Your New Health Care System

1501, 10106; HCERA 1002, 1004

3021

As Amended by Supreme Court, June 28, 2012

5605

3403, 10320
6301
6301
8002
1411
4002

President

1411

3403, 10320

8002

8002

8002

8002

CLASS
Program

8002

1411

8002

8002

3012

1323; HCERA 1204

1323; HCERA: 1204

1322

1411

1322, 10104

Government
Health Benefit
Exchanges

1322, 10104

Private
Purchasing
Council
1322

Internet
Portal
1311

1201, 1301,1302, 1311, 1312, 1313,

1321, 1323, 1334, 1411, 1413, 10104;
HCERA 1204

Small Business
Health Options
Program

Data
Collection

1311

1311

2602

1001, 10101

MEWA
Health Plans

1311

X
TA

Misuse of
HSA Funds

3.8%
Investment
Income Tax

9004

HCERA 1402

9015, 10906;
HCERA 1402

9015, 10906; HCERA 1402

Medicare
Beneficiaries
3311

3004
3004
3004

Rationing Potential

Mandates

Involvement in Health
Insurance Market

Taxes & Monetary Fees/

Penalties/Cuts
Trust Fund
(Rationing Potential)
Other New Trust Funds/
Monetary Benefits

Expanded Government
Government with
Expanded Authority/
Responsibility
Government Financial
Entity with New Inflows/
Outflows
State/Territory with
Expanded Authority/
Responsibility

Private

Individuals

Regulations/
Requirements/Mandates
Reporting Requirements

Unchanged
Private Entity

Money Flows
Consultation/Advisory/
Info Sharing
Structural Connections
(Includes Existing)

Special Interest
Provisions

Oversight

10%
Tax On
Indoor Tanning
Services:

1512
9017, 10907

1311, 1411, 1501, 9003-9005, 9013,

9015, 9017, 10106, 10902, 10906, 10907;
HCERA 1002, 1004, 1402, 1403

9017,
10907
9013

Flexible Spending
Arrangement
9005, 10902; HCERA 1403

9005, 10902; HCERA 1403

New Relationships

Private Entity with

New Mandates/
Regulations/
Responsibilities

1421,
10105

Small Business
Employees

Mandates, Regulations,
& Taxes

3311

New Government

1511, 1512

Small
Business
Health Insurance
Tax Credit

FSA
Contribution
Limit: $2,500
9005, 10902;
HCERA1403

Patients

Only
Medical Expenses
Above 10% of Income
(AGI) are Tax
Deductible

9010, 10905; HCERA 1406

Medicare
Payroll Tax
Increase: 0.9%

Large Business
Employees

1501, 10106;
HCERA 1002, 1004

1304, 1311, 1421, 1512,

10105

1421, 10105

1001, 10101

Small Employers

1511, 1512, 1513, 9001, 9002,

10106, 10901; HCERA 1003, 1401

1512

9003

9002

HSA
Use Restriction

1513, 10106

Individual
Mandate:
Buy Health
Insurance

9001, 10901;
HCERA 1401

1511

1401, 1412, 10105;

HCERA 1001,
1004

1513, 10106; HCERA: 1003

1512
1512

3311

3004

Health Insurance
Policy Holder

1301

Mandates, Regulations,
& Taxes

1501

3004
3004
3004
3004
3004

1511

3311

1511

3311

3007

Cadillac
Plans Tax

1001, 10101

HCERA 1402

3301; HCERA 1101

2701

3301; HCERA
1101

Employers

9003, 9004

1001, 10101

Self-Insured
Health Plans

9001, 10901; HCERA 1401

9001, 10901; HCERA 1401

1411

3004, 3005

Medicare
Prescription Drug
and MA-PD
Complaint System

Subsidy:
Medicare Part D
Drug Program
Donut Hole

Premium
Tax Credit
Subsidies

1304, 1511, 1512, 1513,

1514, 10106

Health Savings
Accounts

Excessive
Profits

9002

1511

9004

Hospital
Quality
Reporting
Program

Medicaid
Quality
Measurement
Program

1402, 1412;
HCERA
1001

9003

3311

3201, 10318; HCERA

1102; CBO Cost
Estimate,
3/20/10

2701

Subsidies:
Out-of-Pocket
Expenses

W2
Health
Insurance
Disclosure

1513, 10106;
HCERA 1003

Large Employers

1201, 1301, 1511

1001, 1201, 1252, 1301, 1334, 1341,

3311, 9001, 9010, 10101, 10104, 10901,
10905; HCERA 1401, 1406

1001, 10101

3007

3007

Medicare
Advantage
Cuts: $205.9bn

9010, 10905;
HCERA 1406

1401, 1412, 10105; HCERA 1001, 1004

3002, 10327, 10331

3002, 10327, 10331

3201, 10318; HCERA 1102

Title III, 2602

2701

2701

3002, 10327,
10331

Physician
Value-Based
Payment
Modifier

Title III;
CBO Cost Estimate,
3/20/10

Annual Fee

2701

Physician
Quality
Reporting
System

(includes MA cuts)

9010, 10905; HCERA 1406

2701

3004

3005

3004

Long-Term
Care Hospitals

3005

1311, 3002, 3003, 10327, 10331

3005

3005

Physicians

Inpatient
Rehabilitation
Facilities

Title III

Medicare
Cuts: $528.9bn

1511

Large Group
Market

Mandates, Regulations,
Required Benefits, &
Taxes

3311

2701

StateSpecific Adult
Health Quality
Measures

Employer
Mandate:
Provide Health
Insurance

Mandatory
Worker AutoEnrollment

1301, 1304, 1342

Health Insurance
Companies

Medicare
Part C & Part D
Insurers

2701

PPS-Exempt
Cancer Hospitals

3004

Medicare

Hospital
Compare
Website
3001

2602, 2701, 2703,

3011

2001-2004
CBO Cost Estimate,
3/20/10

2701

Hospice
Programs

3007

2602

3001, 10335

3004, 3005

3311

1311

3022, 10307

3001

Hospital
Value-Based
Purchasing
Program

Medicare
Administrative
Contractors

1311, 3001-3006, 3311, 9008, 9009,

10327, 10331, 10335, 10904; HCERA
1404, 1405

Public Data
Disclosure
System
3006,
10301

3022, 10307

3006

3001, 10335

3006, 10301

1201, 1301

1311, 3001, 10335

3001, 10335

Medicaid
Expansion:
+16 million

1514, 10106

Hospitals

Mandates, Regulations,
Taxes, & Payment Cuts

Demonstration Program
3001

3001, 10335

1201, 1301, 1304

1514, 10106

1402, 1412; HCERA 1001

Health Industry

State
Medicaid
Agencies

1342

3006, 10301

2703

Small Group
Market

1201, 1301, 1304, 1342

2703

3006, 10301

Medical Device
Manufacturers

? ?
?
?
?
?
Title II; 1413, 3011

FFS
Accountable
Care
Organizations
Program

2703

1341, 10104

3006, 10301

2001-2004

NonHospital
Value-Based
Purchasing
Program

3006, 10310

Medicaid/
CHIP

17

1301, 6605

1201, 1301, 1304

Medicaid
Health Home
Program

2602

Individual Market

6605

1334, 10104

3021, 10305,
10306

3013, 3021, 3026,

3403, 10305, 10306,
10320

3021

2602

2703

3006, 10301

Skilled Nursing
Facilities

CMS

3026

3022, 10307

9009, 10904

9008; HCERA 1404

9009, 10904; HCERA 1405

Ambulatory
Surgical Centers

Center
for Medicare
& Medicaid
Innovation

2602
1311, 1413

3403

1001, 1101,
1201, 1251,
10101,
10103;
HCERA
2301

1001, 10101

Medical
Device
Excise Tax

3011

5 2 0 3 , 52 0 4 , 5 20 5 ,
5311

1331, 3403, 10104

3026

3403, 10320

CommunityBased Care
Transitions
Program

2602

2703

3021, 10305, 10306

9015, 10906; HCERA 1402

Loan
Repayment
& Forgiveness
Programs

Federal
Coordinated
Health Care
Office

CMS
Actuary

3026

3026, 6301

1342

3013

Insurance
Mandates

9001, 10901; HCERA 1401

1334, 10104

1513, 10106

Risk
Corridors

1342

3026

Medicare
Part B Trust
Fund

3403, 10320

Health
Insurance
CO-OP

1322

1421, 10105

CO-OP
Advisory
Board

1322, 10104

1341, 10104

1313, 10104

1313, 10104

1313, 10104

US
Territories

1323; HCERA: 1204

1501, 10106; HCERA 1002, 1004

1321

9004, 9005; HCERA 1402

1341, 10104

1341, 10104

1311, 10104

1311, 10104

1313, 8002,
10104

3001

1401, 10105

1311, 10104

1331, 10104

1411

1411

1342

3403, 10320

Represents Bundles of
Additional Entities

1331, 10104

1001

Eligibility
Determinations

1411

HHS
Inspector
General

1411

IPAB
Consumer
Advisory
Council

Other Expansions

1341, 10104

1411

3026

3403, 10320

Reinsurance
Program

1301, 10104

Privacy
Study

1561

4302

1333, 10104
1333, 10104

1301, 1302,
1311, 10104

1301

Health
IT Policy
Committee

1561

1311, 10104

1001

3026, 3403,
6301,9015

3011

3013

1001

Health
Care Choice
Compacts

NAIC
1333, 1341,
10104

Qualified
Health
Plans

1411

8002

3013, 10304

Value-Based
Insurance Design
& Coverage of
Preventive Health
Services

1001

4302

3011

3403

Medicare
Part A Trust
Fund

9001, 10901; HCERA 1401

1333, 10104

Gold

1311

3011, 3012

National
Health Disparities
Data Collection &
Reporting
System

National
Health Strategy
& Priorities
Office

1201, 1301, 1302

1001

3011

3011

3013

Public
Health Quality &
Efficiency Measures
Development
Program

Health
Care Quality
Website

10407

States

Platinum

1401, 3001, 3403, 6301,

10105, 10320

Vital
Statistics
Agencies

6703

1311,1331,
1333,1341, 10104,
10407

1001

Health & Human

Services

3011
4302

1331, 10104

6703

6703

1411

4004

4002

3011

3011, 4002, 4302

Silver

1341, 10104

1331, 10104

1331, 10104

4305

US
Preventive
Services
Task Force

Secretary

Website
Transparency
in Government
1552

Public
Health
Service

4001

3011

9008; HCERA 1404

Prevention
Website
4004

1001,1201, 1301,
1302

Bronze

State
Surveyors

1201, 1301, 1302

4001

3011

Advisory
Group on
Prevention, Health
Promotion, and
Integrative and
Public Health

4305

3403, 10320

9008; HCERA
1404

3012

1331, 10104

Essential
Health Benefits
Package

1311

Surgeon
General

Optional
Basic Health
Program

1331, 10104

1311, 10104

3012, 3013, 6031

22

GAO

1302

AHRQ

10407

4001

4305

6301

6301

Interagency
Pain Research
Coordinating
Committee

1001, 10101

Annual Fee

26

6703

6703

4001

4001

9008; HCERA 1404

6703

6703

6301

Prevention
& Public
Health Fund

1 4 1 2 , 35 0 9 , 5 10 1 ,
10104, 10221,
10334, 10413,
10501

4001

Rules for
Insurance
Claims Appeals

Pharmaceutical
Companies

1 2 0 1 , 27 0 4 , 2 70 5 , 2 7 06 ,
2707, 3023, 3024, 3113,
3140, 4204, 4206, 5304,
5509, 6112, 6114,
10212, 10221,
10315, 10323,
10326, 10504,
10607

4004

4002

1 1 0 4 , 61 0 2 , 6 10 3

9009, 10904;
HCERA 1405

10407

4001

National
Prevention,
Health Promotion,
& Public Health
Council

4002

Other New
Regulatory
Programs

3006

National
Diabetes Mortality
Statistics Education
Training Program

1001, 4003, 4004,

4102, 10407

1302

Labor
Department

Home
Health Agencies

CDC

Other New
Bureaucracies

1001, 1302, 1311, 1511, 1512,

1513, 6605, 10101, 10106

9009, 10904;
HCERA
1405

National
Training Institute
for Federal and
State Surveyors
6703

1313, 1322

2602

2602

6301

3012

Hours of Service
Determination
for Calculating
Employer Mandate
Penalty

Other New
Demonstration
& Pilot Programs

Comptroller
General

MedPAC

10407

Elder
Justice
Coordinating
Council

Elder Abuse,
Neglect, &
Exploitation
Forensic Centers
6703

10407

4004

4102

4305, 6301,
10409

MultiDisciplinary
Panels on
Improving LongTerm Care
6703

6703

Advisory
Board on Elder
Abuse, Neglect,
& Exploitation
6703

3311

3013

6301

IPAB

National
Diabetes
Report Card
Program
10407

6703

6301

3012

Black Lung
Benefits Act

1513, 10106

4003

10409

6301

PCORI
Expert
Advisory
Panels

6301

1556

1331, 10104

6301

6703

PCORI
Trust Fund

3012

NIH

6301

6703

Interagency
Working Group
on Health Care
Quality

National
Partnership on
Prevention &
Health
Promotion

4004

1334, 10104

Justice
Department

1312

4102

4004

6301, 10602

10409

10409

PCORI
Methodology
Committee

4004

PCORI

1334, 10104

4004

Cures
Acceleration
Network

6301

1312

1331, 10104

4004

6301

3012

Office of
Multi-State
Qualified
Health Plans

8002

PCORI Board
of Governors

6301

19

1 1 0 2 , 1 20 1, 2 0 0 6,3 1 3 7 , 3 20 1 , 3 3 0 1 ,
6 0 0 1 , 9 0 0 1 , 9 0 1 0 , 9 0 14 , 9 0 2 3 , 1 0 2 0 1 ,
1 0 3 1 7 , 1 0 3 2 3, 1 0 3 2 4, 1 0 5 0 2 , 1 0 6 0 1 ,
1 09 0 1 , 1 0 90 5 ; HCERA
1 1 0 1 , 1 10 3 ,
1106, 1203, 1406

1333, 10104

National Oral
Health Public
Education
Campaign

4003

5605

Congress
1312, 1411, 3311, 5605, 8002

5605

6703

National
Public Education
Campaign on
Prevention & Health
Promotion

BENEFICIARIES:
Mut ual of Omaha (NE);
Drug Cos; NJ Drug Cos;
AARP; Libby Mont anans;
Physician-Owned Hospit als;
Univ. of CT; Medigap Plans;
Longshoreman Healt h Plans;
Medicaid: HI, LA, MA, TN, VT;
Medicare: CT, FL, MI, MT, ND

8002

8002

Community
Preventive
Services Task
Force

5605

Office
of Tax
Analysis

CLASS
Independence
Benefit Plan
8002

Cures
Acceleration
Network
Review Board
10409

PCORI
Website

6301

6301

1311, 1331, 4002,

8002, 10104

8002

8002

6301

Personal
Care Attendants
Workforce
Advisory Panel
8002

1513, 10106; HCERA 1003

1401, 1402, 1411, 1412 1414,

1421, 1501, 9004, 9005,9006
10105, 10901; HCERA
1401, 1402

Congress
Members
& Personal Staff
Mandate:
Only Exchange
Coverage

Special
Interest
Provisions

9002

CLASS
Independence
Fund Board of
Trustees

8002

Treasury
Department

Commission
on Key
Indicators

Key
National
Indicator System
Implementation
Institute

5605

3103, 10320

3403, 10320

8002

Office of
Personnel
Management

10323, 10333,
1 0 4 0 8 -1 0 , 1 0 4 1 3 ,
10501, 10503

8002

8002

Social
Security
Administration

59

1 0 0 2 , 10 0 3 , 1 31 1 , 1 3 22 ,
1 5 6 1 , 2 9 5 2 , 2 9 5 3 , 3 5 0 1 -6 ,
3508, 4101, 4108, 4201,
4202, 4304, 5102 , 5206,
5 2 0 8 , 5 3 0 1 -5 3 0 3 , 5 3 0 5 ,
5306, 5309 , 5313,
5 3 1 5 , 5 4 0 5 , 5 5 0 7 -8 ,
5604, 6703,
10301

8002

8002

CLASS
Independence
Fund

IRS

Other New
Grant Programs

5605

8002

State
Protection &
Advocacy
Systems

Eligibility
Assessment
System

CLASS
Independence
Advisory
Council

Life
Independence
Accounts

3012, 3024, 3403, 4001,

8002, 10320

1334, 10104

National Academy
of Sciences

1414
1411

1312

Homeland
Security
Department

5605

5605
5605

8002

9013

1401, 1412, 10105; HCERA 1001, 1004

AGI: Adjusted Gross Income

AHRQ: Agency for Healthcare Research and Quality
CDC: Centers for Disease Control & Prevention
CHIP: Childrens Health Insurance Program
CLASS: Community Living Assistance Services & Supports
CMS: Centers for Medicare & Medicaid Services
CO-OP: Consumer Operated & Oriented Program
FFS: Fee-for-Service
FSA: Flexible Spending Arrangement
GAO: Government Accountability Office
HCERA: Health Care & Education Reconciliation Act
HHS: Health & Human Services Department

HSA: Health Savings Account

IPAB: Independent Payment Advisory Board
IRS: Internal Revenue Service
MA-PD: Medicare Advantage Prescription Drug
MedPAC: Medicare Payment Advisory Commission
MERD: Medical Early Risk Detection
EALORS: Executive Auxiliary Linked Office Regional Systems
MEWA: Multiple Employer Welfare Arrangement
NAIC: National Association of Insurance Commissioners
NIH: National Institutes of Health
PCORI: Patient-Centered Outcomes Research Institute
PPS: Prospective Payment System

1402, 1412; HCERA 1001

Patient Protection & Affordable Care Act, P.L. 111-148;

Health Care & Education Reconciliation Act, P.L. 111-152

Prepared by: Joint Economic Committee, Republican Staff

Congressman Kevin Brady, Senior House Republican
Senator Sam Brownback, Ranking Member