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 Collection: Congressional Research Service Reports
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/
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/
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/
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/
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/
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/
Environmental Exposure to Endocrine Disruptors: What Are the Human Health Risks?
This report discusses the human health risks, specifically from endocrine disruptors that are chemical compounds in drugs, food, consumer products, or the ambient environment that can interfere with internal biological processes of animals that normally are regulated by their hormones. digital.library.unt.edu/ark:/67531/metadc821040/
Public Health, Workforce, Quality, and Related Provisions in H.R. 3962
This report discusses health care reform, which was at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. digital.library.unt.edu/ark:/67531/metadc821068/
Medicaid and SCHIP: The President’s FY2006 Budget Proposals
This report describes the proposal and provides an estimate of the cost or savings based on publicly available information. The report provides a brief background for the proposal and provides a listing of current Congressional Research Service (CRS) reports related to the proposal. digital.library.unt.edu/ark:/67531/metadc821149/
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/metacrs7496/
Health Insurance Coverage for Retirees
This report provides an introduction to demographics of the retiree population. The report discusses health insurance coverage for retirees and reasons for eroding coverage and issues, as well as legislative proposals. digital.library.unt.edu/ark:/67531/metacrs7616/
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/
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/metadc818013/
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/
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/
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 Insurance Coverage: Characteristics of the Insured and Uninsured Populations in 2007
Based on data from the Census Bureau’s Current Population Survey (CPS), 45.7 million people in the United States had no health insurance in 2007 — a decrease of approximately 1.3 million people when compared with 2006. This report briefly examines the characteristics of this uninsured population. digital.library.unt.edu/ark:/67531/metadc821392/
Medicaid Coverage of Long-Term Services and Supports
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. digital.library.unt.edu/ark:/67531/metadc821444/
Medicaid and Graduate Medical Education
This report discusses Medicaid coverage of graduate medical education (GME) costs. GME costs are difficult to determine because teaching occurs in the context of patient care and research. There are direct GME (DGME) costs, which include residents' stipends, payments to supervising physicians, and direct program administration costs. digital.library.unt.edu/ark:/67531/metadc821463/
Contractors and HealthCare.gov: Answers to Frequently Asked Questions
This report provides answers to 20 frequently asked questions regarding contractors and HealthCare.gov, the federal online health insurance portal called for by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148, as amended). Over 50 contractors, including CGI Federal and Quality Software Services, Inc. (QSSI), helped in building the site, which was reportedly largely unusable when it first became available to the public on October 1, 2013. digital.library.unt.edu/ark:/67531/metadc822430/
Medicare: Selected Prescription Drug Proposals in the 107th Congress
Medicare, the nationwide health insurance program for the aged and disabled, does not cover most outpatient prescription drugs. On several occasions, the Congress has considered providing coverage for at least a portion of beneficiaries’ drug costs. The issue received renewed attention in the 106th Congress. However, there was no consensus on how the coverage should be structured. This report provides a side-by-side comparison of bills introduced in the 107th Congress that have received the most attention. digital.library.unt.edu/ark:/67531/metadc820912/
Employment-Based Health Coverage and Health Reform: Selected Legal Considerations
It is estimated that nearly 170 million individuals have employer-based health coverage. As part of a comprehensive health care reform effort, there has been support (including from the Obama Administration) in enacting comprehensive health insurance reform that retains the employer-based system. This report presents selected legal considerations inherent in amending two of the primary federal laws governing employer-sponsored health care: the Employee Retirement Income Security Act (ERISA) and the Internal Revenue Code (IRC). digital.library.unt.edu/ark:/67531/metadc26164/
Medical Child Support: Background and Current Policy
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. digital.library.unt.edu/ark:/67531/metadc272041/
Overview of Health Care Changes in the FY2015 House Budget
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. digital.library.unt.edu/ark:/67531/metadc287964/
Private Health Insurance Market Reforms in the Affordable Care Act (ACA)
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. digital.library.unt.edu/ark:/67531/metadc306460/
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
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. digital.library.unt.edu/ark:/67531/metadc491211/
Bisphenol A (BPA) in Plastics and Possible Human Health Effects
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. digital.library.unt.edu/ark:/67531/metadc491289/
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/
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/
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
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. The World Trade Center (WTC) Medical Monitoring and Treatment Program (MMTP) and the World Trade Center Health Program (WTCHP) are the specific programs compared in this report. digital.library.unt.edu/ark:/67531/metadc491365/
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/
Military Medical Care: Questions and Answers
This report answers several frequently asked questions about military health care, including: how the system is structured, a TRICARE summary, TRICARE eligibility and plan options, cost of military health care to beneficiaries, relationship of TRICARE to MEDICARE, how the Affordable Care Act affects TRICARE, long-term trends of defense health care costs, and a summary of the fund which funds TRICARE. digital.library.unt.edu/ark:/67531/metadc462290/
Public Health Service Agencies: Overview and Funding
Within the Department of Health and Human Services (HHS), eight agencies are designated components of the U.S. Public Health Service (PHS): (1) the Agency for Healthcare Research and Quality (AHRQ), (2) the Agency for Toxic Substances and Disease Registry (ATSDR), (3) the Centers for Disease Control and Prevention (CDC), (4) the Food and Drug Administration (FDA), (5) the Health Resources and Services Administration (HRSA), (6) the Indian Health Service (IHS), (7) the National Institutes of Health (NIH), and (8) the Substance Abuse and Mental Health Services Administration (SAMHSA). This report gives a brief overview of each agency and summarizes its funding for FY2010 through FY2013, as well as its FY2014 budget request. digital.library.unt.edu/ark:/67531/metadc462597/
Military Medical Care: Questions and Answers
This report answers several frequently asked questions about military health care, including: how the system is structured, a TRICARE summary, TRICARE eligibility and plan options, cost of military health care to beneficiaries, relationship of TRICARE to MEDICARE, how the Affordable Care Act affects TRICARE, long-term trends of defense health care costs, and a summary of the fund which funds TRICARE - the Medicare Eligible Retiree Health Care fund. digital.library.unt.edu/ark:/67531/metadc462360/
Long-Term Services and Supports: Overview and Financing
This report provides an overview of Long-term services and supports (LTSS), including who needs LTSS, how need for LTSS is determined, and how much LTSS costs. The report also provides information on who the primary LTSS payers are, how much they spend, and what types of services are purchased. digital.library.unt.edu/ark:/67531/metadc462393/
Does Price Transparency Improve Market Efficiency? Implications of Empirical Evidence in Other Markets for the Health Sector
This report reviews the empirical studies of the effect of changes in price transparency on prices and quality of goods in a variety of industries; addresses the extent to which this evidence might be applicable to the health care market and certain special characteristics of the health care market which may reduce the importance of prices as signals; examines how prices are actually set by hospitals and the evidence that exists on price dispersion both across hospitals and across patient categories; discusses some initiatives undertaken by governments, insurers, and interest groups to improve information about prices and to regulate price discrimination; and finally, suggests that while it is difficult to determine the consequences of greater consumer price transparency, it is reasonable to believe that greater transparency would improve outcomes. digital.library.unt.edu/ark:/67531/metadc463265/
Private Health Insurance Market Reforms in the Affordable Care Act (ACA)
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. digital.library.unt.edu/ark:/67531/metadc462687/
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
The report provides basic consumer sources, including broad overviews of the Affordable Care Act (ACA) law, and resources related to specific provisions. It also has links to contacts for specific questions (including websites, hotlines, and online chat assistance). digital.library.unt.edu/ark:/67531/metadc462747/