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 Country: United States
 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/
Medicare: Enrollment in Medicare Drug Plans
This report discusses the enrollment process for private prescription drug plans (PDPs) or Medicare Advantage prescription drug (MA-PD) plans. At a minimum, these plans offer "standard coverage" or alternative coverage with actuarially equivalent benefits. Beneficiaries are required to enroll in one of these private plans in order to obtain coverage. digital.library.unt.edu/ark:/67531/metadc847769/
Health Care Spending: Context and Policy
This report seeks to put health spending in context. Health care costs and spending are persistent concerns for the Congress. On one hand, policymakers worry about access to care and the burden of health costs on household and employer budgets. On the other hand, rising costs put growing pressure on the federal budget from Medicare, Medicaid, and tax expenditures for private health insurance. digital.library.unt.edu/ark:/67531/metadc847772/
Medicare Prescription Drug Proposals: Estimates of Aged Beneficiaries Who Fall Below Income Criteria, by State
This report discusses bills related to Medicare benefits, which include additional assistance for low-income beneficiaries. The assistance would have been in the form of reduced, subsidized or eliminated premiums, deductibles and other cost-sharing. Proposals in the 108th Congress will probably also include some of these features for low-income beneficiaries. digital.library.unt.edu/ark:/67531/metadc847645/
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/
U.S. and International Responses to the Global Spread of Avian Flu: Issues for Congress
This report will provide an account of global H5N1-related human infections and deaths, outline U.S. government and international responses to the global spread of H5N1, discuss situations in various countries affected by H5N1, and present some foreign policy issues for Congress. digital.library.unt.edu/ark:/67531/metadc847619/
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/
Health Care Spending: Past Trends and Projections
This report focuses on trends in personal health care spending, which includes spending on health care goods and services provided to individuals and excludes expenditures for administrative costs, research, and public health activities. Personal health care expenditures have grown considerably over the past 40 years. It is estimated that personal health spending will exceed $2.9 trillion in 2013. digital.library.unt.edu/ark:/67531/metadc824772/
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/
Medicare Structural Reform: Background and Options
THis report provides a brief overview of major issues underlying the debate about possible structural reforms or improvements to the current Medicare system. Medicare is a nationwide health insurance program for the aged and certain disabled persons. digital.library.unt.edu/ark:/67531/metadc824714/
Implications of the Medicare Prescription Drug Benefit for Dual Eligibles and State Medicaid Programs
This report discusses the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA, P.L. 108-173), which added a new Medicare prescription drug benefit, implemented in January 2006. This report focuses on MMA provisions that added a voluntary prescription drug benefit under a new Medicare Part D, and the effect of this new benefit both on individuals who are dually eligible for Medicaid and Medicare, and on state Medicaid programs. digital.library.unt.edu/ark:/67531/metadc824753/
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/
Tax Benefits for Health Insurance: Current Legislation
This report discusses a variety of potential proposals to change the tax benefits for health insurance and medical expenses, including measures that would expand the availability and attractiveness of health savings accounts (HSAs), or employer tax credits. digital.library.unt.edu/ark:/67531/metadc824518/
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/
Military Medical Care Services: Questions and Answers
This report attempts to answer basic questions about the Military Health Services System (MHSS), its beneficiary population, the medical services it provides, its costs, and major changes that are underway or have been proposed. Citations are made to more detailed CRS studies where appropriate. digital.library.unt.edu/ark:/67531/metadc824459/
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 Expenditures, FY2003 and FY2004
This report discusses the federal medical assistance percentage (FMAP), which is the percentage of Medicaid benefit costs paid for by the federal government. digital.library.unt.edu/ark:/67531/metadc822569/
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/
Transitional Medical Assistance (TMA) Under Medicaid
This report provides an overview of transitional medical assistance (TMA). While Section 1925 of the Social Security Act outlines the provisions requiring states to provide TMA for up to 12 months, states have considerable flexibility in designing and implementing their TMA programs. digital.library.unt.edu/ark:/67531/metadc822344/
Hurricane Katrina: Medicaid Issues
This report discusses the following: Medicaid’s rules on eligibility, benefits, and financing in the context of current questions and issues raised by Hurricane Katrina. Recent state actions in response to Medicaid issues raised by the hurricane. Federal Medicaid waiver authority, including information on current activity in this area and the New York Disaster Relief Medicaid waiver granted in response to the September 11 terrorist attacks. Current federal legislation related to Medicaid and Hurricane Katrina relief efforts. digital.library.unt.edu/ark:/67531/metadc822601/
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/
Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis
This report first analyzes the authority of Congress to pass a proposal of this nature, as well as how a court could analyze this type of proposal if there were to be a constitutional challenge based on various provisions of the Fifth Amendment. Finally, this report discusses whether there must be exceptions to a requirement to purchase health insurance based on First Amendment freedom of religion. digital.library.unt.edu/ark:/67531/metadc822651/
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/
Tax Benefits for Health Insurance and Expenses: Overview of Current Law and Legislation
This report discusses how tax policy affects health insurance and health care spending. digital.library.unt.edu/ark:/67531/metadc820965/
Prescription Drug Coverage Under Medicaid
Medicaid is a joint federal-state entitlement program that pays for medical services on behalf of certain groups of low-income persons. It is the third largest social program in the federal budget, exceeded only by Social Security and Medicare and is typically the second largest spending item for states. This report discusses prescription drug policies under the program. digital.library.unt.edu/ark:/67531/metadc821134/
Prescription Drug Coverage Under Medicaid
Medicaid is a joint federal-state entitlement program that pays for medical services on behalf of certain groups of low-income persons. It is the third largest social program in the federal budget, exceeded only by Social Security and Medicare and is typically the second largest spending item for states. This report discusses prescription drug policies under the program. digital.library.unt.edu/ark:/67531/metadc806352/
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/
Health Insurance Coverage for Retirees
With the retirement of the baby boom generation looming ahead, employers offering coverage to their retired workers will face a huge future financial commitment. Some employers have already reduced or eliminated their commitment to insure their retirees. Recent trends indicate that retiree health benefits are increasingly subject to higher beneficiary cost-sharing. Further, among employers who provide health insurance for current retirees, their current workers are less likely to be guaranteed these benefits upon retirement. This report discusses issues regarding health insurance coverage for retirees. digital.library.unt.edu/ark:/67531/metadc821153/
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