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CRS Updates Overview of Actions to Repeal, Defund, or Delay ACA

JUL. 8, 2015

R43289

DATED JUL. 8, 2015
DOCUMENT ATTRIBUTES
Citations: R43289

 

C. Stephen Redhead

 

Specialist in Health Policy

 

 

Janet Kinzer

 

Information Research Specialist

 

 

July 8, 2015

 

 

Congressional Research Service

 

7-5700

 

www.crs.gov

 

R43289

 

 

                               Contents

 

 

 Introduction

 

 

 A Brief Overview of the ACA

 

 

 ACA's Impact on Federal Spending

 

 

      Mandatory Spending on Expanding Insurance Coverage

 

 

      Mandatory Spending on Other Programs

 

 

      Discretionary Spending

 

 

 ACA Provisions in Authorization Legislation

 

 

 Tables

 

 

 Table 1. Enacted Legislation That Modified, or Extended or Rescinded

 

          Funding for, Programs Established by the ACA

 

 

 Table 2. ACA Provisions in Bills Approved by the House in the

 

          112th, 113th, and 114th Congresses

 

 

 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. 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.

This report summarizes legislative actions taken to repeal, defund, delay, or otherwise amend the ACA since it was signed into law. The information is presented in Table 1 and Table 2. 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 as context for the material in the tables.2 This report is updated periodically to reflect legislative and other developments.

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. A companion report, CRS Report R44100, Use of the Annual Appropriations Process to Block Implementation of the Affordable Care Act (FY2011-FY2016), summarizes the ACA-related language added to annual appropriations legislation by congressional appropriators since the ACA was signed into law.

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 exchanges (also known as marketplaces) 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.

In June 2015, the U.S. Supreme Court in King v. Burwell ruled that the premium tax credits are available to all qualified individuals who enroll in exchange plans and meet the necessary income and other requirements, regardless of whether the exchange is administered by the state or the federal government.3

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.4 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 the federal spending on exchange subsidies and Medicaid expansion.

ACA's 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.5 It includes 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.6Discretionary 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.7

Federal spending on ACA implementation can be grouped into three categories: (1) mandatory spending on expanding insurance coverage, (2) mandatory spending on other programs, and (3) discretionary spending. Each of these categories is briefly discussed below.

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) and the Joint Committee on Taxation (JCT) projected that this and other ACA mandatory spending (discussed in the second category, below) would be more than 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.8

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.9 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 (CMMI), 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) for the federal health centers program and the National Health Service Corps.10 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 supporting 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 pay for 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.11 Second, the two agencies primarily responsible for implementing the ACA's provisions to expand insurance coverage -- CMS's Center for Consumer Information and Insurance Oversight (CCIIO) and the Internal Revenue Service (IRS) -- are incurring significant costs in connection with administering and enforcing the law. Both agencies requested increases in funding in each of their past four budget submissions (i.e., FY2013-FY2016) to help pay for ACA implementation. But congressional appropriators have not provided either agency with any additional discretionary funds. CMS instead has relied on discretionary fund transfers from other accounts, amounts from the Nonrecurring Expenses Fund (NEF),12 and 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 1 summarizes the authorizing legislation to amend the ACA that has been enacted since the ACA became law in March 2010. 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 (HCERA).13

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.

In compiling Table 1, CRS made decisions about which laws -- or specific provisions in a particular law -- to include, and which ones to leave out. CRS elected to include only those provisions that made changes (including funding extensions or rescissions) to new programs and activities first authorized and funded by the ACA. CRS excluded provisions addressing 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 provisions in more recently enacted laws. The ACA also extended funding for a number of existing grant programs whose funding has been further extended by provisions in newer laws. None of these types of provisions are included in Table 1.

Table 2 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 Democratic-led Senate, though neither measure became law. Table 2 also summarizes the ACA legislation that has passed the House to date in the 114th Congress.

The House-passed legislation includes stand-alone bills as well as provisions in broader, often unrelated measures that would (1) repeal the ACA in its entirety and, in some cases, replace it with new law; (2) repeal, or by amendment restrict or otherwise limit, specific provisions in the ACA; (3) eliminate appropriations provided by the ACA and rescind all unobligated funds;14 (4) replace the mandatory appropriations for one or more ACA programs with authorizations of (discretionary) appropriations, and rescind all unobligated funds; and (5) block or otherwise delay implementation of specific ACA provisions.

Generally, Table 2 lists only 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 Congress, are not included.15

On July 30, 2014, the House approved a simple resolution (H.Res. 676) that authorized 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.16

 

Table 1.

 

Enacted Legislation That Modified, or Extended

 

or Rescinded Funding for, Programs Established by the ACA

 

 

114th Congress

 

 

Public Law and Date of Enactment

 

P.L. 114-10

 

Apr. 16, 2015

 

Bill (Sponsor)

 

H.R. 2 (Burgess)

 

Summary of ACA Provisions

 

Medicare Access and CHIP Reauthorization Act of 2015. Among its many provisions, P.L. 114-10:
  • Amended Section 1848(p) of the Social Security Act (SSA), as added by ACA Section 3007, to terminate application of the physician value-based payment modifier (VBM) at the end of 2018. [Beginning in 2019, the VBM will be used as one of the components of the composite score under the new Merit-Based Incentive Payment System (MIPS).]

  • Appropriated a total of $3.910 billion to the CHCF for each of FY2016 and FY2017; $3.600 billion for the health centers program, and $310 million for the NHSC.

  • Appropriated $60 million for each of FY2016 and FY2017 for graduate medical education (GME) payments to teaching health centers, authorized by ACA Section 5508(c).

  • Appropriated $400 million for each of FY2015 through FY2017 for the Maternal, Infant, and Early Childhood Home Visiting program, established by ACA Section 2951.

  • Appropriated $75 million for each of FY2016 and FY2017 for the Personal Responsibility Education Program (PREP), established by ACA Section 2953.

  • Appropriated $85 million for each of FY2016 and FY2017 for the Health Profession Opportunity Grant (HPOG) program, established by ACA Section 5507(a).

  • Appropriated $20 million for the two-year period FY2016 through FY2017 to develop Medicaid adult quality measures, pursuant to ACA Section 2701.

113th Congress

 

 

Public Law and Date of Enactment

 

P.L. 113-93

 

Apr. 1, 2014

 

Bill (Sponsor)

 

H.R. 4302 (Pitts)

 

Summary of ACA Provisions

 

Protecting Access to Medicare Act of 2014. Among its many provisions, P.L. 113-93:
  • 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.]

  • Appropriated $400 million for the first half of FY2015 for the Maternal, Infant, and Early Childhood Home Visiting program, established by ACA Section 2951. [Superseded by the appropriation in P.L. 114-10.]

  • Appropriated $85 million for FY2015 for HPOG program, established by ACA Section 5507(a).

  • Appropriated $75 million for FY2015 for the PREP, established by ACA Section 2953.

112th Congress

 

 

Public Law and Date of Enactment

 

P.L. 112-240

 

Jan. 2, 2013

 

Bill (Sponsor)

 

H.R. 8 (Camp)

 

Summary of ACA Provisions

 

American Taxpayer Relief Act of 2012. Among its many provisions, P.L. 112-240:
  • 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 these funds.a

  • Repealed ACA Title VIII, the Community Living Assistance Services and Supports (CLASS) Act.

  • Repealed the ACA's appropriations for the National Clearinghouse for Long-Term Care Information and rescinded all unobligated funds.

Public Law and Date of Enactment

 

P.L. 112-141

 

July 6, 2012

 

Bill (Sponsor)

 

H.R. 4348 (Mica)

 

Summary of ACA Provisions

 

Moving Ahead for Progress in the 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.

 

Public Law and Date of Enactment

 

P.L. 112-96

 

Feb. 22, 2012

 

Bill (Sponsor)

 

H.R. 3630 (Camp)

 

Summary of ACA Provisions

 

Middle Class Tax Relief and Job Creation Act of 2012. Among its many provisions, P.L. 112-96:
  • Amended ACA Section 4002 to reduce the 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.

  • Amended SSA Section 1923(f) to extend by one year the disproportionate share hospital (DSH) allotment reduction imposed by ACA Section 3203.

  • 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.]

Public Law and Date of Enactment

 

P.L. 112-56

 

Nov. 21, 2011

 

Bill (Sponsor)

 

H.R. 674 (Herger)

 

Summary of ACA Provisions

 

3% Withholding Repeal and Job Creation 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.

 

Public Law and Date of Enactment

 

P.L. 112-9

 

Apr. 14, 2011

 

Bill (Sponsor)

 

H.R. 4 (Lungren)

 

Summary of ACA Provisions

 

Comprehensive 1099 Taxpayer Protection 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 Section 36B of the Internal Revenue Code (IRC), 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

 

 

Public Law and Date of Enactment

 

P.L. 111-383

 

Jan. 7, 2011

 

Bill (Sponsor)

 

H.R. 6523 (Skelton)

 

Summary of ACA Provisions

 

Ike Skelton National Defense 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.

 

Public Law and Date of Enactment

 

P.L. 111-312

 

Dec. 17, 2010

 

Bill (Sponsor)

 

H.R. 4853 (Oberstar)

 

Summary of ACA Provisions

 

Tax Relief, Unemployment Insurance 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.]

 

Public Law and Date of Enactment

 

P.L. 111-309

 

Dec. 15, 2010

 

Bill (Sponsor)

 

H.R. 4994 (Lewis)

 

Summary of ACA Provisions

 

Medicare and Medicaid Extenders Act of 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.]

 

Public Law and Date of Enactment

 

P.L. 111-226

 

Aug. 10, 2010

 

Bill (Sponsor)

 

H.R. 1586 (Rangel)

 

Summary of ACA Provisions

 

FAA Air Transportation Modernization and 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.

 

Public Law and Date of Enactment

 

P.L. 111-173

 

May 27, 2010

 

Bill (Sponsor)

 

H.R. 5014 (Filner)

 

Summary of ACA Provisions

 

[No title.] Amended IRC Section 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.]

 

Public Law and Date of Enactment

 

P.L. 111-159

 

Apr. 26, 2010

 

Bill (Sponsor)

 

H.R. 4887 (Skelton)

 

Summary of ACA Provisions

 

TRICARE Affirmation Act. Amended IRC 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 The FY2011 and FY2012 Labor-HHS-ED appropriations acts (P.L. 112-10 and P.L. 112-74, respectively) rescinded a total of $2.6 billion of the ACA's original $6 billion appropriation for the CO-OP program. 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.

 

END OF FOOTNOTE TO TABLE 1

 

 

Table 2.

 

ACA Provisions in Bills Approved by the House in the

 

112th, 113th, and 114th Congresses

 

 

114th Congress

 

 

Bill (Sponsor)

 

H.R. 1190 (Roe)

 

Bill Title, House Vote, Summary of ACA Provisions

 

Protecting Seniors' Access to Medicare Act of 2015. Passed the House by a vote of 244-154 on June 23, 2015. H.R. 1190 would repeal the authority and appropriations for the Independent Payment Advisory Board (IPAB). It also would reduce the Prevention and Public Health Fund (PPHF) annual appropriations over the period FY2017-FY2025 by a total of $8.846 billion to offset the cost of repealing IPAB. [Note: This is the second time the House has passed a stand-alone bill to repeal IPAB.]

 

Bill (Sponsor)

 

H.R. 160 (Paulsen)

 

Bill Title, House Vote, Summary of ACA Provisions

 

Protect Medical Innovation Act of 2015. Passed the House by a vote of 280-140 on June 18, 2015. H.R. 160 would repeal the ACA's 2.3% excise tax on medical devices. [Note: This is the second time the House has passed a stand-alone bill to repeal the medical device tax.]

 

Bill (Sponsor)

 

H.R. 1191 (Barletta)

 

Bill Title, House Vote, Summary of ACA Provisions

 

Protecting Volunteer Firefighters and Emergency Responders Act. Passed the House by a vote of 415-0 on March 17, 2015. H.R. 1191 would exclude the hours worked by volunteer firefighters and emergency medical responders from being counted toward 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. Last year the IRS ruled that it will not require volunteer emergency responders to count towards these ACA requirements. H.R. 1191 would codify that ruling.] The House passed the same legislation in January 2015 (see H.R. 33 below) and in March 2014 (see H.R. 3979 in the 113th Congress). The Senate took up H.R. 1191 and used it as the legislative vehicle for the Iran Nuclear Agreement Review Act of 2015, which the Senate passed by a vote of 98-1 on May 7, 2015.

 

Bill (Sponsor)

 

H.R. 596 (Byrne)

 

Bill Title, House Vote, Summary of ACA Provisions

 

A bill to repeal the Patient Protection and Affordable Care Act. Passed the House by a vote of 239-186 on February 3, 2015. H.R. 596 would repeal the ACA in its entirety and restore the provisions of law amended or repealed by the ACA as if it had not been enacted. It also instructs four House Committees (Education & Workforce, Energy & Commerce, Judiciary, and Ways & Means) each to report health reform legislation that addresses various issues specified in the bill. [Note: This is the fourth time the House has passed a full-repeal bill.]

 

Bill (Sponsor)

 

H.R. 33 (Barletta)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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 toward 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. Last year the IRS has ruled that it will not require volunteer emergency responders to count towards these ACA requirements. H.R. 33 would codify that ruling.] The House passed the same measure in March 2014 (see H.R. 3979 in the 113th Congress). The Senate took up H.R. 33 and substituted language to amend the Continuing Appropriations Resolution, 2015. As amended by the Senate, H.R. 33 passed both chambers and was signed into law (P.L. 114-3).

 

Bill (Sponsor)

 

H.R. 30 (Young, T.)

 

Bill Title, House Vote, Summary of ACA Provisions

 

Save American Workers Act of 2014. Passed the House by a vote of 252-172 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.]

 

Bill (Sponsor)

 

H.R. 22 (Davis, R.)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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

 

 

Bill (Sponsor)

 

H.R. 3522 (Cassidy)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.]

 

Bill (Sponsor)

 

H.R. 4414 (Carney)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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).]

 

Bill (Sponsor)

 

H.R. 4194 (Issa)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.

 

Bill (Sponsor)

 

H.R. 2575 (Young, T.)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.]

 

Bill (Sponsor)

 

H.R. 4015 (Burgess)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.

 

Bill (Sponsor)

 

H.R. 3979 (Barletta)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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 would have codified that ruling.] The Senate passed H.R. 3979 by a vote of 59-38 on April 7, 2014, after adding a five-month extension of unemployment benefits to the bill, among other provisions, and renaming it the Emergency Unemployment Compensation Act of 2014. No further action was taken on that measure. H.R. 3979 subsequently was used as the legislative vehicle for the FY2015 National Defense Authorization Act (P.L. 113-291).

 

Bill (Sponsor)

 

H.R. 3474 (Davis, R.)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.

 

Bill (Sponsor)

 

H.R. 1814 (Schock)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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).]

 

Bill (Sponsor)

 

H.R. 4118 (Jenkins)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.]

 

Bill (Sponsor)

 

H.R. 7 (Smith)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.]

 

Bill (Sponsor)

 

H.R. 3362 (Lee)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.

 

Bill (Sponsor)

 

H.R. 3811 (Pitts)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.

 

Bill (Sponsor)

 

H.R. 3350 (Upton)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.]

 

Bill (Sponsor)

 

H.R. 2775 (Black)

 

Bill Title, House Vote, Summary of ACA Provisions

 

No Subsidies Without Verification Act. Passed the House by a vote of 235-191 on September 12, 2013. H.R. 2775 would have required the HHS Inspector General to certify to Congress that a program was in place to verify the household income of exchange applicants before making any premium tax credits or cost-sharing subsidies available. [Note: H.R. 2775 became the legislative vehicle for the FY2014 Continuing Appropriations Act, P.L. 113-46. That act incorporated a modified version of the language in H.R. 2775.]

 

Bill (Sponsor)

 

H.R. 2009 (Price))

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.)

 

Bill (Sponsor)

 

H.R. 2668 (Young))

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.)

 

Bill (Sponsor)

 

H.R. 2667 (Griffin))

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.])

 

Bill (Sponsor)

 

H.R. 45 (Bachmann))

 

Bill Title, House Vote, Summary of ACA Provisions

 

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

 

 

Bill (Sponsor)

 

H.R. 6684 (Cantor))

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.)

 

Bill (Sponsor)

 

H.R. 6079 (Cantor))

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.)

 

Bill (Sponsor)

 

H.R. 436 (Paulsen))

 

Bill Title, House Vote, Summary of ACA Provisions

 

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 the 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.)

 

Bill (Sponsor)

 

H.R. 5652 (Ryan))

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.)

 

Bill (Sponsor)

 

H.R. 4628 (Biggert)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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 1). The provision in H.R. 4628 to repeal the PPHF and rescind all unobligated funds was not included in MAP-21.]

 

Bill (Sponsor)

 

H.R. 5 (Gingrey)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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 IPAB.

 

Bill (Sponsor)

 

H.R. 1173 (Boustany)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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 1.]

 

Bill (Sponsor)

 

H.R. 358 (Pitts)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.

 

Bill (Sponsor)

 

H.R. 1216 (Guthrie)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.

 

Bill (Sponsor)

 

H.R. 1214 (Burgess)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.

 

Bill (Sponsor)

 

H.R. 1213 (Upton)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.

 

Bill (Sponsor)

 

H.R. 1217 (Pitts)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.

 

Bill (Sponsor)

 

H.R. 2 (Cantor)

 

Bill Title, House Vote, Summary of ACA Provisions

 

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.

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

 

FOOTNOTES

 

 

1 The ACA was signed into law on March 23, 2010 (P.L. 111-148, 124 Stat. 119). A week later, on March 30, 2010, the President signed the Health Care and Education Reconciliation Act (HCERA; P.L. 111-152, 124 Stat. 1029). HCERA included several new health reform provisions and amended numerous provisions in the ACA. Several subsequently enacted bills made additional changes to selected ACA provisions. All references to the ACA in this report refer collectively to the law and to the changes made by HCERA and subsequent legislation.

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.

3King v. Burwell, No. 14-114 slip op. (June 25, 2015), http://www.supremecourt.gov/opinions/14pdf/14-114_qol1.pdf.

4NFIB 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.

5 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.

6 For further information on direct spending, see CRS Report RS20129, Entitlements and Appropriated Entitlements in the Federal Budget Process, by Bill Heniff Jr.

7 For further information on discretionary spending, see CRS Report R42388, The Congressional Appropriations Process: An Introduction, by Jessica Tollestrup.

8 U.S. Congressional Budget Office, letter to the Honorable Nancy Pelosi, Speaker, U.S. House of Representatives, providing an estimate of the direct spending and revenue effects of ACA, as amended by HCERA (March 20, 2010), http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/113xx/doc11379/amendreconprop.pdf.

9 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.

10 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10, 129 Stat. 87) extended CHCF funding for the health centers program and the NHSC for two years by appropriating a total of $3.910 billion to the fund for each of FY2016 and FY2017. Of that amount, $3.6 billion is for the health centers program and the remaining $310 million is for the NHSC.

11 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-FY2015 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.

12 The Nonrecurring Expenses Fund is an account within the Department of the Treasury. The HHS Secretary is authorized to transfer to the NEF unobligated balances of expired discretionary funds. NEF funds are available until expended for use by the HHS Secretary for capital acquisitions including facility and information technology infrastructure.

13 See footnote 1.

14 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.

15 The House has 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. The House approved budget resolutions for FY2012 and FY2013 (H.Con.Res. 34 and H.Con.Res. 112, respectively) during the 112th Congress and passed budget resolutions for FY2014 and FY2015 (H.Con.Res. 25 and H.Con.Res. 96, respectively) during the 113th Congress. Each of those four House budget resolutions included language addressing full repeal of the ACA. This year the House and the Senate each passed an FY2016 budget resolution (H.Con.Res. 27 and S.Con.Res. 11, respectively). Both measures -- as well as the subsequent conference agreement (S.Con.Res. 11) approved by the two chambers -- included language calling for full repeal of the ACA.

16United 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
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