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71-585: The Community Living Assistance Services and Supports Act (or CLASS Act ) was a U.S. federal law, enacted as Title VIII of the Patient Protection and Affordable Care Act . The CLASS Act would have created a voluntary and public long-term care insurance option for employees, but in October 2011 the Obama administration announced it was unworkable and would be dropped. The CLASS Act was repealed January 1, 2013. Under

142-524: A compromise averting a prolonged tumble off the fiscal cliff." Minutes later, the president flew back to Hawaii to rejoin his family for their holiday vacation. Obama signed the official copy of the bill by autopen from there late on January 2, 2013. The Congressional Budget Office (CBO) analyzes the effects of legislation on the deficit and economy. Describing the effects of the American Taxpayer Relief Act (ATRA) depends on which baseline

213-534: A great extent, rather leaving that for further negotiations and legislation. The American Taxpayer Relief Act passed by a wide majority in the Senate, with both Democrats and Republicans supporting it, while most of the House Republicans opposed it. In all, the bill included $ 600 billion over ten years in new tax revenue, about one-fifth of the revenue that would have been raised had no legislation been passed. For

284-489: A health economist with LeadingAge , the act would have created "a national insurance trust" with a potential "daily cash benefit on the order of about $ 50 to $ 75 a day, depending on your level of disability." The Congressional Budget Office estimated the program would have resulted in $ 72 Billion in deficit reduction in the first ten years, including $ 2 Billion in Medicaid savings because of individuals receiving benefits under

355-501: A negative election similar to some 401(k) plans. Tax treatment would have been the same as for tax-qualified long-term care plans (i.e., benefits would not have been taxable and premiums might have been eligible for medical expense deduction). Participation would have been limited to employees actively at work, and required a five-year vesting period (including three working years) prior to benefit eligibility. The CLASS program did not extend coverage to an employee's family members. It

426-619: A partial resolution to the US fiscal cliff by addressing the expiration of certain provisions of the Economic Growth and Tax Relief Reconciliation Act of 2001 and the Jobs and Growth Tax Relief Reconciliation Act of 2003 (known together as the " Bush tax cuts "), which had been temporarily extended by the Tax Relief, Unemployment Insurance Reauthorization, and Job Creation Act of 2010 . The Act also addressed

497-405: A penalty . The mandate and limits on open enrollment were designed to avoid the insurance death spiral , minimize the free rider problem and prevent the healthcare system from succumbing to adverse selection . The mandate was intended to increase the size and diversity of the insured population, including more young and healthy participants to broaden the risk pool , spreading costs. Among

568-596: A promise in the risk corridors program that it has yet to fulfill. Today, the court directs the Government to fulfill that promise. After all, to say to [Moda], 'The joke is on you. You shouldn't have trusted us,' is hardly worthy of our great government." Moda Health's case was appealed by the government to the United States Court of Appeals for the Federal Circuit along with the appeals of the other insurers; here,

639-540: A source other than premiums.... and any associated interest earnings." Administrative expenses, including advocacy and assistance counseling, were to be limited to three percent of premiums. On October 14, 2011, HHS Secretary Kathleen Sebelius announced that the Obama Administration would not attempt to implement the C.L.A.S.S. Act stating "I do not see a viable path forward for Class implementation at this time." One actuary opined that adverse selection could make

710-542: A subsidy. The subsidies for an ACA plan purchased on an exchange stop at 400% of the federal poverty level (FPL). According to the Kaiser Foundation, this results in a sharp "discontinuity of treatment" at 400% FPL, which is sometimes called the "subsidy cliff". After-subsidy premiums for the second lowest cost silver plan (SCLSP) just below the cliff are 9.86% of income in 2019. Subsidies are provided as an advanceable, refundable tax credit . The amount of subsidy

781-431: A waiver, a state must pass legislation setting up an alternative health system that provides insurance at least as comprehensive and as affordable as ACA, covers at least as many residents and does not increase the federal deficit. These states can escape some of ACA's central requirements, including the individual and employer mandates and the provision of an insurance exchange. The state would receive compensation equal to

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852-457: Is $ 250,000 for a married couple filing jointly (threshold applies to their total compensation), or $ 125,000 for a married person filing separately. In ACA's companion legislation, the Health Care and Education Reconciliation Act of 2010 , an additional tax of 3.8% was applied to unearned income, specifically the lesser of net investment income and the amount by which adjusted gross income exceeds

923-614: Is a fee-for-service model. The Act allowed the creation of accountable care organizations (ACOs), which are groups of doctors, hospitals and other providers that commit to give coordinated care to Medicare patients. ACOs were allowed to continue using fee-for-service billing. They receive bonus payments from the government for minimizing costs while achieving quality benchmarks that emphasize prevention and mitigation of chronic disease . Missing cost or quality benchmarks subjected them to penalties. Unlike health maintenance organizations , ACO patients are not required to obtain all care from

994-411: Is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system 's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965. Most of

1065-530: Is far better than a failure by this Congress to act before it adjourns" but complained that "lawmakers seem to have gotten as close as they could to doing the bare minimum." Economist Paul Krugman wrote that ATRA allowed liberals to avoid spending cuts or entitlement reform, while conservatives allowed income tax rate increases for the first time since 1993. Krugman believed that Obama should have bargained harder for more revenue. He also estimated that another 2% GDP in annual deficit reduction would be required over

1136-405: Is gone, and before the bill's final passage ... House Republican leaders struggled all day to quell a revolt among caucus members who threatened to blow up a hard-fought compromise that they could have easily framed as a victory." The Committee for a Responsible Federal Budget said that the bill avoided most of the economic harm from the fiscal cliff and set useful precedents regarding paying for

1207-409: Is sufficient to reduce the premium for the second-lowest-cost silver plan (SCLSP) on an exchange to a sliding-scale percentage of income. The percentage is based on the percent of federal poverty level (FPL) for the household, and varies slightly from year to year. In 2019, it ranged from 2.08% of income (100%-133% FPL) to 9.86% of income (300%-400% FPL). The subsidy can be used for any plan available on

1278-575: Is used in comparison. The CBO reported its estimates of the budgetary effects of ATRA on January 1, 2013. These effects were measured relative to the CBO's March 2012 "Baseline scenario", which assumed significant deficit reduction due to the expiration of the Bush tax cuts and implementation of spending cuts under the Budget Control Act of 2011. CBO's March 2012 "Baseline scenario" assumed the total deficits for

1349-764: The American Taxpayer Relief Act of 2012 , known as the Fiscal Cliff Bill. This law contains a provision that repeals the Community Living Assistance Services and Supports Act. Republican opponents of the plan called it "a financial gimmick" to manipulate the Congressional Budget Office deficit projections for the PPACA, while Democratic Senator Kent Conrad called it a " Ponzi scheme ," because (a) projected premiums during

1420-531: The Center for Medicare and Medicaid Innovation , the Independent Payment Advisory Board , and accountable care organizations . Health care cost/quality initiatives included incentives to reduce hospital infections , adopt electronic medical records , and to coordinate care and prioritize quality over quantity. Medicare switched from fee-for-service to bundled payments . A single payment

1491-547: The Medicare prescription drug benefit . While many insurers initially offered exchange plans, the program did not pay for itself as planned, losing up to $ 8.3 billion for 2014 and 2015. Authorization had to be given so DHHS could pay insurers from "general government revenues". However, the Consolidated Appropriations Act, 2014 (H.R. 3547) stated that no funds "could be used for risk-corridor payments". leaving

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1562-544: The individual mandate penalty at $ 0 starting in 2019 due to its overall unpopularity and to reduce the federal budget deficit. ACA amended the Public Health Service Act of 1944 and inserted new provisions on affordable care into Title 42 of the United States Code . The individual insurance market was radically overhauled, and many of the law's regulations applied specifically to this market, while

1633-490: The poverty line would qualify for coverage in any state that participated in the Medicaid program. Previously, states could set various lower thresholds for certain groups and were not required to cover adults without dependent children. The federal government was to pay 100% of the increased cost in 2014, 2015 and 2016; 95% in 2017, 94% in 2018, 93% in 2019, and 90% in 2020 and all subsequent years. A 5% "income disregard" made

1704-466: The 2013 spending from $ 3,554 billion to $ 3,604 billion, an increase of $ 41 billion or 1.15% versus 2012 spending of $ 3,563 billion. After adjusting for these changes, the deficit was projected to be $ 971 billion in 2013 instead of the $ 641 billion projected prior to ATRA, an increase of $ 330 billion. Both deficit projections were below the 2012 deficit of $ 1,128 billion by $ 157 billion and $ 487 billion, respectively. The Wall Street Journal reported that

1775-469: The 2013–2022 period would be $ 2,887 billion. Debt held by the public (a partial measure of the national debt) at the end of 2022 would be $ 15,115 billion, resulting in a ratio of debt held by the public to GDP of 61.3%. The ratio was projected to be 73.2% in 2012. Applying the amounts in the ATRA to the baseline (a rough approximation pending further CBO scoring), passage of the ATRA raises the: For comparison,

1846-558: The ACA and the use of riders to de-obligate its from those payments was illegal. The temporary reinsurance program is meant to stabilize premiums by reducing the incentive for insurers to raise premiums due to concerns about higher-risk enrollees. Reinsurance was based on retrospective costs rather than prospective risk evaluations. Reinsurance was available from 2014 through 2016. Risk adjustment involves transferring funds from plans with lower-risk enrollees to plans with higher-risk enrollees. It

1917-512: The ACO. Also, unlike HMOs, ACOs must achieve quality-of-care goals. Medicare Part D participants received a 50% discount on brand name drugs purchased after exhausting their initial coverage and before reaching the catastrophic-coverage threshold . By 2020, the "doughnut hole" would be completely filled. From 2017 onwards, states can apply for a "waiver for state innovation" which allows them to conduct experiments that meet certain criteria. To obtain

1988-540: The Act the Department of Health and Human Services was to set the terms prior to implementation, but determined the program was not viable and could not go into effect. The CLASS Act had been "a key priority" of the late Senator Edward "Ted" Kennedy . Most of the terms were to be developed by the Department of Health and Human Services over several years. However, certain terms were set in statute: According to Barbara Manard,

2059-568: The Baseline scenario. CBO separately indicated in January 2013 that $ 600 billion in additional interest costs over the 2013–2022 period were not included in their initial assessment discussed above. This increases the deficit estimate from $ 6,858 billion (Baseline scenario with ATRA adjustment above) to $ 7,458 billion. This additional interest cost arises due to higher deficits relative to the Baseline. While ATRA would reduce short-term economic impact due to

2130-505: The CBO's "Alternative Scenario", which assumed the Bush tax cuts would be extended and the spending cuts in the Budget Control Act avoided, assumed $ 10,731 billion in cumulative deficits during the 2013–2022 period. The ATRA results in $ 6,858 billion in cumulative deficits, roughly splitting the difference between the two scenarios. In other words, ATRA improves the deficit picture relative to the Alternative scenario, but worsens it relative to

2201-512: The CLASS Act that they could have received under Medicaid , and because no benefits would be paid out at all in the first five years. However, in the longer term, the CBO noted that "In the decade following 2029, the CLASS program would begin to increase budget deficits" as payouts increased, with the trust fund remaining solvent for a seventy-five year period but running bankrupt after that. The effect on

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2272-658: The FPL. Medicaid recipients were not eligible for the reductions. So-called cost-sharing reduction (CSR) subsidies were to be paid to insurance companies to fund the reductions. During 2017, approximately $ 7 billion in CSR subsidies were to be paid, versus $ 34 billion for premium tax credits. The latter was defined as mandatory spending that does not require an annual Congressional appropriation. CSR payments were not explicitly defined as mandatory. This led to litigation and disruption later. ACA implemented multiple approaches to helping mitigate

2343-484: The Federal Circuit reversed the Moda Health ruling and ruled across all the cases in favor of the government, that the appropriations riders ceded the government from paying out remain money due to the insurers. The Supreme Court reversed this ruling in the consolidated case, Maine Community Health Options v. United States , reaffirming as with Judge Wheeler that the government had a responsibility to pay those funds under

2414-600: The House John Boehner voted for the bill, a break from the usual custom of the speaker not voting at all. The action by the House in bringing the bill up was itself a break from the normal " Hastert rule " as well, in that a majority of the majority Republican caucus did not support it. The House's passage brought to a close what the Associated Press called "Congress' excruciating, extraordinary New Year's Day approval of

2485-487: The Obama administration, with the final agreement being attributed to talks between Vice President Joe Biden and Senate Minority Leader Mitch McConnell . Some Democrats criticized the bill for not raising taxes on the wealthy more, while Republicans criticized it for raising tax rates while not providing explicit spending cuts. The final actions on the bill came during Congressional sessions on New Year's Eve and New Year's Day . At around 2 a.m. EST on January 1, 2013,

2556-400: The Senate passed the bill, by a margin of 89–8. 49 Democrats (and Democratic-caucusing Independents) and 40 Republicans voted in favor while 3 Democrats and 5 Republicans voted against. The prospect was raised that the House would pass an amended bill that included $ 300 billion in spending cuts. But it was determined to be unlikely that the Senate would vote on any amended legislation before

2627-440: The above income limits. ACA included an excise tax of 40% (" Cadillac tax ") on total employer premium spending in excess of specified dollar amounts (initially $ 10,200 for single coverage and $ 27,500 for family coverage ) indexed to inflation. This tax was originally scheduled to take effect in 2018, but was delayed until 2020 by the Consolidated Appropriations Act, 2016 and again to 2022. The excise tax on high-cost health plans

2698-510: The act's provisions are still in effect. The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered. The law also enacted a host of delivery system reforms intended to constrain healthcare costs and improve quality. After it went into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans. The increased coverage

2769-517: The activation of the Budget Control Act of 2011 's budget sequestration provisions. A compromise measure, the Act gives permanence to the lower rate of much of the Bush tax cuts, while retaining the higher tax rate at upper income levels that became effective on January 1 due to the expiration of the Bush tax cuts. It also establishes caps on tax deductions and credits for those at upper income levels. It does not tackle federal spending levels to

2840-488: The aggregate amount of any federal subsidies and tax credits for which its residents and employers would have been eligible under ACA, if they cannot be paid under the state plan. The Community Living Assistance Services and Supports Act (or CLASS Act) established a voluntary and public long-term care insurance option for employees, The program was abolished as impractical without ever having taken effect. American Taxpayer Relief Act of 2012 The Act centers on

2911-576: The bill's tax provisions "represented the largest tax increase in the past two decades", based on the year-to-year increase in tax rates from 2012 to 2013. However, Dave Camp , the Republican chair of the House Ways and Means Committee , called the same provisions the "largest tax cut in American history", referring to the fact that the bill's tax rates replace much higher rates for 2013 that were provided for in

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2982-402: The cliff, it would slow long-term growth relative to the lower deficit Baseline scenario. The CBO's August 2012 "Baseline scenario" assumed revenue would increase from $ 2,435 billion in 2012 to $ 2,913 billion in 2013, an increase of $ 478 billion or 19.63%. It also assumed spending would decline from $ 3,563 billion in 2012 to $ 3,554 billion in 2013, a decrease of $ 9 billion or -0.25%. The deficit

3053-533: The congressional staff that helped write it." In 2019, Washington State passed the WA Cares Act , which created a similar system, the first at the state level in the U.S. As of 2022, implementation has been delayed in order to address some criticisms of various provisions. Patient Protection and Affordable Care Act The Affordable Care Act ( ACA ), formally known as the Patient Protection and Affordable Care Act ( PPACA ) and colloquially as Obamacare ,

3124-545: The deficit in the ten-year budget window was particularly important due to the Byrd Rule . Premium rates were to be determined by the Department of Health and Human Services with subsidies for low-income individuals and students. Premium rates would have varied by issue age. The CLASS program contained an implicit redistribution tax to subsidize lower income and full-time student participants. The legislation did not set specific benefits. The Secretary of Health and Human Services

3195-486: The deficit, and that the law reduced income inequality by taxing primarily the top 1% to fund roughly $ 600 in benefits on average to families in the bottom 40% of the income distribution. The act largely retained the existing structure of Medicare, Medicaid, and the employer market , but individual markets were radically overhauled. Insurers were made to accept all applicants without charging based on preexisting conditions or demographic status (except age). To combat

3266-525: The disruptions to insurers that came with its many changes. The risk-corridor program was a temporary risk management device. It was intended to encourage reluctant insurers into ACA insurance market from 2014 to 2016. For those years the Department of Health and Human Services (DHHS) would cover some of the losses for insurers whose plans performed worse than they expected. Loss-making insurers would receive payments paid for in part by profit-making insurers. Similar risk corridors had been established for

3337-910: The effective income eligibility limit for Medicaid 138% of the poverty level. However, the Supreme Court ruled in NFIB v. Sebelius that this provision of ACA was coercive, and that states could choose to continue at pre-ACA eligibility levels. Medicare reimbursements were reduced to insurers and drug companies for private Medicare Advantage policies that the Government Accountability Office and Medicare Payment Advisory Commission found to be excessively costly relative to standard Medicare; and to hospitals that failed standards of efficiency and care. Income from self-employment and wages of single individuals in excess of $ 200,000 annually are subjected to an additional tax of 0.9%. The threshold amount

3408-522: The employee's coverage) through their own or a family member's employer. Households below the federal poverty level are not eligible to receive these subsidies. Lawful Residents and some other legally present immigrants whose household income is below 100% FPL and are not otherwise eligible for Medicaid are eligible for subsidies if they meet all other eligibility requirements. Married people must file taxes jointly to receive subsidies. Enrollees must have U.S. citizenship or proof of legal residency to obtain

3479-551: The end of the 112th Congress at noon on January 3, 2013 (all legislation under consideration expires at the end of each Congress), and failure to pass a bill and thus prolong the time over the cliff was seen as politically disadvantageous by the Republican leadership, and so the House moved towards a vote the same day. The House passed the bill without amendments by a margin of 257–167 at about 11 p. m. EST on January 1, 2013. 85 Republicans and 172 Democrats voted in favor while 151 Republicans and 16 Democrats were opposed. Speaker of

3550-481: The exchange, but not catastrophic plans. The subsidy may not exceed the premium for the purchased plan. (In this section, the term "income" refers to modified adjusted gross income . ) Small businesses are eligible for a tax credit provided they enroll in the SHOP Marketplace. a. ^ In 2019, the federal poverty level was $ 25,100 for family of four (outside of Alaska and Hawaii). b. ^ If

3621-552: The federal government responsible for operating their exchanges. Individuals whose household incomes are between 100% and 400% of the federal poverty level (FPL) are eligible to receive federal subsidies for premiums for policies purchased on an ACA exchange, provided they are not eligible for Medicare , Medicaid , the Children's Health Insurance Program , or other forms of public assistance health coverage, and do not have access to affordable coverage (no more than 9.86% of income for

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3692-503: The government has subsidized a full-time employee's healthcare through tax deductions or other means. This is commonly known as the employer mandate . This provision was included to encourage employers to continue providing insurance once the exchanges began operating. The act includes delivery system reforms intended to constrain costs and improve quality. These include Medicare payment changes to discourage hospital-acquired conditions and readmissions , bundled payment initiatives,

3763-643: The government in a potential breach of contract with insurers who offered qualified health plans. Several insurers sued the government at the United States Court of Federal Claims to recover the funds believed owed to them under the Risk Corridors program. While several were summarily closed, in the case of Moda Health v the United States , Moda Health won a $ 214-million judgment in February 2017. Federal Claims judge Thomas C. Wheeler stated, "the Government made

3834-845: The groups who were not subject to the individual mandate are: The Tax Cuts and Jobs Act of 2017 , set to $ 0 the penalty for not complying with the individual mandate, starting in 2019. ACA mandated that health insurance exchanges be provided for each state. The exchanges are regulated, largely online marketplaces, administered by either federal or state governments, where individuals, families and small businesses can purchase private insurance plans. Exchanges first offered insurance for 2014. Some exchanges also provide access to Medicaid. States that set up their own exchanges have some discretion on standards and prices. For example, states approve plans for sale, and thereby influence (through negotiations) prices. They can impose additional coverage requirements—such as abortion. Alternatively, states can make

3905-406: The law's Medicaid expansion, but upheld the law as a whole. The federal health insurance exchange, HealthCare.gov , faced major technical problems at the beginning of its rollout in 2013. Polls initially found that a plurality of Americans opposed the act, although its individual provisions were generally more popular. By 2017, the law had majority support. The Tax Cuts and Jobs Act of 2017 set

3976-526: The laws previously in effect. In a news analysis piece, The New York Times wrote that "Just a few years ago, the tax deal pushed through Congress ... would have been a Republican fiscal fantasy, a sweeping bill that locks in virtually all of the Bush-era tax cuts, exempts almost all estates from taxation, and enshrines the former president's credo that dividends and capital gains should be taxed equally and gently. But times have changed, President George W. Bush

4047-661: The premium for the second lowest cost silver plan (SLCSP) is greater than the amount in this column, the amount of the premium subsidy will be such that it brings the net cost of the SCLSP down to the amount in this column. Otherwise, there will be no subsidy, and the SLCSP premium will (of course) be no more than (usually less than) the amount in this column. Note: The numbers in the table do not apply for Alaska and Hawaii. As written, ACA mandated that insurers reduce copayments and deductibles for ACA exchange enrollees earning less than 250% of

4118-426: The program financially unsustainable. If correct, this would be because too many people likely to need benefits later in life would buy the insurance, with people unlikely to need the benefits not buying because of the relatively high premiums and the fact the program was voluntary. This would result in more benefits being paid than premiums collected. On January 1, 2013, the CLASS Act was officially repealed as part of

4189-427: The resultant adverse selection , the act mandated that individuals buy insurance (or pay a monetary penalty) and that insurers cover a list of " essential health benefits ". Before and after enactment the ACA faced strong political opposition, calls for repeal and legal challenges . In National Federation of Independent Business v. Sebelius , the Supreme Court ruled that states could choose not to participate in

4260-400: The sequester and doc fix but failed to include any serious entitlement reforms, enact serious spending cuts, or stabilize the debt as a share of the economy. The president of The Peter G. Peterson Foundation said the fiscal cliff agreement "was a significant missed opportunity to put the nation on a sustainable fiscal path." The Washington Post ' s editorial board said "the bill's enactment

4331-482: The structure of Medicare, Medicaid, and the employer market were largely retained. Some regulations applied to the employer market, and the law also made delivery system changes that affected most of the health care system. All new individual major medical health insurance policies sold to individuals and families faced new requirements. The requirements took effect on January 1, 2014. They include: The individual mandate required everyone to have insurance or pay

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4402-426: The tax year 2013, some taxpayers experienced the first year-to-year income-tax rate increase since 1993, although the rate increase came about not as a result of the 2012 Act, but as a result of the expiration of the Bush tax cuts. The new rates for income, capital gains, estates, and the alternative minimum tax would be made permanent. The passage of the bill came after days of negotiations between Senate leaders and

4473-550: The vesting period were counted as revenue during the first decade but promised spending would have begun in the second decade, so the CBO's 10-year estimates included the revenue but not the spending, and (b) benefits would cost more than premiums. Timothy Carney of the Washington Examiner wrote that the Act would have encouraged revolving door behavior, calling the Act "an 'unsustainable' subsidy to companies whose former executives helped write it, and which are now hiring

4544-417: Was completely repealed as part of H.R.1865 - Further Consolidated Appropriations Act, 2020. Excise taxes totaling $ 3 billion were levied on importers and manufacturers of prescription drugs. An excise tax of 2.3% on medical devices and a 10% excise tax on indoor tanning services were applied as well. The tax was repealed in late 2019. The State Children's Health Insurance Program (CHIP) enrollment process

4615-400: Was due, roughly equally, to an expansion of Medicaid eligibility and to changes to individual insurance markets. Both received new spending, funded through a combination of new taxes and cuts to Medicare provider rates and Medicare Advantage . Several Congressional Budget Office (CBO) reports said that overall these provisions reduced the budget deficit , that repealing ACA would increase

4686-403: Was intended to encourage insurers to compete based on value and efficiency rather than by attracting healthier enrollees. Of the three risk management programs, only risk adjustment was permanent. Plans with low actuarial risk compensate plans with high actuarial risk. ACA revised and expanded Medicaid eligibility starting in 2014. All U.S. citizens and legal residents with income up to 133% of

4757-467: Was not clear how non-working spouses could enroll in the program or receive benefits due to the requirement that the beneficiary must have had sufficient earnings to be credited with income quarters under the Social Security Act . The statute says, "No taxpayer funds shall be used for payment of benefits under a CLASS Independent Benefit Plan... the term ‘taxpayer funds’ means any Federal funds from

4828-428: Was projected to be $ 641 billion in 2013, significantly below the 2012 deficit of $ 1,128 billion. The CBO's January 1, 2013 analysis of ATRA included adjustments to the Baseline scenario for 2013 of -$ 280 billion in revenues and +$ 50 billion in spending. This lowers the 2013 Baseline revenue projection from $ 2,913 to $ 2,633 billion, an increase of $ 198 billion or 8.13% versus 2012 revenues of $ 2,435 billion, while raising

4899-435: Was simplified. Beginning September 23, 2010, dependents were permitted to remain on their parents' insurance plan until their 26th birthday, including dependents who no longer lived with their parents, are not a dependent on a parent's tax return, are no longer a student, or are married. Businesses that employ fifty or more people but do not offer health insurance to their full-time employees are assessed additional tax if

4970-576: Was tasked with developing actuarially sound premiums and benefits. Many organizations, including the Congressional Budget Office, developed estimates of potential premiums and benefits: Benefits would have varied by severity of functional limitation, with the average being at least $ 50 per day. The benefit schedule could have been adjusted in future years by the Secretary. Employers would have auto-enrolled employees through payroll deduction,

5041-508: Was to be paid to a hospital and a physician group for a defined episode of care (such as a hip replacement ) rather than separate payments to individual service providers. The Medicare Shared Savings Program (MSSP) was established by section 3022 of the Affordable Care Act. It is the program by which an accountable care organization interacts with the federal government, and by which accountable care organizations can be created. It

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