its many provisions, the Patient Protection and Affordable Care Act (ACA)
restructures the private health insurance market, sets minimum standards
for health coverage, and, beginning in 2014, mandates that most U.S.
residents obtain health insurance coverage or pay a penalty. The law
provides for the establishment by 2014 of state-based health insurance exchanges
for the purchase of private health insurance. Qualifying individuals and
families will be able to receive federal subsidies to reduce the cost of
purchasing coverage through the exchanges. ACA also expands eligibility
for Medicaid; amends the Medicare program in ways that are intended to reduce
the growth in spending; and makes other changes to the tax code, Medicare,
Medicaid, and many other federal programs.
In addition, ACA appropriates billions of dollars to support new or existing
grant programs and other activities. These mandatory appropriations
include funds for a temporary insurance program for individuals who have
been uninsured for several months and have a preexisting condition, as well
as funding for states to plan and establish exchanges. ACA also provides
funding for various Medicare and Medicaid demonstration programs, for the
creation of a Center for Medicare and Medicaid Innovation to test and
implement innovative payment and service delivery models, and for an
independent board to provide Congress with proposals for reducing Medicare cost
growth and improving quality of care for Medicare beneficiaries.
ACA provides funding for health workforce and maternal and child health
programs, and establishes three multi-billion dollar funds. The first fund
will provide a total of $11 billion over five years in funding for
community health centers and the National Health Service Corps. (A separate
appropriation provides $1.5 billion for health center construction and
renovation.) The second fund will support comparative effectiveness
research through FY2019 with a mixture of appropriations and transfers
from the Medicare trust funds. The third fund, for which ACA provides a
permanent annual appropriation, is intended to support prevention, wellness,
and other public health-related programs and activities authorized under
the Public Health Service Act (PHSA).
According to the Office of Management and Budget’s preliminary estimates, the
FY2013 mandatory appropriations in ACA would, in general, be subject to a
7.6% reduction under a sequestration order triggered by the Budget Control
Lawmakers opposed to ACA have introduced numerous bills in the 112th Congress,
several of which have seen legislative action. They include measures to
repeal ACA and replace it with new law; repeal or amend specific ACA
provisions; eliminate certain mandatory appropriations and rescind all
unobligated funds; and block or otherwise delay ACA implementation.
In addition to the mandatory appropriations discussed in this report, ACA
authorizes new funding for numerous existing discretionary grant and other
programs, primarily ones authorized under the PHSA. The law also creates a
number of new discretionary grant programs and activities and provides for
each an authorization of appropriations. Funding for all these discretionary
programs and activities is subject to action by congressional
appropriators. A companion product, CRS Report R41390, Discretionary
Spending in the Patient Protection and Affordable Care Act (ACA), summarizes
all the provisions in ACA that include an authorization of appropriations.
Date of Report: October 26, 2012
Number of Pages: 32 Order Number: R41301 Price: $29.95
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