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Overview of Health Care Changes in the FY2013 Budget Proposal Offered by House Budget Committee Chairman Ryan [March 29, 2012]

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"On March 20, 2012, House Budget Committee Chairman Paul Ryan released the Chairman's mark of the FY2013 House budget resolution together with his report entitled 'The Path to Prosperity: A Blueprint for American Renewal,' which outlines his budgetary objectives. On the same day, CBO [Congressional Budget Office] issued an analysis of the long-term budgetary impact of Chairman Ryan's budget proposal based on specifications provided by House Budget Committee staff. The House Budget Committee considered and amended the Chairman's mark on March 21, 2012, and voted to report the budget resolution to the full House. H.Con.Res. 112 was introduced in the House March 23, 2012, and was accompanied by the committee report H.Rept. 112-421. H.Con.Res. 112 was agreed to by the House on March 29, 2012. [...] This report summarizes the proposed changes to Medicare, Medicaid, and private health insurance as described in H.Con.Res. 112, the accompanying committee report, Chairman Ryan's 'Path to Prosperity' report, and the CBO analysis. Additionally, it briefly examines the potential impact of the proposed changes on health care spending and coverage."

Library of Congress. Congressional Research Service

Fernandez, Bernadette; Mitchell, Alison; Davis, Patricia A.

2012-03-29
Medicare: Part B Premiums [November 6, 2012]

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"This report provides an overview of Medicare Part B premiums, including information on: Part B eligibility and enrollment; late enrollment penalties; collection of premiums; determination of annual premium amounts; premiums for high-income enrollees; premium assistance for lowincome enrollees; protections for Social Security recipients from rising Part B premiums; and, historical Medicare Part B premium trends. This report also provides a summary of various premium related issues that may be of interest to Congress. Specific Medicare and Social Security publications and other resources for beneficiaries (and those who provide assistance to them) are cited where appropriate."

Library of Congress. Congressional Research Service

Davis, Patricia A.

2012-11-06
Overview of Health Care Changes in the FY2014 Budget Proposal Offered by House Budget Committee Chairman Ryan [March 22, 2013]

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"On March 12, 2013, House Budget Committee Chairman Paul Ryan released the chairman's mark of the FY2014 House budget resolution together with his report entitled 'The Path to Prosperity: A Responsible Balanced Budget', which outlines his budgetary objectives. The House Budget Committee considered and amended the chairman's mark on March 13, 2013, and voted to report the budget resolution to the full House. H.Con.Res. [House Concurrent Resolution] 25 was introduced in the House March 15, 2013, and was accompanied by the committee report (H.Rept. [House Report] 113-17). H.Con.Res. 25 was agreed to by the House on March 21, 2013. [...] This report summarizes the proposed changes to Medicare, Medicaid, and private health insurance as described in H.Con.Res. 25, the accompanying committee report, and Chairman Ryan's 'Path to Prosperity' report. Additionally, it briefly examines the potential impact of the proposed changes on health care spending and coverage."

Library of Congress. Congressional Research Service

Davis, Patricia A.; Fernandez, Bernadette; Mitchell, Alison

2013-03-22
Medicare: Insolvency Projections [September 19, 2014]

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"Medicare is the nation's health insurance program for persons age 65 and older and certain disabled persons. Medicare consists of four distinct parts: Part A (Hospital Insurance, or HI); Part B (Supplementary Medical Insurance, or SMI); Part C (Medicare Advantage, or MA); and Part D (the outpatient prescription drug benefit). The Part A program is financed primarily through payroll taxes levied on current workers and their employers; these are credited to the HI trust fund. The Part B program is financed through a combination of monthly premiums paid by current enrollees and general revenues. Income from these sources is credited to the SMI trust fund. As an alternative, beneficiaries can choose to receive all their Medicare services through private health plans under the MA program; payment is made on their behalf in appropriate parts from the HI and SMI trust funds. The Part D drug benefit is funded through a separate account in the SMI trust fund and is financed through general revenues, state contributions, and beneficiary premiums. The HI and SMI trust funds are overseen by a board of trustees that makes an annual report to Congress concerning the financial status of the funds. Almost from its inception, the HI trust fund has faced a projected shortfall. The insolvency date has been postponed a number of times, primarily due to legislative changes that have had the effect of restraining growth in program spending. The 2014 Medicare Trustees report projects that, under intermediate assumptions, the HI trust fund will become insolvent in 2030, four years later than estimated in the prior year's report."

Library of Congress. Congressional Research Service

Davis, Patricia A.

2014-09-19
Medicare Financial Status: In Brief [June 24, 2013]

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"Medicare, administered by the Centers for Medicare & Medicaid Services (CMS), is the nation's federal insurance program that pays for covered health services for most persons age 65 years and older and for most permanently disabled individuals under the age of 65. As a health insurance program, Medicare reimburses health care providers and suppliers, such as hospitals, physicians, and medical equipment companies, for the services and products they provide to Medicare beneficiaries. Medicare is prohibited by law from interfering in the practice of medicine or controlling the manner in which medical services are provided, and is required to pay for covered services provided to eligible persons so long as specific criteria are met. As such, the growth in per person Medicare expenditures largely reflects the medical practices, use of technology, and underlying costs in the broader health care system. Spending under the program (except for a portion of the administrative costs) is considered mandatory spending and is not subject to the appropriations process. Thus, there are generally no limits on annual Medicare spending. Since its enactment in 1965, the Medicare program has undergone considerable change. Because of its rapid growth, both in terms of aggregate dollars and as a share of the federal budget, the Medicare program has been a major focus of deficit reduction legislation passed by Congress. With a few exceptions, reductions in program spending have been achieved largely through freezes or reductions in payments to providers, primarily hospitals and physicians, and by making changes to beneficiary premiums and other cost-sharing requirements. Most recently, the Patient Protection and Affordable Care Act (ACA, P.L. [Public Law] 111-148 as amended) made numerous changes to the Medicare program that modify provider reimbursements, provide incentives to improve the quality and efficiency of care, and enhance certain Medicare benefits."

Library of Congress. Congressional Research Service

Davis, Patricia A.

2013-06-24
Medicare: Insolvency Projections [July 3, 2013]

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"Medicare is the nation's health insurance program for persons age 65 and older and certain disabled persons. Medicare consists of four distinct parts: Part A (Hospital Insurance, or HI); Part B (Supplementary Medical Insurance, or SMI); Part C (Medicare Advantage, or MA); and Part D (the outpatient prescription drug benefit). The Part A program is financed primarily through payroll taxes levied on current workers and their employers; these are credited to the HI trust fund. The Part B program is financed through a combination of monthly premiums paid by current enrollees and general revenues. Income from these sources is credited to the SMI trust fund. As an alternative, beneficiaries can choose to receive all their Medicare services through private health plans under the MA program; payment is made on their behalf in appropriate parts from the HI and SMI trust funds. The Part D drug benefit is funded through a separate account in the SMI trust fund and is financed through general revenues, state contributions, and beneficiary premiums. The HI and SMI trust funds are overseen by a board of trustees that makes an annual report to Congress concerning the financial status of the funds. Almost from its inception, the HI trust fund has faced a projected shortfall. The insolvency date has been postponed a number of times, primarily due to legislative changes that have had the effect of restraining growth in program spending. The 2013 Medicare Trustees report projects that, under intermediate assumptions, the HI trust fund will become insolvent in 2026, two years later than estimated in the prior year's report."

Library of Congress. Congressional Research Service

Davis, Patricia A.

2013-07-03
Medicare Financial Status: In Brief [August 10, 2015]

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This Congressional Research Service (CRS) Report for Congress gives an overview of the "Medical Financial Status: In Brief". Topics covered include an overview of the Medicare program, Medicare trust funds and sources of revenue, Medicare spending in 2014, estimated date of insolvency, and projected Medicare spending growth. This report includes facts, figures, tables, and graphs to illustrate the text.

Library of Congress. Congressional Research Service

Davis, Patricia A.

2015-08-10
Overview of Health Care Changes in the FY2015 House Budget [April 16, 2014]

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"On April 1, 2014, House Budget Committee Chairman Paul Ryan released the chairman's mark of the FY2015 House budget resolution together with his non-binding report entitled 'The Path to Prosperity: Fiscal Year 2015 Budget Resolution,' which outlines his budgetary objectives. The House Budget Committee considered and amended the chairman's mark on April 2, 2014, and voted to report the budget resolution to the full House. H.Con.Res. 96 was introduced in the House April 4, 2014, and was accompanied by the committee report (H.Rept. 113-403). H.Con.Res. 96 was agreed to by the House on April 10, 2014. Once it is agreed to by both chambers of Congress, a budget resolution provides enforceable budgetary parameters; however, it is not a law. [...] Committee documents also suggest restructuring Medicaid from an individual entitlement program to a block grant program. In addition, beginning in 2024, the budget assumes the conversion of Medicare to a fixed federal contribution ('premium support') program. This report summarizes the proposed changes to Medicare, Medicaid, and private health insurance as described in H.Con.Res. 96 and accompanying documents, including the committee report and Chairman Ryan's 'Path to Prosperity' report."

Library of Congress. Congressional Research Service

Davis, Patricia A.; Mitchell, Alison; Fernandez, Bernadette

2014-04-16
Potential Impact of No Social Security COLA on Medicare Part B Premiums in 2016 [October 20, 2015]

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From the Introduction: "Medicare is a federal insurance program that pays for covered health care services of most individuals aged 65 and older and certain disabled persons. In 2015, the program is expected to cover about 55 million persons (46 million aged and 9 million disabled) at a total cost of $649 billion. Most individuals (or their spouses) aged 65 and older who have worked in covered employment and paid Medicare payroll taxes for 40 quarters receive premium-free Medicare Part A (Hospital Insurance). Those entitled to Medicare Part A have the option of enrolling in Medicare Part B, which provides coverage for physicians' services, outpatient hospital services, durable medical equipment, outpatient dialysis, and other medical services. Most beneficiaries (about 92%) with Part A also enroll in Part B. Beneficiaries who choose to receive coverage through a Medicare Advantage (MA) plan (Part C) must enroll in both Medicare Part A and Medicare Part B. Part D provides optional outpatient prescription drug coverage. […] This report provides an overview of Medicare Part B premiums, the relationship between the Social Security cost-of-living increase (COLA) and Part B premiums, and the potential impact of a projected 0% Social Security COLA in 2016 on Medicare premiums, based on recent projections by the Medicare Trustees."

Library of Congress. Congressional Research Service

Davis, Patricia A.

2015-10-20
Medicare Primer [March 31, 2016]

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"Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or have amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease). The program is administered by the Centers for Medicare & Medicaid Services (CMS), and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services."

Library of Congress. Congressional Research Service

Davis, Patricia A.; Talaga, Scott R.; Binder, Cliff . . .

2016-03-31
Use of Modified Adjusted Gross Income (MAGI) in Federal Health Programs [February 25, 2016]

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"The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) created Section 36(B) of the Internal Revenue Code (IRC) to define household income, based on modified adjusted gross income (MAGI). MAGI is used to determine (1) penalty amounts owed if a person does not comply with the individual mandate or whether an individual is exempt from the individual mandate; (2) eligibility for and the amount of a premium credit to purchase coverage through a health insurance exchange; and (3) Medicaid income eligibility for certain populations. MAGI is also used to determine which Medicare beneficiaries pay high-income premiums. However, MAGI has many different definitions, depending on the purpose for which it is being calculated. For these government health programs, MAGI begins with adjusted gross income (AGI) as calculated for tax purposes. From there, various types of income are included (or, in the case of Medicaid, subtracted) to calculate MAGI for each particular program. Although the different health programs use the word 'household,' they do not necessarily refer to the same groupings of people. For example, married couples living together are counted as the same Medicaid household regardless of whether they file a joint tax return. By contrast, married couples must file a joint tax return to be eligible for premium credits. This report explores the different MAGI definitions across health programs, including Medicare, the health insurance exchanges under the ACA, and Medicaid. It also addresses why MAGI is used, and how it is applied, specific to each program."

Library of Congress. Congressional Research Service

Baumrucker, Evelyne P.; Davis, Patricia A.; Fernandez, Bernadette . . .

2016-02-25
Medicare Financial Status: In Brief [June 30, 2016]

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"Medicare, administered by the Centers for Medicare and Medicaid Services (CMS), is the nation's federal insurance program that pays for covered health services for most persons aged 65 years and older and for most permanently disabled individuals under the age of 65. As a health insurance program, Medicare reimburses health care providers and suppliers, such as hospitals, physicians, and medical equipment companies, for the services and products they provide to Medicare beneficiaries. Medicare is prohibited by law from interfering in the practice of medicine or controlling the manner in which medical services are provided. It also is required to pay for covered services provided to eligible persons so long as specific criteria are met. As such, the growth in per person Medicare expenditures largely reflects the medical practices, use of technology, and underlying costs in the broader health care system. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the appropriations process. Thus, there generally are no limits on annual Medicare spending. Since its enactment in 1965, the Medicare program has undergone considerable change. Because of its rapid growth, both in terms of aggregate dollars and as a share of the federal budget, the Medicare program has been a major focus of deficit reduction legislation passed by Congress. With a few exceptions, reductions in program spending have been achieved largely through freezes or reductions in payments to providers, primarily hospitals and physicians, and by making changes to beneficiary premiums and other cost-sharing requirements."

Library of Congress. Congressional Research Service

Davis, Patricia A.

2016-06-30
Medicare: Part B Premiums [August 4, 2016]

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"Medicare is a federal insurance program that pays for covered health care services of most individuals aged 65 and older and certain disabled persons. Medicare serves approximately one in six Americans and virtually all of the population aged 65 and over. In calendar year (CY) 2016, the program is expected to cover about 57 million persons (48 million aged and 9 million disabled) at a total cost of $683 billion, accounting for approximately 3.6% of gross domestic product. The Medicare program is administered by the Centers for Medicare & Medicaid Services (CMS). […] This report provides an overview of Medicare Part B premiums, including information on Part B eligibility and enrollment, late-enrollment penalties, collection of premiums, determination of annual premium amounts, premiums for high-income enrollees, premium assistance for low-income enrollees, protections for Social Security recipients from rising Part B premiums, and historical Medicare Part B premium trends. This report also provides a summary of various premium-related issues that may be of interest to Congress. Specific Medicare and Social Security publications and other resources for beneficiaries, and those who provide assistance to them, are cited where appropriate."

Library of Congress. Congressional Research Service

Davis, Patricia A.

2016-08-04
Medicare: Insolvency Projections [October 5, 2016]

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"Medicare is the nation's health insurance program for persons aged 65 and older and certain disabled persons. Medicare consists of four distinct parts: Part A (Hospital Insurance, or HI); Part B (Supplementary Medical Insurance, or SMI); Part C (Medicare Advantage, or MA); and Part D (the outpatient prescription drug benefit). The Part A program is financed primarily through payroll taxes levied on current workers and their employers; these taxes are credited to the HI Trust Fund. The Part B program is financed through a combination of monthly premiums paid by current enrollees and general revenues. Income from these sources is credited to the SMI Trust Fund. As an alternative, beneficiaries can choose to receive all their Medicare services through private health plans under the MA program; payment is made on beneficiaries' behalf in appropriate parts from the HI and SMI Trust Funds. The Part D drug benefit is funded through a separate account in the SMI Trust Fund and is financed through general revenues, state contributions, and beneficiary premiums. The HI and SMI Trust Funds are overseen by the Medicare Board of Trustees, which makes an annual report to Congress concerning the financial status of the funds. Almost from its inception, the HI Trust Fund has faced a projected shortfall. The insolvency date has been postponed a number of times, primarily due to legislative changes that have had the effect of restraining growth in program spending. The 2016 Medicare trustees' report projects that, under intermediate assumptions, the HI Trust Fund will become insolvent in 2028, two years earlier than estimated in the prior year's report."

Library of Congress. Congressional Research Service

Davis, Patricia A.

2016-10-05
Medicare Trigger [March 8, 2017]

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"The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA; P.L. 108-173) requires the Medicare Board of Trustees to provide in its annual reports an expanded analysis of Medicare expenditures and revenues. Specifically, if the Medicare trustees determine that general revenue funding for Medicare is expected to exceed 45% of Medicare outlays for the current fiscal year or any of the next six fiscal years, a determination of excess general funding is made. If the determination is issued for two consecutive years, a funding warning is issued, which triggers certain presidential and congressional actions related to the introduction and consideration of legislation designed to respond to the warning. […] In each of their 2014 through 2016 reports, the Medicare trustees projected that Medicare general revenue funding would not exceed 45% of total Medicare outlays within seven fiscal years. Therefore, the Medicare trustees did not issue funding warnings in those years, and the President was not required to submit a related legislative proposal subsequent to the release of his FY2016 and FY2017 budgets nor will he be required to submit such legislation subsequent to the submission of his FY2018 budget. The Medicare funding warning focuses attention on the impact of program spending on the federal budget, and it provides one measure of the financial health of the program."

Library of Congress. Congressional Research Service

Davis, Patricia A.; Garvey, Todd; Davis, Christopher M., 1966-

2017-03-08
Medicare Primer [March 16, 2017]

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"Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or have amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease). The program is administered by the Centers for Medicare & Medicaid Services (CMS), and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services. [...] This report provides a general overview of the Medicare program including descriptions of the program's history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes."

Library of Congress. Congressional Research Service

Davis, Patricia A.; Binder, Cliff; Hahn, Jim . . .

2017-03-16
Medicare: Insolvency Projections [August 16, 2017]

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"Medicare is a federal insurance program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act as a federal entitlement program to provide health insurance to individuals aged 65 and older, and it has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare consists of four distinct parts, A through D. Part A covers hospital services, skilled nursing facility (SNF) services, home health visits, and hospice services. Most persons aged 65 and older are automatically entitled to premium-free Part A because they or their spouse paid Medicare payroll taxes for at least 40 quarters (10 years) on earnings covered by either the Social Security or the Railroad Retirement systems. Part B covers a broad range of medical services, including physician services, laboratory services, durable medical equipment, and outpatient hospital services. Enrollment in Part B is voluntary; however, most beneficiaries with Part A also enroll in Part B. Part C, Medicare Advantage (MA), provides private plan options, such as managed care, for beneficiaries who are enrolled in both Part A and Part B. Part D provides optional outpatient prescription drug coverage."

Library of Congress. Congressional Research Service

Davis, Patricia A.

2017-08-16
Comparison of the Bills to Extend State Children's Health Insurance Program (CHIP) Funding [October 23, 2017]

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"The State Children's Health Insurance Program (CHIP) is a means-tested program that provides health coverage to targeted low-income children and pregnant women in families that have annual income above Medicaid eligibility levels but have no health insurance. CHIP is jointly financed by the federal government and the states, and the states are responsible for administering CHIP. In statute, FY2017 is the last year a federal CHIP appropriation is provided. Federal CHIP funding was not extended before the beginning of FY2018. As a result, states do not currently have FY2018 CHIP allotments, and states are funding their CHIP programs with unspent federal CHIP funds from prior years. Some states are expected to exhaust this funding within the first quarter of FY2018. On October 4, 2017, both the Senate Finance Committee and the House Energy and Commerce Committee had markups on different bills that would extend CHIP federal funding through FY2022, among other provisions."

Library of Congress. Congressional Research Service

Mitchell, Alison; Baumrucker, Evelyne P.; Dabrowska, Agata . . .

2017-10-23
Comparison of the Bills to Extend State Children's Health Insurance Program (CHIP) Funding [November 3, 2017]

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"The State Children's Health Insurance Program (CHIP) is a means-tested program that provides health coverage to targeted low-income children and pregnant women in families that have annual income above Medicaid eligibility levels but have no health insurance. CHIP is jointly financed by the federal government and the states, and the states are responsible for administering CHIP. In statute, FY2017 is the last year a federal CHIP appropriation is provided. Federal CHIP funding was not extended before the beginning of FY2018. As a result, states do not currently have FY2018 CHIP allotments, and states are funding their CHIP programs with unspent federal CHIP funds from prior years. Some states are expected to exhaust this funding within the first quarter of FY2018."

Library of Congress. Congressional Research Service

Mitchell, Alison; Baumrucker, Evelyne P.; Dabrowska, Agata . . .

2017-11-03
Medicare Primer [August 02, 2017]

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"Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under 65. The program is administered by the Centers for Medicare & Medicaid Services (CMS), within the U.S. Department of Health and Human Services (HHS)."

Library of Congress. Congressional Research Service

Davis, Patricia A.; Binder, Cliff; Hahn, Jim . . .

2017-08-02
Medicare Financial Status: In Brief [August 09, 2017]

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"Medicare, administered by the Centers for Medicare and Medicaid Services (CMS), is the nation's federal insurance program that pays for covered health services for most persons aged 65 years and older and for most permanently disabled individuals under the age of 65. As a health insurance program, Medicare reimburses health care providers and suppliers, such as hospitals, physicians, and medical equipment companies, for the services and products they provide to Medicare beneficiaries. Medicare is prohibited by law from interfering in the practice of medicine or controlling the manner in which medical services are provided. It also is required to pay for covered services provided to eligible persons so long as specific criteria are met. As such, the growth in per person Medicare expenditures largely reflects the medical practices, use of technology, and underlying costs in the broader health care system. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the appropriations process. Thus, there generally are no limits on annual Medicare spending."

Library of Congress. Congressional Research Service

Davis, Patricia A.

2017-08-09
Medicare Trigger [February 8, 2018]

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"The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA; P.L. 108173) requires the Medicare Board of Trustees to provide in its annual reports an expanded analysis of Medicare expenditures and revenues (§801 of the MMA). Specifically, if the Medicare trustees determine that general revenue funding for Medicare is expected to exceed 45% of Medicare outlays for the current fiscal year or any of the next six fiscal years, a determination of excess general funding is made. If the determination is issued for two consecutive years, a funding warning is issued which triggers certain presidential and congressional actions related to the introduction and consideration of legislation designed to respond to the warning (§§802-804 of the MMA)."

Library of Congress. Congressional Research Service

Davis, Patricia A.; Garvey, Todd; Davis, Christopher M., 1966-

2018-02-08
Use of Modified Adjusted Gross Income (MAGI) in Federal Health Programs [December 6, 2018]

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"Certain portions of federal health programs rely on means testing for eligibility and other purposes. Medicare premiums, the individual mandate exemptions and penalties, eligibility and amounts for tax credits for health insurance exchange coverage, and Medicaid eligibility are determined, in part, using modified adjusted gross income (MAGI). MAGI is a concept that is used throughout federal tax law and certain federal programs. There is no uniform definition of MAGI; rather, the term has different definitions depending on the purpose for which it is being calculated. For each of these federal health programs, MAGI begins with adjusted gross income (AGI) as calculated for tax purposes. From there, various types of income are included (or, in the case of Medicaid, subtracted) to calculate MAGI for each particular program. The different health programs do not necessarily define household income using the same groupings of people. For example, married couples living together are counted as the same Medicaid household regardless of whether they file a joint tax return. By contrast, married couples must file a joint tax return to be eligible for premium credits."

Library of Congress. Congressional Research Service

Baumrucker, Evelyne P.; Davis, Patricia A.; Fernandez, Bernadette . . .

2018-12-06
Comparison of the Bills to Extend State Children's Health Insurance Program (CHIP) Funding [January 17, 2018]

Show summary Open resource [pdf] (open full abstract)
"The State Children's Health Insurance Program (CHIP) is a means-tested program that provides health coverage to targeted low-income children and pregnant women in families that have annual income above Medicaid eligibility levels but have no health insurance. CHIP is jointly financed by the federal government and the states, and the states are responsible for administering CHIP. In statute, FY2017 was the last year a federal CHIP appropriation was provided. Federal CHIP funding was not extended before the beginning of FY2018. As a result, states do not currently have full-year FY2018 CHIP allotments and states are funding their CHIP programs with unspent federal CHIP funds from prior years. The continuing resolutions enacted on December 8, 2017, and December 22, 2017, both include provisions that provide short-term funding for CHIP. The continuing resolution enacted on December 8, 2017, includes a special rule for redistribution funds, and the continuing resolution enacted on December 22, 2017, includes short-term appropriations and an extension of the special rule for redistribution funds. This short-term funding is not sufficient to fund CHIP through the end of FY2018.There are a couple of bills that would extend federal funding for CHIP for five years. On October 4, 2017, both the Senate Finance Committee and the House Energy and Commerce Committee had markups on different bills that would extend CHIP federal funding through FY2022, among other provisions."

Library of Congress. Congressional Research Service

Mitchell, Alison; Baumrucker, Evelyne P.; Dabrowska, Agata . . .

2018-01-17
Medicare: Insolvency Projections [Updated July 3, 2019]

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From the Summary: "Medicare is the nation's health insurance program for persons aged 65 and older and certain disabled persons. Medicare consists of four distinct parts: Part A (Hospital Insurance, or HI); Part B (Supplementary Medical Insurance, or SMI); Part C (Medicare Advantage, or MA); and Part D (the outpatient prescription drug benefit). The Part A program is financed primarily through payroll taxes levied on current workers and their employers; these taxes are credited to the HI Trust Fund. The Part B program is financed through a combination of monthly premiums paid by current enrollees and general revenues. Income from these sources is credited to the SMI Trust Fund. As an alternative, beneficiaries can choose to receive all their Medicare services through private health plans under the MA program; payment is made on beneficiaries' behalf in appropriate parts from the HI and SMI Trust Funds. The Part D drug benefit is funded through a separate account in the SMI Trust Fund and is financed through general revenues, state contributions, and beneficiary premiums. The HI and SMI Trust Funds are overseen by the Medicare Board of Trustees, which makes an annual report to Congress concerning the financial status of the funds. Since the inception of Medicare in 1966, the HI Trust Fund has always faced a projected shortfall. The insolvency date has been postponed a number of times, primarily due to legislative changes that have had the effect of restraining growth in program spending. The 2019 Medicare Trustees Report projects that, under intermediate assumptions, the HI Trust Fund will become insolvent in 2026, the same year as estimated in the prior year's report."

Library of Congress. Congressional Research Service

Davis, Patricia A.

2019-07-03

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