Medicare Program Changes in H.R. 3962, Affordable Health Care for America Act Page: 4 of 66
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Medicare Program Changes in H.R. 3962, Affordable Health Care for America Act
This report describes changes to the Medicare program made in H.R. 3962, the Affordable Health
Care for America Act, as posted on the Rules Committee website on October 29, 2009, and in the
Manager's amendment, as posted on November 3, 2009.1 This report is structured similarly to the
CRS report on Medicare changes in the versions of H.R. 3200, America's Affordable Health
Choices Act of 2009, reported by House Committees on Education and Labor, Ways and Means,
and Energy and Commerce.2
H.R. 3962 contains numerous provisions affecting Medicare payments, payment rules, and
covered benefits, and treats the Medicare program as both a funding source for health reform and
a tool to shape future changes in the way that health services are delivered. Estimates from the
Congressional Budget Office (CBO) on the bill indicate that, absent interaction effects, net
reductions in Medicare direct spending may approach $129.0 billion from 2010 to 2014 and
$461.3 billion from 2010 to 2019.
The proposed legislation includes four divisions; Division B contains the changes to the Medicare
and Medicaid programs. This report discusses all of the proposed changes included in Titles I, III,
and VI and selected provisions in Titles II and IX of Division B in H.R. 3962 concerning payment
and program modifications to Medicare's fee-for-service program, its prescription drug benefit,
and the Medicare Advantage (MA) program; efforts to reform Medicare's payment methods,
program integrity changes to address fraud waste and abuse, and other miscellaneous Medicare
changes. Provisions that would modify Medicare's graduate medical education payments to
teaching hospitals, its preventive care benefits, its quality measurement efforts, and other public
health initiatives are not covered.3 The body of this report includes a discussion of the financial
impact on the Medicare program by H.R. 3962 that the CBO established (the CBO score), then
provides an overview of Medicare changes by provider type and program, followed by a brief
discussion of the program integrity changes.4 The Appendix provides a brief current law
description, explanation of the proposed change, and, where possible, the CBO score for most of
the Medicare-related provisions in H.R. 3962.
Congressional Budget Office (CBO) Score
On October 29, 2009, the CBO and the staff of the Joint Committee on Taxation issued a
preliminary analysis of H.R. 3962, as introduced on October 29, 2009. As explicitly stated by
CBO, its analysis does not constitute a final and comprehensive cost estimate for the bill. The
estimates also do not include certain administrative costs that would be incurred by the
government to implement the changes or H.R. 3962's impact on other federal programs.5
1 The Republican amendment to H.R. 3962 will be addressed in a separate, forthcoming CRS report.
2 CRS Report R40804, Medicare Program Changes in H.R. 3200, America's Affordable Health Choices Act of 2009,
coordinated by Sibyl Tilson.
3 Those provisions are discussed in CRS Report R40892, Public Health, Workforce, Quality, and Related Provisions in
H.R. 3962, coordinated by C. Stephen Redhead.
4 Background information on the Medicare program can be found in the CRS Report R40425, Medicare Primer.
5 The CBO score can be found at http://www.cbo.gov/ftpdocs/106xx/doc1O688/hr3962Rangel.pdf. The Joint
Committee on Taxation score may be found at http://www.jct.gov/publications.html?func=startdown&id=3619.
Congressional Research Service
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Medicare Program Changes in H.R. 3962, Affordable Health Care for America Act, report, November 5, 2009; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc810680/m1/4/: accessed April 20, 2019), University of North Texas Libraries, Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.