Overview of Health Care Changes in the FY2013 Budget Proposal Offered by House Budget Committee Chairman Ryan Page: 4 of 16
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Health Care Changes in the FY2013 Budget Proposal Offered by Chairman Ryan
On March 20, 2012, Representative Paul Ryan, the Chairman of the House Budget Committee,
released the Chairman's mark of the FY20 13 House budget resolution.' Additional detail on
budgetary objectives and justifications was provided in Chairman Ryan's report entitled "The
Path to Prosperity: A Blueprint for American Renewal," issued the same day. 2 The House Budget
Committee considered the Chairman's mark on March 21, 2012, and voted 19-18 to report the
budget resolution to the full House.' H.Con.Res. 112 was introduced in the House March 23,
2012, and was accompanied by the House Budget Committee report (H.Rept. 112-42 1). The
House agreed to H.Con.Res. 112 on March 29, 2012, by a vote of 228 to 191.
The House budget resolution sets general budgetary parameters.' Among other things, it
expresses the desired levels of spending for government health programs over 10 years (FY20 13-
FY2022), creates two health care-related reserve funds, and presents a policy statement regarding
assumptions about future Medicare reforms. The budget resolution includes instructions for
reconciliation to six committees, which are instructed to identify specified dollar amounts of
deficit reduction.' A budget resolution is not intended to establish details of spending or revenue
policy and does not provide levels of spending for specific agencies or programs; it is not a law
and is not signed by the President. Rather, the budget resolution provides the framework for the
consideration of other legislation. While the House budget resolution suggests and assumes
certain health care-related policy changes, separate legislation would need to be developed (by
the committees of jurisdiction) and passed to actually modify federally funded health care
The Congressional Budget Office (CBO) was asked to provide an analysis of the long-term
budgetary impact of Chairman Ryan's budget proposal, and issued its report on March 21, 2012.6
CBO was provided additional detail by the staff of the House Budget Committee regarding
assumptions that should be made while conducting the analysis that were not included in the
budget resolution language or the accompanying report. CBO's analysis, however, does not
provide an official cost estimate for legislation that might implement the proposal, as it did not
conduct its analysis using actual legislative language and was asked to provide an impact analysis
beyond the 10-year budgetary window.7 To conduct its analysis, CBO used its most recent long-
1 The Chairman's mark may be found at http://budget.house.gov/UploadedFiles/chairmans_mark FY013.pdf.
2 This report may be found at http://budget.house.gov/UploadedFiles/Pathtoprosperity2013.pdf.
3~ The Concurrent Resolution on the Budget as Recorded was made available on March 22, 2012,
http://budget.house. gov/UploadedFiles/Concurrent_Resolution_BudgetFY_20 13.pdf.
4 For more information on the budget process, see CRS Report 98-721, Introduction to the Federal Budget Process,
coordinated by Bill Heniff Jr.; CRS Report R40472, The Budget Resolution and Spending Legislation, by Megan
Suzanne Lynch; and CRS Report R41685, The Federal Budget: Issues for FY20]], FY2O]2, and Beyond, by Mindy R.
5These committees include the Ways and Means Committee and the Energy and Commerce Committee, which have
jurisdiction over different parts of Medicare. However, these committees may report legislation to change any spending
and/or revenue policies within their jurisdictions as long as it lowers the deficit by the amount specified. For details on
the reconciliation process, see CRS Report R41 151, Budget Reconciliation Process: Timing of Committee Responses to
Reconciliation Directives, by Megan Suzanne Lynch.
6 Congressional Budget Office, The Long-Term Budgetary Impact of Paths for Federal Revenues and Spending
Specified by Chairman Ryan, March 2012, http://cbo.gov/sites/default/files/cbofiles/attachments/03-20-
Ryan _Specified Paths 2.pdf.
SA cost estimate for legislation would require much more detailed analysis, focus on the first 10 years, and be based on
Congressional Research Service1
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Overview of Health Care Changes in the FY2013 Budget Proposal Offered by House Budget Committee Chairman Ryan, report, March 29, 2012; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc807899/m1/4/: accessed April 22, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.