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Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act

Description: This report summarizes legislative actions taken to repeal, defund, delay, or otherwise amend the Affordable Care Act (ACA) since it was signed into law. The report is divided into two sections. The first section focuses on authorizing legislation, and the second section discusses appropriations bills.
Date: July 8, 2015
Creator: Redhead, C. S. & Kinzer, Janet
Partner: UNT Libraries Government Documents Department

Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions

Description: 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).
Date: January 8, 2015
Creator: Napili, Angela
Partner: UNT Libraries Government Documents Department

Aviation Safety: FAA Should Improve Usability of its Online Application System and Clarity of the Pilot's Medical Form

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Aerospace medical experts GAO interviewed generally agreed that the Federal Aviation Administration's (FAA) medical standards are appropriate and supported FAA's recent data-driven efforts to improve its pilot medical-certification process. Each year, about 400,000 candidates apply for a pilot's medical certificate and complete a medical exam to determine whether they meet FAA's medical standards. From 2008 through 2012, on average, about 90 percent of applicants have been medically certified by an FAA-designated aviation medical examiner (AME) at the time of their medical exam or by a Regional Flight Surgeon. Of the remaining applicants, about 8.5 percent have received a special issuance medical certificate (special issuance) after providing additional medical information to FAA. Approximately 1.2 percent were not medically certified to fly. According to an industry association, the special issuance process adds time and costs to the application process, in part, because applicants might not understand what additional medical information they need to provide to FAA. Officials from FAA's medical certification division have said that technological problems with the aging computer systems that support the medical certification process have contributed to delays in the special issuance process. FAA's medical certification division has identified about 50 potential technological enhancements to its internal computer systems that support the medical certification process, of which about 20 have been identified as high priority, but the division has not yet implemented them or developed a timeline to do so. By developing a timeline to implement the highest-priority enhancements, FAA would take another step toward expediting the certification process for many applicants hoping to obtain a special issuance. FAA recently established a datadriven process using historic medical and accident data that authorizes AMEs to certify a greater number of applicants with medical conditions who ...
Date: April 8, 2014
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Tobacco Products: FDA Spending and New Product Review Time Frames

Description: Testimony issued by the Government Accountability Office with an abstract that begins "The Food and Drug Administration (FDA) spent (obligated) less than half of the $1.1 billion in tobacco user fees it collected from manufacturers and others from fiscal year 2009 through the end of fiscal year 2012; however, FDA's spending increased substantially in fiscal year 2013. Through December 31, 2013, FDA spent nearly 81 percent of the approximately $1.75 billion in fees collected by that time. According to officials in FDA's Center for Tobacco Products (CTP), the center established by the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) to implement the act's provisions, the time it took to award contracts contributed to the center spending less than it had planned to spend. In fiscal year 2013, FDA was able to carry out a number of activities that were originally planned for fiscal years 2011 and 2012, such as efforts to educate youth on the dangers of tobacco use. About 79 percent ($1.12 billion) of user fees spent as of December 31, 2013, was spent by three CTP offices: Office of Health Communication and Education, Office of Science, and Office of Compliance and Enforcement."
Date: April 8, 2014
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Tax-Advantaged Accounts for Health Care Expenses: Side-by-Side Comparison, 2013

Description: This report provides brief summaries of the tax-exempt accounts and compares them with respect to eligibility, contribution limits, use of funds, and other characteristics for tax year 2013. The report concludes with a brief discussion of the usage in these four accounts.
Date: November 8, 2013
Creator: Rapaport, Carol
Partner: UNT Libraries Government Documents Department

Veterans' Health Care Budget: Improvements Made, but Additional Actions Needed to Address Problems Related to Estimates Supporting President's Request

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) expanded the use of the Enrollee Health Care Projection Model (EHCPM) in developing the agency’s health care budget estimate that supported the President’s fiscal year 2014 budget request. VA expanded the use of the EHCPM by using, for the first time, the model’s estimate for the amount of care provided—workload—to develop estimates of the resources needed for 14 long-term care services. However, VA continued to use the most current expenditure data rather than EHCPM estimates for projecting needed resources for these services due to concerns about the reliability of the EHCPM expenditure data. Using this new blended approach, VA used the EHCPM in whole or in part, to develop estimates for 74 health care services that accounted for more than 85 percent of VA’s health care budget estimate. Additionally, VA used a new budget category label for its estimate of certain administrative personnel costs, “Administrative Personnel,” and identified the types of positions this estimate included. However, VA did not consistently use the new label across its three health care appropriations accounts. Instead, VA used “Administration” and provided no information clarifying the costs included in the estimates. Further, VA did not disclose all the costs included under “Administrative Personnel,” nor did VA identify the costs included in one other category containing administrative costs, “Administrative Contract Services.” The lack of transparency regarding administrative costs and inconsistent labeling resulted in Congress and other users of VA’s budget justification not having clear and complete information regarding the agency’s estimates for such costs."
Date: August 8, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Electronic Drug Labeling: No Consensus on the Advantages and Disadvantages of Its Exclusive Use

Description: A letter report issued by the Government Accountability Office with an abstract that begins "GAO found no consensus among stakeholders on the advantages and disadvantages of eliminating paper labeling and relying instead on electronic labeling as a complete substitute for the three types of drug labeling discussed in this report and approved by the Food and Drug Administration (FDA)--an agency within the Department of Health and Human Services (HHS). This report focuses on three types of prescription drug labeling: the prescribing information intended for health care practitioners, Medication Guides intended to inform patients about drugs FDA has determined pose a serious and significant public health concern, and patient package inserts (PPI) required for oral contraceptives and estrogens. Stakeholders said an advantage of such a change would be that it could provide physicians, pharmacists, and patients with the most current drug information in a more user-friendly format, which would positively impact public health. For example, drug labeling could be made interactive to include hyperlinks to definitions of key terms or to additional information, enhancing patients' knowledge about the drugs they are using. However, stakeholders noted disadvantages that could offset any advantages gained from such a change. Relying on electronic labeling as a complete substitute for paper labeling could adversely impact public health by limiting the availability of drug labeling for some physicians, pharmacists, and patients by requiring them to access drug labeling through a medium with which they might be uncomfortable, that they might find inconvenient, or that might be unavailable. In addition, for electronic drug labeling to be successful, stakeholders said it is important to have a single data source that is reliable and unbiased for physicians, pharmacists, and patients to use, particularly given that there are multiple websites these groups can use to access information about prescription drugs. However, ...
Date: July 8, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Internet Pharmacies: Federal Agencies and States Face Challenges Combating Rogue Sites, Particularly Those Abroad

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Rogue Internet pharmacies violate a variety of federal and state laws. Most operate from abroad, and many illegally ship prescription drugs into the United States that have not been approved by the Food and Drug Administration (FDA), an agency within the Department of Health and Human Services (HHS), that is responsible for ensuring the safety and effectiveness of prescription drugs. Many also illegally sell prescription drugs without a prescription that meets federal and state requirements. Rogue sites also often violate other laws, including those related to fraud, money laundering, and intellectual property rights."
Date: July 8, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare: Progress Made to Deter Fraud, but More Could Be Done

Description: Testimony issued by the Government Accountability Office with an abstract that begins "The Centers for Medicare & Medicaid Services (CMS)—the agency that administers Medicare—has made progress in implementing several key strategies GAO identified in prior work as helpful in protecting Medicare from fraud; however, important actions that could help CMS and its program integrity contractors combat fraud remain incomplete."
Date: June 8, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Environmental Health: Action Needed to Sustain Agencies' Collaboration on Pharmaceuticals in Drinking Water

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Drinking water in some metropolitan areas contains concentrations of pharmaceuticals, raising concerns about their potential impact on human health. The Safe Drinking Water Act (SDWA) authorizes the Environmental Protection Agency (EPA) to regulate contaminants, including pharmaceuticals, in public drinking water systems if they may adversely affect human health among other criteria. Pharmaceuticals may enter drinking water supplies from several pathways, including discharge from wastewater facilities. GAO was asked to provide information on the (1) extent to which pharmaceuticals occur in drinking water and their effects, if any, on human health; (2) U.S. and other countries' approaches to reducing their occurrence; and (3) challenges, if any, that EPA faces in determining whether to regulate pharmaceuticals. GAO reviewed federal and peer-reviewed reports, and surveyed a nonprobability sample of five U.S. programs designed to properly dispose of pharmaceuticals. We selected these programs based on geographic diversity and program characteristics. We also researched such programs in two countries, and interviewed scientists and agency officials."
Date: August 8, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Children with Down Syndrome: Families Are More Likely to Receive Resources at Time of Diagnosis Than in Early Childhood

Description: A letter report issued by the Government Accountability Office with an abstract that begins "On October 8, 2008, the Prenatally and Postnatally Diagnosed Conditions Awareness Act was signed into law, requiring GAO to submit a report concerning the effectiveness of current health care and family support programs for the families of children with disabilities. In this report, GAO focused on Down syndrome because it is a medical condition that is associated with disabilities and occurs frequently enough to yield a sufficient population size for an analysis. GAO examined (1) what is known about the extent to which children with Down syndrome receive medical care during early childhood and (2) what resources families of children with Down syndrome receive through their health care providers and what barriers families face to using these resources. GAO analyzed fee-for-service claims data from a very large private health insurance company, for the claims representing its experience with one of the largest national employers, and Medicaid claims data from seven states with high Medicaid enrollment and low percentages of enrollees in Medicaid managed care. GAO also interviewed specialists at six prominent Down syndrome clinics and 12 advocacy groups to examine what resources families receive and to identify barriers they face. GAO also analyzed data from the Health Resources and Services Administration-sponsored 2005-2006 National Survey of Children with Special Health Care Needs on barriers to accessing needed services."
Date: October 8, 2010
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Global Health: Trends in U.S. Spending for Global HIV/AIDS and Other Health Assistance in Fiscal Years 2001-2008

Description: A letter report issued by the Government Accountability Office with an abstract that begins "U.S. funding for global HIV/AIDS and other health-related programs rose significantly from 2001 to 2008. The President's Emergency Plan for AIDS Relief (PEPFAR), reauthorized in 2008 at $48 billion through 2013, has made significant investments in support of prevention of HIV/AIDS as well as care and treatment for those affected by the disease in 31 partner countries and 3 regions. In May 2009, the President proposed spending $63 billion through 2014 on global health programs, including HIV/AIDS, under a new Global Health Initiative. The Office of the U.S. Global AIDS Coordinator (OGAC), at the Department of State (State), coordinates PEPFAR implementation. The Centers for Disease Control and Prevention (CDC) and the U.S. Agency for International Development (USAID), among other agencies, implement PEPFAR as well as other global health-related assistance programs, such as maternal and child health, infectious disease prevention, and malaria control, among others. Responding to legislative directives, this report examines U.S. disbursements (referred to as spending) for global HIV/AIDS- and other health-related bilateral foreign assistance programs (including basic health and population and reproductive health programs) in fiscal years 2001-2008. The report also provides information on models used to estimate HIV treatment costs. GAO analyzed U.S. foreign assistance data, reviewed HIV treatment costing models and reports, and interviewed U.S. and UNAIDS officials."
Date: October 8, 2010
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

School-Based Health Centers: Available Information on Federal Funding

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "Many of our nation's children have difficulty accessing needed health care services. In 2008, the Robert Wood Johnson Foundation reported that about 25 percent of children with insurance and about 55 percent of uninsured children did not receive a recommended routine checkup within the previous year. According to the Department of Health and Human Services (HHS), children face growing risks from chronic physical conditions such as asthma and obesity and from mental health disorders such as depression, and yet, as we have reported, their access to services may be impeded by a number of barriers, including a lack of health insurance and a lack of convenient transportation to medical appointments. Access to mental health care services may also be impeded by concerns about stigma--negative attitudes and beliefs often associated with receiving such care--which can be a deterrent to seeking these services. To help increase children's access to primary health care and other health care services, states and communities have established school-based health centers (SBHC). SBHCs are located on school grounds, provide health care services regardless of ability to pay, and offer a broader range of services than a school nurse generally provides. Almost all SBHCs provide primary care, and they vary in the extent to which they provide other health care services, such as immunizations, behavioral health care, oral health care, health and nutrition education, and reproductive health care. SBHCs improve children's access to health care services by reducing financial and other barriers to care, especially for children who are poor or uninsured. For example, as we reported in our July 2009 report on children's access to mental health care services following Hurricane Katrina, SBHCs in Louisiana have emerged as a key approach to providing access to primary ...
Date: October 8, 2010
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare Advantage Organizations: Actual Expenses and Profits Compared to Projections for 2006

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "The federal government's spending on the Medicare Advantage (MA) program has grown substantially in recent years, from approximately $60 billion in 2006 and $77 billion in 2007 to an estimated $91 billion in 2008. MA organizations provide health care coverage to Medicare beneficiaries through private health plans, thus offering an alternative to the original Medicare fee-for-service (FFS) program. Payments to MA organizations are, in part, based on the projected expenditures organizations submit in their bids for providing Medicare-covered services, as well as actual enrollment and beneficiary health status. Once Medicare payments are determined, they are not modified based on differences between actual and projected expenses. MA organizations are not required to submit claims data to the Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--but they must report actual expenditures for the year 2 years prior to the upcoming contract year. For example, MA organizations reported their actual 2006 expenditures in their bid submission for contract year 2008. When MA organizations submit their bids, the actual expenditures reported in their bid submissions reflect the MA organizations' most recent full calendar year of actual expenditure data. In June 2008, we reported that for 2005, MA organizations generally spent less on medical expenses and earned more profits than projected. MA organizations' self-reported actual profit margin was approximately 5 percent of total revenue, on average, which was approximately $1.1 billion more in 2005 than MA organizations had projected. The accuracy of MA organizations' projections is important because, in addition to determining Medicare payments, these projections also affect the extent to which MA beneficiaries receive additional benefits not provided under FFS and the amounts beneficiaries pay in cost sharing and premiums. For example, if MA organizations had more accurately projected ...
Date: December 8, 2008
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Health Resources and Services Administration: Many Underserved Areas Lack a Health Center Site, and the Health Center Program Needs More Oversight

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Health centers funded through grants under the Health Center Program--managed by the Health Resources and Services Administration (HRSA), an agency in the U.S. Department of Health and Human Services (HHS)--provide comprehensive primary care services for the medically underserved. HRSA provides funding for training and technical assistance (TA) cooperative agreement recipients to assist grant applicants. GAO was asked to examine (1) to what extent medically underserved areas (MUA) lacked health center sites in 2006 and 2007 and (2) HRSA's oversight of training and TA cooperative agreement recipients' assistance to grant applicants and its provision of written feedback provided to unsuccessful applicants. To do this, GAO obtained and analyzed HRSA data, grant applications, and the written feedback provided to unsuccessful grant applicants and interviewed HRSA officials."
Date: August 8, 2008
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Prescription Drugs: Trends in FDA's Oversight of Direct-to-Consumer Advertising

Description: Testimony issued by the Government Accountability Office with an abstract that begins "The Food and Drug Administration (FDA) is responsible for overseeing direct-to-consumer (DTC) advertising of prescription drugs, which includes a range of media, such as television, magazines, and the Internet. If FDA identifies a violation of laws or regulations in a DTC advertising material, the agency may issue a regulatory letter asking the drug company to take specific actions. In 2002, GAO reported on delays in FDA's issuance of regulatory letters. GAO was asked to discuss trends in FDA's oversight of DTC advertising and the actions FDA has taken when it identifies violations. This statement is based on GAO's 2006 report, Prescription Drugs: Improvements Needed in FDA's Oversight of Direct-to-Consumer Advertising, GAO-07-54 (November 16, 2006). In this statement, GAO discusses the (1) DTC advertising materials FDA reviews, (2) FDA's process for issuing regulatory letters citing DTC advertising materials and the number of letters issued, and (3) the effectiveness of FDA's regulatory letters at limiting the dissemination of false or misleading DTC advertising. For its 2006 report, GAO examined FDA data on the advertising materials the agency received and reviewed the regulatory letters it issued citing prescription drug promotion from 1997 through 2005. For this statement, GAO also reviewed data from FDA to update selected information from the 2006 report."
Date: May 8, 2008
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Social Security Administration Field Offices: Reduced Workforce Faces Challenges as Baby Boomers Retire

Description: Testimony issued by the Government Accountability Office with an abstract that begins "Millions of people rely on the services of Social Security Administration (SSA) field offices. In fiscal year 2007, SSA's approximately 1,300 field offices provided service to about 42 million customers. People use these offices to apply for Social Security cards, apply for retirement and disability benefits, establish direct deposit, and a host of other services. While customers may conduct their business using SSA's online, telephone, or other service options, many prefer the personalized contact provided in field offices. Over the last several years, staffing reductions have challenged field offices' ability to manage work, while continuing to deliver quality customer service. To assess how field offices are managing these challenges, GAO was asked to determine (1) the effect that reduced staffing levels may be having on field office operations and (2) the challenges that SSA faces in meeting future service delivery needs. This statement is drawn from GAO's ongoing study on field offices for the committee, which is expected to be issued later this year. To conduct this work, GAO interviewed SSA officials in headquarters, and other components, and analyzed various data on SSA's workloads and other data. In commenting on a draft of this testimony, SSA said that GAO understated the connection between staffing stresses from increased work demands and the agency's funding shortfalls."
Date: May 8, 2008
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Mild Traumatic Brain Injury Screening and Evaluation Implemented for OEF/OIF Veterans, but Challenges Remain

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Traumatic brain injury (TBI) has emerged as a leading injury among servicemembers serving in the Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) combat theaters. The widespread use of improvised explosive devices, such as roadside bombs, in these combat theaters increases the likelihood that servicemembers will be exposed to incidents that can cause a TBI. TBIs can vary from mild to severe, and in general, mild TBI can be difficult to identify. Because mild TBI can have lasting effects if not identified and treated, concerns have been raised about how the Department of Veterans Affairs (VA) identifies and treats OEF/OIF veterans with a mild TBI. In this report GAO describes VA's (1) efforts to screen OEF/OIF veterans for mild TBI, (2) steps taken so that those OEF/OIF veterans at risk for mild TBI are evaluated and treated, and (3) challenges in screening and evaluating OEF/OIF veterans for mild TBI. GAO reviewed VA's policies, interviewed VA officials and TBI experts, and reviewed nine VA medical facilities' efforts to implement TBI screening and evaluation processes."
Date: February 8, 2008
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare Part D: Enrolling New Dual-Eligible Beneficiaries in Prescription Drug Plans

Description: Testimony issued by the Government Accountability Office with an abstract that begins "Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), dual-eligible beneficiaries--individuals with both Medicare and Medicaid coverage--have their drug costs covered under Medicare Part D rather than under state Medicaid programs. The MMA requires the Centers for Medicare & Medicaid Services (CMS) to enroll these beneficiaries in a Medicare prescription drug plan (PDP) if they do not select a plan on their own. CMS enrolled about 5.5 million dual-eligible beneficiaries in late 2005 and about 634,000 beneficiaries who became dually eligible during 2006. GAO was asked to testify on (1) CMS's process for enrolling new dual-eligible beneficiaries into PDPs and its effect on access to drugs and (2) how CMS set the effective coverage date for certain dual-eligible beneficiaries and its implementation of this policy. This testimony is based on a GAO report that is being released today, Medicare Part D: Challenges in Enrolling New Dual-Eligible Beneficiaries (GAO-07-272)."
Date: May 8, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare Part D Low-Income Subsidy: Progress Made in Approving Applications, but Ability to Identify Remaining Individuals Is Limited

Description: Testimony issued by the Government Accountability Office with an abstract that begins "To help the elderly and disabled with prescription drug costs, the Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, which created a voluntary outpatient prescription drug benefit (Medicare Part D). A key element of the prescription drug benefit is the low-income subsidy, or "extra help," available to Medicare beneficiaries with limited income and resources to assist them in paying their premiums and other out-of-pocket costs. To assess Social Security Administration's (SSA) implementation of the Medicare Part D low-income subsidy, GAO was asked to review (1) the progress that SSA has made in identifying and soliciting applications from individuals potentially eligible for the low-income subsidy, and (2) the processes that SSA uses to track its progress in administering the subsidy. This statement is drawn from GAO's ongoing study for the committee on the Medicare Part D low-income subsidy, which is expected to be published at the end of May. To conduct this work, GAO reviewed the law, assessed subsidy data, and interviewed officials from SSA, the Centers for Medicare and Medicaid Services, the Internal Revenue Service, state Medicaid agencies, and advocacy groups."
Date: May 8, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department