Congressional Research Service Reports - 508 Matching Results

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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.
Medicaid Financial Eligibility for Long-Term Services and Supports
This report provides an overview of the financial requirements used for determining eligibility for Medicaid long-term services and supports (LTSS). It first provides background information on the Medicaid program, including general eligibility requirements. Then it describes federal statutes as well as selected regulations and guidance regarding these financial eligibility requirements, including rules related to spousal impoverishment, asset transfers, treatment of certain assets, post-eligibility treatment of income, and estate recovery.
Legislative Actions in the 112th, 113th, and 114th Congresses to Repeal, Defund, or Delay the Affordable Care Act
This report a brief overview of the Affordable Care Act (ACA), and discusses the legislative process known as budget reconciliation in an effort to repeal parts of the ACA.
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 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.
Medicare: Part B Premiums
This report provides an overview of Medicare Part B premiums, including information on Part B eligibility and enrollment, late-enrollment penalties, collection of premiums, determination of annual premium amounts, premiums for high-income enrollees, premium assistance for low-income enrollees, protections for Social Security recipients from rising Part B premiums, and historical Medicare Part B premium trends. This report also provides a summary of various premium-related issues that may be of interest to Congress.
Use of the Annual Appropriations Process to Block Implementation of the Affordable Care Act (FY2011-FY2017)
This report summarizes the ACA-related language added to annual appropriations legislation by congressional appropriators since the ACA was signed into law. The information is presented in Table 1. 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.
Medicare Financial Status: In Brief
This report provides an overview on Medicare, discussing its various components and sources of funding. It also examines projections for spending within the program.
Public Health Service Agencies: Overview and Funding (FY2015-FY2017)
This report gives a brief overview of the eight agencies within the Department of Health and Human Services (HHS) which are designated components of the U.S. Public Health Services (PHS), and summarizes its funding for FY2015 through FY2017.
Overview of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
This report examines the the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which creates a prescription drug benefit for Medicare beneficiaries and establishes a new Medicare Advantage program to replace the current Medicare+Choice program.
Zika Response Funding: Request and Congressional Action
This report presents the Administration's request for supplemental appropriations for the Zika response. It includes sections outlining Congressional actions, the emergency supplemental appropriations request for Zika response efforts -- by both U.S. health and human services agencies and international assistance programs -- and information about unobligated Ebola response funds.
Puerto Rico and Health Care Finance: Frequently Asked Questions
This report provides answers to frequently asked questions (FAQs) about Puerto Rico's health care system.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
Puerto Rico and Health Care Finance: Frequently Asked Questions
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.
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.
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.
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.
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
Medicare Physician Payment Updates and the Sustainable Growth Rate (SGR) System
This report discusses the Sustainable Growth Rate (SGR), which is the statutory method for determining the annual updates to the Medicare physician fee schedule. The SGR system was established because of the concern that the Medicare fee schedule itself would not adequately constrain overall increases in spending for physicians’ services.
Centers for Medicare & Medicaid Services: President’s FY2013 Budget
This report summarizes the President's budget estimates for each section of the CMS budget. Then, for each legislative proposal included in the President's budget, this report provides a description of current law and the President's proposal. The explanations of the President's legislative proposals are grouped by the following program areas: Medicare, Medicaid, program integrity, and health insurance programs.
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.
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.
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.
TRICARE and VA Health Care: Impact of the Patient Protection and Affordable Care Act (ACA)
This report addresses key questions concerning the impact of enactment of the Affordable Care Act (ACA) on the TRICARE and VA health care programs. To provide some context to this discussion, the report begins with a brief overview of the two health systems and eligibility for care under each system.
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.
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.
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.
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.
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.
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.