C. Stephen Redhead
Specialist in Health Policy
Janet Kinzer
Information Research Specialist
Congress is deeply divided over implementation of the Patient Protection and Affordable Care Act (ACA), the health reform law enacted in March 2010.1 Since the ACA’s enactment, lawmakers opposed to specific provisions in the ACA, or to the entire law, have debated implementation of the law on numerous occasions and considered multiple bills to repeal, defund, delay, or otherwise amend the law. Most of the legislative activity on these ACA-related bills has taken place in the House. The legislation has included stand-alone bills as well as provisions in broader, often unrelated measures that would (1) repeal the ACA in its entirety and, in some cases, replace it with new law; (2) repeal, or by amendment restrict or otherwise limit, specific provisions in the ACA; (3) eliminate appropriations provided by the ACA and rescind all unobligated funds; (4) replace the mandatory appropriations for one or more ACA programs with authorizations of (discretionary) appropriations, and rescind all unobligated funds; and (5) block or otherwise delay implementation of specific ACA provisions. A few bills containing provisions to amend the ACA that have attracted sufficiently broad and bipartisan support have been approved in both the House and the Senate and signed into law.
Some lawmakers also have used the annual appropriations process in an effort to eliminate funding for the ACA or delay its implementation. Several ACA-related provisions were included in enacted appropriations acts for FY2011-FY2013. Congress has yet to complete legislative action on any of the 12 annual appropriations bills to fund the routine operations of the federal government for FY2014, which began on October 1, 2013. Moreover, lawmakers initially were unable to agree on a continuing appropriations bill, or a continuing resolution (CR), to provide funding for the new fiscal year. The House repeatedly attached provisions to the CR to defund or delay ACA implementation, which the Senate rejected. The resulting lapse in funding at the beginning of FY2014 led to a partial shutdown of the federal government. Lawmakers finally reached agreement on legislative language on October 16, and the President signed the Continuing Appropriations Act, 2014 (P.L. 113-46), the following day to reopen the government. P.L. 113-46, which funds the federal government through January 15, 2014, does not include any provisions to defund or delay ACA implementation. Instead, it requires the Secretary of Health and Human Services (HHS) to certify to Congress that the ACA health insurance exchanges are
verifying the eligibility of individuals applying for subsidies to help cover the cost of purchasing insurance coverage.
This report summarizes legislative and other actions taken to repeal, defund, or delay the ACA since the law’s enactment. The information is presented in four appendixes. Table A-1 in Appendix A summarizes the authorizing legislation to amend the ACA that has been approved by both chambers and enacted into law. Table B-1 in Appendix B summarizes the ACA provisions in authorizing legislation that passed the House in the 112th Congress (2011-2012) but was not approved by the Senate. It also lists the ACA-related legislation that the House has passed to date in the 113th Congress (2013-2014), but which has not been taken up by the Senate. Table C-1 in Appendix C summarizes the ACA-related provisions in enacted annual appropriations acts for FY2011-FY2013, and in the FY2014 continuing appropriations act. Also included is a brief overview of all the ACA-related provisions added to appropriations bills considered, and in most cases reported, by the House and Senate Appropriations Committees since FY2011. Finally, Table D-1 in Appendix D summarizes the administrative decisions taken by HHS and the Department of the Treasury to delay implementation of specific ACA requirements by one year.
To help provide context for the information presented in the appendixes, the report continues with some background on the core provisions of the ACA. That is followed by an overview of the law’s impact on federal spending. This report is updated periodically to reflect legislative and other developments.
Date of Report: November 22, 2013
Number of Pages: 23
Order Number: R43289
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