Wednesday, November 9, 2011
Deadlines for the HHS Secretary and Other Federal Entities in the Patient Protection and Affordable Care Act: Addendum to CRS Congressional Distribution Memorandum Dated April 5, 2011
This memorandum includes two tables. Table 1 provides updated information on a number of deadlines that were included in the earlier memorandum and for which no or only partial implementation action had been taken through April 1, 2011. Table 2 summarizes the PPACA provisions that require the HHS Secretary (or another federal entity) to take specific action by a specific date during the period March 24, 2011, through October 15, 2011.
Date of Report: November 3, 2011
Number of Pages: 59
Order Number: RL34391
Price: $29.95
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Monday, November 7, 2011
Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA)
Annie L. Mach
Analyst in Health Care Financing
Bernadette Fernandez
Specialist in Health Care Financing
The private health insurance provisions in the Patient Protection and Affordable Care Act (P.L. 111-148, ACA, as amended) include market reforms that impose requirements on private health insurance plans. Such reforms relate to the offer, issuance, generosity, and pricing of health plans, among other requirements.
ACA’s market reforms largely focus on the individual and small group health insurance markets, and in this report the reforms have been grouped by effective dates: “immediate” market reforms that become effective prior to the full implementation date of ACA, and reforms that become effective on the full implementation date (January 1, 2014).
ACA requires implementation of a number of reforms prior to its full implementation date (i.e., prior to plan years beginning on or after January 1, 2014). “Immediate” reforms include a process to review unreasonable rate increases; an Internet portal to assist consumers in identifying coverage options; prohibition on lifetime limits and restriction of annual limits; the prohibition on rescissions; coverage of preventive health services with no cost-sharing; extension of dependent coverage; prohibition of discrimination based on salary; standards related to medical loss ratios and rebates to plan participants; appeals process; coverage of preexisting health conditions for children; patient protections; uniform explanation of coverage documents; and reporting requirements regarding quality of care.
Market reforms effective beginning in 2014 include nondiscrimination based on health status; guaranteed issue and guaranteed renewability; coverage of preexisting health conditions (regardless of age); nondiscrimination regarding clinical trial participation; rating restrictions; waiting period limitation; and nondiscrimination regarding health care providers.
This report provides background information about the private health insurance market, including market segments and regulation. It describes each ACA market reform and notes any major implementation activity that has occurred (e.g., issuance of final rule from a department such as Health and Human Services). The appendices of the report provide additional information about the status of regulations relating to each reform and how the reforms apply to the different market segments and health plans.
Date of Report: November 1, 2011
Number of Pages: 26
Order Number: R42069
Price: $29.95
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Analyst in Health Care Financing
Bernadette Fernandez
Specialist in Health Care Financing
The private health insurance provisions in the Patient Protection and Affordable Care Act (P.L. 111-148, ACA, as amended) include market reforms that impose requirements on private health insurance plans. Such reforms relate to the offer, issuance, generosity, and pricing of health plans, among other requirements.
ACA’s market reforms largely focus on the individual and small group health insurance markets, and in this report the reforms have been grouped by effective dates: “immediate” market reforms that become effective prior to the full implementation date of ACA, and reforms that become effective on the full implementation date (January 1, 2014).
ACA requires implementation of a number of reforms prior to its full implementation date (i.e., prior to plan years beginning on or after January 1, 2014). “Immediate” reforms include a process to review unreasonable rate increases; an Internet portal to assist consumers in identifying coverage options; prohibition on lifetime limits and restriction of annual limits; the prohibition on rescissions; coverage of preventive health services with no cost-sharing; extension of dependent coverage; prohibition of discrimination based on salary; standards related to medical loss ratios and rebates to plan participants; appeals process; coverage of preexisting health conditions for children; patient protections; uniform explanation of coverage documents; and reporting requirements regarding quality of care.
Market reforms effective beginning in 2014 include nondiscrimination based on health status; guaranteed issue and guaranteed renewability; coverage of preexisting health conditions (regardless of age); nondiscrimination regarding clinical trial participation; rating restrictions; waiting period limitation; and nondiscrimination regarding health care providers.
This report provides background information about the private health insurance market, including market segments and regulation. It describes each ACA market reform and notes any major implementation activity that has occurred (e.g., issuance of final rule from a department such as Health and Human Services). The appendices of the report provide additional information about the status of regulations relating to each reform and how the reforms apply to the different market segments and health plans.
Date of Report: November 1, 2011
Number of Pages: 26
Order Number: R42069
Price: $29.95
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Document available via e-mail as a pdf file or in paper form.
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Definition of Income in PPACA for Certain Medicaid Provisions and Premium Credits
Janemarie Mulvey, Coordinator
Specialist in Health Care Financing
Evelyne P. Baumrucker
Analyst in Health Care Financing
Bernadette Fernandez
Specialist in Health Care Financing
Christine Scott
Specialist in Social Policy
Under the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148, as amended), the definition of income for eligibility for certain Medicaid populations and premium credits in the exchanges is based on modified adjusted gross income (MAGI). The initial intent of using MAGI was to standardize the definition of income for Medicaid eligibility purposes to reduce some of the variability and complexity that exists under the current program and to provide consistency between Medicaid and the health insurance exchange. The use of MAGI, however, has raised some concerns among Congress and the Obama Administration, as it excludes some types of income either partially or altogether. Of particular interest has been the potential impact of eligibility for Medicaid and premium credits for early retirees (aged 62 through 64) receiving Social Security benefits, as some or all of their Social Security income may be excluded from the MAGI definition of income. By excluding some types of income, individuals and families with a higher percentage of total income relative to the federal poverty level may qualify for Medicaid and premium credits. A recent cost estimate by the Congressional Budget Office finds that changing the MAGI income calculation to include all Social Security benefits would reduce the deficit by $13 billion over the 2012-2021 period.
Legislative proposals have been introduced in both chambers of Congress to change the definition of income to include the non-taxable portion of Social Security benefits in the definition of MAGI (H.R. 2576, S. 1376). President Obama also included changing the definition of income for these programs in his deficit reduction proposal. In evaluating these proposals, a number of issues might be considered. First, an alternative definition may add complexity compared with the use of MAGI. Specifically, because adjusted gross income (on which MAGI is based) can be computed largely from information on an individual’s federal tax return, verification of income is streamlined. If an alternative definition is used that is not based on tax return information, the administrative complexity of verifying nontaxable income from different sources comes into play. Second, the definition was developed to ensure coordination between Medicaid and premium credits in the health insurance exchange. A change in the definition of income for Medicaid should then also apply to premium credits to ensure consistency between Medicaid and the premium credit offered to selected individuals who purchase private health insurance through the exchanges. Finally, many of the current legislative proposals have focused largely on the inclusion of Social Security benefits in income definitions for eligibility purposes. However, most other low-income programs include other types of income (e.g., nontaxable pensions) and asset holdings that are also excluded from MAGI.
Date of Report: October 24, 2011
Number of Pages: 24
Order Number: R41997
Price: $29.95
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Specialist in Health Care Financing
Evelyne P. Baumrucker
Analyst in Health Care Financing
Bernadette Fernandez
Specialist in Health Care Financing
Christine Scott
Specialist in Social Policy
Under the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148, as amended), the definition of income for eligibility for certain Medicaid populations and premium credits in the exchanges is based on modified adjusted gross income (MAGI). The initial intent of using MAGI was to standardize the definition of income for Medicaid eligibility purposes to reduce some of the variability and complexity that exists under the current program and to provide consistency between Medicaid and the health insurance exchange. The use of MAGI, however, has raised some concerns among Congress and the Obama Administration, as it excludes some types of income either partially or altogether. Of particular interest has been the potential impact of eligibility for Medicaid and premium credits for early retirees (aged 62 through 64) receiving Social Security benefits, as some or all of their Social Security income may be excluded from the MAGI definition of income. By excluding some types of income, individuals and families with a higher percentage of total income relative to the federal poverty level may qualify for Medicaid and premium credits. A recent cost estimate by the Congressional Budget Office finds that changing the MAGI income calculation to include all Social Security benefits would reduce the deficit by $13 billion over the 2012-2021 period.
Legislative proposals have been introduced in both chambers of Congress to change the definition of income to include the non-taxable portion of Social Security benefits in the definition of MAGI (H.R. 2576, S. 1376). President Obama also included changing the definition of income for these programs in his deficit reduction proposal. In evaluating these proposals, a number of issues might be considered. First, an alternative definition may add complexity compared with the use of MAGI. Specifically, because adjusted gross income (on which MAGI is based) can be computed largely from information on an individual’s federal tax return, verification of income is streamlined. If an alternative definition is used that is not based on tax return information, the administrative complexity of verifying nontaxable income from different sources comes into play. Second, the definition was developed to ensure coordination between Medicaid and premium credits in the health insurance exchange. A change in the definition of income for Medicaid should then also apply to premium credits to ensure consistency between Medicaid and the premium credit offered to selected individuals who purchase private health insurance through the exchanges. Finally, many of the current legislative proposals have focused largely on the inclusion of Social Security benefits in income definitions for eligibility purposes. However, most other low-income programs include other types of income (e.g., nontaxable pensions) and asset holdings that are also excluded from MAGI.
Date of Report: October 24, 2011
Number of Pages: 24
Order Number: R41997
Price: $29.95
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Friday, November 4, 2011
Health Coverage Tax Credit
Bernadette Fernandez
Specialist in Health Care Financing
The Trade Act of 2002 (P.L. 107-210) authorized the health coverage tax credit (HCTC)—a federal income tax credit that subsidizes most of the cost of qualified health insurance for eligible taxpayers and their family members. Eligibility for the HCTC is limited to three groups of taxpayers, two of whom are individuals eligible for Trade Adjustment Assistance (TAA) allowances because they experienced job loss. The third group consists of individuals whose defined benefit pension plans were taken over by the Pension Benefit Guaranty Corporation because of financial difficulties. Eligible individuals cannot be enrolled in certain other health insurance (e.g., Medicaid) or entitled to other specified coverage (e.g., Medicare Part A).
The 112th Congress passed the Trade Adjustment Assistance Extension Act of 2011, part of H.R. 2832, “An Act to extend the Generalized System of Preferences,” on October 12, 2011. The President signed it into law on October 21, 2011 (P.L. 112-40). Key changes to the HCTC include establishing a new subsidy rate of 72.5% and termination of the tax credit on January 1, 2014.
The HCTC may be applied to certain categories of qualified health insurance specified in statute; several of those insurance categories require state action (“state-qualified health plans”) to become effective. As of December 2010, 44 states and the District of Columbia made at least one of the state-qualified health plans available. In the remaining six states, only the categories of qualified health insurance not dependent on state action (“automatically qualified health plans”) were potentially available, though not necessarily all persons who were eligible for the credit could avail themselves of these options.
The HCTC is refundable, so taxpayers may claim the full credit amount even if they have little or no federal income tax liability. The credit can also be advanced, so taxpayers need not wait until they file their tax returns in order to benefit from it. Despite these features, the HCTC is not widely used. For each year the HCTC has been available, less than 30,000 individuals have participated, out of hundreds of thousands of individuals who potentially are eligible for the credit. Possible reasons explaining such low participation include not knowing the tax credit is available, barriers to finding qualified insurance, complexity of the application and enrollment process, and difficulties paying the part of the premium not covered by the tax credit. Concerns have also been raised about whether the HCTC is equitable, since it provides a large tax subsidy to some unemployed workers but not others, and whether it is efficient, since it has what some analysts consider large administrative costs.
Date of Report: October 26, 2011
Number of Pages: 18
Order Number: RL32620
Price: $29.95
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Specialist in Health Care Financing
The Trade Act of 2002 (P.L. 107-210) authorized the health coverage tax credit (HCTC)—a federal income tax credit that subsidizes most of the cost of qualified health insurance for eligible taxpayers and their family members. Eligibility for the HCTC is limited to three groups of taxpayers, two of whom are individuals eligible for Trade Adjustment Assistance (TAA) allowances because they experienced job loss. The third group consists of individuals whose defined benefit pension plans were taken over by the Pension Benefit Guaranty Corporation because of financial difficulties. Eligible individuals cannot be enrolled in certain other health insurance (e.g., Medicaid) or entitled to other specified coverage (e.g., Medicare Part A).
The 112th Congress passed the Trade Adjustment Assistance Extension Act of 2011, part of H.R. 2832, “An Act to extend the Generalized System of Preferences,” on October 12, 2011. The President signed it into law on October 21, 2011 (P.L. 112-40). Key changes to the HCTC include establishing a new subsidy rate of 72.5% and termination of the tax credit on January 1, 2014.
The HCTC may be applied to certain categories of qualified health insurance specified in statute; several of those insurance categories require state action (“state-qualified health plans”) to become effective. As of December 2010, 44 states and the District of Columbia made at least one of the state-qualified health plans available. In the remaining six states, only the categories of qualified health insurance not dependent on state action (“automatically qualified health plans”) were potentially available, though not necessarily all persons who were eligible for the credit could avail themselves of these options.
The HCTC is refundable, so taxpayers may claim the full credit amount even if they have little or no federal income tax liability. The credit can also be advanced, so taxpayers need not wait until they file their tax returns in order to benefit from it. Despite these features, the HCTC is not widely used. For each year the HCTC has been available, less than 30,000 individuals have participated, out of hundreds of thousands of individuals who potentially are eligible for the credit. Possible reasons explaining such low participation include not knowing the tax credit is available, barriers to finding qualified insurance, complexity of the application and enrollment process, and difficulties paying the part of the premium not covered by the tax credit. Concerns have also been raised about whether the HCTC is equitable, since it provides a large tax subsidy to some unemployed workers but not others, and whether it is efficient, since it has what some analysts consider large administrative costs.
Date of Report: October 26, 2011
Number of Pages: 18
Order Number: RL32620
Price: $29.95
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Wednesday, November 2, 2011
Title X (Public Health Service Act) Family Planning Program
Angela Napili
Information Research Specialist
The federal government provides grants for voluntary family planning services through the Family Planning Program, Title X of the Public Health Service Act, codified at 42 U.S.C. Section 300 to Section 300a-6. The program, enacted in 1970, is the only domestic federal program devoted solely to family planning and related preventive health services. Title X is administered through the Office of Population Affairs (OPA) under the Office of the Assistant Secretary for Health in the Department of Health and Human Services (DHHS).
Although the authorization of appropriations for Title X ended with FY1985, funding for the program has continued to be provided through appropriations bills for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (Labor-HHS-Education). Within DHHS, Title X receives its funding through the Health Resources and Services Administration (HRSA) account.
P.L. 112-10, the Department of Defense and Full-Year Continuing Appropriations Act, 2011, provided $299.400 million for Title X in FY2011, a 6% decrease from the FY2010 funding level of $317.491 million. The funds were provided under the same conditions as in FY2010. These conditions include that Title X funds not be spent on abortions, that all pregnancy counseling be nondirective, and that funds not be spent on promoting or opposing any legislative proposal or candidate for public office. Grantees must also certify that they encourage “family participation” when minors decide to seek family planning services, and must certify that they counsel minors on how to resist attempted coercion into sexual activity. Appropriations law also clarifies that family planning providers are not exempt from state notification and reporting laws on child abuse, child molestation, sexual abuse, rape, or incest.
The Senate-reported FY2012 Labor-HHS-Education Appropriations bill, S. 1599, would provide $299.400 million for Title X in FY2012, the same as the FY2011 level. The House-introduced FY2012 Labor-HHS-Education Appropriations bill, H.R. 3070, would prohibit the bill’s funds from being used for Title X. H.R. 3070 would also restrict the bill’s funding to Planned Parenthood Federation of America and its affiliates unless they certify that the organization will not perform abortions; the DHHS Secretary would be required to seek repayment of federal funds if the certification terms are violated.
The law (42 U.S.C. §300a-6) prohibits the use of Title X funds in programs where abortion is a method of family planning. According to OPA, family planning projects that receive Title X funds are closely monitored to ensure that federal funds are used appropriately and that funds are not used for prohibited activities such as abortion. The prohibition on abortion does not apply to all the activities of a Title X grantee, but only to activities that are part of the Title X project. A grantee’s abortion activities must be “separate and distinct” from the Title X project activities.
Several bills addressing Title X have been introduced in the 112thCongress. H.R. 217 and S. 96 would prohibit Title X grants to abortion-performing entities. H.R. 408 and S. 178 would eliminate the Title X program. H.R. 1099 would prohibit federal spending on any family planning activity. H.R. 1135/H.R. 1167 would require an overall spending limit on means-tested welfare programs, defined to include family planning. S. 814 would require online disclosure of any audits conducted under Title X on any entity receiving Title X funds. H.R. 1 would have eliminated funding for Title X for the remainder of FY2011. H.R. 1 and H.Con.Res. 36 would have restricted federal funding to the Planned Parenthood Federation of America and its affiliates.
Date of Report: October 14, 2011
Number of Pages: 24
Order Number: RL33644
Price: $29.95
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