Appropriations and Fund Transfers in the
Affordable Care Act (ACA)
C. Stephen Redhead
Specialist in Health Policy
August 1, 2014
Congressional Research Service
7-5700
www.crs.gov
R41301

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Appropriations and Fund Transfers in the Affordable Care Act (ACA)

Summary
Implementation of the Patient Protection and Affordable Care Act (Affordable Care Act, or ACA)
is having a significant impact on federal mandatory—also known as direct—spending. Most of
the projected spending under the law is for expanding health insurance coverage. This spending
includes premium tax credits and other subsidies for individuals and families that purchase
private insurance coverage through the health insurance exchanges established under the ACA, as
well as enhanced federal funding to expand state Medicaid programs and tax credits for small
employers.
In addition, the ACA included numerous appropriations that are providing billions of dollars in
mandatory funds to support new and existing grant programs and other activities. Other ACA
provisions require the Secretary of Health and Human Services (HHS) to transfer amounts from
the Medicare Part A and Part B trust funds for specified purposes. The law appropriated
significant amounts to support short-term health care programs for targeted groups prior to the
health insurance exchanges becoming operational in 2014. It also created a Center for Medicare
and Medicaid Innovation (CMMI) within the Centers for Medicare and Medicaid Services (CMS)
and appropriated $10 billion for the FY2011-FY2019 period—and $10 billion for each
subsequent 10-year period—for CMMI to test and implement innovative payment and service
delivery models.
The ACA established four special funds and appropriated substantial amounts to each one. First,
the Community Health Center Fund, to which the ACA appropriated a total of $11 billion in
annual appropriations over the five-year period FY2011-FY2015, is helping support the federal
health centers program and the National Health Service Corps. Second, the Prevention and Public
Health Fund, for which the ACA provided a permanent annual appropriation, is intended to
support prevention, wellness, and other public health-related programs authorized under the
Public Health Service Act. Third, the Patient-Centered Outcomes Research Trust Fund is
supporting comparative effectiveness research through FY2019 with a mix of annual
appropriations, fees assessed on private health insurance, and Medicare trust fund transfers.
Finally, the Health Insurance Reform Implementation Fund, to which the ACA appropriated $1
billion, is helping cover the administrative costs of implementing the law. Overall, the ACA
included more than $100 billion in appropriations over the 10-year period FY2010-FY2019,
including $40 billion to provide funding for the State Children’s Health Insurance Program for
FY2014 and FY2015.
Federal outlays on insurance expansion coverage under the ACA, which constitutes most of the
law’s mandatory spending, are almost entirely exempt from sequestration. However, the
mandatory appropriations in the ACA are, in general, fully sequestrable at the percentage rate
applicable to nonexempt nondefense mandatory spending.
Besides the mandatory appropriations discussed in this report, the ACA also is having an effect on
federal discretionary spending, which is controlled by the annual appropriations acts. A
companion report, CRS Report R41390, Discretionary Spending Under the Affordable Care Act
(ACA), discusses the law’s impact on discretionary spending.

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Appropriations and Fund Transfers in the Affordable Care Act (ACA)

Contents
Introduction ...................................................................................................................................... 1
ACA Appropriations and Fund Transfers ........................................................................................ 2
Appropriations Vary by Duration and Amount .......................................................................... 2
Numerous Programs Have Received ACA Funding .................................................................. 3
Congress Has Extended and Rescinded Some ACA Funding ................................................... 4
Impact of Sequestration on ACA Mandatory Spending ................................................................... 5

Tables
Table 1. Mandatory Appropriations and Medicare Trust Fund Transfers in the Affordable
Care Act ........................................................................................................................................ 7
Table 2. ACA Appropriations and Fund Transfers by Fiscal Year in Which Funds Are
Available for Obligation ............................................................................................................. 19

Appendixes
Appendix A. Acronyms Used in the Report................................................................................... 25
Appendix B. Annual Spending Reductions Under the Budget Control Act .................................. 26

Contacts
Author Contact Information........................................................................................................... 27
Acknowledgments ......................................................................................................................... 27

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Appropriations and Fund Transfers in the Affordable Care Act (ACA)

Introduction
Implementation of the Patient Protection and Affordable Care Act (Affordable Care Act, or
ACA)1 is having a significant impact on federal mandatory—also known as direct—spending.2
Most of the projected spending under the law is for expanding health insurance coverage. This
spending includes premium tax credits and other subsidies for individuals and families that
purchase private insurance coverage through the health insurance exchanges established under the
ACA, as well as enhanced federal funding to expand state Medicaid programs and tax credits for
small employers.3
The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) estimate
that the gross costs for insurance coverage expansion will total $1,839 billion over the 10-year
period FY2015-FY2024. CBO and the JCT project that those costs will be offset by revenues
from the ACA’s new taxes and fees, and by savings from the law’s changes to the Medicare
program that are designed to slow the rate of growth of Medicare payments to certain health care
providers.4
The ACA also included numerous appropriations that are providing billions of dollars in
mandatory funds to support new and existing grant programs and other activities. Several other
provisions in the law require the Secretary of Health and Human Services (HHS) to transfer
amounts from the Medicare Part A and Part B trust funds for specified purposes.
This report summarizes all the mandatory appropriations and Medicare trust fund transfers in the
ACA and provides details on the status of obligation of these funds. The information is presented
in two tables. The report also includes a brief discussion of the impact that sequestration is having
on ACA mandatory spending. This report is periodically revised and updated to reflect important
legislative and other developments.
Besides its impact on mandatory spending, the ACA also is having an effect on federal
discretionary spending, which is controlled by the annual appropriations acts. Discretionary
spending under the ACA falls into two broad categories. First, there are the amounts provided in

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), which
amended numerous health care and revenue provisions in the ACA and added multiple new stand-alone provisions.
Congress and the President have since enacted several other bills that have made targeted changes to specific ACA
provisions. All references to the ACA in this report refer collectively to the law as amended and to other related
HCERA provisions.
2 Mandatory, or direct, spending generally refers to outlays from budget authority (i.e., the authority to incur financial
obligations that result in government expenditures such as paying salaries, purchasing services, or awarding grants) that
is provided in authorizing laws, as opposed to annual appropriations acts. Mandatory spending includes spending on
entitlement programs (e.g., Medicare, Social Security).
3 While a detailed examination of the ACA is beyond the scope of this report, numerous CRS products that provide
more in-depth information on the many new programs and activities authorized and funded by the law are available at
http://www.crs.loc.gov (see under “Issues Before Congress: Health”).
4 CBO, Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014,
http://www.cbo.gov/sites/default/files/cbofiles/attachments/45231-ACA_Estimates.pdf. For more information on the
ACA’s projected impact on federal direct spending and revenues, see CRS Report R42051, Budget Control Act:
Potential Impact of Sequestration on Health Reform Spending, by C. Stephen Redhead.
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appropriations acts for specific grant and other programs pursuant to explicit authorizations of
appropriations in the ACA. Second, there are the costs incurred by federal agencies to administer
and enforce the health insurance reforms and other core requirements of the law. A companion
CRS report discusses the ACA’s impact on discretionary spending.5
ACA Appropriations and Fund Transfers
Table 1 summarizes all the ACA provisions that include an appropriation of funds or a transfer of
amounts from the Medicare trust funds. The provisions are grouped under the following headings:
(1) Private Health Insurance; (2) Medicaid and the State Children’s Health Insurance Program
(CHIP); (3) Medicare; (4) Fraud and Abuse; (5) Health Centers; (6) Health Workforce and the
National Health Service Corps; (7) Community-Based Prevention and Wellness; (8) Maternal and
Child Health; (9) Long-Term Care; (10) Comparative Effectiveness Research; (11) Biomedical
Research; and (12) ACA Implementation: Administrative Expenses.
Each table row gives information on a specific ACA provision, organized across four columns.
The first column shows the ACA section or subsection number. The second column indicates
whether the provision is freestanding (i.e., new statutory authority that is not amending an
existing statute) or amendatory (i.e., amends an existing statute, typically the Social Security
Act). Amendatory provisions either add a new program to the statute or modify an existing one.
The third column gives a brief description of the program or activity, including details of the
appropriation or fund transfer. The entry also includes the name of the administering agency
within HHS and, if applicable, the Catalog of Federal Domestic Assistance (CFDA) number for
the grant program.6 The fourth column shows the amount of obligations to date, based on
information in the HHS Tracking Accountability in Government Grants System (TAGGS), unless
specified otherwise. The TAGGS database is a central repository for grants awarded by all the
HHS operating divisions (agencies) and several offices within the Office of the Secretary. It is
updated daily with new data provided by these entities.7
Appropriations Vary by Duration and Amount
In many instances the ACA provided annual appropriations of specified amounts for one or more
fiscal years. These funds must be obligated during the fiscal year in which the funds become
available for obligation. A few provisions are multiple-year appropriations, in which the amount
appropriated is available for obligation for a period of time in excess of one fiscal year (e.g., for
the period FY2011 through FY2014). Often the provision includes additional language stating
that the funds are to remain available “until expended” or “without fiscal year limitation.”
Most ACA appropriations and fund transfers are for a limited time period. Some programs
received a single annual appropriation, often with the stipulation that the funds remain available

5 CRS Report R41390, Discretionary Spending Under the Affordable Care Act (ACA), coordinated by C. Stephen
Redhead.
6 CFDA is a government-wide compendium of federal grant and other assistance programs. Each program is assigned a
unique five-digit number, XX.XXX, where the first two digits represent the funding agency and the second three digits
represent the program. Programs funded by the Department of Health and Human Services begin with the number 93.
For more information, see https://www.cfda.gov.
7 To access and search the TAGGS database, go to http://www.taggs.hhs.gov/.
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until expended. Others were provided funding through FY2014 or FY2015, or in some cases
through FY2019. The ACA included four provisions (i.e., Sections 3021(a), 3403, 10323(b), and
4002) that continue to provide annual or multiple-year appropriations beyond FY2019 in
perpetuity.
The ACA also included three indefinite appropriations that provide an unspecified amount of
funding as indicated by the phrase “such sums as may be necessary,” or SSAN. One such
provision (i.e., Section 1311) appropriated SSAN and authorized the HHS Secretary to determine
the specific amount necessary for the grant program.8
Table 2 provides additional details on each of the appropriations (and fund transfers) summarized
in Table 1. It shows the amount available for obligation in each fiscal year (or multi-year period)
over the 10-year period FY2010 through FY2019. Note that the provisions are organized and
grouped under the same headings used in Table 1. The final column in Table 2 (“Total”) shows
for each provision the total amount of appropriations or fund transfers. Note that in several cases
the total amount has yet to be determined (see table entries for Sections 1311, 3403, 6301(d) &
(e), 9023(e), and 10323(a)). For three of the provisions that continue to provide funding beyond
FY2019, the amount in the total column represents the cumulative amount appropriated through
FY2019 (see table entries for Sections 3021(a), 4002, and 10323(b)). Unless otherwise stated,
references to the Secretary in both tables refer to the HHS Secretary. A list of the federal laws and
agencies referred to in this report by their acronym is provided in Appendix A.
Numerous Programs Have Received ACA Funding
As summarized in the tables, the ACA funded a broad range of new and existing programs. The
law appropriated significant amounts to support the following short-term health care programs for
targeted groups prior to the health insurance exchanges becoming operational in 2014: (1) $5
billion for the Pre-Existing Condition Insurance Plan (PCIP), a temporary insurance program to
provide health insurance coverage for uninsured individuals with a pre-existing condition; (2) $5
billion for a temporary reinsurance program to reimburse employers for a portion of the costs of
providing health benefits to early retirees aged 55-64; and (3) $6 billion for the Consumer
Operated and Oriented Plan (CO-OP) program, to support temporary health insurance
cooperatives. The ACA appropriated $2.4 billion for maternal and child health programs and
provided an unspecified amount of funding for state grants to plan and establish health insurance
exchanges.9
The law established the Center for Medicare and Medicaid Innovation (CMMI) within the
Centers for Medicare and Medicaid Services (CMS) and appropriated $10 billion for the FY2011-
FY2019 period—and $10 billion for each subsequent 10-year period—for CMMI to test and
implement innovative payment and service delivery models. It also established and funded an
Independent Payment Advisory Board (IPAB) to make recommendations to Congress for
achieving specific Medicare spending reductions if costs exceed a target growth rate. IPAB’s

8 The two other indefinite appropriations (i.e., Sections 5508(c), and 9023(e)) provide SSAN to carry out a program,
but in each case there is an upper limit on the amount that may be appropriated. Note that a fourth provision (i.e.,
Section 10323(a)) requires the HHS Secretary to transfer SSAN from the Medicare trust funds to carry out a pilot
program.
9 For a state-by-state breakdown of ACA exchange planning and establishment grants, see CRS Report R43066,
Federal Funding for Health Insurance Exchanges, by Annie L. Mach and C. Stephen Redhead.
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recommendations are to take effect unless Congress overrides them, in which case Congress
would be responsible for achieving the same level of savings.
The ACA created four special funds and appropriated substantial amounts to each one:
• The Community Health Center Fund (CHCF), to which the ACA appropriated
a total of $11 billion in annual appropriations over the five-year period FY2011-
FY2015), is helping support the federal health centers program and the National
Health Service Corps (NHSC). [Note: A separate ACA appropriation provided
$1.5 billion for health center construction and renovation.] While CHCF funding
may have been intended to supplement annual discretionary appropriations for
the health centers program and the NHSC, the funds have partially supplanted
(i.e., replaced) discretionary health center funding and have become the sole
source of funding for the NHSC program, which received no discretionary funds
in FY2012, FY2013, or FY2014.10
• The Prevention and Public Health Fund (PPHF), for which the ACA provided
a permanent annual appropriation, is intended to support prevention, wellness,
and other public health-related programs and activities authorized under the
Public Health Service Act (PHSA).11 PPHF funds have been used to support
several new discretionary grant programs authorized by the ACA. The funds are
also supplementing, and in some cases supplanting, annual discretionary
appropriations for a number of established programs, including ones that were
reauthorized by the ACA. In FY2013, almost half of the PPHF funds were used
to help pay for CMS’s administrative costs associated with exchange
operations.12
• The Patient-Centered Outcomes Research Trust Fund (PCORTF) is
supporting comparative effectiveness research with a mix of annual
appropriations—some of which are offset by revenues from a fee imposed on
private health plans—and transfers from the Medicare Part A and Part B trust
funds through FY2019.
• The Health Insurance Reform Implementation Fund (HIRIF), to which the
ACA appropriated $1 billion, is helping cover the administrative costs of
implementing the law.
Overall, the law included more than $100 billion in direct appropriations over the 10-year period
FY2010-FY2019, including $40 billion to provide CHIP funding for FY2014 and FY2015.
Congress Has Extended and Rescinded Some ACA Funding
As already noted, most of the ACA funding is for a limited period of time. Three laws enacted
since 2012 have extended funding for some programs whose ACA funding was (or is) about to

10 For more information, see CRS Report R42433, Federal Health Centers, by Elayne J. Heisler; and CRS Report
R41390, Discretionary Spending Under the Affordable Care Act (ACA), coordinated by C. Stephen Redhead.
11 Section 3205 of the Middle Class Tax Relief and Job Creation Act of 2012 (P.L. 112-96, 126 Stat. 156) reduced the
ACA’s annual appropriations to the PPHF over the period FY2013-FY2021 by a total of $6.25 billion. See Table 1.
12 For more information, see CRS Report R41390, Discretionary Spending Under the Affordable Care Act (ACA),
coordinated by C. Stephen Redhead.
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lapse. Those laws are the American Taxpayer Relief Act of 2012 (ATRA),13 the Pathway for SGR
Reform Act of 2013 (PSGRRA),14 and the Protecting Access to Medicare Act of 2014 (PAMA).15
Lawmakers opposed to specific ACA provisions have also succeeded in getting some ACA
funding rescinded. ATRA, the Middle Class Tax Relief and Job Creation Act of 2012, and enacted
appropriations acts for each of the past four fiscal years (i.e., FY2011, FY2012, FY2013, and
FY2014) have all included ACA funding rescissions.16
All the ACA funding extensions and rescissions are summarized in the tables.
Impact of Sequestration on ACA Mandatory
Spending
Federal outlays on insurance expansion coverage under the ACA, which constitute most of the
mandatory spending under the ACA, are almost entirely exempt from the annual sequestration
triggered by the Budget Control Act of 2011 (BCA).17 However, the mandatory appropriations in
the ACA are, in general, fully sequestrable at the percentage rate applicable to nonexempt
nondefense mandatory spending. For more background on the BCA’s annual spending reductions,
see Appendix B.
The FY2013 sequestration order reduced spending on nonexempt nondefense mandatory
programs by 5.1%. [Note: This percentage reflects adjustments made by ATRA, which reduced
the overall dollar amount that needed to be cut from FY2013 defense and nondefense spending.]
The FY2014 sequestration order reduced spending on nonexempt nondefense mandatory
programs by 7.2%. Finally, the FY2015 sequestration order, issued on March 10, 2014, will
reduce spending on nonexempt nondefense mandatory programs by 7.3%.
For technical reasons, OMB concluded that cuts in CHCF funding for community health centers
and migrant health centers are capped at 2%.
Importantly, only new budget authority for nondefense programs is sequestrable in any given
fiscal year. That includes advance appropriations that first become available for obligation in that
year. Unobligated balances carried over from previous fiscal years are exempt from
sequestration.18

13 P.L. 112-240, 126 Stat. 2313.
14 P.L. 113-67, Division B, 127 Stat. 1195.
15 P.L. 113-93, 128 Stat. 1040.
16 For more information on all the legislative actions taken to amend the ACA since its enactment, including actions
taken through the annual appropriations process, see CRS Report R43289, Legislative Actions to Repeal, Defund, or
Delay the Affordable Care Act, by C. Stephen Redhead and Janet Kinzer.
17 P.L. 112-25, 125 Stat. 240.
18 The exemption for nondefense unobligated balances is provided in BBEDCA Section 255(e). It reads as follows:
“Unobligated balances of budget authority carried over from prior fiscal years, except balances in the defense category,
shall be exempt from reduction under any order issued under this part.” 2 U.S.C. § 905(e).
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The exemption for unobligated balances carried over from prior fiscal years applies to a number
of ACA appropriations. As already mentioned, the appropriations provision often specifies that
the funds are to remain available “until expended” or “without fiscal year limitation.” One
example is the PCIP program to provide temporary health insurance coverage for eligible
individuals who have been uninsured for six months and have a pre-existing condition. The ACA
appropriated $5 billion in FY2010, to remain available without fiscal year limitation, to pay
claims against the PCIP that are in excess of the premiums collected from enrollees. Unobligated
PCIP funds carried over to FY2013 or FY2014 were exempt from sequestration. Another example
is CMMI, which received a $10 billion multiple-year appropriation in FY2011 to remain
available for obligation through FY2019.


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Table 1. Mandatory Appropriations and Medicare Trust Fund Transfers in the Affordable Care Act

ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
Private Health Insurance
1002
New PHSA Sec.
Consumer Assistance Program (CAP). Appropriated $30 million, to
$40 million
2793
remain available without fiscal year limitation, for CAP grants to states to
enable them (or the exchanges operating in such states) to establish, expand, Total includes original funding plus awards made using
or provide support for offices of health insurance consumer assistance, and
additional funds. See http://www.cms.gov/CCIIO/Programs-
health insurance ombudsman programs. [CMS/CCIIO; CFDA 93.519]
and-Initiatives/Consumer-Support-and-Information/
Consumer-Assistance-Program-Grants.html.
1003
New PHSA Sec.
Review of health insurance premium rates. Appropriated $250 million
$215 million
2794
for grants to states over the five-year period FY2010-FY2014 to support
programs that review annual increases in health insurance premiums. No
To date, three rounds of rate review grants have been
state may receive less than $1 million or more than $5 million in a grant
awarded. See http://www.cms.gov/CCIIO/Programs-and-
year. Unobligated funds the end of FY2014 are to remain available for grants
Initiatives/Health-Insurance-Market-Reforms/Review-of-
to states for planning and implementing ACA’s individual and group market
Insurance-Rates.html.
reforms. [CMS/CCIIO; CFDA 93.511]
1101 New
Pre-Existing Condition Insurance Plan (PCIP). Required the Secretary According to the most recent quarterly update, net PCIP
freestanding
to establish a temporary program—PCIP—to provide health insurance
outlays through September 2013 totaled $3.956 billion.
authority
coverage for eligible individuals who have been uninsured for six months and
have a pre-existing condition. Appropriated $5 billion, to remain available
More than 134,000 individuals have received coverage under
without fiscal year limitation, to pay claims against (and administrative costs
PCIP. Originally scheduled to end on January 1, 2014, the
of) the PCIP program that are in excess of premiums col ected from
program was extended through March 31, 2014. However,
enrollees. Note: Until June 2013, 27 states administered their own PCIP
the federally-run PCIP and the state-based PCIPs stopped
programs; the remaining 23 states and DC elected to have their PCIP
accepting new enrol ees on February 16, 2013, and March 2,
program federal y administered. Seventeen state-run PCIP programs then
2013, respectively, because of the limited amount of funding.
transferred administration to the federal program. [CMS/CCIIO; CFDA
See http://www.cms.gov/CCIIO/Programs-and-Initiatives/
93.529]
Insurance-Programs/Pre-Existing-Condition-Insurance-
Plan.html; and https://www.pcip.gov.
1102 New
Early Retiree Reinsurance Program (ERRP). Required the Secretary
According to the most recent program update, ERRP outlays
freestanding
to establish a temporary ERRP to provide reimbursement to participating
through February 2012 totaled $4.725 billion.
authority
employer-based plans for a portion of the cost of providing health benefits
to early retirees age 55-64 and their families. Appropriated $5 billion, to
ERRP has provided payments to more than 2,800 employers
remain available without fiscal year limitation, to carry out the ERRP.
and other sponsors of retiree plans. The program ended on
[CMS/CCIIO]
January 1, 2014; however, HHS stopped accepting new ERRP
applications on May 5, 2011, because of limited funding. See
http://www.cms.gov/CCIIO/Programs-and-Initiatives/
Insurance-Programs/Early-Retiree-Reinsurance-Program.html;
and http://www.errp.gov.
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ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
1311 New
Health insurance exchange grants. Appropriated to the Secretary an
$4.755 billion
freestanding
amount necessary to award exchange planning and establishment grants to
authority
states. Instructs the Secretary each fiscal year to determine the total amount
For more information on federal funding for health insurance
to be made available. No grants may be awarded after January 1, 2015, by
exchanges, see CRS Report R43066, Federal Funding for Health
which time exchanges must be self-sustaining. [CMS/CCIIO; CFDA 93.525]
Insurance Exchanges.
1322 New
Consumer Operated and Oriented Plan (CO-OP). Required the
According to a December 13, 2013, fact sheet, the CO-OP
freestanding
Secretary to establish the CO-OP program to provide low-interest loans
program has awarded a total of $2.103 billion in loans to 23
authority
until July 1, 2013, for the creation of nonprofit member-run health insurance
nonprofits that plan to offer coverage in a total of 26 states.
issuers that offer qualified health plans in the individual and small group
markets. Appropriated $6 billion to carry out the CO-OP program. Note:
See http://www.cms.gov/CCIIO/Programs-and-Initiatives/
The FY2011 and FY2012 Labor-HHS-Education appropriations acts (P.L.
Insurance-Programs/Consumer-Operated-and-Oriented-Plan-
112-10 and P.L. 112-74, respectively) together rescinded a total of $2.6
Program.html.
billion of the original appropriation. The American Taxpayer Relief Act of
2012 (ATRA; P.L. 112-240) rescinded 90% of the program’s unobligated
balance as of January 2, 2013, and transferred the remaining unobligated
funds to a new CO-OP contingency fund to provide assistance and oversight
to CO-OP loan recipients, ending CMS’s authority to make new loans.
Overall, Congress rescinded a total of $4.879 billion, leaving $1.121 billion of
the original $6 billion CO-OP program appropriation. [CMS/CCIIO]
1323 New
Funding for territories. Appropriated $1 billion, available for the period
No public information located on funding obligations.
freestanding
FY2014-FY2019, for U.S. territories that elect to establish a health insurance
authority
exchange. Funds must be used to provide premium and cost-sharing
assistance to territory residents who obtain health insurance coverage
through the exchange.
Medicaid and State Children’s Health Insurance Program (CHIP)
2701
New SSA Sec.
Medicaid adult health quality measures. Required the Secretary to
$49 million
1139B
develop and, not later than January 1, 2012, publish an initial core set of
quality measures for Medicaid-eligible adults. Appropriated $60 mil ion for
See http://www.medicaid.gov/Medicaid-CHIP-Program-
each of FY2010-FY2014, to remain available until expended. Total amount =
Information/By-Topics/Quality-of-Care/Adult-Health-Care-
$300 million. Note: The Protecting Access to Medicare Act of 2014 (PAMA;
Quality-Measures.html.
P.L. 113-93) requires $15 million of these funds to be used for the
development of quality measures for children enrolled in Medicaid and
CHIP, pursuant to SSA Sec. 1139A. [CMS; CFDA 93.609]
2707 New
Medicaid emergency psychiatric demonstration program.
Eleven states plus DC are participating in the demonstration,
freestanding
Appropriated $75 million for FY2011, to remain available for obligation
which began in July 2012. No public information located on
authority
through December 2015, for a three-year demonstration in which eligible
funding obligations.
states are required to reimburse certain institutions for mental disease
(IMDs) for services provided to Medicaid beneficiaries aged 21 through 64
See http://innovation.cms.gov/initiatives/Medicaid-Emergency-
who are in need of medical assistance to stabilize an emergency psychiatric
Psychiatric-Demo/.
condition. [CMS/CMI; CFDA 93.537]
CRS-8

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ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
2801 Amends
SSA
Medicaid and CHIP Payment and Access Commission (MACPAC).
ACA funding was obligated in FY2011 and FY2012.
Sec. 1900
Clarified and expanded MACPAC’s duties; for example, to include a review
and assessment of payment policies under Medicaid and CHIP and how
See http://www.macpac.gov/.
factors affecting expenditures and payment methodologies enable
beneficiaries to obtain services, affect provider supply, and affect providers
that serve a disproportionate share of low-income and other vulnerable
populations. Appropriated $9 million and transferred from CHIP funding an
additional $2 million for FY2010. Total amount = $11 million, to remain
available until expended.
4108 New
Medicaid Incentives for the Prevention of Chronic Diseases
$51 million
freestanding
(MIPCD). Required the Secretary to award five-year grants to states,
authority
subject to annual renewal of funding, to provide incentives for Medicaid
MIPCD grants have been awarded to 10 states. See
beneficiaries to participate in evidence-based healthy lifestyle programs to
http://www.innovations.cms.gov/initiatives/MIPCD/index.html.
prevent or help manage chronic disease. Appropriated $100 million for the
five-year period beginning January 1, 2011, to remain available until
expended. [CMS/CMI; CFDA 93.536]
4306 Amends
SSA
CHIP childhood obesity demonstration program. Appropriated $25
$24 million
Sec. 1139A(e)
mil ion for the period FY2010 through FY2014 for a program authorized by
the Children’s Health Insurance Program Reauthorization Act of 2009
Funding has been awarded to three research facilities to
(CHIPRA; P.L. 111-3), which requires the Secretary to conduct a
identify effective childhood obesity prevention strategies, and
demonstration project to develop a model for reducing childhood obesity.
to a fourth facility to evaluate the strategies and share
[CDC; CFDA 93.535]
successes. See http://www.cdc.gov/obesity/childhood/
researchproject.html.
10203(d) Amends
SSA CHIP annual appropriations, and outreach and enrollment grants.
Since 2009, CMS has awarded three cycles of outreach and
Secs. 2104 &
Appropriated funding for the CHIP program for FY2014 ($19.147 billion)
enrollment grants totaling $122 million to states, local
2113
and FY2015 ($21.061 billion); the program previously had been funded
governments, community organizations, and tribal
through FY2013. Also, extended the time period for the Connecting Kids to
organizations.
Coverage Outreach and Enrol ment grants through FY2015 and increased
the existing appropriation for such grants from $100 million to $140 million.
See http://www.insurekidsnow.gov/professionals/outreach/
[CMS; CFDA 93.767]
grantees/index.html.
CRS-9

---

ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
Medicare
3014 Amends
SSA
Medicare quality and efficiency measures. Expanded the duties of the
No public information located on funding obligations.
Sec. 1890(b).
consensus-based entity under contract with CMS pursuant to SSA Sec. 1890
New SSA Sec.
(currently the National Quality Forum). Required the entity to convene
1890A
multi-stakeholder groups to provide input on the national priorities for
health care quality improvement (developed under the ACA). In addition,
the multi-stakeholder groups are required to provide input on the selection
of quality measures for use in various specified Medicare payment systems
for hospitals and other providers, as wel as in other health care programs,
and for use in reporting performance information to the public. Established a
multi-step pre-rulemaking process and timeline for the adoption,
dissemination, and review of measures by the Secretary. Required the
Secretary to transfer from the Medicare Part A and Part B trust funds $20
mil ion for each of FY2010 through FY2014, to remain available until
expended.a Total amount = $100 million. [CMS]
3021(a)
New SSA Sec.
Center for Medicare and Medicaid Innovation (CMMI). Required the
According to CMS’s budget documents (FY2013-FY2015),
1115A
Secretary, no later than January 1, 2011, to establish the CMMI within CMS.
CMMI’s obligations are as follows: FY2011 (actual) = $95
The purpose of CMMI is to test and evaluate innovative payment and service
mil ion; FY2012 (actual) = $781 mil ion; FY2013 (actual) =
delivery models to reduce program expenditures under Medicare, Medicaid,
$953 million; FY2014 (current law) = $1.637 billion; FY2015
and CHIP while preserving or enhancing the quality of care furnished under
(estimate) = $1.522 billion.
these programs. In selecting the models, the Secretary is also required to
give preference to those that improve the coordination, quality, and
For information on CMI’s programs, which include several of
efficiency of health care services. Appropriated (1) $5 million for FY2010 for
the initiatives summarized in this table, see
the selection, testing, and evaluation of new payment and service delivery
http://www.innovations.cms.gov/.
models; and (2) $10 billion for the period FY2011 through FY2019, plus $10
billion for each subsequent 10-year period, to continue such activities and
for the expansion and nationwide implementation of successful models.
Amounts are to remain available until expended.b [CMS]
3024
New SSA Sec.
Medicare independence at home demonstration program. Required
Fourteen independent practices and three consortia are
1866E
the Secretary to conduct a three-year Medicare demonstration program,
participating in the independence at home demonstration,
beginning no later than January 1, 2012, to test a payment incentive and
administered by CMMI. No public information located on
service delivery model that uses physician- and nurse practitioner-directed
funding obligations.
primary care teams to provide home-based services to chronically ill
patients. The Secretary must submit a plan, no later than January 1, 2016, for See http://innovation.cms.gov/initiatives/Independence-at-
expanding the program if it is determined that such expansion would
Home/index.html.
improve the quality of care and reduce spending. Required the Secretary to
transfer from the Medicare Part A and Part B trust funds $5 million for each
of FY2010 through FY2015 for administering and carrying out the
demonstration, to remain available until expended.a Total amount = $30
million. [CMS]
CRS-10

---

ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
3026 New
Community-based Care Transitions Program (CCTP). Required the
There are currently 102 organizations participating in the
freestanding
Secretary to establish a five-year program, beginning January 1, 2011, to
CCTP, which is administered by CMMI as part of the
authority
provide funding to eligible hospitals and community-based organizations to
Partnership for Patients initiative. No public information
test models for improving care transitions from the hospital to other
located on funding obligations.
settings for high-risk Medicare beneficiaries. Required the Secretary to
transfer from the Medicare Part A and Part B trust funds $500 million for
See http://www.innovations.cms.gov/initiatives/CCTP/.
the period FY2011 through FY2015, to remain available until expended.a
Note: The FY2013 Labor-HHS-Education appropriations act (P.L. 113-6)
rescinded $200 million of CCTP’s transfer. [CMS]
3027(b) Amends
DRA Medicare hospital gainsharing demonstration program. CMS is
There are two hospitals participating in the gainsharing
Sec. 5007
supporting two projects that al ow hospitals to provide gainsharing payments demonstration, which is administered by CMMI. No public
to physicians that represent a share of the savings incurred as a result of
information located on funding obligations.
collaborative efforts to improve overall quality and efficiency. The ACA
appropriated $1.6 million for FY2010, to remain available through FY2014 or See http://innovation.cms.gov/initiatives/Medicare-Hospital-
until expended, for carrying out the demonstration. [CMS]
Gainsharing/.
3113 New
Diagnostic laboratory test demonstration program. Required the
Payments under the demonstration began in January 2012.
freestanding
Secretary to conduct a two-year demonstration program beginning July 1,
authority
2011, with a subsequent report to Congress, to test the impact of direct
See http://www.cms.gov/Medicare/Demonstration-Projects/
payments for certain complex laboratory tests on Medicare costs and quality DemoProjectsEvalRpts/Downloads/TCCDLT_FactSheet.pdf.
of care. Payments are to be made from the Part B trust fund and may not
exceed $100 million. Transferred $5 million from the Medicare Part B trust
fund, to remain available until expended, for carrying out the demonstration
program and preparing the subsequent report. [CMS]
3306 Amends
MIPPA
Outreach and assistance for Medicare low-income programs.
$41 million (FY2009-FY2014)
Sec. 119
Transferred a total of $45 million from the Medicare Part A and Part B trust
funds for the period FY2010 through FY2012 to extend funding for the

fol owing beneficiary outreach and education activities for Medicare low-
income programs that were funded by the Medicare Improvements for
Patients and Providers Act of 2008 (MIPPA; P.L. 110-275): (1) State Health
Insurance Counseling and Assistance Programs (SHIPs), $15 million; (2) Area
Agencies on Aging (AAAs), $15 million; (3) Aging and Disability Resource
Centers (ADRCs), $10 million; and (4) the National Center for Benefits
Outreach and Enrollment (NCBOE), $5 million. Note: ATRA (P.L. 112-240)
transferred $25 million for FY2013 for these programs: (1) SHIPs, $7.5
million; (2) AAAs, $7.5 million; (3) ADRCs, $5 million; and (4) NCBOE, $5
mil ion. The Pathway for SGR Reform Act of 2013 (PSGRRA; P.L. 113-67,
Division B) transferred $12.5 million to provide prorated funding for the
first half of FY2014. PAMA (P.L. 113-93) amended PSGRRA by transferring
$25 million for FY2014 (same as FY2013) and by transferring $12.5 million
for the first half of FY2015. Funds are to remain available until expended.c
[ACL, CMS; CFDA 93.071]
CRS-11

---

ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
3403
New SSA Sec.
Independent Payment Advisory Board (IPAB). Established an
The President has not appointed, nor has the Senate
1899A
independent, 15-member advisory board tasked with presenting Congress
approved, any IPAB members.
with comprehensive proposals to reduce excess cost growth and improve
quality of care for Medicare beneficiaries. Appropriated $15 million for
FY2012 to support the board’s activities. For each subsequent fiscal year,
appropriates the amount from the previous fiscal year adjusted for inflation.
Sixty percent of the appropriation is to be derived by transfer from the
Medicare Part A trust fund, and 40% is to be derived by transfer from the
Medicare Part B trust fund. Note: The Labor-HHS-Education appropriations
acts for FY2012, FY2013 and FY2014 (P.L. 112-74, P.L. 113-6, and P.L. 113-
76, respectively) each rescinded $10 million of IPAB’s appropriation for that
fiscal year.
4202(b) New
Medicare prevention and wellness evaluation. Transferred $50 million
No public information located on funding obligations.
freestanding
from the Medicare Part A and Part B trust funds, to remain available until
authority
expended, to fund an evaluation of community-based prevention and
wel ness programs and, based on the findings, develop a plan to promote
healthy lifestyles and chronic disease self-management among Medicare
beneficiaries.a [CMS]
4204(e) New
Medicare vaccine coverage. Appropriated $1 million for FY2010 for a
Report released in December 2011 (GAO-12-61).
freestanding
GAO report on the impact of Medicare Part D vaccine coverage on access
authority
to those vaccines among beneficiaries.
10323(a)
New SSA Sec.
Environmental health hazards. Extended Medicare eligibility to
No public information located on funding obligations.
1881A
individuals with specified health conditions linked to environmental
exposures, who have resided for specified times in an area subject to a
Superfund public health emergency declaration. Required the Secretary to
establish a pilot program, with appropriate reimbursement methodologies,
to provide comprehensive, coordinated, and cost-effective care to such
individuals. Transferred such sums as may be necessary from the Medicare
Part A and Part B trust funds to carry out the pilot program.a [CMS]
10323(b)
New SSA Sec.
Environmental health hazards. Appropriated $23 million for the period
$10 million
2009
FY2010 through FY2014, and $20 million for each five-year period
thereafter, for grants to state and local government agencies, health care
Funding provided for an asbestos health screening program in
facilities, and other entities to (1) provide screening for specified lung
Libby, Montana.
diseases and other environmental health conditions to individuals who have
resided for specified times in an area subject to a Superfund public health
emergency declaration; and (2) disseminate public information about the
availability of screening, the detection and treatment of environmental health
conditions, and the availability of Medicare benefits to certain individuals
diagnosed with such conditions, pursuant to new SSA Sec. 1881A (as added
by ACA Sec. 10323(a)). [CMS; CFDA 93.534]
CRS-12

---

ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
Fraud and Abuse
6402(i) &
Amends SSA
Health Care Fraud and Abuse Control (HCFAC) Account. Applied a No public information located on ACA funding obligations.
HCERA
Sec. 1817(k)
permanent inflation adjustment to the annual appropriation (provided under
Sec.
SSA Sec. 1817(k)) for the HCFAC account. Appropriated from the Medicare
1303(a)
Part A trust fund the fol owing supplemental amounts for the HCFAC
account: $10 million for each of FY2011 through FY2020; plus an additional
$95 million for FY2011, $55 million for FY2012, $30 million for each of
FY2013 and FY2014, and $20 million for each of FY2015 and FY2016. Total
amount = $350 million. Funds are to remain available until expended. [CMS]
Health Centers
4101(a) New
School-based health centers (SBHCs). Appropriated $50 million for
$140 million
freestanding
each of FY2010 through FY2013, to remain available until expended, for a
authority
grant program to fund the construction and renovation of school-based
See http://bphc.hrsa.gov/about/schoolbased/index.html.
health centers. Total amount = $200 million. [HRSA; CFDA 93.501]
10503(b)(1) New
Community-based health centers. Transferred from the CHCF the
According to the Budget Appendices for FY2013-FY2015, the
freestanding
fol owing amounts for health center operations, to remain available until
obligations of ACA funds for health centers are as follows:
authority
expended: FY2011 = $1 billion; FY2012 = $1.2 billion; FY2013 = $1.5 billion;
FY2011 (actual) = $998 million; FY2012 (actual) = $1.171
FY2014 = $2.2 billion; and FY2015 = $3.6 billion. Total amount = $9.5
billion; FY2013 (actual) = $1.491 billion; FY2014 (actual) =
billion. [HRSA; CFDA 93.527]
$2.145 billion; FY2015 (estimate) = $3.600 billion.
See http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf.
10503(c) New
Health center construction and renovation. Appropriated $1.5 billion,
$1.486 billion
freestanding
to be available for the period FY2011 through FY2015, and to remain
authority
available until expended, for health center construction and renovation.
[HRSA; CFDA 93.526]
Health Workforce and the National Health Service Corps
10503(b)(2) New
National Health Service Corps (NHSC). Transfers from the CHCF the
According to the Budget Appendices for FY2013-FY2015, the
freestanding
following amounts for NHSC operations, scholarships, and loan repayments,
obligations of ACA funds for the NHSC are as follows:
authority
to remain available until expended: FY2011 = $290 million; FY2012 = $295
FY2011 (actual) = $289 million; FY2012 (actual) = $297
million; FY2013 = $300 million; FY2014 = $305 million; and FY2015 = $310
mil ion; FY2013 (actual) = $286 mil ion; FY2014 (estimate) =
million. Total amount = $1.5 billion. [HRSA; CFDA 93.547]
$283 million; FY2015 (estimate) = $310 million.
CRS-13

---

ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
5507(a)
New SSA Sec.
Health workforce demonstration programs. Required the Secretary
$264 million: Health Profession Opportunity Grant (HPOG)
2008
to establish two demonstration projects. The first is to award health
profession opportunity grants to states, Indian tribes, institutions of higher
$13 million: Personal and Home Care Aide State Training
education, and local workforce investment boards to help low-income
(PHCAST) program
individuals obtain education and training in health care jobs that pay wel and
See http://www.acf.hhs.gov/programs/ofa/programs/hpog; and
are in high demand. Funds may be used to provide financial aid and other
http://bhpr.hrsa.gov/nursing/grants/phcast.html.
supportive services. The second project is to provide states with grants to
develop core training competencies and certification programs for personal
and home care aides. Appropriated $85 million for each of FY2010 through
FY2014, of which $5 million in each of FY2010 through FY2012 is to be used
for the second project. Total amount = $425 million. Note: PAMA (P.L. 113-
93) provided an additional year of funding (i.e., $85 million for FY2015).
[ACF, HRSA; CFDA 93.093, 93.512]
5507(b) Amends
SSA Family-to-family health information centers. Renewed funding for the
$11 million (FY2012-FY2014)
Sec. 501(c)
family-to-family information centers, which assist families of children with
disabilities or special health care needs and the professionals who serve
See http://mchb.hrsa.gov/programs/familytofamily/index.html.
them, by appropriating $5 million for each of FY2010 through FY2012, to
remain available until expended. Total amount = $15 million. Note: ATRA
(P.L. 112-240) appropriated $5 mil ion for FY2013; PSGRRA (P.L. 113-67,
Division B) appropriated $2.5 million for the first half of FY2014; and PAMA
(P.L. 113-93) appropriated $2.5 mil ion for the second half of FY2014 and
$2.5 million for the first half of FY2015. [HRSA; CFDA 93.504]
5508(c)
New PHSA Sec.
Teaching health centers. Appropriated such sums as may be necessary,
$99 million
340H
not to exceed $230 million, for the period FY2011 through FY2015 to make
payments for direct and indirect graduate medical education (GME) costs to
See http://bhpr.hrsa.gov/grants/teachinghealthcenters/.
qualified teaching health centers (THCs). [HRSA; CFDA 93.530]
5509 New
Medicare graduate nurse education demonstration program.
CMMI, which is administering this program, selected five
freestanding
Appropriated $50 million for each of FY2012 through FY2015, to remain
participating hospitals and has begun making reimbursement
authority
available until expended, for a Medicare demonstration program under
payments.
which up to five eligible hospitals will receive reimbursement for providing
advanced practice nurses with clinical training in primary care, preventive
See http://innovations.cms.gov/initiatives/GNE/index.html.
care, transitional care, and chronic care management. Total amount = $200
million. [CMS/CMI]
10502 New
Health care facility construction. Appropriated $100 million for
$100 million
freestanding
FY2010, to remain available for obligation until Sept. 30, 2011, for debt
authority
service on, or construction or renovation of, a hospital affiliated with a
Funding awarded to Ohio State University.
state’s sole public medical and dental school. [HRSA; CFDA 93.502]
CRS-14

---

ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
Community-Based Prevention and Wellness
4002 New
Prevention and Public Health Fund (PPHF). Established a PPHF and
PPHF funds are annual appropriations that must be obligated
freestanding
original y provided a permanent annual appropriation to the fund, as fol ows:
during the fiscal year in which they are made available. For an
authority
FY2010 = $500 million; FY2011 = $750 million; FY2012 = $1 billion; FY2013
analysis and complete list of all PPHF awards for FY2010 and
= $1.25 billion; FY2014 = $1.5 billion; FY2015 and each year thereafter = $2
FY2011, see the GAO report, Prevention and Public Health
billion. Required the Secretary to transfer amounts from the fund to HHS
Fund: Activities Funded in Fiscal Years 2010 and 2011 (GAO-12-
accounts to increase funding, over the FY2008 level, for PHSA-authorized
788), at http://www.gao.gov/assets/650/648310.pdf.
prevention, wellness, and public health activities, including prevention
research and health screenings. Provided House and Senate appropriators
For a summary of the allocation of PPHF funds for FY2012,
with the authority to transfer monies from the PPHF to eligible activities.
FY2013 and FY2014, by agency and program, see
Note: The Middle Class Tax Relief and Job Creation Act of 2012 (P.L. 112-
http://www.hhs.gov/open/recordsandreports/prevention/
96) reduced the annual appropriations to the PPHF over the period FY2013-
index.html.
FY2021 as fol ows: FY2013 through FY2017 = $1 billion; FY2018 and FY2019 The listed CFDA programs do not capture all the uses of
= $1.25 billion; FY2020 and FY2021 = $1.5 billion; FY2022 and each year
PPHF funding. PPHF funds have also been integrated into
thereafter = $2 billion. [OS, CDC, HRSA, SAMHSA, ACL; CFDA 93.507,
existing programs that do not mention PPHF.
93.521, 93.522, 93.523, 93.524, 93.531, 93.533, 93.538, 93.539, 93.540,
93.542.]
Maternal and Child Health
2951
New SSA Sec.
Maternal, infant, and early childhood home visiting program.
$1.071 billion
511
Appropriated the fol owing amounts for grants to states, U.S. territories, and
Indian tribes to develop and implement early childhood home visiting
See http://mchb.hrsa.gov/programs/homevisiting/.
programs that adhere to evidence-based models of service delivery: FY2010
= $100 million; FY2011 = $250 mil ion, FY2012 = $350 million; FY2013 =
$400 million; FY2014 = $400 mil ion. Total amount = $1.5 billion. Programs
must establish benchmarks to measure improvements for the participating
families in maternal and newborn health; prevention of child abuse or neglect
or child injuries; school readiness and achievement; reductions in crime or
domestic violence; family economic self-sufficiency; and coordination and
referrals for other community resources and supports. Note: PAMA (P.L.
113-93) appropriated $400 million for the first half of FY2015. [HRSA, ACF;
CFDA 93.505, 93.508]
CRS-15

---

ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
2953
New SSA Sec.
Personal Responsibility Education Program (PREP). Established a
$303 million
513
state formula grant program to support evidence-based PREPs designed to
educate adolescents about abstinence, contraception, and adulthood. Also,
See http://www.acf.hhs.gov/programs/fysb/programs/
required the Secretary to award grants to implement innovative youth
adolescent-pregnancy-prevention/programs/prep-competitive.
pregnancy prevention strategies and to target services at high-risk
populations. Appropriated $75 mil ion for each of FY2010 through FY2014,
of which $10 million each year is to be reserved for the youth pregnancy
prevention grants. Total amount = $375 million. Funds are to remain
available until expended. Note: PAMA (P.L. 113-93) appropriated $75 million
for FY2015. [ACF; CFDA 93.092]
2954 Amends
SSA
Abstinence education grants. Renewed funding for the state formula
$156 million (FY2010-FY2014)
Sec. 510
grant program to support abstinence education programs by appropriating
$50 million for each of FY2010 through FY2014. Total amount = $250
See http://www.acf.hhs.gov/programs/fysb/resource/aegp-fact-
million. Funds are awarded to states based on the proportion of low-income
sheet.
children in each state compared to the national total, and may only be used
for teaching abstinence. Note: PAMA (P.L. 113-93) appropriated $50 million
for FY2015. [ACF, CDC; CFDA 93.235]
10211-
New
Pregnancy assistance grants. Appropriated $25 million for each of
$89 million
10214
freestanding
FY2010 through FY2019 (total amount = $250 million) to establish a
authority
Pregnancy Assistance Fund for the purpose of awarding grants to states to
See http://www.hhs.gov/ash/oah/oah-initiatives/paf/home.html.
assist pregnant and parenting teens and women. State grantees have the
flexibility to make funds available to institutions of higher education, high
schools and community service centers, and to the state attorneys general
to improve services for pregnant women who are victims of domestic
violence, sexual assault, or stalking. [OS; CFDA 93.500]
Long-Term Care
2403 Amends
DRA
Medicaid Money Follows the Person (MFP) demonstration
$1.563 billion (FY2007-FY2014)
Sec. 6071(h)
program. Extended funding for the MFP demonstration through FY2016.
The program authorizes the Secretary to award competitive grants to states
See http://www.medicaid.gov/Medicaid-CHIP-Program-
to reduce their reliance on institutional care for people needing long-term
Information/By-Topics/Long-Term-Services-and-Supports/
care, and expand options for elderly people and individuals with disabilities
Balancing/Money-Follows-the-Person.html.
to receive home and community-based long-term care services.
Appropriated $450 million for each of FY2012 through FY2016, to remain
available through FY2016. Total amount = $2.25 billion. [CMS; CFDA
93.791]
CRS-16

---

ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
2405 New
State Aging and Disability Resource Centers (ADRCs). Appropriated $21 million (FY2010-FY2014; includes ACA mandatory +
freestanding
$10 million for each of FY2010 through FY2014 (total amount = $50 million) discretionary funds)
authority
for ADRCs, authorized under OAA Sec. 202. ADRCs serve as a single,
coordinated resource for consumer information on the range of long-term
See http://www.acl.gov/Programs/CDAP/OIP/ADRC/
care options in community and institutional settings. Some ADRCs also
index.aspx.
serve as the entry point to publicly administered long-term care programs
(e.g., Medicaid, OAA services, state assistance programs). Over 500 ADRC
sites have been established across 50 states, DC, and two territories. See
also the entry for ACA Sec. 3306, above. [ACL; CFDA 93.517]
6201 New
Background checks of long-term care providers. Required the
$57 million
freestanding
Secretary to establish a nationwide program for background checks on
authority
direct patient access employees of long-term care facilities or providers, and
to provide federal matching funds to states to conduct these activities.
Required the Treasury Secretary to transfer to HHS an amount, not to
exceed $160 million, specified by the HHS Secretary as necessary to carry
out the program for the period FY2010 through FY2012. Funds are to
remain available until expended. [CMS; CFDA 93.506]
8002(d) Amends
DRA National Clearinghouse for Long-Term Care Information.
$6 million (FY2011-FY2014)
Sec. 6021(d)
Appropriated $3 million for each of FY2011 through FY2015 for the
National Clearinghouse for Long-Term Care Information, and required the
See http://longtermcare.gov/.
Clearinghouse to include information on the Community Living Assistance
Services and Supports (CLASS) program, established under ACA Sec.
8002(a). Total amount = $15 million. Note: ATRA (P.L. 112-240) repealed
the appropriations for the National Clearinghouse and rescinded al
unobligated FY2013 funds (as of January 3, 2013), and repealed the CLASS
program. [ACL]
Comparative Effectiveness Research
6301(d)-(e)
New IRC Secs.
Patient-Centered Outcomes Research Trust Fund (PCORTF).
Details of all the PCORI research awards are available at
9511, 4375, &
Established the PCORTF to fund the new Patient-Centered Outcomes
http://www.pcori.org/.
4376. New SSA
Research Institute (PCORI) and its comparative effectiveness research
Sec. 1183
activities. Appropriated to the PCORTF $10 million for FY2010, $50 million
for FY2011, and $150 million for each of FY2012 through FY2019, for a total
of $1.26 billion over that 10-year period. For each of FY2013 through
FY2019, the PCORTF is to receive additional appropriations equal to the net
revenues from a new fee on health insurance policies and self-insured plans,d
as well as Medicare trust fund transfers.e Each fiscal year, 20% of the funds in
the PCORTF are to be transferred to the Secretary, to remain available until
expended. Of those transferred funds, 80% are to be provided to AHRQ.
[OS, AHRQ]
CRS-17

---

ACA
Statutory
Obligations as of July 22, 2014, Based on TAGGS
Section
Authority
Summary of Provision
Unless Specified Otherwise
Biomedical Research
9023
New IRC Sec.
Therapeutic research and development tax credits and grants.
According to the IRS: total grant awards = $970 million; total
48D
Created a two-year tax credit program, subject to an overall cap of $1
tax credits = $17 million.
billion, for small companies (250 or fewer employees) that invest in new
therapies to prevent, diagnose, and treat cancer and other diseases.
See http://www.irs.gov/Businesses/Small-Businesses-&-Self-
Companies could apply for one or more tax credits, each covering up to
Employed/Qualifying-Therapeutic-Discovery-Project-Credits-
50% of the cost of qualifying research investments made in 2009 and 2010.
and-Grants.
However, the total amount of tax credits any one company receives for the
two years could not exceed $5 mil ion. Companies could elect to receive
one or more grants in lieu of tax credits, subject to the same restrictions
(i.e., grants could cover up to 50% of the cost of qualifying investments made
in 2009 and 2010; the total amount of grants any one company receives for
the two years could not exceed $5 million). Appropriated such sums as may
be necessary to carry out the grant program. [IRS]
ACA Implementation: Administrative Expenses
HCERA
New
Health Insurance Reform Implementation Fund (HIRIF).
According to the FY2015 Budget, there was an unobligated
Sec. 1005
freestanding
Appropriated $1 billion to the HIRIF for federal administrative expenses to
balance of $87 million at the beginning of FY2014.
authority
carry out the ACA. [OS]
Source: Prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended.
a. Transfers from the two trust funds are in such proportion as the Secretary determines appropriate.
b. Of the amounts appropriated for the period FY2011-FY2019, and for each subsequent 10-year period, at least $25 million must be made available each fiscal year for
the selection, testing, and evaluation of new payment and service delivery models.
c. Transfers from the two trust funds are in the same proportion as the Secretary determines under SSA Sec. 1853(f).
d. The health insurance fee is to equal $2 multiplied by the average number of covered lives in a policy/plan year ($1 in the case of a policy/plan year ending during
FY2013), updated annual y by the rate of medical inflation beginning in FY2015.
e. The trust fund transfers are to equal $2 ($1 in FY2013) multiplied by the average number of individuals entitled to benefits under Part A or enrolled under Part B in a
given fiscal year, updated annual y by the rate of medical inflation beginning in FY2015.


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Table 2. ACA Appropriations and Fund Transfers by Fiscal Year in Which Funds Are Available for Obligation
Dollars in Millions, Includes Funding Extensions and Rescissions
Fiscal Year
ACA
Section
Program
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Totala
Private Health Insurance
1002 Health
insurance
consumer
information
30b (Note: This section also authorizes to be appropriated SSAN for FY2011 and each fiscal year thereafter.)
30
1003
Review of health insurance
premium rates
250 — — — — — — — — —
250
1101
Temporary high-risk health
insurance pools
5,000b — — — — — — — — —
5,000
1102
Early retiree reinsurance
program
5,000b — — — — — — — — —
5,000
1311 Health
insurance
exchange Appropriates amounts necessary for grants each fiscal year, as
— — — —
TBDc
planning and establishment
determined by the Secretary; no grant awards after Jan. 1, 2015.
1322
Consumer operated and
1,121d
— — — — — — — — —
1,121d
oriented plans (CO-OPs)
1323 Health
insurance
exchange —
—
—
—
$1 billion total for CY2014 through CY2109e 1,000
subsides (U.S. territories)
Medicaid and Children’s Health Insurance Program (CHIP)
2701
Medicaid adult health quality
measures
60 60 60 60 60 — — — — —
300f
2707 Medicaid
emergency
psychiatric demonstration
— 75g — — — — — — — — 75
2801
Medicaid and CHIP Payment
and Access Commission
11h (Note: This section also authorizes to be appropriated SSAN for FY2011 and each fiscal year thereafter.)
11
4108
Medicaid prevention and
—
$100 million total for CY2011 through CY2015f —
—
—
—
100
wellness incentives
4306
CHIP childhood obesity
$25 million total for FY2010 through FY2014
—
—
—
—
—
25
demonstration
10203(d)
CHIP annual appropriationi —
—
—
—
19,147
21,061 — — — —
40,208
10203(d)
CHIP outreach and
Increases total funding from $100 million to $140 million and extends
— — — — 40
enrollment grants
funding period through FY2015.
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Fiscal Year
ACA
Section
Program
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Totala
Medicare
3014
Medicare quality and
efficiency measures
20j 20 20 20 20 — — — — —
100
3021(a)
Center for Medicare and
Medicaid Innovation
5
$10 billion total for FY2011 through FY2019, and $10 billion for each subsequent 10-year period.
10,005f
3024
Medicare independence at
home demonstration
5j 5 5 5 5 5 — — — — 30
3026 Community-based
care
transition services
—
$300 million total for FY2011 through FY2015k —
—
—
—
300k
3027(b) Medicare
gainsharing
demonstration
2 — — — — — — — — — 2f
3113
Diagnostic laboratory test
5l — — — — — — — — — 5
demonstration
3306
Outreach and assistance for
$45 million total for FY2010
25m
25m 12.5m — — — —
107.5
low-income beneficiaries
through FY2012m
3403 Independent
Payment
— — 5n
For FY2013 and each subsequent fiscal year, appropriates previous year’s
TBDc
Advisory Board
amount adjusted for inflation; funds derived from the Medicare trust funds.n
4202(b)
Prevention and wellness
50j — — — — — — — — — 50
evaluation
4204(e)
GAO study of Medicare
1 — — — — — — — — — 1
vaccine coverage
10323(a) Environmental
health
pilot
SSANj









TBDc
program
10323(b) Environmental
health
$23 million total for FY2010 through FY2014
$20 million total for FY2015 though FY2019, and for
43f
screening and education
each 5-year period thereafter
Fraud and Abuse
6402(i) &
Health Care Fraud and
HCERA
Abuse Control (HCFAC)
— 105 65 40 40 30 30 10 10 10
350o
1303(a)
Account
Health Centers
4101(a)
School-based health center
establishment grants
50 50 50 50 — — — — — —
200f
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Fiscal Year
ACA
Section
Program
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Totala
10503(b)(1) Community-based
health
center operations (CHCF)
— 1,000 1,200 1,500 2,200
3,600 — — — —
9,500f
10503(c)
Health center construction
and renovation
—
$1.5 billion total for FY2011 through FY2015
—
—
—
—
1,500f
Health Workforce and the National Health Service Corps
10503(b)(2) National Health Service
Corps (CHCF)
— 290 295 300 305 310 — — — —
1,500f
5507(a) Health
workforce
demonstration grants
85 85 85 85 85 85p — — — —
510
5507(b) Family-to-family
health
information centers
5 5 5
5q
5q 2.5q — — — —
27.5f
5508(c) Teaching
health
centers,
SSAN for FY2011 through FY2015, not to exceed $230
GME payments
—
million
— — — —
≤230
5509 Medicare
graduate
nurse
education demonstration
— — 50 50 50 50 — — — —
200f
10502 Health
care
facility
construction
100 — — — — — — — — —
100r
Community-Based Prevention and Wellness
4002
Prevention and Public Health
Fund
500 750 1,000 1,000 1,000 1,000 1,000 1,000 1,250 1,250
9,750s
Maternal and Child Health
2951
Maternal, infant, and early
100 250 350 400 400 400t — — — —
1,900
childhood home visitation
2953 Personal
responsibility
75 75 75 75 75 75u — — — —
450f
education program grants
2954
Abstinence education state
grants
50 50 50 50 50 50v — — — —
300
10214
Pregnancy assistance grants
25
25
25
25
25 25 25 25 25 25
250
Long-Term Care
2403
Medicaid money follows the
— 450 450 450 450 450 450 — — —
2,700
person demonstration
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Fiscal Year
ACA
Section
Program
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Totala
2405
State Aging and Disability
Resource Centers
10 10 10 10 10 — — — — — 50
6201
Background checks of long-
Up to $160 million total for
term care providers
FY2010 through FY2012
—
— — — — — —
≤160w
8002(d)
National Clearinghouse for
Long-Term Care Information
— 3 3
0x
0x
0x — — — — 6
Comparative Effectiveness Research
6301(d)
Medicare trust fund transfers
For each of FY2013-FY2019, transfers amounts from the Medicare trust funds as
(PCORTF)
— — —
determined by a formula.y
TBDc
6301(e)
Appropriations and fees
For each of FY2013-FY2019, appropriates $150 million plus an amount equal to
(PCORTF)
10 50 150
the net revenue from a fee levied on health insurance and self-insured plans.z
TBDc
Biomedical Research
9023(e)
Grants for investment in
new therapeutics
SSAN — — — — — — — — —
≤1aa
ACA Implementation: Administrative Expenses
HCERA
Health Insurance Reform
1,000 — — — — — — — — —
1,000
1005
Implementation Fund
Source: Prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended.
Notes: Funds are provided from the Treasury unless otherwise noted. A dash means that ACA does not appropriate or transfer funds for the fiscal year(s) noted.
a. Total represents the cumulative amount of appropriations or fund transfers over the 10-year period FY2010-FY2019. Note that in several instances the 10-year total is
yet to be determined (TBD); see table entries for ACA Secs. 1311, 3403, 6301(d) & (e), 9023(e), and 10323(a). In addition, four provisions provide annual or multiple-
year appropriations beyond FY2019. The total shown in the table for three of these provisions represents the cumulative amount appropriated through FY2019; see
table entries for ACA Secs. 3021(a), 4002 (discussed in table note “s” below), and 10323(b). Final y, the total for ACA Sec. 6402(i) includes an amount appropriated in
FY2020 (see table note “o” below).
b. Funds are to remain available without fiscal year limitation.
c. To be determined.
d. ACA Sec. 1322 appropriated $6 billion for the CO-OP program. P.L. 112-10 rescinded $2.2 billion of that amount, and then P.L. 112-74 rescinded an additional $400
mil ion. Finally, P.L. 112-240 rescinded 90% of the program’s unobligated balance as of January 2, 2013, and transferred the remaining unobligated funds to a new CO-
OP contingency fund to provide assistance and oversight to CO-OP loan recipients. This effectively terminated CMS’s authority to make new loan awards. Overall,
Congress rescinded a total of $4.879 billion, leaving $1.121 billion of the original $6 billion CO-OP program appropriation.
e. Of this total amount, $925 million is for Puerto Rico, and the remaining $75 million is for the other U.S. territories in amounts as specified by the Secretary.
f.
Funds are to remain available until expended.
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g. Funds are to remain available for obligation through December 31, 2015.
h. Of this total amount, $9 million is appropriated, and the remaining $2 million is a transfer from CHIP funding for FY2010. Funds are to remain available until expended.
i.
Prior to enactment of ACA, the CHIP program was funded through FY2013.
j.
The Secretary is required to transfer amounts from the Medicare Part A and Part B trust funds each fiscal year in such proportion as the Secretary determines
appropriate. Funds are to remain available until expended.
k. The Secretary is required to transfer amounts from the Medicare Part A and Part B trust funds each fiscal year in such proportion as the Secretary determines
appropriate. Funds are to remain available until expended. P.L. 113-6 rescinded $200 million of the ACA’s original transfer of $500 million for CCTP.
l.
The Secretary is required to transfer the $5 million from the Medicare Part B trust fund, to remain available until expended.
m. The Secretary is required to transfer amounts from the Medicare Part A and Part B trust funds in the same proportion as the Secretary determines under SSA Sec.
1853(f). P.L. 112-240 extended funding for an additional year by transferring $25 million for FY2013 for the four outreach and assistance programs funded by ACA
through FY2012. P.L. 113-93 further extended funding for the programs by transferring $25 million for FY2014 and $12.5 million for the first half of FY2015. Funds are
to remain available until expended. See Table 1.
n. P.L. 112-74 rescinded $10 million of IPAB’s $15 million appropriation for FY2012; P.L. 113-6 rescinded $10 million of IPAB’s appropriation for FY2013; and P.L. 113-76
rescinded $10 million of IPAB’s appropriation for FY2014.
o. Funds are to be appropriated from the Medicare Part A trust fund. Note: the total amount appropriated (i.e., $350 million) includes a final appropriation of $10 million
for FY2020.
p. P.L. 113-93 provided an additional year of funding for health workforce demonstration grants.
q. P.L. 112-240 appropriated $5 mil ion for FY2013 for family-to-family health information centers. P.L. 113-67 and P.L. 113-93 provided an additional $5 million for
FY2014 and a prorated amount for the first half of FY2015. See Table 1.
r. Funds are to remain available for obligation until September 30, 2011.
s. ACA Sec. 4002 originally provided a permanent annual appropriation to the Prevention and Public Health Fund, as follows: FY2010 = $500 million; FY2011 = $750
million; FY2012 = $1 billion; FY2013 = $1.25 billion; FY2014 = $1.5 billion; FY2015 and each year thereafter = $2 billion. P.L. 112-96 reduced the annual appropriations
to the PPHF over the period FY2013-FY2021, as fol ows: FY2013 through FY2017 = $1 billion; FY2018 and FY2019 = $1.25 billion; FY2020 and FY2021 = $1.5 billion;
FY2022 and each year thereafter = $2 billion. Thus, appropriations to the fund now total $9.750 billion over the period FY2010-FY2019.
t.
P.L. 113-93 appropriated $400 mil ion for the first half of FY2015.
u. P.L. 113-93 provided an additional year of funding for PREP grants.
v. P.L. 113-93 provided an additional year of funding for abstinence education grants.
w. The HHS Secretary is required to notify the Treasury Secretary of the amount necessary to carry out activities under this section for the period of FY2010 through
FY2012, but not to exceed $160 mil ion. The Treasury Secretary must then transfer the amount specified from the Treasury to the HHS Secretary. Funds are to
remain available until expended.
x. P.L. 112-240 repealed the appropriations for the National Clearinghouse and rescinded al unobligated FY2013 funds (as of January 3, 2013).
y. ACA Sec. 6301(d) provided the fol owing formula for the transfer of funds from the Medicare Part A and Part B trust funds to the PCORTF: (1) for FY2013, an
amount from each respective Medicare trust fund equal to $1 multiplied by the average number of individuals entitled to Part A benefits, or enrolled in Part B during
that period; and (2) for each of FY2014-FY2019, an amount from each respective Medicare trust fund equal to $2 multiplied by the average number of individuals
entitled to Part A benefits, or enrol ed in Part B during that fiscal year. Beginning in FY2015, amounts are subject to adjustment for increases in health care spending.
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The FY2015 Budget includes the fol owing transfer amounts from the Medicare trust funds to the PCORTF: FY2013 actual = $52 mil ion; FY2014 estimate = $107
million; FY2015 estimate = $117 million.
z. The fee is equal to $2 multiplied by the average number of covered lives in a policy/plan year ($1 in the case of policy/plan years ending during FY2013). Beginning in
FY2015, amounts are subject to adjustment for increases in health care spending. The FY2015 Budget includes the fol owing fee revenue: FY2013 actual = $277 million;
FY2014 estimate = $347 million; FY2015 estimate = $392 million.
aa. To be determined. ACA Sec. 9023(e) created a two-year tax credit program, subject to an overall cap of $1 billion, for small companies that invest in new therapies to
prevent, diagnose and treat cancer and other diseases. The total amount of tax credits any one company can receive for the two years may not exceed $5 million.
Companies may elect to receive one or more grants—for which SSAN are appropriated—in lieu of tax credits. Grant applications must be received before January 1,
2013.

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Appropriations and Fund Transfers in the Affordable Care Act (ACA)

Appendix A. Acronyms Used in the Report
The following laws and federal agencies are referred to in this report by their acronym:
ACA
Patient Protection and Affordable Care Act (P.L. 111-148)
ACF
Administration for Children and Families
ACL
Administration for Community Living
AHRQ
Agency for Healthcare Research and Quality
ATRA
American Taxpayer Relief Act of 2012 (P.L. 112-240)
BBEDCA
Balanced Budget and Emergency Deficit Control Act of 1985 (P.L. 99-177)
CBO
Congressional Budget Office
CCIIO
Center for Consumer Information and Insurance Oversight
CDC
Centers for Disease Control and Prevention
CMI
Center for Medicare & Medicaid Innovation
CMS
Centers for Medicare & Medicaid Services
DRA
Deficit Reduction Act of 2005 (P.L. 109-171)
HCERA
Health Care and Education Reconciliation Act of 2010 (P.L. 111-152)
HHS
(Department of) Health and Human Services
HRSA
Health Resources and Services Administration
OS
Office of the Secretary (HHS)
IRC
Internal Revenue Code
IRS
Internal Revenue Service
MIPPA
Medicare Improvements for Patients and Providers Act of 2008 (P.L. 110-275)
OAA
Older Americans Act
OMB
Office of Management and Budget
PAMA
Protecting Access to Medicare Act of 2014 (P.L. 113-93)
PHSA
Public Health Service Act
PSGRRA
Pathway for SGR Reform Act of 2013 (P.L. 113-67, Division B)
SSA Social
Security
Act

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Appropriations and Fund Transfers in the Affordable Care Act (ACA)

Appendix B. Annual Spending Reductions Under
the Budget Control Act
The Budget Control Act of 2011 (BCA)19 amended the Balanced Budget and Emergency Deficit
Control Act of 1985 (BBEDCA) by establishing two budget enforcement mechanisms to reduce
federal spending by at least $2.1 trillion over the 10-year period FY2012 through FY2021. First,
the BCA established enforceable limits, or caps, on discretionary spending for each of those
years. Second, the BCA created a Joint Committee on Deficit Reduction to develop legislation to
further limit federal spending. The failure of the Joint Committee to agree on deficit-reduction
legislation triggered automatic annual spending reductions for each of FY2013 through FY2021.
The BCA specified that a total of $109 billion must be cut each year from nonexempt budget
accounts. That amount is equally divided between defense and nondefense spending. Within each
category—defense and nondefense—the spending cuts are divided proportionately between
discretionary spending and nonexempt mandatory (i.e., direct) spending. Under the BCA, the
spending reductions are achieved through a combination of sequestration (i.e., an across-the-
board cancellation of budgetary resources) and lowering the BCA-imposed discretionary
spending caps.
The BCA requires that the mandatory spending reductions in each category—defense and
nondefense—must be executed each year by a sequestration of all nonexempt accounts, subject to
the BBEDCA sequestration rules. Discretionary spending in each category is also subject to
sequestration, but only in FY2013. For each of the remaining fiscal years (i.e., FY2014 through
FY2021), discretionary spending reductions are to be achieved by lowering the discretionary
spending caps for defense and nondefense spending by the total dollar amount of the reduction.
Thus, congressional appropriators get to decide how to apportion the cuts within the lowered
spending caps rather than having the cuts applied across-the-board to all nonexempt discretionary
spending accounts through sequestration. The Office of Management and Budget (OMB) is
responsible for calculating the percentages and amounts by which mandatory and discretionary
spending are required to be reduced each year, and for applying the BBEDCA’s sequestration
exemptions and rules.
The American Taxpayer Relief of 2012 (ATRA)20 revised the discretionary spending caps for
FY2013 and FY2014 and reduced the overall dollar amount that needed to be sequestered from
FY2013 defense and nondefense spending. The Bipartisan Budget Act of 201321 further revised
the spending caps for FY2014 and FY2015 and eliminated the requirements that these caps be
lowered pursuant to the BCA’s annual spending reductions.22


19 P.L. 112-25, 125 Stat. 240.
20 P.L. 112-240, 126 Stat. 2313.
21 P.L. 113-67, Division A, 127 Stat. 1165.
22 For a more complete analysis of the Budget Control Act of 2011 and the amendments that were made to it by the
American Taxpayer Relief Act of 2012, see CRS Report R41965, The Budget Control Act of 2011, by Bill Heniff Jr.,
Elizabeth Rybicki, and Shannon M. Mahan; and CRS Report R42949, The American Taxpayer Relief Act of 2012:
Modifications to the Budget Enforcement Procedures in the Budget Control Act, by Bill Heniff Jr.
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Appropriations and Fund Transfers in the Affordable Care Act (ACA)


Author Contact Information

C. Stephen Redhead

Specialist in Health Policy
credhead@crs.loc.gov, 7-2261

Acknowledgments
The following CRS analysts contributed to earlier versions of this report: Kirsten Colello, Patricia Davis,
Gary Guenther, Elayne Heisler, Lisa Herz, Janet Kinzer, Sarah Lister, Alison Mitchell, Bernice Reyes,
Amanda Sarata, Carmen Solomon-Fears, Emilie Stoltzfus, and Susan Thaul.

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