. & Thomas, Kenneth R.
Description: 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.
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Community Living Assistance Services and Supports (CLASS) Provisions in the Patient Protection and Affordable Care Act (PPACA)

Community Living Assistance Services and Supports (CLASS) Provisions in the Patient Protection and Affordable Care Act (PPACA)

Date: January 5, 2011
Creator: Mulvey, Janemarie & Colello, Kirsten J.
Description: 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.
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Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Date: December 16, 2010
Creator: Staman, Jennifer; Brougher, Cynthia; Liu, Edward C.; Lunder, Erika K. & Thomas, Kenneth R.
Description: 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.
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Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis

Date: May 7, 2010
Creator: Staman, Jennifer; Brougher, Cynthia; Liu, Edward C.; Lunder, Erika K. & Thomas, Kenneth R.
Description: 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.
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Medicare Home Health Benefit Primer: Benefit Basics and Issues

Medicare Home Health Benefit Primer: Benefit Basics and Issues

Date: February 6, 2014
Creator: Talaga, Scott R.
Description: 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.
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Eligibility and Determination of Health Insurance Premium Tax Credits and Cost-Sharing Subsidies: In Brief

Eligibility and Determination of Health Insurance Premium Tax Credits and Cost-Sharing Subsidies: In Brief

Date: March 23, 2016
Creator: Fernandez, Bernadette
Description: 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.
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Consumer Operated and Oriented Plan (CO-OP) Program: Frequently Asked Questions

Consumer Operated and Oriented Plan (CO-OP) Program: Frequently Asked Questions

Date: March 11, 2016
Creator: Mach, Annie L.
Description: 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.
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The Affordable Care Act's (ACA) Employer Shared Responsibility Determination and the Potential Employer Penalty

The Affordable Care Act's (ACA) Employer Shared Responsibility Determination and the Potential Employer Penalty

Date: April 19, 2016
Creator: Whittaker, Julie M.
Description: 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.
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Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief

Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief

Date: March 24, 2016
Creator: Mach, Annie L.
Description: 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).
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Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA)

Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA)

Date: February 10, 2016
Creator: Mach, Annie L. & Fernandez, Bernadette
Description: 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.
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Medicaid Coverage of Long-Term Services and Supports

Medicaid Coverage of Long-Term Services and Supports

Date: December 5, 2013
Creator: Colello, Kirsten J.
Description: This report provides a description of the various statutory authorities that either require or otherwise allow states to cover LTSS under Medicaid. The Appendix provides a brief legislative history of Medicaid LTSS from Medicaid’s enactment and initial coverage requirements for institutional care through the evolution of HCBS options available to states.
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Medical Child Support: Background and Current Policy

Medical Child Support: Background and Current Policy

Date: December 18, 2013
Creator: Solomon-Fears, Carmen
Description: This report describes current federal policy with respect to medical child support. It also examines the potential impact of the Affordable Care Act (ACA) on the Child Support Enforcement (CSE) program. It provides a legislative history of medical support provisions in the CSE program and state data on the medical support coverage of children in the CSE program.
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Overview of Health Care Changes in the FY2015 House Budget

Overview of Health Care Changes in the FY2015 House Budget

Date: April 16, 2014
Creator: Davis, Patricia A.; Mitchell, Alison & Fernandez, Bernadette
Description: This report summarizes the proposed changes to Medicare, Medicaid, and private health insurance as described in H.Con.Res. 96 and accompanying documents, including the committee report and Chairman Ryan's Path to Prosperity report.
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Private Health Insurance Market Reforms in the Affordable Care Act (ACA)

Private Health Insurance Market Reforms in the Affordable Care Act (ACA)

Date: May 6, 2014
Creator: Mach, Annie L. & Fernandez, Bernadette
Description: This report provides background information about the private health insurance market, including market segments and regulation. It then describes each Affordable Care Act (ACA) market reform.
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Comparison of the Current World Trade Center Medical Monitoring and Treatment Program and the World Trade Center Health Program Proposed by Title I of H.R. 847

Comparison of the Current World Trade Center Medical Monitoring and Treatment Program and the World Trade Center Health Program Proposed by Title I of H.R. 847

Date: December 14, 2010
Creator: Szymendera, Scott & Lister, Sarah A.
Description: This report compares the current federally supported medical screening and treatment program offered to various persons affected by the terrorist attack on New York City on September 11, 2001, with the federal program proposed to be established by Title I of H.R. 847, the James Zadroga 9/11 Health and Compensation Act of 2010, as amended and passed by the House of Representatives.
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Bisphenol A (BPA) in Plastics and Possible Human Health Effects

Bisphenol A (BPA) in Plastics and Possible Human Health Effects

Date: August 13, 2010
Creator: Schierow, Linda-Jo & Lister, Sarah A.
Description: This report discusses Bisphenol A (BPA). BPA is used to produce certain types of plastic that are used in thousands of formulations for myriad products. Containers made with these plastics may expose people to small amounts of BPA in food and water. Medical devices and other more ubiquitous products, such as thermal paper coatings, also may contribute significantly to human exposure. Some animal experiments have found that fetal and infant development may be harmed by small amounts of BPA, but scientists disagree about the value of the animal studies for predicting harmful effects in people.
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