CRS Updates Overview of Actions to Repeal, Defund, or Delay ACA
R43289
- AuthorsRedhead, C. StephenKinzer, Janet
- Institutional AuthorsCongressional Research Service
- Code Sections
- Subject Area/Tax Topics
- Jurisdictions
- LanguageEnglish
- Tax Analysts Document NumberDoc 2015-3043
- Tax Analysts Electronic Citation2015 TNT 26-52
C. Stephen Redhead
Specialist in Health Policy
Janet Kinzer
Information Research Specialist
February 3, 2015
Congressional Research Service
7-5700
www.crs.gov
R43289
Contents
Introduction
A Brief Overview of the ACA
Impact on Federal Spending
ACA Provisions in Authorization Legislation
Outlook for the 114th Congress
ACA Provisions in Appropriations Acts
Government Shutdown
Outlook for the 114th Congress
Tables
Table A-1. Enacted Authorizing Legislation That Amends the ACA
Table B-1. ACA Provisions in Bills Approved by the House in the
112th, 113th, and 114th
Congresses
Table C-1. ACA-Related Provisions in Appropriations Acts,
FY2011-FY2015
Appendixes
Appendix A. ACA Provisions in Enacted Authorizing Legislation in
the 111th, 112th, and 113th
Congresses
Appendix B. ACA Provisions in Bills Approved by the House in the
112th, 113th, and 114th
Congresses
Appendix C. ACA Provisions in Appropriations Acts (FY2011-FY2015)
Contacts
Author Contact Information
Introduction
Congress remains 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 the entire law have repeatedly debated its implementation and considered bills to repeal, defund, delay, or otherwise amend the law. To date, most of this legislative activity has taken place in the House, which reverted to Republican control in 2011. Over the past four years, the Republican-led House has passed numerous ACA-related bills, including legislation that would repeal the entire law. But there has been far less debate in the Senate, which remained under Democratic control through 2014. Most of the ACA legislation that passed the House during this period was not considered in the Senate. However, a few bills to amend specific elements of the ACA that attracted sufficiently broad and bipartisan support were approved by both the House and the Senate and signed into law. Now that Republicans control both chambers of Congress, opponents of the ACA see new opportunities to pass and send to the President legislation that would change the law.
In addition to considering ACA repeal or amendment in authorizing legislation, some lawmakers have used the annual appropriations process in an effort to eliminate funding for the ACA's implementation and address other concerns they have with the law. ACA-related provisions have been included in enacted appropriations acts each year since the ACA became law. In October 2013, disagreement between the House and Senate over the inclusion of ACA language in a temporary spending bill for the new fiscal year (i.e., FY2014) resulted in a partial shutdown of government operations that lasted 16 days.
This report summarizes legislative actions taken to repeal, defund, delay, or otherwise amend the 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. While a detailed examination of the ACA itself is beyond the scope of this report, a brief overview of the ACA's core provisions and its impact on federal spending is provided.2 This material is included to help provide context for the discussion of ACA legislative activity that follows. This report is updated periodically to reflect legislative and other developments.
A Brief Overview of the ACA
The ACA made significant changes to the way U.S. health care is financed, organized, and delivered. Its primary goal is to increase access to affordable health care for the medically uninsured and underinsured. To that end, the law included a complex set of interconnected provisions that address the private health insurance market.
First, the ACA requires health insurers to comply with a set of federal standards ("market reforms") to ensure that individuals may purchase, keep, and renew coverage that provides a minimum level of benefits and consumer protections, with some limits on costs. Second, the law establishes competitive private health insurance marketplaces -- or exchanges -- through which individuals and small employers are able to compare and enroll in qualified health plans. Exchanges operate in every state and the District of Columbia. They are administered by states or by the federal government, or through a partnership between the state and federal governments. Qualified individuals who enroll in exchange plans may receive financial assistance if they meet income and certain other requirements. Refundable tax credits are available to individuals and families with incomes between 100% and 400% of the federal poverty level (FPL) to help pay the insurance premium. The premium tax credits are available upon enrollment so that eligible individuals and families can choose to receive the subsidy immediately rather than wait until they file taxes the following year. In addition, certain individuals and families receiving the tax credit may be eligible for cost-sharing subsidies to reduce their out-of-pocket costs (e.g., deductibles, copays) when receiving health services. Small employers with fewer than 25 full-time equivalent employees (FTEs) may also use the exchanges to purchase insurance coverage for their employees and may qualify for a tax credit to help cover the cost of providing that coverage.
Third, the ACA's "individual mandate" requires most U.S. citizens and legal residents to obtain coverage. Those who remain uninsured may have to pay a penalty unless they qualify for an exemption. The individual mandate is intended to encourage healthy individuals to participate in the insurance market and not wait until they get sick to buy coverage. Finally, the law requires larger employers with 50 or more FTEs to offer health coverage that meets affordability and adequacy standards for their full-time employees and those workers' dependents. Employers who do not comply with these requirements may be subject to a tax if one or more of their employees purchase coverage through an exchange and receive a subsidy. The purpose of the ACA's employer requirements is to encourage larger firms to maintain affordable and adequate coverage for their employees.
The ACA coupled its private insurance provisions with the requirement that states expand their Medicaid programs to cover all nonelderly individuals with incomes up to 138% FPL. Those with higher incomes, up to 400% FPL, may be eligible to get subsidized coverage through an exchange. In June 2012, the U.S. Supreme Court in NFIB v. Sebelius found the Medicaid expansion to be unconstitutionally coercive and prohibited the federal government from enforcing it.3 The Court's decision made Medicaid expansion optional for states.
In addition to expanding access to insurance coverage, the ACA contains hundreds of other provisions that address health care access, costs, and quality. They include new programs to test alternative ways of delivering and paying for health care. The law also includes new taxes and fees as well as adjustments to Medicare payments to hospitals and other health care providers. These provisions are designed to offset spending on exchange subsidies and Medicaid expansion.
Impact on Federal Spending
Implementation of the ACA is affecting both mandatory and discretionary spending. Mandatory spending -- also referred to as direct spending -- is controlled through authorizing laws.4 Itincludes spending on entitlement programs such as Medicare and Social Security. Authorizing laws may provide permanent or temporary appropriations or other forms of budget authority for such spending. When the authorizing law contains no appropriations, mandatory programs may be funded through the annual appropriations process. This is sometimes referred to as "appropriated mandatory" or "appropriated entitlement" spending.5Discretionary spending is both controlled and funded through the annual appropriations process. It typically covers the routine costs of running federal agencies and offices, including wages and salaries.6
Federal spending on ACA implementation can be grouped into the following three categories:
Mandatory Spending on Expanding Insurance Coverage. This category accounts for most of the federal spending under the ACA. It includes the exchange subsidies (i.e., premium tax credits and cost-sharing subsidies), the federal government's share of the costs of Medicaid expansion, and tax credits for small employers. The Congressional Budget Office (CBO) projected that this spending, along with other ACA mandatory spending (discussed in the second category), would be fully offset by (1) revenues from the ACA's new taxes and fees, and (2) savings from the law's adjustments to Medicare provider payments that are projected to slow the rate of growth of Medicare spending.7
Mandatory Spending on Other Programs. The ACA authorized new Medicare and Medicaid spending. For example, it phased out the Medicare prescription drug benefit "donut hole" through a combination of subsidies and manufacturer discounts, and it increased Medicare payments for primary care services and medical education. The ACA also included numerous appropriations that are providing billions of dollars of mandatory funding to support grant programs and other activities authorized by the law.8 For example, the law funded temporary insurance programs for targeted groups prior to the exchanges becoming operational, and it provided funding for grants to states to plan and establish health insurance exchanges. The ACA included a permanent appropriation, available for 10-year periods, for the Center for Medicare & Medicaid Innovation (CMI), within the Centers for Medicare & Medicaid Services (CMS), to test and implement innovative health care payment and service delivery models.
In addition, the ACA created four special funds and appropriated amounts to each one. First, the Community Health Center Fund (CHCF) has provided almost $11 billion over five years (FY2011-FY2015) to help support community health center operations and the National Health Service Corps. Second, the Patient-Centered Outcomes Research Trust Fund (PCORTF) is supporting patient-centered comparative clinical effectiveness research through FY2019 with a mix of appropriations, fees on health plans, and transfers from the Medicare trust funds. Third, the Prevention and Public Health Fund (PPHF), for which the ACA provided a permanent annual appropriation, is intended to support prevention, wellness, and other public health-related programs and activities. Finally, the Health Insurance Reform Implementation Fund (HIRIF), for which the ACA appropriated $1 billion, helped cover the initial administrative costs of implementing the law.
Discretionary Spending. The ACA is affecting discretionary spending in two ways. First, the law created numerous new discretionary grant programs and provided each of them with an authorization of appropriations. To date, however, few of these programs have received discretionary funding through annual appropriations acts, though several of them have been supported with mandatory funds from the PPHF.9 Second, the two agencies largely responsible for the ACA's implementation -- CMS and the Internal Revenue Service (IRS) -- are incurring significant costs in connection with administering and enforcing the law. Both agencies requested an increase in funding in each of the past three years (FY2013-FY2015) to help pay for ACA implementation. But congressional appropriators did not provide either agency with any additional discretionary funds (see discussion under "ACA Provisions in Appropriations Acts"). CMS has instead relied on discretionary fund transfers from other accounts and on ACA mandatory funds (i.e., HIRIF, PPHF) to support its ACA implementation activities. CMS also has transferred HIRIF funds to the IRS.
ACA Provisions in Authorization Legislation
Table A-1 in Appendix A summarizes the authorizing legislation to amend the ACA that has been signed into law since the ACA's enactment in March 2010. During the 111th Congress, when the House was still under Democratic control, a number of clarifications and technical adjustments to the law were enacted. In the 112th and 113th Congresses, several more substantive ACA amendments that garnered bipartisan support were signed into law. For example, Congress repealed Title VIII of the ACA -- the Community Living Assistance Services and Supports (CLASS) Act -- which would have established a voluntary, long-term care insurance program to pay for community-based services and supports for individuals with functional limitations. Lawmakers also repealed a tax-filing provision (IRS Form 1099) that had been included in the ACA, and they reduced the PPHF annual appropriation over the period FY2013-FY2021 by a total of $6.25 billion.
As discussed in the introduction to this report, the Republican-controlled House approved numerous other ACA bills during the 112th and 113th Congresses, none of which became law. Two of these bills were considered by the Democratic-led Senate. The legislation included stand-alone bills as well as provisions in broader, often unrelated measures that would have (1) repealed the ACA in its entirety and, in some cases, replaced it with new law; (2) repealed, or by amendment restricted or otherwise limited, specific provisions in the ACA; (3) eliminated appropriations provided by the ACA and rescinded all unobligated funds;10 (4) replaced the mandatory appropriations for one or more ACA programs with authorizations of (discretionary) appropriations, and rescinded all unobligated funds; and (5) blocked or otherwise delayed implementation of specific ACA provisions.
Table B-1 in Appendix B summarizes all the House-passed ACA bills in the 112th and 113th Congresses. Many of the entries in the table include a brief explanation of the ACA provisions that the bill addresses to help provide some legislative context for the reader. During this period the House voted on three separate occasions to repeal the ACA in its entirety. Other House-approved bills included measures that would have amended or delayed implementation of the ACA's private insurance coverage provisions -- including delaying the individual mandate and the employer requirements -- and rescinded certain ACA appropriations. Some of the bills passed with Democratic support.
Outlook for the 114th Congress
The ACA legislation approved by the House during the previous Congress provides a menu of policy options for the new Republican-controlled Congress. Several of the ACA bills that passed the House in the 113th Congress have been reintroduced and the House has already voted on and passed three of them. These bills, which have been referred to the Senate, are listed in Table B-1.
Now that Republicans control both chambers, opponents of the ACA are taking action to pass legislation to repeal or otherwise amend the ACA and send it to the President. In the Senate, however, Republicans do not have a filibuster-proof majority. Thus, they would need to secure some Democratic support for any ACA bills they wish to consider in order to gain the 60 votes needed to pass the legislation if the Democrats decide to filibuster. A bill that would repeal or make other substantive changes to the ACA's core provisions would almost certainly draw a presidential veto. Both the House and the Senate would then require a two-thirds vote -- 290 House votes and 67 Senate votes -- to override the veto and allow the bill to become law.
Faced with these procedural hurdles, lawmakers opposed to the ACA may look for areas of compromise and consider legislative changes to the ACA that gain significant bipartisan support.
ACA Provisions in Appropriations Acts
The ACA's opponents in Congress have used the annual appropriations process in an effort to block agency spending on its implementation and address other concerns they have with the law. Language that addresses the ACA has been included in enacted appropriations acts in each of the past five years (i.e., FY2011-FY2015).
The House Appropriations Committee has added numerous ACA -- related provisions to annual appropriations acts since the Republicans regained control of the House in 2011. Most of these provisions were included in the Departments of Labor, Health and Human Services, Education, and Related Agencies ("Labor-HHS-ED") Appropriations Act, which funds CMS. A few were incorporated in the Financial Services and General Government ("Financial Services")
Appropriations Act, which funds the IRS. By comparison, the Labor-HHS-ED and Financial Services appropriations bills drafted by the Senate Appropriations Committee, which was under Democratic control over the past four years, were largely free of any ACA-related provisions with one key exception. Each year the Senate Labor-HHS-ED appropriations bill included instructions on the allocation of PPHF funding.
Congressional appropriators have used a number of legislative options available to them through the appropriations process in an effort to defund, delay, or otherwise address implementation of the ACA. First, they have denied CMS and the IRS any new funding to cover the administrative costs of ACA implementation. CMS requested substantial increases in funding for its Program Management account in the FY2013, FY2014 and FY2015 budgets. These new funds were to help support operation of the federally facilitated exchanges and other ACA-related activities. Congress, however, did not provide any additional discretionary funds for CMS in the Labor-HHS-ED appropriations acts for FY2013-FY2015. Similarly, the IRS requested additional discretionary funds for each of those three years to support administration and enforcement of the ACA's tax provisions, including the premium tax credits and the individual mandate penalties. Again, congressional appropriators did not give the IRS the extra funds it requested.11 Both agencies have asked for additional ACA funding in the FY2016 budget.
Second, House appropriators repeatedly have added limitations (often referred to as riders) to the Labor-HHS-ED and Financial Services appropriations bills. Limitation provisions within appropriations measures are provisions that restrict the use of discretionary funds provided by the bill. They do this either by capping the amount of funding that may be used for a particular purpose or by prohibiting the use of any funds for a specific purpose. For example, appropriators on multiple occasions added language prohibiting an agency from using any of the discretionary funds in its appropriations bill for ACA implementation activities. Limitation provisions also may be used to restrict the availability of funds for transfer.12 To date, the ACA limitation provisions added by House appropriators have been removed during negotiations with the Senate. None of them have been incorporated into the final appropriations legislation agreed to by both chambers and signed into law.
Third, House appropriators have incorporated legislative language in the Labor-HHS-ED appropriations bills. Unlike limitations, legislative provisions have the effect of making new law or changing existing law.13 As an example, appropriators included language to rescind (i.e., cancel) certain mandatory funding provided by the ACA. House rules prohibit legislative provisions in appropriations acts, while the rules of the Senate allow exceptions under some circumstances. However, special rules in the House (approved by the Rules Committee) and unanimous consent agreements in the Senate can be used to set aside each chamber's rules, including those that relate to legislating in appropriations measures.
Finally, congressional appropriators have added to recent Labor-HHS-ED appropriations acts several reporting and other administrative requirements regarding implementation of the ACA. These include instructing the HHS Secretary to establish a website with information on the allocation of PPHF funds, and provide an accounting of administrative spending on ACA implementation.
Table C-1 in Appendix C summarizes the ACA-related legislative and other provisions that were incorporated in the enacted Labor-HHS-ED and Financial Services appropriations acts for each of FY2011-FY2015. For each fiscal year the table also provides a brief overview of any legislative action taken by the House and Senate Appropriations Committees on their respective versions of the two appropriations bills prior to the two chambers reaching agreement on the final version of the legislation. This discussion lists all the ACA language added to the bills by the committees. As already noted, none of the ACA limitations added by the House appropriators were included in the enacted Labor-HHS-ED and Financial Services appropriations acts.
Government Shutdown
Disagreement between the Republican-controlled House and the Democrat-led Senate on whether to include ACA provisions in the FY2014 continuing resolution (CR) shut down programs and activities across the federal government in October 2013. Congress took up consideration of the FY2014 CR to ensure continued funding for the government at the start of the new fiscal year (i.e., October 1) after lawmakers failed to complete legislative action on any of the FY2014 annual appropriations acts. The House tried three times to attach provisions to the CR to defund or delay ACA implementation. Each time the Senate rejected the House language. With no agreement in place at the start of FY2014, the resulting lapse in discretionary funding led to a partial shutdown of government operations.
Lawmakers finally reached agreement on legislative language on October 16, and the President signed the Continuing Appropriations Act, 2014, the following day to reopen the government.14 The measure funded the federal government through January 15, 2014, and did not include any provisions to defund or delay ACA implementation. Instead, it required the HHS Secretary to certify to Congress that the ACA health insurance exchanges were verifying the eligibility of individuals applying for subsidies to help cover the cost of purchasing insurance coverage. In January 2014, Congress completed action on the FY2014 appropriations process by approving the Consolidated Appropriations Act, 2014, which included all 12 annual appropriations acts for FY2014.15
Outlook for the 114th Congress
Republican leaders in the House and Senate have indicated that they plan to use the appropriations process in the 114th Congress to address ACA implementation.16 With majorities in both chambers, House and Senate appropriators may find it easier to coordinate their efforts to include ACA limitations and other legislative language in the appropriations bills, which must be enacted each year to fund government operations.
Senate Republicans may still need to persuade a handful of Democrats to join them to get to the 60 votes needed to debate and pass appropriations bills if the Democrats decide to filibuster the legislation. An appropriations bill that contains limitations or other language intended to defund or otherwise impede ACA implementation is likely to be vetoed by the President. In that case each chamber would require a two-thirds vote to override the veto.
Another option would be to use the threat of a government shutdown at the beginning of the new fiscal year as leverage to try and get ACA limitations and other legislative provisions included in appropriations measures. However, that option appears less likely in the 114th Congress. Republican leaders in both chambers have made it clear that they will not support another shutdown, like the one that occurred in 2013, suggesting that lawmakers on both sides of the issue may have to find areas of compromise.17
* * * * *
Appendix A. ACA Provisions in Enacted Authorizing
Legislation in the 111th, 112th,
and 113th Congresses
Table A-1 summarizes the authorizing legislation enacted to date to amend the ACA. Each table entry includes the public law number and date of enactment, the original bill number and sponsor, and a brief description and explanation of the change(s) made to the ACA. The laws are listed in reverse chronological order beginning with the most recently enacted legislation and extending back to the first measure signed into law following enactment of the ACA and the accompanying package of amendments in the Health Care and Education Reconciliation Act.18 In compiling the table, CRS made decisions about which laws -- or specific provisions in a particular law -- to include, and which ones to leave out. Generally, CRS included only those laws that amend, or make changes that relate to, new programs and activities that were established under the ACA. CRS excluded laws that amend or extend established programs and activities that predate the ACA and were amended or extended by it. For example, the ACA extended multiple existing Medicare and Medicaid program payments and activities that have since been further extended and/or modified by more recently enacted laws. None of those laws are included in Table A-1.
The following laws are referred to in Table A-1 by their acronyms:
Health Care and Education Reconciliation Act (HCERA; P.L. 111-152)
Internal Revenue Code (IRC)
Medicare Improvements for Patients and Providers Act (MIPPA; P.L. 110-275)
Social Security Act (SSA)
Table A-1. Enacted Authorizing Legislation That Amends the ACA
_____________________________________________________________________________
Public Law
and Date of
Enactment Bill (Sponsor) Summary of ACA Provisions
_____________________________________________________________________________
113th Congress
_____________________________________________________________________________
P.L. 113-93 H.R. 4302 (Pitts) Protecting Access to Medicare Act of
Apr. 1, 2014 2014. Among its many provisions, P.L.
113-93:
o Eliminated paragraph (2) of ACA Section
1302(c), which capped deductibles for
small group health plans at $2,000 for
singles and $4,000 for families
(indexed after 2014 to average per
capita premium costs). [Insurers were
finding it difficult staying within the
deductible cap while covering all
essential health benefits and meeting
the 60% actuarial value (AV) level for
bronze plans. In fact, CMS had already
agreed to waive the deductible cap if a
plan could not "reasonably reach" the
AV level without exceeding the cap.]
_____________________________________________________________________________
112th Congress
_____________________________________________________________________________
P.L. 112-240 H.R. 8 (Camp) American Taxpayer Relief Act of 2012.
Jan. 2, 2013 Among its many provisions, P.L. 112-240:
o Amended MIPAA Section 119 to provide a
total of $25 million for FY2013 for the
four outreach and assistance programs,
which ACA Section 3306 funded through
FY2012.
o Amended SSA Section 501(c)(1)(A) to
provide $5 million for FY2013 for the
family-to-family information centers,
which ACA Section 5507(b) funded
through FY2012.
o Transferred 10% of the remaining
unobligated Consumer Operated and
Oriented Plan (CO-OP) program funds to
a new CO-OP contingency fund (to
provide assistance and oversight to
CO-OP loan recipients) and rescinded
the other 90% of those funds (see
entries for P.L. 112-10 and P.L.
112-74, which predate this act, in
Table C-1).a
o Repealed ACA Title VIII, the Community
Living Assistance Services and Supports
(CLASS) Act.
o Repealed the ACA's appropriations for
the National Clearinghouse for
Long-Term Care Information and
rescinded all unobligated funds.
P.L. 112-141 H.R. 4348 (Mica) Moving Ahead for Progress in the
July 6, 2012 21st Century Act, or
"MAP-21." Among its many
provisions, P.L. 112-141 further modified
the Medicaid disaster-recovery FMAP
adjustment (see entry for P.L. 112-96,
below) by changing the adjustment factor
and the effective date.
P.L. 112-96 H.R. 3630 (Camp) Middle Class Tax Relief and Job
Feb. 22, 2012 Creation Act of 2012. Among its
many provisions, P.L. 112-96:
o Amended ACA Section 4002 to reduce the
Prevention and Public Health Fund
(PPHF) annual appropriations over the
period FY2013-FY2021 by a total of
$6.25 billion to help offset the cost
of extending the payroll tax cut and
other programs in P.L. 112-96.
o Amended SSA Section 1923(f) to extend
by one year the disproportionate share
hospital (DSH) allotment reduction
imposed by ACA Section 3203.
o Amended SSA Section 1905(aa), as added
by ACA Section 2006, to make a
technical correction to the formula to
phase down the Medicaid disaster-
recovery Federal Medical Assistance
Percentage (FMAP) adjustment as
originally intended. [The purpose of
the adjustment was to help Louisiana
avoid a significant reduction in its
federal Medicaid match (i.e., FMAP) in
the aftermath of Hurricane Katrina. As
written in ACA Section 2006, the
formula for the disaster-recovery FMAP
adjustment unintentionally caused the
FMAP adjustment to increase, rather
than phase down, each year the state
qualifies for the adjustment.]
P.L. 112-56 H.R. 674 (Herger) 3% Withholding Repeal and Job Creation
Nov. 21, 2011 Act. Among its many provisions,
P.L. 112-56 amended IRC Section 36B, as
added by ACA Section 1401(a) (as
amended), by modifying the calculation of
Modified Adjusted Gross Income (MAGI) to
include Social Security benefits. MAGI
will be used to determine eligibility for
exchange subsidies and Medicaid,
beginning in 2014.
P.L. 112-9 H.R. 4 (Lungren) Comprehensive 1099 Taxpayer Protection
Apr. 14, 2011 and Repayment of Exchange Subsidy
Overpayments Act of 2011. Amended IRC
Section 6041, as amended by ACA Section
9006, to repeal the requirement that
businesses file an information report
(IRS Form 1099) whenever they pay a
vendor more than $600 for goods in a
single year. To pay for the 1099 repeal,
P.L. 112-9 amended IRC Section 36B, as
added by ACA Section 1401(a), by further
modifying the sliding scale that
determines the amount of excess premium
tax credits that individuals have to
repay based on household income (see
entry for P.L. 111-309, below).
_____________________________________________________________________________
111th Congress
_____________________________________________________________________________
P.L. 111-383 H.R. 6523 (Skelton) Ike Skelton National Defense
Jan. 7, 2011 Authorization Act for Fiscal Year 2011.
Extended TRICARE coverage to dependent
adult children up to age 26, to conform
to the private health insurance
requirements under the ACA.
P.L. 111-312 H.R. 4853 (Oberstar) Tax Relief, Unemployment Insurance
Dec. 17, 2010 Reauthorization, and Job Creation Act of
2010. Amended ACA Section 10909 to extend
the nonrefundable adoption tax credit
through tax year 2012. The adoption tax
credit helps offset the cost of qualified
adoption expenses. [Subsequently, P.L.
112-240 made the nonrefundable adoption
tax credit permanent.]
P.L. 111-309 H.R. 4994 (Lewis) Medicare and Medicaid Extenders Act of
Dec. 15, 2010 2010. To help offset the costs of the
Medicare and Medicaid program extensions
and the postponement of cuts in Medicare
physician payments, P.L. 111-309 amended
IRC Section 36B, as added by ACA Section
1401(a), to modify the amount of excess
premium tax credits that individuals
would have to repay. The ACA created a
sliding scale for such repayments based
on household income. P.L. 111-309
modified the sliding scale. [Under the
ACA, the amount received in premium
credits is based on income as reported on
tax returns. These amounts are reconciled
the following year, which could result in
an overpayment of credits if income
increases. The ACA placed limits on the
amount of any premium credit overpayment
that had to be repaid to the government.]
P.L. 111-226 H.R. 1586 (Rangel) FAA Air Transportation Modernization and
Aug. 10, 2010 Safety Improvement Act. Among its many
provisions, P.L. 111-226 amended SSA
Section 1927(k)(1)(B)(i)(IV) (as added by
ACA Section 2503(a)(2)(B), as amended by
HCERA Section 1101(c)) by modifying the
definition of average manufacturer price
(AMP) to include inhalation, infusion,
implanted, or injectable drugs that are
not generally dispensed through a retail
community pharmacy.
P.L. 111-173 H.R. 5014 (Filner) [No title.] Amended IRC Section
May 27, 2010 5000A(f)(1)(A), as added by ACA Section
5101(b), to clarify that health care
provided by the Department of Veterans
Affairs constitutes minimal essential
health care coverage as required by the
ACA. [Beginning in 2014, the ACA requires
most U.S. citizens and legal residents to
have minimal essential health care
coverage or pay a penalty.]
P.L. 111-159 H.R. 4887 (Skelton) TRICARE Affirmation Act. Amended IRC
Apr. 26, 2010 Section 5000A(f)(1)(A), as added by ACA
Section 5101(b), to clarify that health
care provided under TRICARE, TRICARE for
Life, and the Nonappropriated Fund Health
Benefits program constitutes minimal
essential health care coverage as
required by the ACA. [Beginning in 2014,
the ACA requires most U.S. citizens and
legal residents to have minimal essential
health care coverage or pay a penalty.]
______________________________________________________________________________
Source: Prepared by the Congressional Research Service based on the text of
the public laws listed in the table.
FOOTNOTE TO TABLE 1
a P.L. 112-10 and P.L. 112-74 rescinded a total of $2.6 billion
of the ACA's original $6 billion appropriation for the CO-OP program (see
Table C-1). At the time P.L. 112-240 was enacted, according to HHS
budget documents, the CO-OP program had an unobligated balance of $2.532
billion. P.L. 112-240 rescinded 90% of that amount (i.e., $2.279 billion), and
transferred the remaining funds (i.e., $253 million) to the contingency fund.
In all, Congress has rescinded $4.879 billion of the $6 billion CO-OP program
appropriation.
* * * * *
Appendix B. ACA Provisions in Bills Approved
by the House in the 112th, 113th,
and 114th Congresses
As discussed earlier in this report, 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 this legislative activity has taken place in the House. However, 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. Those laws are summarized in Table A-1 in Appendix A.
Table B-1 below summarizes the ACA provisions in authorizing legislation that passed the House in the 112th and 113th Congresses (2011 -2014), but saw little if any further legislative action. Two of these bills, both of which passed the House in the 113th Congress, were taken up and approved by the Senate though neither measure ended up getting enacted into law. The bills are listed in reverse chronological order beginning with the most recently passed one. Table B-1 also summarizes the ACA legislation that has passed the House to date in the 114th Congress. Generally, the table only lists legislation that, if enacted, would have a direct impact on the ACA and its implementation; measures that would not have such an effect are not included. Thus, budget resolutions, which are only binding on certain matters before the Congress, are not included.19
On July 30, 2014, the House approved a simple resolution (H.Res. 676) that authorized the Speaker John Boehner to sue the Obama Administration on behalf of the House of Representatives over implementation of the ACA's private health insurance provisions. The House filed a lawsuit in federal district court on November 21, 2014, seeking to invalidate two actions taken by the Administration. First, the lawsuit claims that HHS abused its authority by delaying enforcement of the ACA's employer mandate. Second, it argues that Congress has never appropriated funds for the ACA's cost-sharing subsidies.20
Table B-1. ACA Provisions in Bills Approved by the House in the
112th, 113th, and 114th Congresses
_____________________________________________________________________
Bill (Sponsor) Bill Title, House Vote, Summary of ACA Provisions
_____________________________________________________________________
114th Congress
_____________________________________________________________________
H.R. 33 (Barletta) Protecting Volunteer Firefighters and
Emergency Responders Act. Passed the House
by a vote of 401-0 on January 12, 2015. H.R.
33 would exclude the hours worked by
volunteer firefighters and emergency medical
responders from being counted towards the
ACA's 30-hour-a-week benchmark that
determines whether an employee is classified
as full-time. [Note: The ACA requires
employers with at least 50 FTEs to offer
affordable health coverage or risk paying a
penalty if at least one full-time worker
gets a premium tax credit for coverage
purchased at an exchange. The IRS has ruled
that it will not require volunteer emergency
responders to count towards these ACA
requirements. The House passed the same
measure in 2014; see H.R. 3979 below.]
H.R. 30 (Young, T.) Save American Workers Act of 2014. Passed
the House by a vote of 252-72 on January
8, 2015. H.R. 30 would amend the ACA's
definition of full-time employees to those
who work on average at least 40 hours a
week. [Note: The ACA requires employers with
at least 50 full-time equivalent employees
(FTEs) to offer affordable health coverage
or risk paying a penalty if at least one
full-time worker gets a premium tax credit
for coverage purchased at an exchange.
Full-time employees are defined as those who
work on average at least 30 hours a week.
The House passed the same measure in 2014;
see H.R. 2575 below.]
H.R. 22 (Davis, R.) Hire More Heroes Act of 2014. Passed the
House by a vote of 412-0 on January 6, 2015.
H.R. 22 would exclude employees who receive
health care through the Department of
Veterans Affairs or TRICARE from an
employer's FTE count. [Note: The House
passed a similar measure in 2014; see H.R.
3474 below.]
_____________________________________________________________________
113th Congress
_____________________________________________________________________
H.R. 3522 (Cassidy) Employer Health Care Protection Act of
2014. Passed the House by a vote of 247-167
on September 11, 2014. H.R. 3522 would have
permitted health insurance companies to
continue to offer group coverage that was in
effect on any date during 2013, even if the
coverage does not meet the ACA's essential
health benefit standards and other market
reforms that took effect at the beginning of
2014. Insurers could offer such coverage to
existing or new enrollees through December
31, 2018, but could not offer the coverage
through health insurance exchanges. [Note:
The House passed a comparable measure in
2013; see H.R. 3350 below.]
H.R. 4414 (Carney) Expatriate Health Coverage Clarification
Act of 2014. Passed the House by a vote of
268-150 on April 29, 2014. H.R. 4414 would
have exempted from certain ACA requirements
expatriate health care plans offered to
individuals working outside the United
States. These plans are often used by
corporate executives, nongovernmental
organization employees, foreign aid workers,
contractors, and others working abroad. U.S.
insurance companies offering these plans are
required to comply with the ACA whereas
foreign insurance companies are not. [Note:
A modified version of this legislation was
enacted into law as Division M of the
Consolidated and Further Continuing
Appropriations Act, 2015 (P.L. 113-235); see
Table C-1 in Appendix C.]
H.R. 4194 (Issa) Government Reports Elimination Act of
2014. Passed the House by voice vote on
April 28, 2014. Among its provisions, H.R.
4194 would have modified the ACA's
requirement for periodic reviews and
evaluations of all federal disease
prevention and health promotion programs.
Instead of joint reviews conducted by the
HHS and GAO, the reviews would be conducted
by HHS alone. H.R. 4194 subsequently
passed the Senate, amended, by unanimous
consent on September 16, 2014.
H.R. 2575 (Young, T.) Save American Workers Act of 2014. Passed
the House by a vote of 248-179 on April 3,
2014. H.R. 2575 would have amended the ACA's
definition of full-time employees to those
who work on average at least 40 hours a
week. [Note: The ACA requires employers with
at least 50 full-time equivalent employees
(FTEs) to offer affordable health coverage
or risk paying a penalty if at least one
full-time worker gets a premium tax credit
for coverage purchased at an exchange.
Full-time employees are defined as those who
work on average at least 30 hours a week.]
H.R. 4015 (Burgess) SGR Repeal and Medicare Provider Payment
Modernization Act of 2014. Passed the House
by a vote of 238-181 on March 14, 2014. H.R.
4015 would have replaced the Sustainable
Growth Rate (SGR) formula, which determines
the annual updates to Medicare's payment
rates for physician services, with new
systems for establishing those payment
rates. To help pay for its cost, H.R. 4015
would have delayed enforcement of the ACA's
individual mandate by five years by shifting
the schedule of penalties for individuals
who do not comply with the mandate (or
obtain an exemption) to begin in 2019. CBO
estimated that this would result in 13
million fewer Americans with health
insurance coverage in 2018 relative to
current-law projections.
H.R. 3979 (Barletta) Protecting Volunteer Firefighters and
Emergency Responders Act of 2014. Passed the
House by a vote of 410-0 on March 11, 2014.
H.R. 3979 would have excluded the hours
worked by volunteer firefighters and
emergency medical responders from being
counted towards the ACA's 30-hour-a-week
benchmark that determines whether an
employee is classified as full-time. [Note:
The ACA requires employers with at least 50
FTEs to offer affordable health coverage or
risk paying a penalty if at least one
full-time worker gets a premium tax credit
for coverage purchased at an exchange. Prior
to passage of H.R. 3979, the IRS ruled that
it will not require volunteer emergency
responders to count towards these ACA
requirements.] H.R. 3979 passed the
Senate by a vote of 59-83 on April 7, 2014.
The Senate added a five-month extension of
unemployment benefits to the bill, among
other things, and renamed it the Emergency
Unemployment Compensation Act of 2014. H.R.
3979 subsequently became the legislative
vehicle for the FY2015 National Defense
Authorization Act (P.L. 113-291), which did
not include the ACA provisions.
H.R. 3474 (Davis, R.) Hire More Heroes Act of 2014. Passed the
House by a vote of 406-1 on March 11, 2014.
H.R. 3474 would have permitted an employer
to exclude employees who receive health care
through the Department of Veterans Affairs
or TRICARE from its FTE count.
H.R. 1814 (Schock) Equitable Access to Care and Health
(EACH) Act. Passed the House by voice vote
on March 11, 2014. H.R. 1814 would have
expanded the religious exemption in the ACA
by exempting from the law's insurance
mandate any individual who objects to
purchasing health coverage because of
sincerely held religious beliefs. [Note: The
ACA's religious exemption applies only to
religious sects that are recognized by the
Social Security Administration as being
conscientiously opposed to accepting
insurance benefits (e.g., Amish).]
H.R. 4118 (Jenkins) Suspending the Individual Mandate Penalty
Law Equals (SIMPLE) Fairness Act. Passed the
House by a vote of 250-160 on March 5, 2014.
H.R. 4118 would have delayed enforcement of
the ACA's individual mandate by one year by
shifting the schedule of penalties for
individuals who do not comply with the
mandate (or obtain an exemption) to begin in
2015. [Note: The House passed similar
legislation in 2013; see H.R. 2668 below.]
H.R. 7 (Smith) No Taxpayer Funding for Abortion and
Abortion Insurance Full Disclosure Act of
2014. Passed the House by a vote of 227-188
on January 28, 2014. H.R. 7 would have
prohibited exchange applicants from
obtaining premium tax credits or
cost-sharing subsidies to help purchase
health plans that cover elective abortions,
and would have prohibited tax credits for
health plans offered by an employer that
include elective abortion coverage.
Individuals would still be able to purchase
separate abortion coverage, but would not be
able to receive a tax credit or cost-sharing
subsidy. H.R. 7 also would have prohibited
OPM-contracted multi-state plans from
including elective abortion coverage. [Note:
The ACA permits exchange applicants to
obtain premium tax credits and cost-sharing
subsidies to help purchase health plans that
cover elective abortions; however, the law
prohibits the use of those federal funds to
pay for abortion services and requires plans
to collect an abortion surcharge from
enrollees to pay for such services. The ACA
also specifies that at least one multi-state
plan offered in an exchange must not include
elective abortion coverage.]
H.R. 3362 (Lee) Exchange Information Disclosure Act. Passed
the House by a vote of 259-154 on January
16, 2014. H.R. 3362 would have required the
HHS Secretary to submit to Congress and make
public a detailed weekly report, through
March 2015, on (1) consumer interactions
with healthcare.gov (or subsequent sites)
and efforts undertaken to remedy problems
that impact consumers; and (2) calls to the
federal consumer service call center,
including the number of calls received by
the call center, problems identified by
users, and referrals of those calls. The
Secretary also would have been required to
make public a list (with contact
information) of all navigators and certified
application counselors trained and certified
by exchanges, and a list of all agents and
brokers trained and certified by the
federally facilitated exchange. Both lists
would have to be updated weekly through
March 2015.
H.R. 3811 (Pitts) Health Exchange Security and Transparency
Act of 2014. Passed the House by a vote of
291-122 on January 10, 2014. H.R. 3811 would
have required the HHS Secretary to notify
affected individuals within two business
days of a breach of their personally
identifiable information maintained by an
exchange.
H.R. 3350 (Upton) Keep Your Health Plan Act of 2013. Passed
the House by a vote of 261-157 on November
15, 2013. H.R. 3350 would have permitted
health insurance companies to continue to
offer individual coverage that was in effect
as of January 1, 2013, even if the coverage
did not meet the ACA's essential health
benefit standards and other market reforms
that took effect at the beginning of 2014.
Insurers could offer such coverage to
existing or new enrollees at any time during
2014, but could not offer the coverage
through health insurance exchanges. [Note:
This legislation was prompted by the
decision of insurers to send cancellation
notices to individuals and small businesses
with health plans in the individual and
small group markets. The Administration also
has taken steps to address this issue. On
November 14, 2013, it announced a
transitional policy under which insurers may
choose, subject to the approval of state
insurance regulators, to renew noncompliant
health plans that have been cancelled, or
are slated for cancellation. Under the ACA,
insurers are not permitted to sell
noncompliant coverage to new enrollees. H.R.
3350 would allow insurers to sell such
coverage in the individual market during
2014.]
H.R. 2009 (Price) Keep the IRS Off Your Health Care Act of
2013. Passed the House by a vote of 232-185
on August 2, 2013. H.R. 2009 would have
prohibited the Internal Revenue Service
(IRS) from implementing or enforcing any
provisions of the ACA.
H.R. 2668 (Young) Fairness for American Families Act.
Passed the House by a vote of 251-174 on
July 17, 2013. H.R. 2668 would have delayed
enforcement of the ACA's individual mandate
by one year by shifting the schedule of
penalties for individuals who do not comply
with the mandate (or obtain an exemption) to
begin in 2015. It also would have
incorporated the provisions in H.R. 2667
(see below) to delay the employer mandate
and related reporting requirements.
H.R. 2667 (Griffin) Authority for Mandate Delay Act. Passed
the House by a vote of 264-161 on July 17,
2013. H.R. 2667 would have delayed for one
year certain ACA reporting requirements for
insurers and employers as well as the
penalties for employers who do not offer
affordable coverage. [Note: H.R. 2667 would
have essentially codified the
Administration's announcement on July 2,
2013, that it was delaying the ACA employer
mandate and related reporting requirements.]
H.R. 45 (Bachmann) A bill to repeal the Patient Protection
and Affordable Care Act. Passed the House by
a vote of 229-195 on May 16, 2013. H.R. 45
would have repealed the ACA in its entirety
and restored the provisions of law amended
or repealed by the ACA as if it had not been
enacted.
_____________________________________________________________________
112th Congress
_____________________________________________________________________
H.R. 6684 (Cantor) Spending Reduction Act of 2012. Passed
the House by a vote of 215-209 on December
20, 2012. H.R. 6684 would have eliminated
the FY2013 sequestration of direct defense
spending (as required under the Budget
Control Act of 2011), reduced the FY2013
overall discretionary cap by $19 billion,
and implemented numerous other mandatory
spending reductions. Among its provisions,
H.R. 6684 would have (1) repealed the
authority and appropriations for the
exchange planning and establishment grants
and rescinded all unobligated funds; (2)
repealed the authority and appropriations
for the PPHF and rescinded all unobligated
funds; (3) rescinded all remaining
unobligated funds for the Consumer Operated
and Oriented Plan (CO-OP) program; and (4)
eliminated all limits on repayment of any
premium credit overpayment, making
individuals liable for the full amount.
H.R. 6079 (Cantor) Repeal of Obamacare Act. Passed the House
by a vote of 244-185 on July 11, 2012. H.R.
6079 would have repealed the ACA in its
entirety and restored the provisions of law
amended or repealed by the ACA as if it had
not been enacted.
H.R. 436 (Paulsen) Health Care Cost Reduction Act of 2012.
Passed the House by a vote of 270-146 on
June 7, 2012. H.R. 436 would have (1)
repealed ACA's 2.3% excise tax on medical
devices; (2) repealed the law's restrictions
on using tax-preferred accounts to pay for
over-the-counter drugs; (3) allowed
individuals to recoup up to $500 of unused
funds remaining in their flexible spending
account (FSA) after the end of the plan
year; and (4) eliminated all limits on
repayment of any premium credit overpayment,
making individuals liable for the full
amount.
H.R. 5652 (Ryan) Sequester Replacement Reconciliation Act
of 2012. Passed the House by a vote of
218-199 on May 10, 2012. H.R. 5652, which
was introduced pursuant to the
reconciliation instructions in the House
FY2013 budget resolution (H.Con.Res. 112),
would have eliminated the FY2013
sequestration of direct defense spending (as
required under the Budget Control Act of
2011), reduced the FY2013 overall
discretionary cap by $19 billion, and
implemented a series of mandatory program
savings recommended by six House committees.
Among its many provisions, H.R. 5652 would
have (1) eliminated all limits on repayment
of any premium credit overpayment, making
individuals liable for the full amount; (2)
repealed the authority and appropriations
for the exchange planning and establishment
grants and rescinded all unobligated funds;
(3) repealed the authority and
appropriations for the PPHF and rescinded
all unobligated funds; (4) rescinded all
remaining unobligated funds for the CO-OP
program; (5) extended by one year the
disproportionate share hospital (DSH)
allotment reduction imposed by the ACA; and
(6) repealed the ACA's Medicaid maintenance
of effort requirements.
H.R. 4628 (Biggert) Interest Rate Reduction Act. Passed the
House by a vote of 215-195 on April 27,
2012. H.R. 4628 would have postponed by one
year a scheduled increase in Stafford
education loan rates and, to offset the
costs of that adjustment, repealed the
authority and appropriations for the PPHF
and rescinded all unobligated funds. [Note:
The one-year Stafford loan rate extension
was incorporated as Division F, Title III of
MAP-21, the surface transportation
reauthorization bill (see entry for P.L.
112-141 in Table A-1 in Appendix A). The
provision in H.R. 4628 to repeal the PPHF
and rescind all unobligated funds was not
included in MAP-21.]
H.R. 5 (Gingrey) Protecting Access to Healthcare Act.
Passed the House by a vote of 223-181 on
March 22, 2012. Title II of H.R. 5 would
have repealed the authority and
appropriations for the Independent Payment
Advisory Board (IPAB).
H.R. 1173 (Boustany) Fiscal Responsibility and Retirement
Security Act of 2012. Passed the House by a
vote of 267-159 on February 1, 2012. H.R.
1173 would have repealed Title VIII of the
ACA, the Community Living Assistance
Services and Supports (CLASS) Act. [Note:
P.L. 112-240, enacted January 2, 2013,
included a repeal of the CLASS Act; see
Table A-1 in Appendix A.]
H.R. 358 (Pitts) Protect Life Act. Passed the House by a
vote of 251-172 on October 13, 2011. H.R.
358 would have prohibited using any funds
authorized or appropriated by the ACA to pay
for an abortion or to pay for any part of
the costs of a health plan that covers
abortions, except if the pregnancy is the
result of rape or incest, or the life of the
pregnant female is at risk unless an
abortion is performed. It would have
required insurers that offer plans through
the exchanges that cover abortion services
to offer identical plans that do not cover
abortion services. It also would have
prohibited federal, state, or local
government programs that receive ACA funding
from discriminating against health care
entities that refuse to provide abortion
services or abortion training.
H.R. 1216 (Guthrie) A bill to convert funding for graduate
medical education (GME) in qualified
teaching health centers (THCs) to an
authorization of appropriations. Passed the
House by a vote of 234-185 on May 25, 2011.
H.R. 1216 would have replaced the
appropriation for GME payments to THCs with
an authorization of appropriations for each
of FY2012 through FY2015, and rescinded all
unobligated funds. It would have prohibited
the GME funds from being used to provide
abortions, except in cases of rape or incest
or when the woman's life is in danger.
H.R. 1214 (Burgess) A bill to repeal ACA funding for
school-based health center (SBHC)
construction. Passed the House by a vote of
235-191 on May 4, 2011. H.R. 1214 would
have repealed the authority and
appropriations for SBHC construction grants
and rescinded all unobligated funds.
H.R. 1213 (Upton) A bill to repeal ACA funding for health
insurance exchanges. Passed the House by a
vote of 238-183 on May 3, 2011. H.R. 1213
would have repealed the authority and
appropriations for state exchange planning
and establishment grants and rescinded all
unobligated funds.
H.R. 1217 (Pitts) A bill to repeal the Prevention and
Public Health Fund (PPHF). Passed the House
by a vote of 236-183 on April 13, 2011. H.R.
1217 would have repealed the authority and
appropriations for the PPHF and rescinded
all unobligated funds.
H.R. 2 (Cantor) Repealing the Job-Killing Health Care Law
Act. Passed the House by a vote of 245-189
on January 19, 2011. It was offered as an
amendment during Senate floor debate on an
unrelated bill (S. 223) and rejected on a
procedural motion by a vote of 47-51. H.R. 2
would have repealed the ACA in its entirety
and restored the provisions of law amended
or repealed by the ACA as if it had not been
enacted.
_____________________________________________________________________
Source: Prepared by the Congressional Research Service based on the
text of the bills listed in the table.
Appendix C. ACA Provisions in Appropriations Acts
(FY2011-FY2015)
Table C-1 summarizes the ACA-related provisions in enacted annual appropriations acts for eachof FY2011 through FY2015. It also provides a brief summary of the legislative actions taken by the House and Senate Appropriations Committees on both the Labor-HHS-ED and the Financial Services appropriations acts each year, prior to agreement on the final version of the legislation, and lists the ACA-related provisions included in these committee bills.
Table C-1. ACA-Related Provisions in Appropriations Acts,
FY2011-FY2015
_____________________________________________________________________
Public Law and
Date of Enactment Summary of Provisions
_____________________________________________________________________
FY2015
_____________________________________________________________________
P.L. 113-235 Consolidated and Further Continuing
Dec. 16, 2014 Appropriations Act, 2015. Division G of P.L.
113-235 -- the FY2015 L-HHS-ED Appropriations
Act -- includes the following ACA-related provisions:
o Rescinds $10 million of the FY2015
appropriation for the Independent Payment
Advisory Board (IPAB), which was authorized
and funded by ACA Section 3403. [Note: The
same rescission was included in the FY2012,
FY2013, and FY2014 appropriations acts; see
below.]
o Requires the HHS Secretary to transfer the
FY2015 PPHF funds to the accounts specified,
in the amounts specified, and for the
activities specified in a table included in
the explanatory statement to accompany P.L.
113-235 (Congressional Record, December 11,
2014, p. H9839). Prohibits the Secretary from
making further transfers. [Note: The
requirement to transfer PPHF funds in
accordance with the allocations specified in
an accompanying table has been included in
each L-HHS-ED appropriations bill reported by
the Senate Appropriations Committee since
FY2011; however, the provision did not get
included in the final enacted appropriations
legislation until FY2014.]
o Requires the HHS Secretary to establish a
website with detailed information on the
allocation and use of PPHF funds, organized
by program or by state. [Note: The same
provision was included in the FY2014
appropriations act; see below.]
o Prohibits the use of PPHF funds for lobbying,
publicity, or propaganda purposes. [Note: The
same provision was included in the FY2014
appropriations act; see below.]
o Authorizes the HHS Secretary to transfer up
to $305 million from the Medicare trust funds
to the CMS Program Management account for
Medicare operations, but prohibits the use of
such transferred funds for ACA
implementation. [Note: The same provision was
included in the FY2014 appropriations act;
see below.]
o Requires the HHS Secretary to include in the
FY2016 budget justification and on the HHS
website a detailed breakdown of the ACA
programs and activities receiving funds
appropriated to implement the law, including
the number of full-time equivalents (FTEs),
for FY2015 and for each of the past four
fiscal years (i.e., FY2011-FY2014). [Note:
The same provision was included in the FY2014
appropriations act; see below.]
o Requires the HHS Secretary to include in the
FY2016 budget justification a detailed
breakdown of all funds used to date by CMS
for the exchanges, including the proposed use
of such funds in FY2016. Funding details must
be provided for all the activities specified
under the heading "Health Insurance
Marketplace Transparency" in the explanatory
statement to accompany P.L. 113-235
(Congressional Record, December 11, 2014, p.
H9837). [Note: A less specific provision was
included in the FY2014 appropriations act;
see below.]
o Prohibits risk corridor payments (authorized
by ACA Section 1342) from the CMS Program
Management appropriations account.
The explanatory statement to accompany P.L.
113-235, submitted by the House
Appropriations Committee Chairman and
published in the December 11, 2014,
Congressional Record, instructs HHS to
include in the FY2016 budget justification
the amount of expired unobligated balances
available for transfer to the non-recurring
expenses fund (NEF), and the amount of any
such balances transferred to the NEF. In
addition, the explanatory statement instructs
the HHS Office of the Inspector General to
(1) submit to Congress, within 60 days of
enactment, a plan of how it will conduct
health reform oversight activities; and (2)
report to Congress (jointly with the Treasury
Inspector General), no later than June 1,
2015, on the IRS's procedures for reconciling
premium tax credits and reducing fraud and
overpayments. [Note: Section 4 of P.L.
113-235 states that the explanatory statement
is to be treated as if it were a joint
explanatory statement of the conference
committee.] Division E of P.L. 113-235 -- the
FY2015 Financial Services Appropriations Act
-- does not include any ACA-related
provisions. However, the explanatory
statement to accompany P.L. 113-235
(discussed above) instructs the IRS to submit
quarterly reports to Congress during FY2015
on actions taken to reconcile advance premium
tax credit payments received in 2014 when
2014 tax returns are filed in 2015, and
requires the Treasury Secretary to provide
Congress an accounting each month of the
number of individuals who had not paid the
full amount of any premium owed for the
preceding month for health coverage obtained
through an exchange.
Division M of P.L. 113-235 -- the Expatriate
Health Coverage Clarification Act of 2014 --
would exempt expatriate health plans offered
to individuals working outside the United
States from certain ACA requirements. Prior
to enactment of this law, U.S. insurance
companies offering these plans had to fully
comply with the ACA, whereas foreign
insurance companies did not. [Note: The House
passed a similar bill, H.R. 4414, on April
29, 2014; see Table B-1 in Appendix B.]
Legislative activity prior to enactment of P.L. 113-235. The
House passed the FY2015 Financial Services appropriations bill (H.R.
5016, H.Rept. 113-508) on July 16, 2014. The measure did not include
the $436 million increase in funding requested by the IRS for ACA
implementation. Moreover, it would have (1) prohibited the IRS from
using any of the discretionary funds provided in the bill to
implement the individual mandate; (2) prohibited any transfers from
HHS to the IRS for ACA implementation; and (3) required the Treasury
Secretary to provide Congress an accounting each month of the number
of individuals who had not paid the full amount of any premium owed
for the preceding month for health coverage obtained through an
exchange. Language in H.Rept. 113-508 would have directed the IRS to
submit monthly status reports to Congress during FY2015 on actions
taken to reconcile advance premium tax credit payments received in
2014 when 2014 tax returns are filed in 2015.
The House Appropriations Subcommittee on Labor-HHS-ED did not report
a FY2015 appropriations bill.
The Senate Appropriations Subcommittee on Labor-HHS-ED approved a
draft bill for FY2015 on June 10, 2014, but no further action was
taken. The Senate Appropriations Subcommittee on Financial Services
approved a draft bill for FY2015 on June 24, 2014, but no further
action was taken.
_____________________________________________________________________
FY2014
_____________________________________________________________________
P.L. 113-76 Consolidated Appropriations Act, 2014.
Jan. 17, 2014 Division H of P.L. 113-76 -- the FY2014
L-HHS-ED Appropriations Act -- included the
following ACA-related provisions:
o Rescinded $10 million of the FY2014
appropriation for the Independent Payment
Advisory Board (IPAB), which was authorized
and funded by ACA Section 3403. [Note: The
same rescission was included in both the
FY2012 and FY2013 appropriations acts; see
below.]
o Required the HHS Secretary to transfer the
FY2014 PPHF funds to the accounts specified,
in the amounts specified, and for the
activities specified in a table included in
the explanatory statement to accompany P.L.
113-76 (Congressional Record, January 15,
2014, p. H1041). Prohibited the Secretary
from making further transfers. [Note: The
requirement to transfer PPHF funds in
accordance with the allocations specified in
an accompanying table was included in each of
the FY2011, FY2012, and FY2013 L-HHS-ED
appropriations bills reported by the Senate
Appropriations Committee, but the provision
was not included in the final enacted
appropriations legislation for those years;
see below.]
o Required the HHS Secretary to establish a
website with detailed information on the
allocation and use of PPHF funds, organized
by program or by state. [Note: A similar, but
less detailed, provision was included in the
FY2012 appropriations act and remained in
effect in FY2013 under P.L. 113-6; see
below.]
o Prohibited the use of PPHF funds for
lobbying, publicity, or propaganda purposes.
[Note: This provision first appeared in the
FY2012 appropriations act and remained in
effect in FY2013 under P.L. 113-6; see
below.]
o Authorized the HHS Secretary to transfer up
to $305 million from the Medicare trust funds
to the CMS Program Management account for
Medicare operations, but prohibited the use
of such transferred funds for ACA
implementation.
o Required the HHS Secretary to include in the
FY2015 budget justification and on the HHS
website a detailed breakdown of the ACA
programs and activities receiving funds
appropriated to implement the law, including
the number of full-time equivalents (FTEs),
for FY2014 and for each of the past four
fiscal years (i.e., FY2010-FY2013).
o Required the HHS Secretary to include in the
FY2015 budget justification a detailed
breakdown of all funds used to date by CMS
for the exchanges, including the proposed use
of such funds in FY2015.
o Required the HHS Secretary to include in the
FY2016 budget justification an analysis of
how the ACA requirement that health plans
cover recommended immunizations and other
preventive services without any cost-sharing
will impact eligibility for HHS discretionary
programs.
The explanatory statement to accompany P.L.
113-76, submitted by the House Appropriations
Committee Chairman and published in the
January 15, 2014, Congressional Record,
instructed HHS to include in the FY2015
budget justification the amount of expired
unobligated balances available for transfer
to the non-recurring expenses fund (NEF), and
the amount of any such balances transferred
to the NEF. [Note: Section 4 of P.L. 113-76
stated that the explanatory statement was to
be treated as if it were a joint explanatory
statement of the conference committee.]
Division E of P.L. 113-76 -- the FY2014
Financial Services Appropriations Act --
included the following ACA-related provision:
o Required the IRS Commissioner to allocate $92
million in general program funds among the
agency's appropriations accounts for various
specified activities (e.g., improve delivery
of services to taxpayers), but prohibited the
use of such funds for ACA implementation.
P.L. 113-46 Continuing Appropriations Act, 2014. P.L.
Oct. 17, 2013 113-46 provided continuing appropriations for
the federal government through January 15,
2014, generally at FY2013 post-sequestration
funding levels. It included the following
ACA-related provisions:
o Required the HHS Secretary to certify in a
report to Congress, due by January 1, 2014,
that the health exchanges are verifying the
eligibility of individuals applying for
premium tax credits and cost-sharing
subsidies consistent with the requirements of
the ACA.
o Required the HHS Inspector General to report
to Congress not later than July 1, 2014, on
the effectiveness of procedures and
safeguards provided under the ACA for
preventing exchange applicants from
submitting inaccurate or fraudulent
information.
Legislative activity prior to enactment of P.L. 113-46. On
September 20, 2013, in the absence of any enacted appropriations
bills for FY2014, the House approved a continuing resolution (CR;
H.J.Res. 59) to provide temporary funding for the federal government
through December 15. H.J.Res. 59, as passed by the House,
incorporated language that would have prohibited the use of any
federal funds -- mandatory or discretionary -- to carry out the ACA.
The Senate amendment to H.J.Res. 59 did not incorporate the House ACA
defunding language. On September 29, the House amended the Senate
amendment with language that would have (1) repealed the ACA's
medical device tax, and (2) delayed the law's implementation by one
year, but the Senate tabled both of these amendments. On September
30, the House further amended the Senate amendment by adding language
to (1) delay the ACA's individual insurance mandate by one year, and
(2) expand the ACA's requirement for Members of Congress and their
staff to obtain health coverage through the exchanges by including
the President, Vice President, and political appointees, and by
prohibiting any premium contribution by the government. Once again,
the Senate tabled the House amendments. With the House and Senate
unable to agree on the CR, the Administration on October 1, 2013,
commenced a partial shutdown of the federal government. The
government resumed full operations on October 17, 2013, after House
and Senate lawmakers reached an agreement on a temporary funding
measure, and the Continuing Appropriations Act, 2014, was signed into
law (see above).
Earlier in the summer of 2013, the House and Senate Appropriations
Committees took the following actions on FY2014 appropriations. The
Senate Appropriations Committee reported its FY2014 Labor-HHS-ED
appropriations bill (S. 1284) on July 11, 2013. For the fourth year
in a row, the Senate's L-HHS-ED appropriations bill would have
instructed the HHS Secretary to allocate the PPHF funds to the
programs specified, and in the amounts specified in a table included
in the accompanying committee report (S.Rept. 113-71). S. 1284 also
would have prohibited the Secretary from making any further transfers
of PPHF funds. In addition, the bill would have required the HHS
Secretary to establish a website with detailed information on the
allocation and use of PPHF funds. S. 1284 would have provided CMS
with its requested $1.4 billion increase in discretionary funds for
ACA implementation in FY2014.
The Senate Appropriations Committee reported its FY2014 Financial
Services appropriations bill (S. 1371, S.Rept. 113-80) on July 25,
2013. S. 1371 would have provided some but not all of the requested
$440 million increase in IRS funding for ACA implementation.
The House Appropriations Committee reported its version of the FY2014
Financial Services appropriations bill (H.R. 2786, H.Rept. 113-172)
on July 23, 2013. The measure did not provide any of the new IRS
funds requested in the President's FY2014 budget for ACA
implementation. H.R. 2786, as reported, would have prohibited the IRS
from using any of the discretionary funds provided in the bill to
implement the individual mandate, and would have prohibited transfers
from HHS to the IRS to implement the ACA. The House Appropriations
Subcommittee on Labor-HHS-ED did not introduce or report a FY2014
appropriations bill.
_____________________________________________________________________
FY2013
_____________________________________________________________________
P.L. 113-6 Consolidated and Further Continuing
Mar. 26, 2013 Appropriations Act, 2013. Division F, Title V
of P.L. 113-6 provided full-year continuing
appropriations for Labor-HHS-ED for FY2013
generally at FY2012 levels, but with some
spending adjustments -- reductions and
increases -- for specified programs. It
included the following ACA-related provisions:
o Rescinded $200 million of the $500 million
transfer from the Medicare Part A and Part B
trust funds for the 5-year Community-Based
Care Transition Program, which was
established and funded by ACA Section 3026.
o Rescinded $10 million of IPAB's FY2013
appropriation. [Note: The same rescission was
included in the FY2012 appropriations act;
see below.]
o Required the HHS Secretary to establish a
website with detailed information on the
allocation and use of PPHF funds. [Note: This
provision first appeared in the FY2012
appropriations act and remained in effect in
FY2013 under P.L. 113-6; see below.]
o Prohibited the use of PPHF funds for
lobbying, publicity, or propaganda purposes.
[Note: This provision first appeared in the
FY2012 appropriations act and remained in
effect in FY2013 under P.L. 113-6; see
below.]
Legislative activity prior to enactment of P.L. 113-6. The
House Appropriations Subcommittee on Labor-HHS-ED approved a draft
bill for FY2013 on July 18, 2012, but no further action was taken.
The measure did not provide CMS with any of the requested $1.0
billion increase in funding for FY2013 to help pay for ACA
implementation and related activities, and it would have prohibited
using any of the discretionary funding provided in the bill to
support CMS's Center for Consumer Information and Insurance Oversight
(CCIIO). The draft bill also included the following ACA-related
provisions that would have (1) rescinded the entire FY2013
appropriations for PPHF and IPAB, and rescinded the FY2013 base
appropriation of $150 million for the Patient-Centered Outcomes
Research Trust Fund (PCORTF); (2) rescinded $3 billion of the
remaining $3.4 billion for the CO-OP funds (see P.L. 112-74, above);
(3) rescinded $1.590 billion of the $10 billion appropriation for CMI
for the period FY2011-FY2019; (4) rescinded $300 million of the $1.5
billion CHCF appropriation in FY2013 for community health centers;
(5) prohibited using any of the discretionary funds provided in the
bill to implement and administer the ACA; (6) instructed the HHS
Secretary to establish a website with detailed information on the
allocation and use of FY2013 PPHF funds; and (7) prohibited the use
of PPHF funds for lobbying, publicity, or propaganda purposes.
The House Appropriations Committee reported its FY2013 Financial
Services appropriations bill (H.R. 6020, H.Rept. 112-550) on June 26,
2012. The measure did not include the IRS's requested funding
increase of $360 million for FY2013 for ACA implementation. Moreover,
H.R. 6020 would have prohibited the IRS from using any of the
discretionary funds provided in the bill to carry out the transfer of
ACA funds to the agency.
The Senate Appropriations Committee reported its version of the
FY2013 Labor-HHS-ED appropriations bill (S. 3295) on June 14, 2012.
The measure included about half of the funding increase requested by
CMS for ACA implementation. As with the Senate's Labor-HHS-ED
appropriations bills for the previous two fiscal years, S. 3295 would
have instructed the HHS Secretary to allocate the PPHF funds for
FY2013 to the programs specified, and in the amounts specified, in a
table included in the accompanying committee report (S.Rept.
112-176). In addition, the bill would have directed the HHS Secretary
to establish a website with detailed information on the allocation
and use of PPHF funds.
The Senate Appropriations Committee reported the FY2013 Financial
Services appropriations bill (S. 3301) on June 14, 2012. The measure
did not include any ACA-related provisions. However, the accompanying
committee report (S.Rept. 112-177) directed the IRS to submit a
detailed table itemizing each fund transfer from the Health Insurance
Reform Implementation Fund (HIRIF) to the IRS for the purpose of ACA
implementation.
_____________________________________________________________________
FY2012
_____________________________________________________________________
P.L. 112-74 Consolidated Appropriations Act, 2012. Division
Dec. 23, 2011 F of P.L. 112-74 -- the FY2012 Labor-HHS-ED
Appropriations Act -- included the following
ACA-related provisions:
o Rescinded $400 million of the remaining $3.8
billion for the Consumer Operated and
Oriented Plan (CO-OP) program; see P.L.
112-10, below.
o Rescinded $10 million of IPAB's FY2012
appropriation.
o Required the HHS Secretary to establish a
website with detailed information on the
allocation and use of PPHF funds.
o Prohibited the use of PPHF funds for
lobbying, publicity, or propaganda purposes.
Legislative activity prior to enactment of P.L. 112-74. The
chairman of the House Appropriations Subcommittee on
Labor-HHS-Education introduced a chairman's bill (H.R. 3070) on
September 29, 2011, but the subcommittee did not mark up or report
the measure to the full committee. The bill received no full
committee action. H.R. 3070, as introduced, included the following
ACA-related provisions that would have (1) rescinded the entire
FY2012 appropriations for CHCF, PPHF, IPAB, the pregnancy assistance
grants, the home visitation program, state Aging and Disability
Resource Centers (ADRCs), and the health workforce demonstration
grants; (2) rescinded all the remaining CO-OP funds (i.e., $3.8
billion); (3) rescinded $1.862 billion of the $10 billion
appropriation for the Center for Medicare and Medicaid Innovation
(CMI) for the period FY2011-FY2019; and (4) prohibited using any of
the discretionary funds provided in the bill to implement and
administer the ACA until 90 days after all ACA legal challenges are
complete.
The House Appropriations Committee reported the FY2012 Financial
Services appropriations bill (H.R. 2434, H.Rept. 112-136) on July 7,
2011. The measure included the following ACA-related provisions that
would have (1) prohibited the IRS from using any of the discretionary
funds provided in the bill to implement the ACA individual mandate;
and (2) prohibited the transfer of any ACA funds to the IRS.
The Senate Appropriations Committee reported its version of the
FY2012 Labor-HHS-ED appropriations bill (S. 1599) on September 22,
2011. Similar to the previous year's bill, S. 1599 would have
instructed the HHS Secretary to allocate the PPHF funds for FY2012 to
the programs specified, and in the amounts specified, in a table
included in the accompanying committee report (S.Rept. 112-84). In
addition, S.Rept. 112-84 included language directing the HHS
Secretary to submit a detailed report on all the recipients of PPHF
funding.
The Senate Appropriations Committee reported its FY2012 Financial
Services appropriations bill (S. 1573) on September 15, 2011. The
measure did not include any ACA provisions. However, the accompanying
committee report (S.Rept. 112-79) directed the IRS to submit a
detailed table itemizing each fund transfer from HHS to the IRS for
the purpose of ACA implementation.
_____________________________________________________________________
FY2011
_____________________________________________________________________
P.L. 112-10 Department of Defense and Full-Year
Apr. 15, 2011 Continuing Appropriations Act, 2011.
Division B, Title VIII of P.L. 112-10 provided
full-year continuing appropriations for
Labor-HHS-ED for FY2011 generally at FY2010
levels, but with numerous spending reductions
for specified agencies and programs. It
included the following ACA-related provisions:
o Permanently canceled $2.2 billion of the $6
billion appropriation for CO-OP program,
which was established and funded by ACA
Section 1322.
o Repealed the free choice voucher program,
established by ACA Section 10108, which would
have required certain employers to provide
vouchers to qualified employees for
purchasing coverage through a health
insurance exchange.
o Prohibited transfers from the Public Health
and Social Services Emergency Fund to support
the U.S. Public Health Sciences Track,
pursuant to ACA Section 5315.
o Removed the maintenance of effort requirement
for use of monies in the Community Health
Center Fund (CHCF), which was established and
funded by ACA Section 10503 (as amended by
HCERA Section 2303).
o Mandated a Government Accountability Office
(GAO) study of the costs and processes of ACA
implementation, and a Medicare actuarial
analysis of the impact of the ACA's private
insurance reforms on employer-sponsored
health insurance premiums.
Legislative activity prior to enactment of P.L. 112-10. The
Senate Appropriations Committee reported its version of the FY2011
Labor-HHS-ED appropriations bill (S.3686) on August 2, 2010. The
measure would have instructed the HHS Secretary to allocate the PPHF
funds for FY2011 to the programs specified, and in the amounts
specified, in a table included in the accompanying committee report
(S.Rept. 111-243). The House Appropriations Subcommittee on
Labor-HHS-ED also approved a draft FY2011 bill, but the full
committee took no further action on it.
On February 19, 2011, the House by a vote of 235-189 passed its
version of a full-year continuing resolution for FY2011 (H.R. 1). The
bill included nine separate but overlapping provisions that would
have prohibited using any of the discretionary funds provided in the
bill to implement specific ACA provisions or the entire law. The
Senate subsequently rejected H.R. 1 by a vote of 44-56 on March 9,
2011.
_____________________________________________________________________
Source: Prepared by the Congressional Research Service based on the
text of the public laws listed in the table.
Author Contact Information
C. Stephen Redhead
Specialist in Health Policy
credhead@crs.loc.gov, 7-2261
Janet Kinzer
Information Research Specialist
jkinzer@crs.loc.gov, 7-7561
1 The ACA was signed into law on March 23, 2010 (P.L. 111-148, 124 Stat. 119). On March 30, 2010, the President signed the Health Care and Education Reconciliation Act (HCERA; P.L. 111-152, 124 Stat. 1029), which amended numerous provisions in the ACA. HCERA also included some new provisions related to the ACA. Several subsequently enacted bills -- some of which are summarized in this report -- made additional changes to selected ACA provisions. All references to the ACA in this report refer collectively to the law as amended and to the related HCERA provisions.
2 Numerous CRS products that provide more in-depth information on the many new programs and activities authorized and funded by the ACA are available at http://www.crs.gov/pages/subissue.aspx?cliid=3746&parentid=13&preview=False.
3NFIB v. Sebelius, No. 11-393, slip op. (June 28, 2012), http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf. For more information, see CRS Report R42367, Medicaid and Federal Grant Conditions After NFIB v. Sebelius: Constitutional Issues and Analysis, by Kenneth R. Thomas.
4 Authorizing legislation generally refers to substantive legislation, reported by a committee (or committees) of jurisdiction other than the House or Senate Appropriations Committees, that establishes or continues the operation of a federal program or agency either indefinitely or for a specific period.
5 For further information on direct spending, see CRS Report RS20129, Entitlements and Appropriated Entitlements in the Federal Budget Process, by Bill Heniff Jr.
6 For further information on discretionary spending, see CRS Report R42388, The Congressional Appropriations Process: An Introduction, by Jessica Tollestrup.
7 For more analysis of the ACA's projected impact on federal direct spending and revenues, including details of CBO's budgetary estimates, see CRS Report R42051, Budget Control Act: Potential Impact of Sequestration on Health Reform Spending, by C. Stephen Redhead.
8 For a summary of all the ACA's mandatory appropriations, and the status of obligation of those funds, see CRS Report R41301, Appropriations and Fund Transfers in the Affordable Care Act (ACA), by C. Stephen Redhead.
9 The ACA also reauthorized funding for many existing discretionary grant programs authorized under the Public Health Service Act; notably, the federal health workforce programs administered by the Health Resources and Services Administration (HRSA). The authorizations of appropriations for many of these programs expired prior to the ACA's enactment, though most of them were still receiving annual appropriations. The ACA also permanently reauthorized appropriations for the federal health centers program and for programs and services provided by the Indian Health Service (IHS). Congressional appropriators have in general continued to provide discretionary funding for these long-standing programs, though typically at funding levels below the amounts authorized by the ACA. For more details on all the authorizations (and reauthorizations) of discretionary funding in ACA, including the FY2011-FY2014 funding levels for programs that received an appropriation, see CRS Report R41390, Discretionary Spending Under the Affordable Care Act (ACA), coordinated by C. Stephen Redhead.
10 Appropriations bills provide agencies with budget authority, which is the legal authority to incur financial obligations (e.g., hire employees, purchase services, award grants, or sign contracts) that result in immediate or future government expenditures (or outlays). Budget authority is generally made available for obligation during a specified time period, typically the upcoming fiscal year. Once budget authority reaches the end of that time period, it "expires," meaning that it is no longer available for obligation. A rescission is a provision of law that cancels budget authority prior to when it would otherwise expire, making it unavailable for future obligation. For further explanations of these terms, see GAO, A Glossary of Terms Used in the Federal Budget Process, GAO-05-734SP, September 2005, pp. 85-86, available at http://www.gao.gov.
11 For more discussion on the budget requests for, and sources of, funding to cover the administrative costs of implementing the ACA, see CRS Report R41390, Discretionary Spending Under the Affordable Care Act (ACA), coordinated by C. Stephen Redhead.
12 For more discussion and analysis of limitation provisions, including the relevant House and Senate rules and the procedural issues that arise during floor consideration of general appropriations measures that include such provisions, see CRS Report R41634, Limitations in Appropriations Measures: An Overview of Procedural Issues, by Jessica Tollestrup.
13 CRS Report R41634 (see footnote 2) discussed the differences between limitations and legislative provisions in appropriations measures, and how to distinguish between the two.
14 P.L. 113-46, 127 Stat. 558. For more analysis of the various legal and procedural considerations arising from the use of the appropriations process to delay or defund the ACA, see CRS Report R43246, Affordable Care Act (ACA) and the Appropriations Process: FAQs Regarding Potential Legislative Changes and Effects of a Government Shutdown,coordinated by C. Stephen Redhead.
15 P.L. 113-76, 128 Stat. 5.
16 Tamar Hallerman, "Republicans Could Use Spending Bills to Challenge Obama," CQ Roll Call, November 6, 2014.
17 Carl Hulse and Jeremy W. Peters, "Boehner Uses New Mandate to Muffle Talk of a Shutdown," New York Times, November 30, 2014; Paul Kane, "McConnell's Promise of No Shutdowns Will Be Tested by Senate's Staunch Conservatives," Washington Post, November 15, 2014.
18 See footnote 1.
19 Both the House and the Senate have taken multiple votes on amendments to, and passage of, budget resolutions that expressed support for a full repeal of the ACA, or the repeal or amendment of specific provisions in the law. However, budget resolutions are concurrent resolutions that apply only to Congress. They are not presented to the President for his signature and do not have the force of law. In the 112th Congress, for example, the House voted on several ACA-related amendments to, and passage of, the FY2012 and FY2013 budget resolutions (H.Con.Res. 34 and H.Con.Res. 112, respectively).
20United States House of Representatives v. Burwell, 1:14-cv-01967 (D.D.C. 2014), http://www.speaker.gov/sites/speaker.house.gov/files/HouseLitigation.pdf.
END OF FOOTNOTES
- AuthorsRedhead, C. StephenKinzer, Janet
- Institutional AuthorsCongressional Research Service
- Code Sections
- Subject Area/Tax Topics
- Jurisdictions
- LanguageEnglish
- Tax Analysts Document NumberDoc 2015-3043
- Tax Analysts Electronic Citation2015 TNT 26-52