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 Collection: Congressional Research Service Reports
Medicare Primer

Medicare Primer

Date: March 31, 2016
Creator: Davis, Patricia A.; Talaga, Scott R.; Binder, Cliff; Hahn, Jim; Kirchhoff, Suzanne M. & Morgan, Paulette C.
Description: 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.
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Medicare: Enrollment in Medicare Drug Plans

Medicare: Enrollment in Medicare Drug Plans

Date: October 20, 2006
Creator: O'Sullivan, Jennifer
Description: 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.
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Health Care Spending: Context and Policy

Health Care Spending: Context and Policy

Date: September 6, 2005
Creator: Jenson, Jennifer
Description: 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.
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Medicare Prescription Drug Proposals: Estimates of Aged Beneficiaries Who Fall Below Income Criteria, by State

Medicare Prescription Drug Proposals: Estimates of Aged Beneficiaries Who Fall Below Income Criteria, by State

Date: February 11, 2003
Creator: Peterson, Chris L. & Morgan, Paulette C.
Description: 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.
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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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U.S. and International Responses to the Global Spread of Avian Flu: Issues for Congress

U.S. and International Responses to the Global Spread of Avian Flu: Issues for Congress

Date: February 6, 2006
Creator: Salaam-Blyther, Tiaji & Chanlett-Avery, Emma
Description: 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.
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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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Health Care Spending: Past Trends and Projections

Health Care Spending: Past Trends and Projections

Date: April 8, 2004
Creator: Morgan, Paulette C.
Description: 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.
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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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Health-Related Tax Expenditures: Overview and Analysis

Health-Related Tax Expenditures: Overview and Analysis

Date: January 8, 2016
Creator: Lowry, Sean
Description: 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).
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Medicare Structural Reform: Background and Options

Medicare Structural Reform: Background and Options

Date: January 28, 2003
Creator: Chaikind, Hinda R.; O'Sullivan, Jennifer & Boulanger, Jennifer
Description: 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.
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Implications of the Medicare Prescription Drug Benefit for Dual Eligibles and State Medicaid Programs

Implications of the Medicare Prescription Drug Benefit for Dual Eligibles and State Medicaid Programs

Date: January 19, 2006
Creator: Tritz, Karen
Description: 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.
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Use of the Annual Appropriations Process to Block Implementation of the Affordable Care Act (FY2011-FY2016)

Use of the Annual Appropriations Process to Block Implementation of the Affordable Care Act (FY2011-FY2016)

Date: January 5, 2016
Creator: Redhead, C. S. & Cornell, Ada S.
Description: 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.
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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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Tax Benefits for Health Insurance: Current Legislation

Tax Benefits for Health Insurance: Current Legislation

Date: February 6, 2006
Creator: Lyke, Bob
Description: 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.
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Discretionary Spending Under the Affordable Care Act (ACA)

Discretionary Spending Under the Affordable Care Act (ACA)

Date: January 13, 2016
Creator: Redhead, C. Stephen; Colello, Kirsten J.; Heisler, Elayne J.; Lister, Sarah A. & Sarata, Amanda K.
Description: 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.
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The Ebola Outbreak: Quarantine and Isolation Authority

The Ebola Outbreak: Quarantine and Isolation Authority

Date: October 28, 2014
Creator: unknown
Description: 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.
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Military Medical Care Services: Questions and Answers

Military Medical Care Services: Questions and Answers

Date: January 26, 2005
Creator: Best, Richard A., Jr.
Description: 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.
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Puerto Rico and Health Care Finance: Frequently Asked Questions

Puerto Rico and Health Care Finance: Frequently Asked Questions

Date: February 3, 2016
Creator: Mach, Annie L.
Description: 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.
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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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