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 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 mix 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 authorized under the Public Health Service Act (PHSA).
Generally, the FY2013 mandatory appropriations in ACA would be fully
sequestrable at the rate applicable to nonexempt nondefense mandatory
spending, under a sequestration order triggered by the Budget Control Act.
Lawmakers opposed to ACA introduced numerous bills in the 112th Congress, several of which saw legislative action. They
included 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. Similar legislation may be introduced and debated during
the 113th Congress.
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: January 15, 2013
Number of Pages: 34 Order Number: R41301 Price: $29.95
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