Health Policy

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Prescription Drug Monitoring Programs

In the midst of national concern over the opioid epidemic, federal and state officials are paying greater attention to the manner in which opioids are prescribed. Nearly all prescription drugs involved in overdoses are originally prescribed by a physician (rather than, for example, being stolen from pharmacies). Thus, attention has been directed toward better understanding how opioids are being prescribed and preventing the diversion of prescription drugs after the prescriptions are dispensed.

Prescription drug monitoring programs (PDMPs) maintain statewide electronic databases of...

Federal Financing for the State Children’s Health Insurance Program (CHIP)

The State Children’s Health Insurance Program (CHIP) is a means-tested program that provides health coverage to targeted low-income children and pregnant women in families that have annual income above Medicaid eligibility levels but have no health insurance. CHIP is jointly financed by the federal government and the states, and the states are responsible for administering CHIP.

The federal government’s share of CHIP expenditures (including both services and administration) is determined by the enhanced federal medical assistance percentage (E-FMAP) rate. The E-FMAP varies by state;...

Commemorations in Congress: Options for Honoring Individuals, Groups, and Events

Since its inception, Congress has used commemorative legislation to express public gratitude for distinguished contributions; dramatize the virtues of individuals, groups, and causes; and perpetuate the remembrance of significant events. During the past two centuries, commemoratives have become an integral part of the American political tradition. They have been used to authorize the minting of commemorative coins and Congressional Gold Medals; fund monuments and memorials; create federal holidays; establish commissions to celebrate important anniversaries; and name public works,...

Indian Health Service (IHS) FY2019 Budget Request and Funding History: A Fact Sheet

The Indian Health Service (IHS) within the Department of Health and Human Services (HHS) is the lead federal agency charged with improving the health of American Indians and Alaska Natives. IHS provides health care for approximately 2.2 million eligible American Indians/Alaska Natives through a system of programs and facilities located on or near Indian reservations, and through contractors in certain urban areas. IHS provides services to members of 573 federally recognized tribes. It provides services either directly or through facilities and programs operated by Indian tribes or tribal...

Medicare Primer

Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or...

The House Agriculture Committee’s 2018 Farm Bill (H.R. 2): A Side-by-Side Comparison with Current Law

Congress establishes national food and agriculture policy through periodic omnibus farm bills. The 115th Congress has the opportunity to set the direction for farm and food policy because many of the provision in the current farm bill (the Agricultural Act of 2014, (P.L. 113-79) expire in 2018. The 2014 farm bill consists of 12 titles that address commodity price and income support, crop insurance, conservation, domestic food assistance, trade and international food aid, credit, rural development, research, horticulture, forestry, bioenergy, and various other provisions.

The House...

Science, Technology, and Innovation Policy: CRS Experts

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cience, technology, and innovation (STI) play important roles in the nation’s economic and military strength, public health and safety, and the quality of our lives. Individuals, companies, governments, universities, and other organizations fund, conduct, disseminate, and acquire science and technology for a myriad of purposes. Among the purposes: providing for the national defense and homeland security; improving manufacturing processes and enabling the manufacture of new products; developing new materials; advancing computing and communications tools; preventing and treating disease,...

How FDA Approves Drugs and Regulates Their Safety and Effectiveness

The Food and Drug Administration (FDA), a regulatory agency within the Department of Health and Human Services, regulates the safety and effectiveness of drugs sold in the United States. FDA divides that responsibility into two phases. In the preapproval (premarket) phase, FDA reviews manufacturers’ applications to market drugs in the United States; a drug may not be sold unless it has FDA approval. Once a drug is on the market, FDA continues its oversight of drug safety and effectiveness. That postapproval (postmarket) phase lasts as long as the drug is on the market. Beginning with the...

Medicare: Part B Premiums

Medicare is a federal insurance program that pays for covered health care services of most individuals aged 65 and older and certain disabled persons. In calendar year 2018, the program is expected to cover about 60 million persons (51 million aged and 9 million disabled) at a total cost of $744 billion. Most individuals (or their spouses) aged 65 and older who have worked in covered employment and paid Medicare payroll taxes for 40 quarters receive premium-free Medicare Part A (Hospital Insurance). Those entitled to Medicare Part A (regardless of whether they are eligible for premium-free...

Federal Grants to State and Local Governments: A Historical Perspective on Contemporary Issues

The federal government is expected to provide state and local governments about $728 billion in federal grants in FY2018, funding a wide range of public policies, such as health care, transportation, income security, education, job training, social services, community development, and environmental protection. Federal grants account for about one-third of total state government funding, and more than half of state government funding for health care and public assistance.

Congressional interest in federal grants to state and local governments has always been high given the central role...

High Intensity Drug Trafficking Areas (HIDTA) Program

Drug trafficking is a significant public health and safety threat facing the United States. The federal government has taken a variety of actions aimed at countering this threat. These have ranged from giving law enforcement more tools for combatting traffickers to establishing programs and initiatives to reduce the supply of and demand for illegal drugs. Within the larger framework of the federal government’s efforts to counter drug trafficking is the High Intensity Drug Trafficking Areas (HIDTA) program. The program supports multiagency activities ranging from enforcement initiatives...

NIH Funding: FY1994-FY2019

The National Institutes of Health (NIH) is the primary federal agency charged with conducting and supporting biomedical and behavioral research. About 81% of the NIH budget funds extramural research through grants, contracts, and other awards. Almost all of NIH’s funding is provided in the annual Departments of Labor, Health and Human Services, and Education, and Related Agencies appropriations act.

[Key terms: National Institutes of Health, NIH, NIH budget, NIH funding,]

Tracking Federal Awards: USAspending.gov and Other Data Sources

USAspending.gov, available at http://www.USAspending.gov, is a government source for data on federal awards by state, congressional district (CD), county, and zip code. The awards data in USAspending.gov are provided by federal agencies and represent contracts, grants, loans, and other forms of financial assistance. USAspending.gov also provides tools for examining the broader picture of federal spending obligations by categories, such as budget function, agency, and object class.

Using USAspending.gov to locate and compile accurate data on federal awards can be challenging due to...

Federal Disaster Assistance After Hurricanes Katrina, Rita, Wilma, Gustav, and Ike

This report provides information on federal financial assistance provided to the Gulf States after major disasters were declared in Alabama, Florida, Louisiana, Mississippi, and Texas in response to the widespread destruction that resulted from Hurricanes Katrina, Rita, and Wilma in 2005 and Hurricanes Gustav and Ike in 2008.

Though the storms happened over a decade ago, Congress has remained interested in the types and amounts of federal assistance that were provided to the Gulf Coast for several reasons. This includes how the money has been spent, what resources have been provided to...

The Supplemental Nutrition Assistance Program (SNAP): Categorical Eligibility

The Supplemental Nutrition Assistance Program (SNAP) provides benefits to low-income, eligible households on an electronic benefit transfer (EBT) card; benefits can then be exchanged for foods at authorized retailers. SNAP reaches a large share of low-income households. In FY2017, a monthly average of 42.2 million persons in 20.9 million households participated in SNAP.

Federal SNAP law provides two basic pathways for financial eligibility to the program: (1) meeting program-specific federal eligibility requirements; or (2) being automatically or “categorically” eligible for SNAP based on...

Federal Requirements on Private Health Insurance Plans

A majority of Americans have health insurance from the private health insurance (PHI) market. Health plans sold in the PHI market must comply with requirements at both the state and federal levels; such requirements often are referred to as market reforms.

The first part of this report provides background information about health plans sold in the PHI market and briefly describes state and federal regulation of private plans. The second part summarizes selected federal requirements and indicates each requirement’s applicability to one or more of the following types of private health...

Teen Pregnancy: Federal Prevention Programs

Congress has an interest in preventing pregnancy among teenagers because of the long-term consequences for the families of teen parents and society more generally. Since the 1980s, Congress has authorized—and the U.S. Department of Health and Human Services (HHS) has administered—programs with a focus on teen pregnancy prevention. This report intends to assist Congress with tracking developments in four teen pregnancy prevention programs that are currently funded. The report provides detailed information about each program and includes a table that can illustrate the ways in which the...

Abortion At or Over 20 Weeks’ Gestation: Frequently Asked Questions

Legislation at the federal and state levels seeking to limit or ban abortions in midpregnancy has focused attention on the procedure and the relatively small number of women who choose to undergo such an abortion. According to the Guttmacher Institute, about 926,200 abortions were performed in 2014; 1.3% of abortions were performed at or over 21 weeks’ gestation in 2013. A 2018 National Academies of Sciences, Engineering, and Medicine study found that most women who have abortions are unmarried (86%), are poor or low-income (75%), are under age 30 (72%), and are women of color...

Family Planning Program Under Title X of the Public Health Service Act

The federal government provides grants for family planning services through the Family Planning Program, Title X of the Public Health Service Act (42 U.S.C. §§300 to 300a-6). Title X, enacted in 1970, is the only domestic federal program devoted solely to family planning and related preventive health services. In 2016, Title X-funded clinics served 4 million clients.

Title X is administered through the Office of Population Affairs (OPA) in the Department of Health and Human Services (HHS). Although the authorization of appropriations for Title X ended in FY1985, funding for the program has...

The Peace Corps: Current Issues

Founded in 1961, the Peace Corps has sought to meet its legislative mandate of promoting world peace and friendship by sending American volunteers to serve at the grassroots level in villages and towns in all corners of the globe. As of the end of September 2017, about 7,376 volunteers were serving in 65 nations.

In 2018, the 115th Congress may consider the President’s annual funding request for the Peace Corps, changes to the Peace Corps authorization legislation, and related issues.

On March 23, 2018, the Consolidated Appropriations, 2018 (P.L. 115-141), was signed into law, providing...

The National Health Service Corps

The National Health Service Corps (NHSC) provides scholarships and loan repayments to health care providers in exchange for a period of service in a health professional shortage area (HPSA). The program places clinicians at facilities—generally not-for-profit or government-operated—that might otherwise have difficulties recruiting and retaining providers.

The NHSC is administered by the Health Resources and Services Administration (HRSA), within the Department of Health and Human Services (HHS). Congress created the NHSC in the Emergency Health Personnel Act of 1970 (P.L. 91-623), and its...

Medicaid’s Federal Medical Assistance Percentage (FMAP)

Medicaid is a means-tested entitlement program that finances the delivery of primary and acute medical services as well as long-term services and supports. Medicaid is jointly funded by the federal government and the states. The federal government’s share of most Medicaid expenditures is called the federal medical assistance percentage (FMAP). The remainder is referred to as the state share.

Generally determined annually, the FMAP formula is designed so that the federal government pays a larger portion of Medicaid costs in states with lower per capita incomes relative to the national...

Frequently Asked Questions About Prescription Drug Pricing and Policy

Prescription drugs play an important role in the U.S. health care system. Innovative, breakthrough drugs are providing cures for diseases such as hepatitis C and helping individuals with chronic conditions lead fuller lives. Studies show that prescription drug therapy can produce health care savings by reducing the number of hospitalizations and other costly medical procedures.

Congress and presidential administrations have attempted to ensure that Americans have access to pharmaceuticals by enacting the Medicare Part D prescription drug benefit as part of the Medicare Modernization and...

Children’s Hospital Graduate Medical Education (CHGME)

The Children’s Hospital Graduate Medical Education (CHGME) program provides direct financial support to children’s hospitals to train medical residents and fellows. The program is administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) and is authorized in Section 340E of the Public Health Service Act (PHSA). CHGME receives annual discretionary appropriations and received $299.3 million in FY2017. The program is currently funded under the FY2018 continuing resolution (P.L. 115-96) until January 19, 2018.

Hospitals...

Health Insurance Premium Tax Credits and Cost-Sharing Subsidies

Certain individuals without access to subsidized health insurance coverage may be eligible for premium tax credits, as established under the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended). The dollar amount of the premium credit varies from individual to individual, based on a formula specified in statute. Individuals who are eligible for the premium credit, however, generally are still required to contribute some amount toward the purchase of health insurance.

In order to be eligible to receive premium tax credits, individuals must have annual household income...

The Mental Health Workforce: A Primer

Congress has held hearings and some Members have introduced legislation addressing the interrelated topics of the quality of mental health care, access to mental health care, and the cost of mental health care. The mental health workforce is a key component of each of these topics. The quality of mental health care depends partially on the skills of the people providing the care. Access to mental health care relies on, among other things, the number of appropriately skilled providers available to provide care. The cost of mental health care depends in part on the wages of the people...

The Veterans Choice Program (VCP): Program Implementation

Authorized under Section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (VACAA), the Veterans Choice Program (VCP) is a new, temporary program that enables eligible veterans to receive medical care in the community. (P.L. 115-26 eliminated the August 7, 2017, expiration date for the VCP and allowed the program to continue until the initial $10 billion deposited in the Veterans Choice Fund was expended. The VA Choice and Quality Employment Act of 2017, P.L. 115-46, authorized and appropriated an additional $2.1 billion to continue the VCP until funds were expended, and...

Legal Authorities Under the Controlled Substances Act to Combat the Opioid Crisis

According to the Centers for Disease Control and Prevention, the annual number of drug overdose deaths involving prescription opioids (such as hydrocodone, oxycodone, and methadone) and illicit opioids (such as heroin and non-pharmaceutical fentanyl) has more than quadrupled since 1999. A November 2017 report issued by the President’s Commission on Combating Drug Addiction and the Opioid Crisis also observed that “[t]he crisis in opioid overdose deaths has reached epidemic proportions in the United States ... and currently exceeds all other drug-related deaths or traffic fatalities.” How...

Supplemental Nutrition Assistance Program (SNAP): A Primer on Eligibility and Benefits

The Supplemental Nutrition Assistance Program (SNAP), formerly called the Food Stamp Program, is designed primarily to increase the food purchasing power of eligible low-income households to help them buy a nutritionally adequate low-cost diet. This report describes the rules related to eligibility for SNAP benefits as well as the rules for benefits and their redemption. SNAP is administered by the U.S. Department of Agriculture’s Food and Nutrition Service (USDA-FNS). SNAP is authorized by the Food and Nutrition Act of 2008. This law, formerly the Food Stamp Act of 1977, has since 1973...

Federal Research and Development (R&D) Funding: FY2019

President Trump’s budget request for FY2019 includes approximately $131.0 billion for research and development (R&D), of which $118.056 billion is included in the President’s budget and an estimated additional $12.9 billion in nondefense discretionary R&D is requested as part of an addendum to the President’s budget. The additional funding requested in the addendum followed enactment of the Bipartisan Budget Act of 2018 (P.L. 115-123), which raised defense and nondefense discretionary spending caps for FY2018 and FY2019. The budget documents released by the Office of Management and Budget...

Errors and Fraud in the Supplemental Nutrition Assistance Program (SNAP)

The Supplemental Nutrition Assistance Program (SNAP) is the nation’s largest domestic food assistance program, serving about 42.2 million recipients in an average month at a federal cost of over $68 billion in FY2017. SNAP is jointly administered by state agencies, which handle most recipient functions, and the federal government—specifically, the U.S. Department of Agriculture’s Food and Nutrition Service (USDA-FNS)—which supports and oversees the states and handles most retailer functions. In a program with so many diverse stakeholders, detecting, preventing, and addressing errors and...

State Innovation Waivers: Frequently Asked Questions

Section 1332 of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) provides states with the option to waive specified requirements of the ACA. In the absence of these requirements, the state is to implement its own plan to provide health insurance coverage to state residents that meets the ACA’s terms.

Under a state innovation waiver, a state can apply to waive ACA requirements related to qualified health plans, health insurance exchanges, premium tax credits, cost-sharing subsidies, the individual mandate, and the employer mandate. The state can apply to waive...

Department of Health and Human Services: FY2019 Budget Request

This report provides information about the FY2019 budget request for the Department of Health and Human Services (HHS). The report begins by reviewing the department’s mission and structure. Next, the report offers a brief explanation of the conventions used for the FY2018 estimates and FY2019 request levels in the budget documents released by the HHS and the Office of Management and Budget (OMB). The report also discusses the concept of the HHS budget as a whole, in comparison to how funding is provided to HHS through the annual appropriations process. The report concludes with a...

Domestic Food Assistance: Summary of Programs

Over the years, Congress has authorized and the federal government has administered programs to provide food to the hungry and to other vulnerable populations in this country. This report offers a brief overview of hunger and food insecurity along with the related network of programs. The report is structured around three main tables that contain information about each program, including its authorizing language, administering agency, eligibility criteria, services provided, participation data, and funding information. In between the tables, contextual information about this policy area...

2017 Disaster Supplemental Appropriations: Overview

According to the National Oceanographic and Atmospheric Administration (NOAA), 2017 was “a historic year of weather and climate disasters” for the United States. A combination of deadly hurricanes and wildfires were among the 57 major disasters declared under the Stafford Act in 2017. The series of supplemental appropriations requested and provided in the wake of 2017’s hurricanes and wildfires are the latest exercise of one congressional role in disaster situations—to exercise “the power of the purse” to provide relief to state and local governments overwhelmed by disaster response and...

Bipartisan Budget Act of 2018 (P.L. 115-123): CHIP, Public Health, Home Visiting, and Medicaid Provisions in Division E

The Bipartisan Budget Act of 2018 (BBA 2018, P.L. 115-123), which was enacted on February 9, 2018, addresses a number of issues that were before Congress. For example, appropriations for most federal agencies and programs were to expire on February 8, 2018, and BBA 2018 extends continuing appropriations for these agencies and programs through March 23, 2018. In addition, BBA 2018 includes FY2018 supplemental appropriations, an increase to the debt limit, increases to the statutory spending limits for FY2018 and FY2019, tax provisions, and numerous provisions extending or making changes to...

Paid Family Leave in the United States

Paid family leave (PFL) refers to partially or fully compensated time away from work for specific and generally significant family caregiving needs, such as the arrival of a new child or serious illness of a close family member. Although the Family and Medical Leave Act of 1993 (FMLA; P.L. 103-3) provides eligible workers with a federal entitlement to unpaid leave for a limited set of family caregiving needs, no federal law requires private-sector employers to provide paid leave of any kind. Currently, employees may access paid family leave if offered by an employer. In addition, workers...

Federal Support for Drug Courts: In Brief

The United States has gradually shifted its formal drug policy from a punishment-focused model toward a more comprehensive approach—one that focuses on prevention, treatment, and enforcement. The proliferation of drug courts in American criminal justice fits this more comprehensive model. These specialized court programs are designed to divert certain defendants and offenders away from traditional criminal justice sanctions such as incarceration while reducing overall costs and helping these defendants and offenders with substance abuse issues.

Drug courts present an alternative to the...

The Individual Mandate for Health Insurance Coverage: In Brief

The individual mandate, as established under the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended), has been in effect since 2014. The mandate requires most individuals to maintain health insurance coverage, but some individuals are exempt from the mandate. Those who are not exempt and who do not maintain coverage are subject to a penalty for noncompliance implemented through the Internal Revenue Code.

The penalty for noncompliance is assessed for each month in which an individual does not have coverage or is not exempt from the mandate. The annual penalty is the...

FDA Risk Evaluation and Mitigation Strategies (REMS): Description and Effect on Generic Drug Development

The Federal Food, Drug, and Cosmetic Act (FFDCA) authorizes the Food and Drug Administration (FDA) to regulate the safety and effectiveness of drug products sold in the United States. The statutory standard for FDA approval is that a drug is safe and effective for its intended use. FDA’s determination that a drug is safe does not signify an absence of risk but rather that the drug’s clinical benefits outweigh its known and potential risks.

For most drugs, FDA has generally considered routine risk minimization measures to be sufficient; for example, updated labeling based on new information...

Prescription Drug User Fee Act (PDUFA): 2017 Reauthorization as PDUFA VI

The Prescription Drug User Fee Act (PDUFA, now called PDUFA I) was reauthorized as PDUFA VI by the Food and Drug Administration Reauthorization Act of 2017 (FDARA, P.L. 115-52). First passed by Congress in 1992, PDUFA gave the Food and Drug Administration (FDA) the authority to collect fees from the pharmaceutical industry and to use the revenue to support “the process for the review of human drug applications.” FDA regulates the safety and effectiveness of drug and biological products sold in the United States. Prior to marketing a drug, a manufacturer must submit to FDA a new drug...

The United Kingdom: Background, Brexit, and Relations with the United States

Many U.S. officials and Members of Congress view the United Kingdom (UK) as the United States’ closest and most reliable ally. This perception stems from a combination of factors, including a sense of shared history, values, and culture; a large and mutually beneficial economic relationship; and extensive cooperation on foreign policy and security issues.

Conservative-Led Minority Government Following 2017 Election

The government of the UK is led by Prime Minister Theresa May of the Conservative Party. Her leadership position was weakened after she triggered an early election in June 2017,...

Bipartisan Budget Act of 2018 (P.L. 115-123): Brief Summary of Division E—The Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act

On February 9, 2018, President Donald Trump signed into law the Bipartisan Budget Act of 2018 (BBA 2018; P.L. 115-123). Division E of that law is titled the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act. This report provides a brief summary of each of the provisions included in the ACCESS Act, along with the contact information for the CRS expert who can answer questions about each provision. Division E consists of 12 titles. Each title is addressed in a separate table, and the provisions are discussed in the order they appear in the law. Topics discussed in this...

Health Care for Dependents and Survivors of Veterans

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) was established by the Veterans Health Care Expansion Act of 1973 (P.L. 93-82). CHAMPVA is primarily a health insurance program where certain eligible dependents and survivors of veterans receive care from private sector health care providers. The program is administered by the Veterans Health Administration (VHA), Office of Community Care, located in Denver, CO.

Eligibility

To be eligible for CHAMPVA benefits, the beneficiary must be the spouse or child of a veteran who has a total and permanent...

Welfare Reform: Work Status of Single Mothers, In Brief

Welfare reform; Single Mothers; Employment trends; Poverty

Appropriations: CRS Experts

Agriculture appropriations; Commerce, Justice, Science appropriations; Department of Defense appropriations, Energy and Water appropriations; Financial Services and General Provisions Government-wide appropriations; Departments of Homeland Security appropriations; Department of Interior, Environment appropriations; Labor, Health and Human Services, Education appropriations, Legislative Branch appropriations; Military Construction and Veterans Affairs appropriations, Department of State, Foreign Operations appropriations, Transportation, Housing and Urban Development appropriations.

Medicare and Budget Sequestration

Sequestration is the automatic reduction (i.e., cancellation) of certain federal spending, generally by a uniform percentage. The sequester is a budget enforcement tool that was established by Congress in the Balanced Budget and Emergency Deficit Control Act of 1985 (BBEDCA; also known as the Gramm-Rudman-Hollings Act; P.L. 99-177) and was intended to encourage compromise and action, rather than actually being implemented (also known as “triggered”). Generally, this budget enforcement tool has been incorporated into laws to either discourage Congress from violating specific budget...

Puerto Rico: CRS Experts

SUPPRESS Puerto Rico is in the midst of a fiscal crisis resulting from economic contraction, public sector debt, outmigration, and other factors. To address the crisis, Congress passed the Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA; P.L. 114-187), which was enacted on June 30, 2016. PROMESA established the Financial Oversight and Management Board for Puerto Rico (Oversight Board), created processes for adjusting the island’s public debts, among other provisions. PROMESA allocated no federal funds to Puerto Rico.

The Puerto Rican Governor was charged with...

Child Support Enforcement Annual User Fee: In Brief

Section 454(6)(B)(ii) of the Social Security Act (42 U.S.C. 654) requires that states impose an annual user fee for Child Support Enforcement (CSE) services provided to families with no connection to the welfare system. (The act also requires that an application fee be collected and provides the authority to recover costs.)

When the annual user fee was first established by the Deficit Reduction Act of 2005 (P.L. 109-171), the amount of the fee was $25 and it was to be assessed if the state CSE agency collected at least $500 in child support payments on behalf of the family in a given...

The Veterans Health Administration and Medical Education: In Brief

In the wake of World War II, an influx of veterans requiring medical care threatened to overwhelm the capacity of the Department of Veterans Affairs (VA) to provide such care. In 1946, the VA began entering into affiliations with medical schools as one strategy to increase capacity—both in the short term and in the long term. In the short term, some trainees—in particular, those in the later years of training—may provide direct care to patients, thereby increasing provider capacity and patient access. In the long term, training physicians at the VA creates a pipeline for recruiting...

Medicare Trigger

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA; P.L. 108-173) requires the Medicare Board of Trustees to provide in its annual reports an expanded analysis of Medicare expenditures and revenues (§801 of the MMA). Specifically, if the Medicare trustees determine that general revenue funding for Medicare is expected to exceed 45% of Medicare outlays for the current fiscal year or any of the next six fiscal years, a determination of excess general funding is made. If the determination is issued for two consecutive years, a funding warning is issued which...

Nutrition Labeling of Restaurant Menu and Vending Machine Items

High rates of obesity and chronic diseases have prompted various federal, state, and local nutrition labeling initiatives. The 1990 Nutrition Labeling and Education Act (P.L. 101-535) required nutrition labeling of most foods and dietary supplements, but it did not require labeling of food sold in restaurants. However, consumption data indicate that Americans consume more than one-third of their calories outside the home, and frequent eating out is associated with increased caloric intake.

In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA, P.L. 111-148)...

Vulnerable Youth: Background and Policies

The majority of young people in the United States grow up healthy and safe in their communities. Most of those of school age live with parents who provide for their well-being, and they attend schools that prepare them for advanced education or vocational training and, ultimately, self-sufficiency. Many youth also receive assistance from their families during the transition to adulthood. During this period, young adults cycle between attending school, living independently, and staying with their families. A study from 2009 found that over 60% of young people ages 19 to 22 receive financial...

Abortion: Judicial History and Legislative Response

In 1973, the U.S. Supreme Court concluded in Roe v. Wade that the U.S. Constitution protects a woman’s decision to terminate her pregnancy. In Doe v. Bolton, a companion decision, the Court found that a state may not unduly burden the exercise of that fundamental right with regulations that prohibit or substantially limit access to the means of effectuating the decision to have an abortion. Rather than settle the issue, the Court’s rulings since Roe and Doe have continued to generate debate and have precipitated a variety of governmental actions at the national, state, and local levels...

Federal Research and Development Funding: FY2018

President Trump’s budget request for FY2018 includes $117.697 billion for research and development (R&D). This represents a $30.605 billion (20.6%) decrease from the FY2016 actual level of $148.302 billion (FY2017 enacted levels were not available at the time of publication). Adjusted for inflation, the President’s FY2018 R&D request represents a constant dollar decrease of 23.6% from the FY2016 actual level.

However, in 2016 the Office of Management and Budget changed the definition used for “development” to “experimental development.” This new definition was used in calculating R&D in...

Labor, Health and Human Services, and Education: FY2018 Appropriations

This report offers an overview of actions taken by Congress and the President to provide FY2018 appropriations for accounts funded by the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations bill. This bill includes all accounts funded through the annual appropriations process at the Departments of Labor (DOL) and Education (ED). It also provides annual appropriations for most agencies within the Department of Health and Human Services (HHS), with certain exceptions (e.g., the Food and Drug Administration is funded via the Agriculture...

Prevalence of Mental Illness in the United States: Data Sources and Estimates

Determining how many people have a mental illness can be difficult, and prevalence estimates vary. While numerous surveys include questions related to mental illness, few provide prevalence estimates of diagnosable mental illness (e.g., major depressive disorder as opposed to feeling depressed, or generalized anxiety disorder as opposed to feeling anxious), and fewer still provide national prevalence estimates of diagnosable mental illness. This report briefly describes the methodology and results of three large surveys (funded in whole or in part by the U.S. Department of Health and Human...

Comparison of the Bills to Extend State Children’s Health Insurance Program (CHIP) Funding

The State Children’s Health Insurance Program (CHIP) is a means-tested program that provides health coverage to targeted low-income children and pregnant women in families that have annual income above Medicaid eligibility levels but have no health insurance. CHIP is jointly financed by the federal government and the states, and the states are responsible for administering CHIP.

In statute, FY2017 was the last year a federal CHIP appropriation was provided. Federal CHIP funding was not extended before the beginning of FY2018. As a result, states do not currently have full-year FY2018 CHIP...

Animal Drug User Fee Programs

The Food and Drug Administration’s (FDA’s) review of brand-name and generic animal drug applications is funded through a combination of annual discretionary appropriations from Congress and user fees collected from the regulated industry.

The Animal Drug User Fee Act of 2003 (ADUFA I, P.L. 108-130) gave FDA initial authority to collect user fees from sponsors to improve the timeliness of review of animal drug applications. ADUFA I did not cover generic animal drugs. In 2008, in response to concerns regarding generic drug application review times and a backlog of applications, Congress...

Drug Compounding: FDA Authority and Possible Issues for Congress

Drug compounding is a process by which a pharmacist or physician combines, mixes, or alters various drug ingredients to create a drug to meet the unique needs of an individual patient for whom an approved drug may not be appropriate (e.g., due to an allergy to a dye in the product).

The Federal Food, Drug, and Cosmetic Act (FFDCA) authorizes the Food and Drug Administration (FDA) to regulate the manufacturing and sale of drugs in the United States, including compounded drugs. Generally, a drug may not be sold unless the FDA, through its drug approval process, has determined that the drug...

Division A of H.R. 3922: The CHAMPIONING HEALTHY KIDS Act

On October 30, 2017, the House Rules Committee posted an amendment in the nature of a substitute for the Community Health And Medical Professionals Improve Our Nation Act of 2017 (CHAMPION Act, H.R. 3922). The amendment considered by the House struck the text of the CHAMPION Act and replaced it with the text of the amendment in the nature of the substitute.

The amendment in the nature of a substitute is entitled the Continuing Community Health And Medical Professional Programs to Improve Our Nation, Increase National Gains, and Help Ensure Access for Little Ones, Toddlers, and Hopeful...

Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions

The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) has numerous provisions affecting private health insurance and public health coverage programs. This report provides resources to help congressional staff respond to constituents’ frequently asked questions (FAQs) about the law. The report lists selected resources regarding consumers, employers, and other stakeholders, with a focus on federal sources. It also lists Congressional Research Service (CRS) reports that summarize the ACA’s provisions.

The report begins with links to contacts for constituents’ specific...

Military Benefits for Former Spouses: Legislation and Policy Issues

In 1981, the Supreme Court ruled that the former spouse of a military member or retiree could not be awarded any share of that member’s/retiree’s retired pay as a part of a divorce property settlement in a community property state. In response, Congress enacted the Uniformed Services Former Spouses’ Protection Act (USFSPA) in 1982. Under the USFSPA, state courts can treat disposable military retired pay as divisible property in divorce cases. However, state laws may vary on these concepts. The USFSPA makes no assumption of such a division nor does it presume how much of a division should...

Funding Gaps and Government Shutdowns: CRS Experts

Contacting CRS Subject Matter Experts

In the event of a funding gap, the potential impacts of a government shutdown would depend on a program’s or agency’s specific circumstances and, furthermore, how relevant law is interpreted. Table 1 provides names and contact information for CRS subject matter experts on policy concerns and legal issues relating to funding gaps and the processes and effects that may be associated with a government shutdown. Policy areas that are identified in Table 1 include

agencies and programs funded by specific regular appropriations bills;

cross-cutting shutdown...

FDA Human Medical Product User Fee Programs: In Brief

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The Food and Drug Administration (FDA) regulates human medical products to ensure they are safe and effective for their intended use in patients. Medical products include prescription and nonprescription (over-the-counter) drugs, biologics or biological products, and medical devices. FDA regulation of these products involves both premarket and postmarket regulatory requirements. The four user fee programs discussed in this report are prescription drugs, medical devices, generic drugs, and biosimilars....

Telehealth Services Proposed for Medicare Part B Reimbursements, 2018: Fact Sheet

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During the 115th Congress, several bipartisan bills have been introduced that aim to expand the number of telehealth services that are covered under Medicare. Telehealth is the electronic delivery of a health care service via a technological method. Health care providers use telehealth to improve patients’ access to and quality of care. Under Medicare, these patients are likely to live in rural areas, be under the age of 65, and be disabled.

The Centers for Medicare and Medicaid Services (CMS) administers the Medicare program and makes decisions on telehealth coverage and...

The Independent Payment Advisory Board (IPAB): Frequently Asked Questions

This report responds to frequently asked questions about the Independent Payment Advisory Board (IPAB), including the board’s background, current status, controversial issues including legal challenges, and recent legislative efforts to repeal the IPAB.

For additional information, see CRS Report R41511, The Independent Payment Advisory Board, by Jim Hahn and Christopher M. Davis.

Presidential Appointments to Full-Time Positions in Executive Departments During the 114th Congress

The President makes appointments to positions within the federal government, either using the authorities granted by law to the President alone, or with the advice and consent of the Senate. There are some 350 full-time leadership positions in the 15 executive departments for which the Senate provides advice and consent. This report identifies all nominations submitted to the Senate during the 114th Congress for full-time positions in these 15 executive departments.

Information for each department is presented in tables. The tables include full-time positions confirmed by the Senate, pay...

Biologics and Biosimilars: Background and Key Issues

A biological product, or biologic, is a preparation, such as a drug or a vaccine, that is made from living organisms. Compared with conventional chemical drugs, biologics are relatively large and complex molecules. They may be composed of proteins (and/or their constituent amino acids), carbohydrates (such as sugars), nucleic acids (such as DNA), or combinations of these substances. Biologics may also be cells or tissues used in transplantation.

A biosimilar, sometimes referred to as a follow-on biologic, is a therapeutic drug that is similar but not structurally identical to the...

Niger: Frequently Asked Questions About the October 2017 Attack on U.S. Soldiers

A deadly attack on U.S. soldiers in Niger and their local counterparts on October 4, 2017, has prompted many questions from Members of Congress about the incident. It has also highlighted a range of broader issues for Congress pertaining to oversight and authorization of U.S. military deployments, evolving U.S. global counterterrorism activities and strategy, interagency security assistance and cooperation efforts, and U.S. engagement with countries historically considered peripheral to core U.S. national security interests. This report provides background information in response to the...

The Opioid Epidemic and Federal Efforts to Address It: Frequently Asked Questions

Over the last several years, there has been growing concern among the public and lawmakers in the United States about rising drug overdose deaths, which more than tripled from 1999 to 2014. In 2015, more than 52,000 people died from drug overdoses, and approximately 63% of those deaths involved an opioid.

Many federal agencies are involved in efforts to combat opioid abuse. The primary federal agency involved in drug enforcement, including diversion control efforts for prescription opioids, is the Drug Enforcement Administration (DEA). The primary agency supporting drug treatment and...

School Meals Programs and Other USDA Child Nutrition Programs: A Primer

“Child nutrition programs” is an overarching term used to describe the U.S. Department of Agriculture’s Food and Nutrition Service (USDA-FNS) programs that provide food for children in school or institutional settings. The best known programs, which serve the largest number of children, are the school meals programs: the National School Lunch Program (NSLP) and the School Breakfast Program (SBP). The child nutrition programs also include the Child and Adult Care Food Program (CACFP), which provides meals and snacks in day care and after school settings; the Summer Food Service Program...

Overview of Continuing Appropriations for FY2018 (P.L. 115-56)

This report provides an analysis of the continuing appropriations provisions for FY2018 in Division D of H.R. 601. The measure also included separate divisions that establish a program to provide foreign assistance concerning basic education (Division A—Reinforcing Education Accountability in Development Act), supplemental appropriations for disaster relief requirements for FY2017 (Division B), and a temporary suspension of the public debt limit (Division C). On September 8, 2017, the President signed H.R. 601 into law (P.L. 115-56).

Division D of H.R. 601 was termed a “continuing...

FDA Reauthorization Act of 2017 (FDARA, P.L. 115-52)

Food and Drug Administration (FDA) review of medical products (human drugs and devices) is funded through a combination of annual discretionary appropriations from Congress (budget authority) and user fees collected from industry. The human medical product user fee programs require reauthorization every five years to continue uninterrupted. Prior to the passage of the Food and Drug Administration Reauthorization Act of 2017 (FDARA, P.L. 115-52), these programs were set to expire on September 30, 2017. The reauthorization legislation typically includes additional provisions related to FDA,...

Regulatory Exclusivity Reform in the 115th Congress

Regulatory exclusivities provide incentives for pharmaceutical innovation in the United States. Overseen by the Food and Drug Administration (FDA), regulatory exclusivities are alternatively known as marketing exclusivities, data exclusivities, or data protection. Each of the distinct regulatory exclusivities establishes a period of time during which the FDA affords an approved drug protection from competing applications for marketing approval.

Between them, the Federal Food, Drug, and Cosmetic Act, P.L. 75-717 (as amended), and the Public Health Service Act, P. L. 78-410 (as amended),...

Chemical, Hazardous Substances, and Petroleum Spills: CRS Experts

Hurricane Harvey Irma Jose Katia Katrina flooding storm surge water tropical storms weather climate change sewage treatment overflow tropical storm cyclone A recent spill from a storage tank of 4-methyl cyclohexane methanol from Freedom Industries into the Elk River near Charleston, West Virginia in early January 2014 has raised questions about the adequacy of spill response and chemical safety. Thousands of oil and chemical spills of varying size occur in the United States each year. State and local officials located in proximity to these incidents generally are the first responders and...

Labor, Health and Human Services, and Education: FY2017 Appropriations

This report provides an overview of actions taken by Congress and the President to provide FY2017 appropriations for accounts funded by the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations bill. This bill provides funding for all accounts funded through the annual appropriations process at the Departments of Labor (DOL) and Education (ED). It provides annual appropriations for most agencies within the Department of Health and Human Services (HHS), with certain exceptions (e.g., the Food and Drug Administration is funded via the...

Congressional Primer on Responding to Major Disasters and Emergencies

The principles of disaster management assume a leadership role by the local, state, and tribal governments affected by the incident. The federal government provides coordinated supplemental resources and assistance, only if requested and approved. The immediate response to a disaster is guided by the National Response Framework (NRF), which details roles and responsibilities at various levels of government, along with cooperation from the private and nonprofit sectors, for differing incidents and support functions. A possible declaration of a major disaster or emergency under the authority...

Flooding Events: CRS Experts

The following table provides access to names and contact information for CRS experts on policy concerns relating to flooding events in the United States. Policy areas identified include disaster assistance and recovery matters extending to impacts such as displaced residents and business, losses in agricultural production, disruptions in transportation (river, rail, and highway), problems with water treatment and supply; responses and recovery operations such as disaster declarations and federal assistance, public health provisions, federal flood insurance, agricultural disaster relief and...

Title X (Public Health Service Act) Family Planning Program

The federal government provides grants for family planning services through the Family Planning Program, Title X of the Public Health Service Act (42 U.S.C. §§300 to 300a-6). Enacted in 1970, it is the only domestic federal program devoted solely to family planning and related preventive health services. In 2015, Title X-funded clinics served 4.0 million clients.

Title X is administered through the Office of Population Affairs (OPA) in the Department of Health and Human Services (HHS). Although the authorization of appropriations for Title X ended with FY1985, funding for the program has...

Natural Disasters and Hazards: CRS Experts

The following table provides access to names and contact information for CRS experts on policy concerns relating to natural disasters and hazards in the United States. Policy areas identified include disaster assistance and recovery matters extending to impacts such as displaced residents and business, losses in agricultural production, disruptions in transportation (river, rail, and highway), problems with water treatment and supply; responses and recovery operations such as disaster declarations and federal assistance, public health provisions, federal flood insurance, agricultural...

Hurricane Events: CRS Experts

The following table provides access to names and contact information for CRS experts on policy concerns relating to hurricane events in the United States. Policy areas identified include disaster assistance and recovery matters extending to impacts such as displaced residents and business, , disruptions in the energy sector and transportation, problems with water treatment and supply; responses and recovery operations such as disaster declarations and federal assistance, public health provisions, federal flood insurance, agricultural disaster relief and assistance, tax relief,...

Maternal and Child Health Services Block Grant: Background and Funding

The Maternal and Child Health (MCH) Services Block Grant is a federal-state partnership program that aims to improve the health of low-income pregnant women, mothers, and children. In addition, the program aims to connect low-income families with other services and programs, such as Medicaid and the State Children’s Health Insurance Program (CHIP). This federal-state partnership is composed of three programs. First, formula-based block grants are provided to states and territories (collectively referred to as states in this report). Second, competitive grants are available through the...

The Patient Protection and Affordable Care Act’s (ACA’s) Transitional Reinsurance Program

Section 1341 of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) establishes a transitional reinsurance program that is designed to provide payment to non-grandfathered, non-group market health plans (also known as individual market health plans) that enroll high-risk enrollees for 2014 through 2016. Under the program, the Secretary of the Department of Health and Human Services (HHS) collects reinsurance contributions from health insurers and from third-party administrators on behalf of group health plans. The Secretary then uses those contributions to make...

Corporate Expatriation, Inversions, and Mergers: Tax Issues

News reports in the late 1990s and early 2000s drew attention to a phenomenon sometimes called corporate “inversions” or “expatriations”: instances where U.S. firms reorganize their structure so that the “parent” element of the group is a foreign corporation rather than a corporation chartered in the United States. The main objective of these transactions was tax savings and they involved little to no shift in actual economic activity. Bermuda and the Cayman Islands (countries with no corporate income tax) were the location of many of the newly created parent corporations.

These types of...

Public Health Service Agencies: Overview and Funding (FY2016-FY2018)

Within the Department of Health and Human Services (HHS), eight agencies are designated components of the U.S. Public Health Service (PHS). The PHS agencies are funded primarily with annual discretionary appropriations. They also receive significant amounts of funding from other sources, including mandatory funds from the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended), user fees, and third-party reimbursements (collections).

The Agency for Healthcare Research and Quality (AHRQ) funds research on improving the quality and delivery of health care. For more than a...

Public Health and Emergency Management: CRS Experts

The following table provides names and contact information for CRS experts on policy concerns relating to public health and emergency management. Policy areas identified include public health and medical system preparedness and response; mental and behavioral health; food safety and food defense; health care financing in disaster response; Stafford Act assistance and the role of the Federal Emergency Management Agency (FEMA); Department of Defense (DOD) incident response and civil support; global health and international preparedness; selected legal issues in preparedness and response;...

Medicare: Insolvency Projections

Medicare is the nation’s health insurance program for persons aged 65 and older and certain disabled persons. Medicare consists of four distinct parts: Part A (Hospital Insurance, or HI); Part B (Supplementary Medical Insurance, or SMI); Part C (Medicare Advantage, or MA); and Part D (the outpatient prescription drug benefit).

The Part A program is financed primarily through payroll taxes levied on current workers and their employers; these taxes are credited to the HI Trust Fund. The Part B program is financed through a combination of monthly premiums paid by current enrollees and...

Status of FY2017 Labor-HHS-Education Appropriations

This report provides a brief summary of the general scope of the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations bill. The report also provides a high-level overview of congressional action with regard to the FY2017 LHHS bill (S. 3040 and H.R. 5926), FY2017 continuing resolutions (CRs; P.L. 114-223, P.L. 114-254, and P.L. 115-30), and LHHS components of the FY2017 omnibus (P.L. 115-31). The report concludes with a list of additional resources.

Medicare Financial Status: In Brief

This report provides a brief overview of the financial status of the two Medicare trust funds (Hospital Insurance and Supplementary Medical Insurance) based on the findings of the 2017 Medicare Trustees Report. It includes an overview of Medicare and its financing, summary data on the program’s 2016 operations, current estimates of the insolvency date of the Hospital Insurance Trust Fund, and estimates of spending growth. These estimates include measures of Medicare spending as a portion of GDP, unfunded obligations, and alternative projections.

Updated Standards for SNAP-Authorized Retailers

The Supplemental Nutrition Assistance Program (SNAP), the largest of the U.S Department of Agriculture’s (USDA’s) domestic food assistance programs, provides benefits to eligible participants; these benefits are redeemable for SNAP-eligible foods at SNAP-authorized retailers. SNAP-authorized retailers are stores and other food sellers that are allowed to accept SNAP benefits. In FY2015, the vast majority of benefits were redeemed at “super stores” and supermarkets.

On December 15, 2016, USDA’s Food and Nutrition Service (FNS) published in the Federal Register a final rule, “Enhancing...

Provisions of Obamacare Repeal Reconciliation Act of 2017 (ORRA)

Per the reconciliation instructions in the budget resolution for FY2017 (S.Con.Res. 3), the House passed its reconciliation bill, H.R. 1628—the American Health Care Act (AHCA)—with amendments on May 4, 2017. The House bill was received in the Senate on June 7, 2017, and the next day the Senate majority leader had it placed on the calendar, making it available for floor consideration. The Senate Budget Committee published on its website a “discussion draft” titled, “The Better Care Reconciliation Act of 2017” (BCRA) on June 22, 2017, and subsequently updated the discussion draft on June 26,...

Comparison of the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA)

Per the reconciliation instructions in the budget resolution for FY2017 (S.Con.Res. 3), the House passed its reconciliation bill, H.R. 1628—the American Health Care Act (AHCA)—with amendments on May 4, 2017. The House bill was received in the Senate on June 7, 2017, and the next day the Senate majority leader had it placed on the calendar, making it available for floor consideration. The Senate Budget Committee published on its website a “discussion draft” titled, “The Better Care Reconciliation Act of 2017” (BCRA) on June 22, subsequently updated the discussion draft on June 26, again on...

Health Policy: Resources for Congressional Staff

KEYWORDS: Health policy, health insurance, public health, medical research, health workforce, health spending, health expenditures, Medicare, Medicaid, CHIP, SCHIP, state children’s health insurance program, children’s health insurance program.

Indian Health Service (IHS) Funding: Fact Sheet

The Indian Health Service (IHS) within the Department of Health and Human Services (HHS) is the lead federal agency charged with improving the health of American Indians and Alaska Natives. IHS provides health care for approximately 2.2 million eligible American Indians/Alaska Natives through a system of programs and facilities located on or near Indian reservations, and through contractors in certain urban areas. IHS provides services to members of 566 federally recognized tribes. It provides services either directly or through facilities and programs operated by Indian Tribes or Tribal...

Health Resources and Services Administration (HRSA) Funding: Fact Sheet

The Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) is the federal agency charged with improving the health safety net by providing access to health care for those who are uninsured, isolated, or medically vulnerable. The agency currently awards funding to more than 3,000 grantees, including community-based organizations; colleges and universities; hospitals; state, local, and tribal governments; and private entities to support health services projects, such as training health care workers or providing specific health services....

The Food and Drug Administration (FDA) Budget: Fact Sheet

The Food and Drug Administration (FDA) regulates the safety of foods (including dietary supplements), cosmetics, and radiation-emitting products; the safety and effectiveness of drugs, biologics (e.g., vaccines), and medical devices; and public health aspects of tobacco products. Seven centers within FDA represent the broad program areas for which the agency has responsibility: the Center for Biologics Evaluation and Research (CBER), the Center for Devices and Radiological Health (CDRH), the Center for Drug Evaluation and Research (CDER), the Center for Food Safety and Applied Nutrition...

Department of Health and Human Services: FY2018 Budget Request

This report provides information about the FY2018 budget request for the Department of Health and Human Services (HHS). It begins by reviewing the department’s mission and structure. This is followed by an overview of the total FY2018 request for the department. Next, the report discusses the concept of the HHS budget as a whole, compared to funding provided to HHS through the annual appropriations process. This distinction is important because certain amounts shown in FY2018 HHS budget materials (including amounts for prior years) will not match amounts provided to HHS by annual...

Older Americans Act: Background and Overview

The Older Americans Act (OAA) is the major federal vehicle for the delivery of social and nutrition services for older persons. These include supportive services, congregate nutrition services (meals served at group sites such as senior centers, schools, churches, or senior housing complexes), home-delivered nutrition services, family caregiver support, community service employment, the long-term care ombudsman program, and services to prevent the abuse, neglect, and exploitation of older persons. The OAA also supports grants to older Native Americans as well as research, training, and...

Indian Elementary-Secondary Education: Programs, Background, and Issues

The federal government provides elementary and secondary education and educational assistance to Indian children, either directly through federally funded schools or indirectly through educational assistance to public schools. Direct education is provided by the Bureau of Indian Education (BIE) in the U.S. Department of the Interior (DOI), through elementary and secondary schools funded by the BIE. Educational assistance to public schools is provided chiefly through programs of the U.S. Department of Education (ED). The student population served by federal Indian education programs...

Prescription Drug Discount Coupons and Patient Assistance Programs (PAPs)

U.S. pharmaceutical manufacturers fund a variety of programs to help consumers defray the cost of prescription drugs. Industry assistance includes drug discount coupons, as well as free drugs and cost-sharing payments for individuals with lower incomes or high medical expenses. According to one analysis, drug manufacturers tendered discount coupons for more than 600 brands in 2016. Nonprofit patient assistance programs (PAPs) offered by drug manufacturers and independent charities dispense billions of dollars in assistance annually, placing them among the nation’s largest charitable...

Maternal and Infant Early Childhood Home Visiting (MIECHV) Program: Background and Funding

The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program supports home visiting services for families with young children who reside in communities that have concentrations of poor child health and other risk indicators. Home visits are conducted by nurses, mental health clinicians, social workers, or paraprofessionals with specialized training. Generally, they visit the homes of eligible families on a regular basis (e.g., weekly or monthly) over an extended period (e.g., six months or longer) to provide support to caregivers and children, such as guidance on...

The ACA Prevention and Public Health Fund: In Brief

SUPPRESS: Section 4002 of the Affordable Care Act (ACA, P.L. 111-148, as amended), Prevention and Public Health Fund (PPHF) a permanent annual appropriation to be administered by the Secretary of Health and Human Services (HHS). PPHF was intended to support an “expanded and sustained national investment in prevention and public health programs.” (42 U.S.C. 300u-11)

PPHF amounts for each fiscal year are available to the Secretary of HHS beginning October 1, the start of the respective fiscal year. Congress may explicitly direct the distribution of PPHF funds, and did so for FY2014 through...

U.S. Strategy for Engagement in Central America: Policy Issues for Congress

Central America has received renewed attention from U.S. policymakers over the past few years as the region has become a major transit corridor for illicit drugs and a significant source of irregular migration to the United States. These narcotics and migrant flows are the latest symptoms of deep-rooted challenges in several countries in the region, including widespread insecurity, fragile political and judicial systems, and high levels of poverty and unemployment. Although the Obama Administration and governments in the region launched new initiatives designed to improve conditions in...

Discretionary Budget Authority by Subfunction: An Overview

This report provides a graphical overview of historical trends in discretionary budget authority (BA) from FY1977 through FY2016, preliminary estimates for FY2017 spending, and the levels reflecting the President’s proposals for FY2018 through FY2022 using data from the FY2018 budget submission released on May 23, 2017. This report, by illustrating trends in broad budgetary categories, provides a starting point for discussions about fiscal priorities. Other CRS products analyze spending trends in specific functional areas. Functional categories (e.g., national defense, agriculture, etc.)...

SAMHSA FY2018 Budget Request and Funding History: A Fact Sheet

The Substance Abuse and Mental Health Services Administration (SAMHSA), at the U.S. Department of Health and Human Services (HHS), is the lead federal agency for increasing access to behavioral health services. SAMHSA supports community-based mental health and substance abuse treatment and prevention services through formula grants to the states and U.S. territories and through competitive grant programs to states, territories, tribal organizations, local communities, and private entities. SAMHSA also engages in a range of other activities, such as technical assistance, data collection,...

H.R. 1628: The American Health Care Act (AHCA)

In January 2017, the House and Senate adopted a budget resolution for FY2017 (S.Con.Res. 3), which reflects an agreement between the chambers on the budget for FY2017 and sets forth budgetary levels for FY2018-FY2026. S.Con.Res. 3 also includes reconciliation instructions directing specific committees to develop and report legislation that would change laws within their respective jurisdictions to reduce the deficit. These instructions trigger the budget reconciliation process, which may allow certain legislation to be considered under expedited procedures. The reconciliation instructions...

President’s FY2018 Budget Proposes Cuts in Public Health Service (PHS) Agency Funding

The President’s FY2018 budget proposes significant reductions in funding for the Public Health Service (PHS) agencies within the Department of Health and Human Services. The budget reflects the PHS agency funding priorities outlined in the budget blueprint released in March. Among other things, the President’s budget would cut funding for medical research, public health prevention programs, and mental health services.

The proposed cuts are to discretionary funding, which is controlled through the annual appropriations process. PHS agencies also receive funding from various mandatory...

Tracking the Next Child Nutrition Reauthorization: An Overview

The “child nutrition programs” (National School Lunch Program [NSLP] and certain other institutional food service programs) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were last reauthorized by the Healthy, Hunger-Free Kids Act of 2010 (HHFKA, P.L. 111-296). Some of the authorities created or extended in the last reauthorization law expired on September 30, 2015, but the vast majority of operations and activities continue because appropriations laws continued funding.

In the 114th Congress, both committees of jurisdiction—the Senate Committee on...

Science and Technology Issues in the 115th Congress

Science and technology (S&T) have a pervasive influence over a wide range of issues confronting the nation. Public and private research and development spur scientific and technological advancement. Such advances can drive economic growth, help address national priorities, and improve health and quality of life. The constantly changing nature and ubiquity of science and technology frequently create public policy issues of congressional interest.

The federal government supports scientific and technological advancement directly by funding and performing research and development and...

Federal Health Centers: An Overview

The federal Health Center Program is authorized in Section 330 of the Public Health Service Act (PHSA) (42 U.S.C. §254b) and administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services. The program awards grants to support outpatient primary care facilities that provide care to primarily low-income individuals or individuals located in areas with few health care providers.

Federal health centers are required to provide health care to all individuals, regardless of their ability to pay, and to be located in geographic areas with...

Factors Related to the Use of Planned Parenthood Affiliated Health Centers (PPAHCs) and Federally Qualified Health Centers (FQHCs)

Recent debates about federal funding for the Planned Parenthood Federation of America (PPFA) and its affiliated health centers (PPAHCs) have raised questions about the services that PPAHCs provide and the availability of alternative facilities to provide similar services to disadvantaged populations. This report provides background information and data that may be useful for policymakers evaluating these recent debates. Although a number of other facility types could potentially provide similar services as PPAHCs, this report focuses on federally qualified health centers (FQHCs)—a term...

Use of the Annual Appropriations Process to Block Implementation of the Affordable Care Act (FY2011-FY2017)

Congress is deeply divided over implementation of the Affordable Care Act (ACA), the health reform law enacted in March 2010. Since the ACA’s enactment, lawmakers opposed to specific provisions in the ACA or the entire law have repeatedly debated its implementation and considered bills to repeal, defund, delay, or otherwise amend the law.

In addition to considering ACA repeal or amendment in authorizing legislation, some lawmakers have used the annual appropriations process in an effort to eliminate funding for the ACA’s implementation and address other aspects of the law. ACA-related...

Selected Homeland Security Issues in the 115th Congress

In 2001, in the wake of the terrorist attacks of September 11th, “homeland security” went from being a concept discussed among a relatively small cadre of policymakers and strategic thinkers to a broadly discussed issue among policymakers, including those in Congress. Debates over how to implement coordinated homeland security policy led to the passage of the Homeland Security Act of 2002 (P.L. 107-296) and the establishment of the Department of Homeland Security (DHS). Evolution of America’s response to terrorist threats has continued under the leadership of different Administrations,...

Zika Virus: CRS Experts

In late 2015, health officials in Brazil recognized a marked increase in the number of infants born with microcephaly (from Greek, meaning “small head”), a birth defect that may accompany significant, permanent brain damage. Although not conclusive, the increase in microcephaly is suspected to be related to the emergence of Zika virus infections in Brazil early in 2015.

Zika virus is related to the viruses that cause yellow fever, dengue, West Nile, and Japanese encephalitis viruses. Historically Zika virus was found in Africa. Since 2007, Zika transmission has also occurred in Southeast...

Presidential Appointee Positions Requiring Senate Confirmation and Committees Handling Nominations

As part of the process of making an appointment to an advice and consent position, the President submits a nomination to the Senate. Most nominations are referred to the appropriate Senate committee or committees on the day they are received. Such referrals are guided by Senate Rule XXV, which establishes the subject matter under the purview of each committee and directs that “all proposed legislation, messages, petitions, memorials, and other matters relating primarily to [those] subjects” be referred to that committee. Precedents set by prior referrals, standing orders, and unanimous...

Advanced Gene Editing: CRISPR-Cas9

Scientists have long sought the ability to control and modify DNA—the code of life. A new gene editing technology known as CRISPR-Cas9 offers the potential for substantial improvement over previous technologies in that it is simple to use and inexpensive and has a relatively high degree of precision and efficiency. These characteristics have led many in the scientific and business communities to assert that CRISPR-Cas9 will lead to groundbreaking advances in many fields, including agriculture, energy, ecosystem conservation, and the investigation, prevention, and treatment of...

Regulation of Clinical Tests: In Vitro Diagnostic (IVD) Devices, Laboratory Developed Tests (LDTs), and Genetic Tests

In vitro diagnostic (IVD) devices are used in the analysis of human samples, such as blood or tissue, to provide information in making health care decisions. Examples of IVDs include (1) pregnancy test kits or blood glucose tests for home use; (2) laboratory tests for infectious disease, such as HIV or hepatitis, and routine blood tests, such as cholesterol and anemia; and (3) tests for various genetic diseases or conditions. More recently, a specific type of diagnostic test—called a companion diagnostic—has been developed that may be used to select the best therapy, at the right dose, at...

A Primer on WIC: The Special Supplemental Nutrition Program for Women, Infants, and Children

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition-rich foods, nutrition education (including breastfeeding promotion and support), and health care and social services referrals to eligible low-income women, infants, and children. In FY2016, approximately 7.7 million people participated in WIC each month. WIC is authorized by the Child Nutrition Act, as is the related WIC Farmers’ Market Nutrition Program (WIC FMNP). WIC, WIC FMNP, school meals, and the other child nutrition programs are typically reauthorized together; these programs were...

Implementing the Affordable Care Act: Delays, Extensions, and Other Administrative Actions Taken by the Obama Administration

During the Obama Administration, the two federal agencies primarily responsible for administering the private health insurance provisions in the Affordable Care Act (ACA)—the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS), and the Internal Revenue Service (IRS) within the Treasury Department—took a series of actions to delay, extend, or otherwise modify the law’s implementation.

This report summarizes selected administrative actions taken by CMS and the IRS through February 2015 to address ACA implementation. The report is no longer...

Employer Wellness Programs and Genetic Information: Frequently Asked Questions

Since the passage of the Patient Protection and Affordable Care Act of 2010 (ACA, P.L. 111-148, as amended), which encouraged use of wellness programs, employers have increasingly established employer wellness programs in an effort to support better health among their employees and reduce their own health care costs. Employer wellness programs often focus on improving wellness overall, but they may target a specific disease (e.g., diabetes) or behavior (e.g., smoking), and they may include the provision of health or other services. These programs often include incentives for participation,...

President’s Budget Blueprint Seeks Changes for Public Health Service Agencies

The White House has released a “budget blueprint” that outlines President Trump’s priorities for funding the federal government in FY2018. The document covers only discretionary spending, which is controlled through the annual appropriations process. It does not address mandatory spending—including spending on entitlement programs such as Medicare and Social Security—or interest payments on the federal debt. The complete FY2018 budget is expected to be released in May.

Although the budget blueprint provides limited details on the agency, account, or program level, it indicates Trump...

Geographical Indications (GIs) in U.S. Food and Agricultural Trade

Geographical indications (GIs) are place names used to identify products that come from these places and to protect the quality and reputation of a distinctive product originating in a certain region. The term is most often applied to wines, spirits, and agricultural products. Some food producers benefit from the use of GIs by giving certain foods recognition for their distinctiveness, differentiating them from other foods in the marketplace. In this manner, GIs can be commercially valuable. GIs may be eligible for relief from acts of infringement or unfair competition. GIs may also...

Privacy Protections for Individuals with Substance Use Disorders: The Part 2 Final Rule in Brief

On January 18, 2017, the Secretary of Health and Human Services (HHS) published a final rule to amend the federal regulations known as “Part 2” that protect the privacy of patient records maintained by alcohol and drug treatment programs across the country. Part 2 was developed in the 1970s to allay the concerns of individuals with substance use disorders who were afraid to get treatment for fear that their medical information would be released, leading to discrimination and even prosecution.

Health care providers participating in new health care delivery models such as accountable care...

Previewing a 2018 Farm Bill

Congress periodically establishes agricultural and food policy in an omnibus farm bill. The 115th Congress faces reauthorization of the 2014 farm bill—the Agricultural Act of 2014 (P.L. 113-79, H.Rept. 113-333)—because many of its provisions expire in 2018.

The 2014 farm bill is the most recent omnibus farm bill. It was enacted in February 2014 and succeeded the Food, Conservation, and Energy Act of 2008 (P.L. 110-246, “2008 farm bill”). In recent decades, the breadth of farm bills has steadily grown to include new and expanding food and agricultural interests. The 2014 farm bill contains...

The Marijuana Policy Gap and the Path Forward

Under federal law, the cultivation, possession, and distribution of marijuana are illegal, except for the purposes of sanctioned research. States, however, have established a range of laws and policies regarding marijuana’s medical and recreational use. Most states have deviated from an across-the-board prohibition of marijuana, and it is now more so the rule than the exception that states have laws and policies allowing for some cultivation, sale, distribution, and possession of marijuana—all of which are contrary to the federal Controlled Substances Act (CSA). As of March 2017, nearly...

Judge Neil M. Gorsuch: His Jurisprudence and Potential Impact on the Supreme Court

On January 31, 2017, President Donald J. Trump announced the nomination of Judge Neil M. Gorsuch of the U.S. Court of Appeals for the Tenth Circuit (Tenth Circuit) to fill the vacancy on the Supreme Court of the United States created by the death of Justice Antonin Scalia in 2016. Judge Gorsuch was appointed to the Tenth Circuit by President George W. Bush in 2006. The Tenth Circuit’s territorial jurisdiction covers Colorado, Kansas, New Mexico, Oklahoma, Utah, Wyoming, and parts of Yellowstone National Park that extend into Idaho and Montana.

Immediately prior to his appointment to the...

Medicaid Financial Eligibility for Long-Term Services and Supports

Medicaid is a means-tested entitlement program that finances the delivery of health care and long-term services and supports (LTSS) to certain eligible low-income individuals. Established under Title XIX of the Social Security Act (SSA), the Medicaid program is state-operated within broad federal guidelines, and is jointly funded by the federal government and states. To qualify for Medicaid, individuals must meet certain categorical and financial requirements. To qualify for Medicaid LTSS, individuals must also meet state-based functional eligibility criteria that determine need for...

Medicaid Coverage of Long-Term Services and Supports

Long-term services and supports (LTSS) refer to a broad range of health and health-related services and supports needed by individuals who lack the capacity for self-care due to a physical, cognitive, or mental disability or condition. Often the individual’s disability or condition results in the need for hands-on assistance or supervision over an extended period of time. Medicaid plays a key role in covering LTSS to aged and disabled individuals. As the largest single payer of LTSS in the United States, federal and state Medicaid spending accounted for $149.4 billion or 42.5% of all LTSS...

Democratic Republic of Congo: Background and U.S. Relations

War and humanitarian suffering in the Democratic Republic of Congo (DRC) have long preoccupied U.S. policymakers, including many Members of Congress. Since the 1990s, cyclical conflicts in eastern DRC have caused regional instability and impeded investment, becoming the focus of international attention toward the country. Since 2015, attention has turned toward DRC’s political trajectory as President Joseph Kabila’s efforts to remain in office past the end of his second elected term in 2016 (his last, under the constitution) have sparked unrest. Unable for now to amend constitutional term...

Health Care-Related Expiring Provisions of the 115th Congress, First Session

This report provides descriptions of selected health care-related provisions that are scheduled to expire during the 115th Congress, first session (i.e., during calendar year [CY] 2017). For purposes of this report, expiring provisions are defined as portions of law that are time limited and will lapse once a statutory deadline is reached absent further legislative action. The expiring provisions included in this report are those related to Medicare, Medicaid, State Children’s Health Insurance Program (CHIP), and private health insurance programs and activities. The report also includes...

Medicare Advantage (MA)–Proposed Benchmark Update and Other Adjustments for CY2018: In Brief

SUMMARY TO BE SUPPRESSED

Medicare Advantage MA Part C Advance notice of methodological changes for CY2018 Capitation Rates, AHIP Benchmark Bid National Per Capita MA Growth Percentage US Per Capita Cost Growth Percentage USPCC, NPCMAGP EGWP Employer Group Waiver risk adjustment normalization cap payments quality bonus payment demonstration applicable amount specified amount Affordable Care Act phase-in to new benchmark coding pattern differences normalization ACA (P.L. 111-148, as amended)

Child Welfare: Oversight of Psychotropic Medication for Children in Foster Care

Children in foster care are children that the state has removed from their homes and placed in another setting designed to provide round-the-clock care (e.g., foster family home, group home, child care institution). The large majority of children enter foster care because of neglect or abuse at the hands of their parents. Maltreatment by a caregiver is often traumatic for children, and may lead to children having challenges regulating their emotions and interpreting cues and communication from others, among other problem behaviors. Children in foster care are more likely to have mental...

Long-Term Care Services for Veterans

The Veterans Health Administration (VHA), an operating unit of the Department of Veterans Affairs (VA), is a direct service provider of health care, similar in many ways to a large private sector health care system. In addition to providing inpatient, outpatient, and a range of other medical care services, the VHA provides and purchases long-term care services. The VA is one of two federal payers of long-term care services (the other being Medicaid).

Since the 1960s, the VA has been authorized to provide nursing home care to eligible veterans in various settings, including VA facilities,...

Discretionary Spending Under the Affordable Care Act (ACA)

The Affordable Care Act (ACA) authorized many new discretionary grant programs and provided each one with an authorization of appropriations—typically through FY2014 or FY2015—to carry them out. The ACA also reauthorized funding for numerous existing programs with expired authorizations of appropriations, most of which were still receiving annual funding.

The Congressional Budget Office (CBO) estimated that fully funding the discretionary grant programs authorized (or reauthorized) by the ACA, based on the amounts specified in the authorizations of appropriations, would result in...

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

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 federal matching funds for states that have expanded their Medicaid programs.

In addition, the ACA included numerous...

Legislative Actions in the 112th, 113th, and 114th Congresses to Repeal, Defund, or Delay the Affordable Care Act

Congress is deeply divided over implementation of the Affordable Care Act (ACA), the health reform law enacted in March 2010 during the 111th Congress. Since the ACA’s enactment, lawmakers opposed to specific provisions in the ACA or the entire law have repeatedly debated its implementation and considered bills to repeal, defund, delay, or otherwise amend the law.

During the 112th, 113th, and 114th Congresses, the Republican-led House passed numerous ACA-related bills, including legislation that would repeal the entire law. There was much less debate in the Senate, which remained under...

Present Trends and the Evolution of Mandatory Spending

Federal spending is divided into three broad categories: discretionary spending, mandatory spending, and net interest. Mandatory spending is composed of budget outlays controlled by laws other than appropriation acts, including federal spending on entitlement programs. Entitlement programs such as Social Security, Medicare, and Medicaid make up the bulk of mandatory spending. Other mandatory spending funds various income support programs, including Supplemental Security Income (SSI), unemployment insurance, and the Supplemental Nutrition Assistance Program (SNAP), as well as federal...

Farm Bill: CRS Experts

The 115th Congress faces reauthorization of the current five-year farm bill—the Agricultural Act of 2014 (P.L. 113-79)—because many of its provisions expire in 2018. The following table provides names and contact information for CRS experts on policy issues related to the farm bill. Numerous agricultural and food issues are addressed in the farm bill, including farm commodity support, conservation, international food aid and agricultural trade, nutrition assistance, farm credit, rural development, agricultural research, forestry, bioenergy, horticulture and organic agriculture, crop...

The Community Health Center Fund: In Brief

The Health Center Program, which is administered by the Health Resources and Services Administration within the Department of Health and Human Services, awards grants to outpatient health care facilities that provide care to medically underserved populations. The program’s annual funding has more than tripled between FY2002 and FY2016, which has, in turn, increased the number of centers operating, the number of patients they see, and the volume and type of services available.

The program’s funding increase occurred partially because of the Community Health Center Fund (CHCF), a mandatory...

Increasing Choice, Access, and Quality in Health Care for Americans Act (Division C of P.L. 114-255)

This report summarizes the Increasing Choice, Access, and Quality in Health Care for Americans Act, enacted December 13, 2016, as Division C of the 21st Century Cures Act (P.L. 114-255). Division C comprises Title XV through Title XVII, which include provisions primarily relating to Medicare and Title XVIII, which includes a provision relating to the small-group health insurance market.

Title XV Medicare Part A provisions:

extend the Rural Community Hospital demonstration five years;

require the Secretary of the Department of Health and Human Services (HHS) to account for socioeconomic...

Overview of Further Continuing Appropriations for FY2017 (H.R. 2028)

This report is an analysis of the provisions in H.R. 2028, which provides further continuing appropriations for FY2017 through April 28, 2017. The measure also included appropriations for the remainder of the fiscal year for Overseas Contingency Operations in the Security Assistance Appropriations Act (Division B). On December 10, 2016, the President signed H.R. 2028 into law (P.L. 114-254).

Division A of H.R. 2028 was termed a “continuing resolution” (CR) because it provided temporary authority for federal agencies and programs to continue spending in FY2017 in the same manner as a...

The 21st Century Cures Act (Division A of P.L. 114-255)

The 21st Century Cures Act (P.L. 114-255) was signed into law on December 13, 2016, by President Barack Obama. On November 30, 2016, the House passed the House amendment to the Senate amendment to H.R. 34, the 21st Century Cures Act, on a vote of 392 to 26. The bill was then sent to the Senate where it was considered and passed, with only minor technical modification, on December 7, 2016, on a vote of 94 to 5. The law consists of three divisions: Division A—21st Century Cures Act; Division B—Helping Families in Mental Health Crisis; and Division C—Increasing Choice, Access, and Quality...

The Helping Families in Mental Health Crisis Reform Act of 2016 (Division B of P.L. 114-255)

This report summarizes the Helping Families in Mental Health Crisis Reform Act of 2016, enacted on December 13, 2016, as Division B of the 21st Century Cures Act (P.L. 114-255). Division B comprises Title VI through Title XIV. The first five titles in Division B (Title VI – Title X) deal primarily with the Substance Abuse and Mental Health Services Administration (SAMHSA) within the Department of Health and Human Services (HHS). SAMHSA is the federal agency with primary responsibility for increasing access to community-based services to prevent and treat mental disorders and substance use...

The Health Coverage Tax Credit (HCTC): In Brief

The Health Coverage Tax Credit (HCTC) subsidizes most of the cost of qualified health insurance for eligible taxpayers and their family members. Potential eligibility for the HCTC is limited to two groups of taxpayers. One group is comprised of individuals eligible for Trade Adjustment Assistance (TAA) allowances because they experienced qualifying job losses. The other group consists of individuals whose defined-benefit pension plans were taken over by the Pension Benefit Guaranty Corporation (PBGC) because of financial difficulties. HCTC-eligible individuals are allowed to receive the...

Drug Testing and Crime-Related Restrictions in TANF, SNAP, and Housing Assistance

Throughout the history of social assistance programs, administrators have attempted to limit access only to those families considered “worthy” of assistance. Policies about worthiness have included both judgments about need—generally tied to income, demographic characteristics, or family circumstances—and judgments about moral character, often as evidenced by behavior. Past policies evaluating moral character based on family structure have been replaced by today’s policies, which focus on criminal activity, particularly drug-related criminal activity. The existing crime- and drug-related...

Work Requirements, Time Limits, and Work Incentives in TANF, SNAP, and Housing Assistance

Congress is again debating work requirements in the context of programs to aid poor and low-income individuals and families. The last major debate in the 1990s both significantly expanded financial supports for working poor families with children and led to the enactment of the 1996 welfare reform law. That law created the Temporary Assistance for Needy Families (TANF) block grant, which time-limited federally funded aid and required work for families receiving cash assistance. Work requirements, time limits, and work incentives are intended to offset work disincentives in social...

Treatment of Noncitizens Under the Affordable Care Act

The degree to which foreign nationals (noncitizens/aliens) should be accorded access to certain benefits as a result of their presence in the United States, as well as the responsibilities of such persons given their legal status (e.g., immigrants, nonimmigrants, unauthorized aliens), often figures into policy discussions in Congress. These issues become particularly salient when Congress considers legislation to establish new immigration statuses or to create or modify benefit or entitlement programs.

The 111th Congress enacted the Patient Protection and Affordable Care Act (P.L....

Medicare Part D Prescription Drug Benefit

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA, P.L. 108-173) established a voluntary, outpatient prescription drug benefit under Medicare Part D, effective January 1, 2006. Medicare Part D provides coverage through private prescription drug plans (PDPs) that offer only drug coverage, or through Medicare Advantage (MA) prescription drug plans (MA-PDs) that offer coverage as part of broader, managed care plans. Private drug plans participating in Part D bear some financial risk, though federal subsidies cover most program costs in an effort to encourage...

Homelessness: Targeted Federal Programs

The causes of homelessness and determining how best to assist those who find themselves homeless became particularly prominent, visible issues in the 1980s. The concept of homelessness may seem straightforward, with individuals and families who have no place to live falling within the definition. However, the extent of homelessness in this country and how best to address it depend upon how one defines the condition of being homeless.

There is no single federal definition of homelessness, although a number of programs, including those overseen by the Department of Housing and Urban...

The Agency for Healthcare Research and Quality (AHRQ) Budget: Fact Sheet

The Agency for Healthcare Research and Quality (AHRQ), within the Department of Health and Human Services (HHS), is the federal agency charged with supporting research designed to improve the quality of health care, increase the efficiency of its delivery, and broaden access to health services. In addition, AHRQ is required to disseminate its research findings to health care providers, payers, and consumers, among others. The agency collects data on health care expenditures and utilization through the Medical Expenditure Panel Survey (MEPS) and the Healthcare Cost and Utilization Project...

Overview of Continuing Appropriations for FY2017 (H.R. 5325)

The purpose of this report is to provide an analysis of the continuing appropriations provisions for FY2017 in H.R. 5325. The measure also included provisions covering appropriations in the Military Construction and Veterans Affairs Appropriations bill for all of FY2017 (Division A), as well as emergency funds to combat the Zika virus and provide relief for flood victims in Louisiana and other affected states (Division B). On September 29, 2016, the President signed H.R. 5325 into law (P.L. 114-223).

Division C of H.R. 5325 was termed a “continuing resolution” (CR) because measures to...

Patents and Prescription Drug Importation

Prescription drugs often cost far more in the United States than in other countries. Some consumers have attempted to import medications from abroad in order to realize cost savings. The practice of importing prescription drugs outside the distribution channels established by the brand-name drug company is commonly termed “parallel importation” or “re-importation.” Parallel imports are authentic products that are legitimately distributed abroad and then sold to consumers in the United States, without the permission of the authorized U.S. dealer.

Numerous bills have been introduced in the...

Labor, Health and Human Services, and Education: FY2016 Appropriations

This report provides an overview of actions taken by Congress and the President to provide FY2016 appropriations for accounts funded by the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations bill. This bill provides funding for all accounts funded through the annual appropriations process at the Departments of Labor (DOL) and Education (ED). It provides annual appropriations for most agencies within the Department of Health and Human Services (HHS), with certain exceptions (e.g., the Food and Drug Administration is funded via the...

Internships, Fellowships, and Other Work Experience Opportunities in the Federal Government

While there are many opportunities in the federal government for internships, fellowships, and other work experience, there is no comprehensive source to assist in locating these opportunities. This report describes Internet resources for prominent and popular opportunities for internship, fellowship, and work experience programs within the federal government. The report is intended as a selective guide for students of all levels: high school, undergraduate, graduate, and postgraduate. It provides information on legislative, executive, and judicial branch opportunities and links to several...

Zika Response Funding: Request and Congressional Action

The second session of the 114th Congress has considered whether and how to provide funds to control the spread of the Zika virus throughout the Americas. Zika infection, which is primarily spread by Aedes mosquitoes and sexual contact, has been linked to birth defects and other health concerns. Local transmission of the virus has occurred in Puerto Rico, American Samoa, the U.S. Virgin Islands, and Florida.

On February 22, 2016, the Obama Administration requested more than $1.89 billion in supplemental funding for the Zika response, all of which it asked to be designated as an emergency...

The Hatch-Waxman Act: A Primer

Congress has for many years expressed interest in both medical innovation and the growing cost of health care. The Drug Price Competition and Patent Term Restoration Act of 1984, commonly known as the Hatch-Waxman Act, addressed each of these concerns. Through amendments to both the patent law and the food and drug law, the Hatch-Waxman Act established several practices intended to facilitate the marketing of generic pharmaceuticals while providing brand-name firms with incentives to innovate.

The Hatch-Waxman Act established an expedited pathway for generic drug companies to obtain Food...

CHIP and the ACA Maintenance of Effort (MOE) Requirement: In Brief

The State Children’s Health Insurance Program (CHIP) is a means-tested program that provides health coverage to targeted low-income children and pregnant women in families that have annual income above Medicaid eligibility levels but do not have health insurance. CHIP is jointly financed by the federal government and the states and administered by the states. The federal government sets basic requirements for CHIP, but states have the flexibility to design their own version of CHIP within the federal government’s basic framework. States may design their CHIP programs in three ways: a CHIP...

Behavioral Health Among American Indian and Alaska Natives: An Overview

Behavioral health problems (e.g., mental disorders, substance use disorders, and suicide) among the American Indian and Alaska Native (AI/AN) population have been the subject of multiple congressional hearings, introduced bills, and Administration initiatives in recent years.

Research on AI/AN behavioral health demonstrates three key points: Relative to the general U.S. population, the AI/AN population has (1) a high prevalence of risk factors for behavioral health problems, (2) a high prevalence of behavioral health problems, and (3) limited access to care for behavioral health problems....

Zimbabwe: Current Issues and U.S. Policy

Zimbabwe, a southern African country of about 14 million people, gained independence from the United Kingdom in 1980 after a lengthy armed struggle against white minority rule. The armed struggle, and the enduring effects of land allocations that favored whites, have profoundly shaped post-independence politics, as have the nationalist economic policies of the ruling Zimbabwe National Union-Patriotic Front (ZANU-PF), led by long-time president Robert Mugabe. Land seizures, state-centric economic policies, and persistent political turmoil under Mugabe led to a severe economic contraction...

FDA Regulation of Medical Devices

Prior to and since the passage of the Medical Device Amendments of 1976, Congress has debated how best to ensure that consumers have access, as quickly as possible, to new and improved medical devices and, at the same time, prevent devices that are not safe and effective from entering or remaining on the market. Medical device regulation is complex, in part, because of the wide variety of items that are categorized as medical devices; examples range from a simple tongue depressor to a life-sustaining heart valve. The regulation of medical devices can affect their cost, quality, and...

Preschool Development Grants (FY2014-FY2016) and Race to the Top-Early Learning Challenge Grants (FY2011-FY2013)

The importance of children’s early learning experiences to their development and later success in school and the workforce has become a subject of increasing interest to the public, Members of Congress, and the Administration. During recent congresses many bills have been introduced that would provide funding to states aiming to facilitate improvements in the quality of, and access to, early childhood education (ECE) programs.

This report focuses on two early childhood initiatives—Race to the Top-Early Learning Challenge (RTT-ELC) grants for FY2011-FY2013 and Preschool Development Grants...

Reforming the U.S. Postal Service: Background and Issues for Congress

This report provides background information on the responsibilities, financial challenges, and workforce issues facing the U.S. Postal Service (USPS). Additionally, it covers the current strategies and initiatives under development by the USPS and discusses further options for postal reforms.

In FY2015, the USPS marked its ninth consecutive year of financial losses with a net loss of $5.1 billion. In addition, the USPS has reached its statutory debt limit of $15 billion. In recent years, the USPS has experienced growth in the package and shipping part of its business (known as Competitive...

Federal Support for Reproductive Health Services: Frequently Asked Questions

This report provides answers to frequently asked questions concerning the provision, funding, and coverage of reproductive health services. The report is organized by the federal program that pays for or directly provides these services. It concludes with questions about coverage requirements for reproductive health services under the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), and discussions of various federal programs that provide grants to non-governmental entities to provide reproductive health services.

Search terms: family planning, abortion,...

Heroin Trafficking in the United States

Over the past several years, the nation has seen an uptick in the use and abuse of opioids—both prescription substances and non-prescription substances such as heroin. The estimated number of individuals who had used heroin was 914,000 in 2014. Further, about 586,000 individuals (0.2% of the 12 and older population) had a heroin use disorder in 2014. In addition to an increase in heroin use over the past several years, there has been a simultaneous increase in its availability in the United States. This has been fueled by a number of factors, including increased production and trafficking...

Zika Virus in the Western Hemisphere: CRS Products

In late 2015, health officials in Brazil saw a spike in the number of infants born with microcephaly, a birth defect that may be associated with significant, permanent brain damage. The increase in microcephaly was later linked to prenatal infection with the Zika virus (ZIKV), which appears to have emerged in Brazil early in 2015. ZIKV has spread from South America into Central America and the Caribbean. Puerto Rico has been hard hit, with more than 6,500 locally transmitted (i.e., mosquito-borne) infections reported to date. In late July 2016, local transmission of ZIKV was reported for...

The 2016 Olympic Games: Health, Security, Environmental, and Doping Issues

The 2016 Olympic Games will be held in Rio de Janeiro, Brazil, August 5-21, 2016, and will be followed by the Paralympic Games, September 7-18, 2016. Notably, these are the first games to be hosted by a South American city. Reportedly, 10,500 athletes from 206 countries will participate in the Olympics, including 555 athletes from the United States. Most Olympic events will take place in and around Rio de Janeiro. In addition to Rio de Janeiro, soccer matches will be held in the cities of Belo Horizonte, Brasília, Manaus, São Paulo, and Salvador.

Host countries and cities often have to...

Medicaid Provider Taxes

States are able to use revenues from health care provider taxes to help finance the state share of Medicaid expenditures. Federal statute and regulations define a provider tax as a health care-related fee, assessment, or other mandatory payment for which at least 85% of the burden of the tax revenue falls on health care providers. For states to be able to draw down federal Medicaid matching funds, the provider tax must be both broad-based (i.e., imposed on all providers within a specified class of providers) and uniform (i.e., the same tax for all providers within a specified class of...

Overview of Funding Mechanisms in the Federal Budget Process, and Selected Examples

Every year, Congress considers numerous pieces of legislation that would create or modify federal government programs and activities. The variety of approaches used across the federal budget to fund these programs and activities involve different timelines for budgetary decisionmaking, and different processes (and committees) within Congress to make those decisions. How a particular funding mechanism is structured requires tradeoffs between the frequency of congressional review and the predictability of funding for the program. The purpose of this report is to explain these approaches,...

Federal Benefits and Services for People with Low Income: Overview of Spending Trends, FY2008-FY2015

The Congressional Research Service (CRS) regularly receives requests about the number, size, and programmatic details of federal benefits and services targeted toward low-income populations. This report is the most recent in a series that attempts to identify and discuss such programs, focusing on aggregate spending trends. The report looks at federal low-income spending from FY2008 (at the onset of the 2007-2009 recession) through FY2015 (after implementation of the Patient Protection and Affordable Care Act, or ACA).

Programs discussed here provide health care, cash aid, food...

Federal Student Loan Forgiveness and Loan Repayment Programs

Student loan forgiveness and loan repayment programs provide borrowers a means of having all or part of their student loan debt forgiven or repaid in exchange for work or service in specific fields or professions or following a prolonged period during which their student loan debt burden is high relative to their income. In both loan forgiveness and loan repayment programs, borrowers typically qualify for benefits by working or serving in certain capacities for a specified period of time or by satisfying other program requirements over an extended term. Upon qualifying for benefits, some...

Abortion and Whole Woman’s Health v. Hellerstedt

In Whole Woman’s Health v. Hellerstedt, the U.S. Supreme Court (Court) invalidated two Texas requirements that applied to abortion providers and physicians who perform abortions. Under a Texas law enacted in 2013, a physician who performs or induces an abortion was required to have admitting privileges at a hospital within 30 miles from the location where the abortion was performed or induced. In general, admitting privileges allow a physician to transfer a patient to a hospital if complications arise in the course of providing treatment. The Texas law also required an abortion facility to...

The U.S. Wine Industry and Selected Trade Issues with the European Union

Global wine production totaled roughly 28 billion liters in 2014. The European Union (EU) dominates world production, accounting for nearly 60% of all wine produced each year. France, Italy, and Spain are among the principal EU wine-producing countries. The United States is the world’s second-largest wine-producing region, accounting for about 10% of global production. The value of world trade in wine totaled more than $21 billion in 2013. The EU accounted for nearly 60% of the world’s export market for wine, valued at $12 billion in 2013. Other exporting nations include Australia, Chile,...

Overview of ESEA Title I-A and the School Meals’ Community Eligibility Provision

The primary source of federal funding for elementary and secondary schools is the Title I-A program. Under Title I-A, the allocation of funds to schools, eligibility to operate certain programs, and accountability requirements are based in part in identifying students from low-income families. Historically, this has been achieved by using National School Lunch Program (NSLP) eligibility data. However, a new school meals eligibility option—the Community Eligibility Provision (CEP)—has been implemented that changes the eligibility determinations for NSLP as well as the School Breakfast...

Medicare Skilled Nursing Facility (SNF) Payments

A Medicare skilled nursing facility (SNF) is an institution, or distinct part of an institution (e.g., building, floor, wing), that provides post-acute skilled nursing care and/or skilled rehabilitation services, has in effect a written agreement to transfer patients between one or more hospitals and the SNF, and is certified by Medicare. In general, skilled nursing and rehabilitative care are services ordered by a physician that require the skills of professional personnel (e.g., registered nurse, physical therapist) and are provided under the supervision of such personnel. Over 95% of...

Public Trust and Law Enforcement—A Brief Discussion for Policymakers

Events over the past several years involving conflict between the police and citizens have generated interest in what role Congress could play in facilitating efforts to build trust between law enforcement and the people they serve while promoting effective crime reduction. This report provides a brief overview of the federal government’s role in police-community relations.

Despite what appears to be an apparent decreasing amount of trust between law enforcement and the public, Gallup poll data show that, overall, Americans are confident in the police; but, confidence in the police varies...

Supplemental Appropriations for Zika Response: The FY2016 Conference Agreement in Brief

This report presents funding proposals for response to the Zika outbreak, including proposals in Division B of the conference report, and, where applicable, associated proposed rescissions, including those in Division D of the conference report.

Agriculture and the Transatlantic Trade and Investment Partnership (T-TIP) Negotiations

The Transatlantic Trade and Investment Partnership (T-TIP) is a potential reciprocal free trade agreement being negotiated between the United States and the European Union (EU). Formal negotiations began in July 2013. Through the negotiations, both sides are seeking to liberalize transatlantic trade and investment, set globally relevant rules and disciplines that could boost economic growth, support multilateral trade liberalization through the World Trade Organization (WTO), and address third-country trade policy challenges. Agricultural issues have been an active topic of debate in the...

Consumer Operated and Oriented Plan (CO-OP) Program: Frequently Asked Questions

The Consumer Operated and Oriented Plan (CO-OP) program was included in the Patient Protection and Affordable Care Act (ACA; P.L. 111-148) in an effort to increase the competitiveness of state health insurance markets and improve choice. Under the program, the Centers for Medicare & Medicaid Services (CMS) uses appropriated funds to award low-interest loans to organizations applying to become CO-OPs—nonprofit, member-run health insurance issuers that sell health insurance in the state(s) in which they are licensed.

CMS awarded loans to 24 CO-OPs. One of the 24 CO-OPs was dropped from the...

Overview of Health Insurance Exchanges

The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) requires health insurance exchanges to be established in every state. Exchanges are marketplaces where individuals and small businesses can shop for and purchase private health insurance coverage. States must have two types of exchanges: an individual exchange and a small business health options program (SHOP) exchange.

Exchanges may be established either by the state itself as a state-based exchange (SBE) or by the Secretary of Health and Human Services (HHS) as a federally-facilitated exchange (FFE). In states...

The Patient Protection and Affordable Care Act’s Essential Health Benefits (EHB)

The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) requires all non-grandfathered health plans in the non-group and small-group private health insurance markets to offer a core package of health care services, known as the essential health benefits (EHB). The ACA does not specifically define this core package but rather lists 10 benefit categories from which benefits and services must be included. The 10 benefit categories are as follows: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance...

Zika Virus in Latin America and the Caribbean: U.S. Policy Considerations

Congress is debating how to respond to an ongoing outbreak of Zika virus, a mosquito-borne illness that has no treatment or vaccine and can cause microcephaly—a severe birth defect—and other neurological complications. As of June 16, 2016, 60 countries and territories had reported mosquito-borne transmission of the virus, 39 of which are in Latin America and the Caribbean and are reporting cases of Zika for the first time. Brazil, which has registered the most confirmed cases of Zika in Latin America, will host the summer Olympics in August 2016. Scientists expect that travel destinations...

Puerto Rico and Health Care Finance: Frequently Asked Questions

Puerto Rico’s financial circumstances, including uncertainty about its ability to service its large public debt, have drawn attention in recent months. As Congress examines Puerto Rico’s finances, questions have arisen about how federal health care programs (Medicare, Medicaid, and the State Children’s Health Insurance Program [CHIP]) and private health insurance requirements apply to Puerto Rico. Is Puerto Rico treated like a state, or is it treated differently?

This report provides answers to frequently asked questions (FAQs) about Puerto Rico’s health care system. The FAQs are divided...

The Orlando Mass Shooting: CRS Experts

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Medicaid Disproportionate Share Hospital Payments

The Medicaid statute requires states to make disproportionate share hospital (DSH) payments to hospitals treating large numbers of low-income patients. This provision is intended to recognize the disadvantaged financial situation of those hospitals because low-income patients are more likely to be uninsured or Medicaid enrollees. Hospitals often do not receive payment for services rendered to uninsured patients, and Medicaid provider payment rates are generally lower than the rates paid by Medicare and private insurance.

As with most Medicaid expenditures, the federal government reimburses...

Medicare’s Skilled Nursing Facility (SNF) Three-Day Inpatient Stay Requirement: In Brief

Medicare beneficiaries are generally entitled to coverage for care they receive in a skilled nursing facility (SNF). However, Medicare beneficiaries can be liable for substantial cost sharing related to the care they receive in an SNF if that care is not preceded by a hospital inpatient stay of at least three days. On an increasing basis, however, Medicare beneficiaries are failing to meet this three-day inpatient stay requirement because they are receiving shorter inpatient hospital stays and overnight observation care as hospital outpatients, often for days at a time, which does not...

The Comprehensive Addiction and Recovery Act of 2016 (S. 524): Comparison of Senate- and House-Passed Versions

The Comprehensive Addiction and Recovery Act of 2016 (CARA; S. 524) aims to address the problem of opioid addiction in the United States. It passed the Senate (S. 524 ES) on March 10, 2016, and it passed the House with an amendment in the nature of a substitute (S. 524 EAH) on May 13, 2016. The two versions of the bill differ substantially. The scope of the differences may be illustrated by their structures: The Senate bill has 28 sections organized in 8 titles, whereas the House bill has 69 sections organized in 18 titles. This report discusses selected differences and similarities...

Substance Abuse and Mental Health Services Administration (SAMHSA): Agency Overview

In recent years, Members of both chambers have introduced legislation that would reauthorize, amend, add, or eliminate programs and activities undertaken by the Substance Abuse and Mental Health Services Administration (SAMHSA). This report briefly summarizes SAMHSA’s major programs and activities and describes the agency’s organizational structure. The Appendix provides an overview of SAMHSA’s budget.

SAMHSA’s two biggest programs are the Community Mental Health Services Block Grant (MHBG, $533 million in FY2016) and the Substance Abuse Prevention and Treatment Block Grant (SABG, $1.9...

Status of the Ebola Outbreak in West Africa: Overview and Issues for Congress

The 2014-2015 outbreak and spread of Ebola Virus Disease (EVD, or Ebola) in West Africa became an international public health emergency that, in no small part due to international intervention, abated significantly by the end of 2015 and early 2016. The issue remains of interest toward the end of the 114th Congress for a number of reasons, including ongoing concerns about the status of disease and risks of future outbreaks, and interest in the disposition of funds appropriated by Congress in response to Ebola, especially in view of the more recent health challenge posed by the Zika virus....

Public Health Service Agencies: Overview and Funding (FY2015-FY2017)

Within the Department of Health and Human Services (HHS), eight agencies are designated components of the U.S. Public Health Service (PHS). The PHS agencies are funded primarily with annual discretionary appropriations. They also receive significant amounts of funding from other sources including mandatory funds from the Affordable Care Act (ACA), user fees, and third-party reimbursements (collections).

The Agency for Healthcare Research and Quality (AHRQ) funds research on improving the quality and delivery of health care. For several years prior to FY2015, AHRQ did not receive its own...

Senate Medical Innovation Bills: Overview and Comparison with the 21st Century Cures Act (H.R. 6)

Both the House and the Senate are considering legislation to support medical innovation, primarily through reforms to the National Institutes of Health (NIH) and changes to the drug, biologic, and device approval pathways at the Food and Drug Administration (FDA). On February 3, 2015 Senators Lamar Alexander and Patty Murray, chairman and ranking Member of the Committee on Health, Education, Labor and Pensions, announced the start of a bipartisan initiative to “examine the process for getting safe treatments, devices and cures to patients and the roles of the [FDA] and the [NIH] in that...

Synthetic Drugs: Overview and Issues for Congress

Synthetic drugs, as opposed to natural drugs, are chemically produced in a laboratory. Their chemical structure can be either identical to or different from naturally occurring drugs, and their effects are designed to mimic or even enhance those of natural drugs. When produced clandestinely, they are not typically controlled pharmaceutical substances intended for legitimate medical use. Designer drugs are a form of synthetic drugs. They contain slightly modified molecular structures of illegal or controlled substances, and they are modified in order to circumvent existing drug laws. While...

Patents and Prescription Drug Importation

Prescription drugs often cost far more in the United States than in other countries. Some consumers have attempted to import medications from abroad in order to realize cost savings. The practice of importing prescription drugs outside the distribution channels established by the brand-name drug company is commonly termed “parallel importation” or “re-importation.” Parallel imports are authentic products that are legitimately distributed abroad and then sold to consumers in the United States, without the permission of the authorized U.S. dealer.

Numerous bills have been introduced in the...

The Maternal and Child Health Services Block Grant: Background and Funding

The Maternal and Child Health (MCH) Services Block Grant program, authorized under Title V of the Social Security Act, is a flexible source of funds that states use to support maternal and child health programs. The program provides grants to states and territories to enable them to coordinate programs, develop systems, and provide a broad range of direct health services. In addition to block grants to states, the MCH Services Block Grant includes a set-aside for Special Projects of Regional and National Significance (SPRANS), and another set-aside for the Community Integrated Service...

Judge Merrick Garland: His Jurisprudence and Potential Impact on the Supreme Court

On March 16, 2016, President Obama nominated Judge Merrick Garland of the U.S. Court of Appeals for the District of Columbia Circuit (D.C. Circuit) to fill the vacancy on the Supreme Court created by the unexpected death of Justice Antonin Scalia in February. Judge Garland was appointed to the D.C. Circuit by President Clinton in 1997, and is currently its chief judge, an administrative position that rotates among the active judges on the circuit. Prior to his appointment to the bench, Judge Garland served in the Criminal Division of the U.S. Department of Justice, where he notably oversaw...

Health Care for Veterans: Answers to Frequently Asked Questions

The Veterans Health Administration (VHA), within the Department of Veterans Affairs (VA), operates the nation’s largest integrated health care delivery system, provides care to approximately 6.7 million unique veteran patients, and employs more than 311,000 full-time equivalent employees.

Eligibility and Enrollment. Contrary to claims concerning promises of “free health care for life,” not every veteran is automatically entitled to medical care from the VA. Eligibility for VA health care is based primarily on veteran status resulting from military service. Generally, veterans must also...

DHS Appropriations FY2016: Protection, Preparedness, Response, and Recovery

This report is part of a suite of reports that discuss appropriations for the Department of Homeland Security (DHS) for FY2016. It specifically discusses appropriations for the components of DHS included in the third title of the homeland security appropriations bill—the National Protection and Programs Directorate (NPPD), the Office of Health Affairs (OHA), and the Federal Emergency Management Agency (FEMA). Collectively, Congress has labeled these components in the appropriations act in recent years as “Protection, Preparedness, Response, and Recovery.”

The report provides an overview of...

Lead in Flint, Michigan’s Drinking Water: CRS Experts

Head Start; Home Visiting; Maternal, Infant, and Early Childhood Home Visiting; MIECHV; Early Childhood; Child Development; blood lead reference level; blood lead level; lead poisoning prevention; health registries; EPA; toxicology of lead poisoning; EPSDT; Early and Periodic Screening, Diagnostic and Treatment; special education; Office of Lead Hazard Control and Healthy Homes; healthy homes; Safe Drinking Water Act; SDWA; Safe Drinking Water State Revolving Fund; Drinking Water State Revolving Fund, water infrastructure; Lead and Copper Rule; corrosion control; Water Infrastructure...

Overview of Private Health Insurance Provisions in the Patient Protection and Affordable Care Act (ACA)

Private health insurance is the predominant form of health insurance coverage in the United States, covering about two-thirds of Americans in 2014. The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) builds on and modifies existing sources of private health insurance coverage—the non-group (individual), small-group, and large-group markets. The ACA provisions follow a federalist model in which they establish federal minimum requirements and give states the authority to enforce and expand those federal standards.

The ACA includes provisions that restructure the...

Offender Reentry: Correctional Statistics, Reintegration into the Community, and Recidivism

The number of people incarcerated in the United States grew steadily for nearly 30 years. That number has been slowly decreasing since 2008, but as of 2014 there were still over 2 million people incarcerated in prisons and jails across the country. The Bureau of Justice Statistics (BJS) reports that between 1990 and 2014 an average of 594,600 inmates have been released annually from state and federal prisons and almost 5 million ex-offenders are under some form of community-based supervision.

Nearly all prisoners will return to their communities as some point. Offender reentry can include...

Telehealth and Telemedicine: Description and Issues

Telehealth is the use of electronic information and telecommunications technologies to support remote clinical health care, patient and professional health-related education, public health, and other health care delivery functions. A narrower concept, telemedicine, refers to clinical services that are provided remotely via telecommunications technologies. Some sources use the two terms interchangeably, and there is no consensus among federal programs and among health care providers on the definition of either term.

Federal involvement in telehealth is varied. As of 2014, more than 20...

Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief

The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) includes a 40% excise tax on high-cost employer-sponsored health coverage. This excise tax is often called the Cadillac tax. Under the ACA, the excise tax was to be implemented beginning in 2018; however, the Consolidated Appropriations Act of 2016 (P.L. 114-113) delays implementation until 2020.

The excise tax applies to the aggregate cost of an employee’s applicable coverage that exceeds a dollar limit. Applicable coverage includes, but is not limited to, the employer’s and the employee’s contribution to...

Justice Antonin Scalia: His Jurisprudence and His Impact on the Court

On February 13, 2016, Justice Antonin Scalia passed away unexpectedly at the age of 79, vacating a seat on the Supreme Court which he had held for nearly 30 years. Justice Scalia’s lengthy tenure on the Court, coupled with his strongly held views on how constitutional and statutory texts are to be interpreted, led him to have significant influence on the development of the jurisprudence of various areas of law. He was also an active speaker and author outside the Court, having, among other things, recently coauthored a book which sought to articulate interpretative canons that would, in...

Congressional Liaison Offices of Selected Federal Agencies

This report is a list of about 200 congressional liaison offices, intended to help congressional offices in placing telephone calls and addressing correspondence to government agencies. In each case, the information was supplied by the agency itself and is current as of the date of publication. Entries are arranged alphabetically in four sections: legislative branch; judicial branch; executive branch; and agencies, boards, and commissions.

Veterans’ Medical Care: FY2016 Appropriations

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility criteria. Benefits to veterans range from disability compensation and pensions to hospital and medical care. The VA provides these benefits through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA). This report focuses on funding for the VHA.

The President submitted his FY2016 budget request to Congress on February 2, 2015. The President’s request for the VHA is approximately $60.6...

The Ryan White HIV/AIDS Program: Overview and Impact of the Affordable Care Act

The Ryan White HIV/AIDS Program makes federal funds available to eligible metropolitan areas, states, and local community-based organizations to assist with health care costs and support services for individuals and families affected by the human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). The Ryan White HIV/AIDS Program reports that in 2014 it served 512,214 low-income people with HIV/AIDS in the United States, 25.4% of whom were uninsured and 64.2% of whom were living at or below 100% of the federal poverty level.

The Ryan White HIV/AIDS Program is...

The Internet of Things: CRS Experts

“Internet of Things” (IoT) refers to networks of objects that communicate with other objects and with computers through the Internet. “Things” may include virtually any object for which remote communication, data collection, or control might be useful, such as meters, vehicles, appliances, medical devices, electric grids, transportation infrastructure, manufacturing equipment, or building systems. Although the full extent and nature of the IoT’s impacts remain uncertain, economic analyses predict that it will contribute trillions of dollars to economic growth over the next decade. Sectors...

The Use of Modified Adjusted Gross Income (MAGI) in Federal Health Programs

The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) created Section 36(B) of the Internal Revenue Code (IRC) to define household income, based on modified adjusted gross income (MAGI). MAGI is used to determine (1) penalty amounts owed if a person does not comply with the individual mandate or whether an individual is exempt from the individual mandate; (2) eligibility for and the amount of a premium credit to purchase coverage through a health insurance exchange; and (3) Medicaid income eligibility for certain populations. MAGI is also used to determine which...

Local Food Systems: Selected Farm Bill and Other Federal Programs

Sales of locally produced foods comprise a small but growing part of U.S. agricultural sales. Estimates vary but indicate that local food sales total between $4 billion to $12 billion annually. The U.S. Department of Agriculture (USDA) estimates that local food sales totaled $6.1 billion in 2012, reflecting sales from nearly 164,000 farmers selling locally marketed foods. This represents 8% of U.S. farms, and an estimated 1.5% of the value of total U.S. agricultural production. Most (85%) of all local-food farms are smaller in size, with gross revenues under $75,000.

Local and regional...

Agriculture and Related Agencies: FY2016 Appropriations

The Agriculture appropriations bill funds the U.S. Department of Agriculture (USDA), except for the Forest Service. It also funds the Food and Drug Administration (FDA) and—in even-numbered fiscal years—the Commodity Futures Trading Commission (CFTC).

Agriculture appropriations include both mandatory and discretionary spending. Discretionary amounts, though, are the primary focus during the bill’s development since mandatory amounts generally are set by authorizing laws such as the farm bill.

The largest discretionary spending items are the Special Supplemental Nutrition Program for Women,...

Prescription Drug Abuse

An estimated 6.5 million individuals currently abuse prescription drugs in the United States. Unlike policy on street drugs, federal policy on prescription drug abuse is complicated by the need to maintain access to prescription controlled substances (PCS) for legitimate medical use. The federal government has several roles in reducing prescription drug abuse.

Coordination. The Office of National Drug Control Policy (ONDCP) coordinates and tracks prescription drug abuse reduction efforts and funding of multiple federal agencies.

Regulation. The primary federal statutes governing...

Health Care for Veterans: Suicide Prevention

This report focuses on suicide prevention activities of the Veterans Health Administration (VHA) within the Department of Veterans Affairs (VA). The VHA’s approach to suicide prevention is based on a public health framework, which has three major components: (1) surveillance, (2) risk and protective factors, and (3) interventions.

Surveillance, or systematic collection of data on completed (i.e., fatal) suicides, is essential to define the scope of the problem (i.e., the suicide rate among veterans), identify characteristics associated with higher or lower risk of suicide, and track...

President’s FY2017 Budget for the Centers for Medicare & Medicaid Services (CMS): CRS Experts

Federal law requires the President to submit an annual budget request to Congress no later than the first Monday in February. The budget informs Congress of the President’s overall federal fiscal policy based on proposed spending levels, revenues, and deficit (or surplus) levels. The budget request lays out the President’s relative priorities for federal programs, such as how much should be spent on defense, education, health, and other federal programs. The President’s budget also may include legislative proposals for spending and tax policy changes. Although the President is not required...

Federal Support for Graduate Medical Education: An Overview

Access to health care is, in part, determined by the availability of physicians, a function of the physician supply. Policymakers have demonstrated a long-standing interest in access to care, both in general and for specific populations. Moreover, federal support for medical residency training (a.k.a., graduate medical education [GME]) is the largest source of federal support for the health care workforce. Although the health workforce includes a number of professions, the size of the federal investment in GME—estimated at $15 billion in FY2012—makes it a policy lever often considered to...

Department of Health and Human Services: FY2017 Budget Request

This report provides information about the FY2017 budget request for the Department of Health and Human Services (HHS). It begins by reviewing the department’s mission and structure. This is followed by an overview of the total FY2017 request for the department. Next, the report discusses the concept of the HHS budget as a whole, compared to funding provided to HHS through the annual appropriations process. This distinction is important because certain amounts shown in FY2017 HHS budget materials (including amounts for prior years) will not match amounts provided to HHS by annual...

SAMHSA FY2017 Budget Request and Funding History: A Fact Sheet

The Substance Abuse and Mental Health Services Administration (SAMHSA), at the U.S. Department of Health and Human Services (HHS), is the lead federal agency for increasing access to behavioral health services. SAMHSA supports community-based mental health and substance abuse treatment and prevention services through formula grants to the states and U.S. territories and through competitive grant programs to states, territories, tribal organizations, local communities, and private entities. SAMHSA also engages in a range of other activities, such as technical assistance, data collection,...

Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA)

The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) establishes federal requirements that apply to private health insurance. Its market reforms affect insurance offered to groups and individuals and impose requirements on sponsors of coverage (e.g., employers). In general, all of the ACA’s market reforms are currently effective; some became effective shortly after the ACA was passed in 2010, and others became effective for plan years beginning in 2014.

Although some of the market reforms had previously been enacted in some states, many of the reforms are new at...

Zika Virus: Basics About the Disease

In late 2015, health officials in Brazil recognized a marked increase in the number of infants born with microcephaly (from Greek, meaning “small head”), a birth defect that may accompany significant, permanent brain damage. Although not conclusive, the increase in microcephaly is suspected to be related to the emergence of Zika virus infections in Brazil early in 2015.

Zika virus is related to the viruses that cause yellow fever, dengue, West Nile, and Japanese encephalitis viruses. Historically Zika virus was found in Africa. Since 2007, Zika transmission has also occurred in Southeast...

Federal Employees Health Benefits (FEHB) Program: An Overview

The Federal Employees Health Benefits (FEHB) Program provides health insurance to federal employees, retirees, and their dependents. This report provides a general overview of FEHB. It describes the structure of FEHB, including eligibility for the program and coverage options available to enrollees, as well as premiums, benefits and cost sharing, and general financing of FEHB. The report also describes the role of the Office of Personnel Management (OPM) in administering the program.

Eligible individuals include federal employees, retirees, and their family members. As of calendar year...

Dietary Guidelines for Americans: Frequently Asked Questions

The Dietary Guidelines for Americans (DGA) is a policy document that provides federally developed, nutrition-based recommendations for Americans two years of age and older. The guidelines are statutorily mandated under the 1990 National Nutrition Monitoring and Related Research Act (P.L. 101-445), which requires the Departments of Health and Human Services (HHS) and Agriculture (USDA) to jointly publish the DGA policy document at least once every five years.

The DGA forms the basis for all federal nutrition policies, including the National School Lunch Program and the Special Supplemental...

Provisions of the Senate Amendment to H.R. 3762

The FY2016 budget resolution (S.Con.Res. 11) established the congressional budget for the government for FY2016 and set forth budgetary levels for FY2017-FY2025. It also included reconciliation instructions for House and Senate committees to submit changes in laws to reduce the federal deficit to their respective budget committees.

Specifically, S.Con.Res. 11 instructed three committees of the House and two committees of the Senate to submit changes in laws within each committee’s jurisdiction to reduce the deficit by not less than $1 billion for the period FY2016-FY2025. Additionally,...

The Indian Health Service (IHS): An Overview

The IHS provides an array of medical services, including inpatient, ambulatory, emergency, dental, public health nursing, and preventive health care. The IHS does not have a defined medical benefit package that includes or excludes specific health services or health conditions. The majority of IHS facilities provide outpatient care, focusing on primary and preventive care including preventive screenings and health education. IHS provides services directly when possible; when needed services are not available, IHS beneficiaries may be referred to private providers for care. This is called...

Health-Related Tax Expenditures: Overview and Analysis

Public and private health care spending is growing due to increased enrollment in health insurance, demographic changes of an aging society, and the expansion of government programs, among other reasons. While much attention is being paid to the budgetary cost of outlays from the largest federally funded health programs (Medicare, Medicaid, and the Children’s Health Insurance Program), the implicit subsidies in the Internal Revenue Code for the provision of private- and publicly-provided health insurance are sometimes less prominent in public debates. These subsidies are tax expenditures,...

Gun Control: CRS Experts

The following table provides names and contact information for CRS experts on policy and legal issues related to gun control. In the wake of mass shootings and other firearms-related violence, several gun control issues are often raised. They include improving and expanding background checks, further regulating certain semiautomatic firearms (“assault weapons” or “military-style” firearms) that accept detachable ammunition feeding devices (“magazines”), combating illegal gun trafficking, interstate concealed carry of handguns, and enacting or repealing appropriations limitations related...

Need-Tested Benefits: Estimated Eligibility and Benefit Receipt by Families and Individuals

Need-tested benefits have received increased attention from policymakers in recent years, as spending levels for these programs remain elevated well into the economic expansion that followed the 2007-2009 recession. While information is available on the number of people who receive benefits from individual programs, it is more challenging to examine how these programs interact and the cumulative benefits families receive from them. Case studies based on hypothetical families often show how much in benefits a family may potentially receive from multiple programs under federal and state...

Health Insurance Expiring Provisions of the 114th Congress, Second Session

This report provides a list of expiring health insurance provisions. Specifically, it lists Medicare, Medicaid, State Children’s Health Insurance Program (CHIP), and private health insurance programs and activities under Chapter 7 of the United States Code (U.S.C.)—Social Security—and Chapter 157 of the U.S.C.—Quality, Affordable Health Care for All Americans, as created by the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended)—that are scheduled to expire between the date of this report and after the end of the 114th Congress (i.e., December 31, 2016). Health...

Medicaid Financing and Expenditures

Medicaid is a means-tested entitlement program that finances the delivery of primary and acute medical services as well as long-term services and supports. Medicaid is a federal and state partnership that is jointly financed by both the federal government and the states.

The federal government’s share for most Medicaid expenditures is called the federal medical assistance percentage (FMAP). Generally determined annually, the FMAP formula is designed so that the federal government pays a larger portion of Medicaid costs in states with lower per capita incomes relative to the national...

Potential Policy Implications of the House Reconciliation Bill (H.R. 3762)

On December 3, 2015, the Senate passed an amendment to H.R. 3762. For information about the Senate amendment to H.R. 3762 and how it compares to the House-passed version of H.R. 3762, see CRS Report R44300, Provisions of the Senate Amendment to H.R. 3762, coordinated by Annie L. Mach. This report will not be updated to reflect the Senate’s actions or subsequent actions taken by the House.

The FY2016 budget resolution (S.Con.Res. 11) established the congressional budget for the federal government for FY2016 and set forth budgetary levels for FY2017-FY2025. It also included reconciliation...

Chronic Homelessness: Background, Research, and Outcomes

Chronically homeless individuals are those who spend long periods of time living on the street or other places not meant for human habitation, and who have one or more disabilities, frequently including mental illnesses and substance use disorders. In the 2015 Department of Housing and Urban Development (HUD) point-in-time count of people experiencing homelessness, more than 83,000 individuals met the definition of chronically homeless, down from nearly 120,000 in 2008. In part the decline is due to the federal government’s plan, announced in 2002, to end chronic homelessness within 10...

Veterans and Homelessness

The wars in Iraq and Afghanistan brought renewed attention to the needs of veterans, including the needs of homeless veterans. Researchers have found both male and female veterans to be overrepresented in the homeless population, and, as the number of veterans increased due to these conflicts, there was concern that the number of homeless veterans could rise commensurately. The 2007-2009 recession and the subsequent slow economic recovery also raised concerns that homelessness could increase among all groups, including veterans.

Congress has created numerous programs that serve homeless...

Potential Impact of No Social Security COLA on Medicare Part B Premiums in 2016

Medicare Part B covers physician services, outpatient care, durable medical equipment, laboratory services, and some home health services. Most beneficiaries pay a monthly Part B premium that is set at a rate to cover about 25% of the costs of Part B. The General Fund of the U.S. Treasury covers most of the remaining costs.

These monthly Medicare Part B premiums are automatically deducted from the checks of Social Security beneficiaries. Current projections indicate that there will be no Social Security cost-of-living adjustment (COLA) in 2016, which means that monthly Social Security...

Free Exercise of Religion by Closely Held Corporations: Implications of Burwell v. Hobby Lobby Stores, Inc.

A 5-4 decision, issued over a highly critical dissent, Burwell v. Hobby Lobby Stores, Inc. resolved one of the many challenges raised in response to the contraceptive coverage requirement of the Affordable Care Act (ACA). Imputing the beliefs of owners of closely held corporations to such corporations, the U.S. Supreme Court found that closely held corporations that hold religious objections to certain contraceptive services cannot be required to provide coverage of those services in employee health plans. The Court’s decision was based on the protections offered under the federal...

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10)

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10), as passed by the Senate on April 14, 2015, and by the House on March 26, 2015. The act repeals the sustainable growth rate (SGR) formula for calculating updates to Medicare payment rates to physicians and establishes an alternative set of annual updates. In addition, MACRA introduces a new merit-based incentive payment system and puts in place processes for developing, evaluating, and adopting alternative payment models (APMs).

The act also extends funding that...

Recognition of Same-Sex Marriage: Implications for Religious Objections

The U.S. Supreme Court’s landmark decision in Obergefell v. Hodges in June 2015 held that the Fourteenth Amendment of the U.S. Constitution required states to issue marriage licenses to same-sex couples and to recognize same-sex marriages formed in other states. The Court’s decision in Obergefell does not directly address incidental claims related to religious freedom in the context of same-sex marriage. However, the case has generated a number of other questions regarding potential implications of the Court’s decision, particularly with respect to the rights of individuals or entities...

Public Health Service Agencies: Overview and Funding (FY2010-FY2016)

Within the Department of Health and Human Services (HHS), eight agencies are designated components of the U.S. Public Health Service (PHS). The PHS agencies are funded primarily with annual discretionary appropriations. They also receive significant amounts of funding from other sources including mandatory funds from the Affordable Care Act (ACA), user fees, and third-party reimbursements (collections).

The Agency for Healthcare Research and Quality (AHRQ) funds research on improving the quality and delivery of health care. For several years prior to FY2015, AHRQ did not receive a direct...

Issues in a Tax Reform Limited to Corporations and Businesses

Some tax proposals have focused on broadening the tax base and lowering the rates of both individual and corporate income taxes. In some cases, these proposals have advanced a revenue-neutral tax reform. In other instances, they have proposed revenue increases. An example of a broad-based revenue-neutral income tax reform is H.R. 1 introduced in the 113th Congress by then Ways and Means Chairman Dave Camp. The bill proposed lowering both individual and corporate rates, while increasing the tax base through revising both business-related tax benefits (such as accelerated depreciation) and...

Overview of the FY2016 Continuing Resolution (H.R. 719)

The purpose of this report is to provide an analysis of the FY2016 continuing appropriations in H.R. 719. None of the FY2016 regular appropriations bills were enacted by the start of the fiscal year (October 1, 2015). On September 30, 2015, H.R. 719, a continuing resolution (CR) for FY2016, was signed into law by the President (P.L. 114-53).

The CR for FY2016 covers all 12 regular appropriations bills by providing continuing budget authority for projects and activities funded in FY2015 by that fiscal year’s regular appropriations acts, with some exceptions. It includes both budget...

Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146)

Congressional Research Service 7-5700 www.crs.gov R43704 Summary On August 7, 2014, President Obama signed the Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; H.Rept. 113-564; P.L. 113-146). The Department of Veterans Affairs Expiring Authorities Act of 2014 (H.R. 5404; P.L. 113-175), the Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83; P.L. 113-235), the Construction Authorization and Choice Improvement Act (H.R. 2496; P.L. 114-19), and the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (H.R. 3236; P.L. 114-41) made...

Health Insurance: Small is the New Large

This report discusses aspects of the Patient Protection and Affordable Care Act that expand the definition of small employer to include employers with 100 or fewer employees. States must implement the expanded definition for plan years beginning in 2016, but have the option of implementing the expanded definition prior to the deadline.

The Excise Tax on High-Cost Employer-Sponsored Health Coverage: Background and Economic Analysis

Congressional Research Service 7-5700 www.crs.gov R44160 Summary Beginning in 2018, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) imposes a 40%, nondeductible excise tax on the value of applicable employer-sponsored health coverage above specific dollar thresholds. In 2018, these thresholds are $10,200 for single health coverage and $27,500 for non-single (e.g., family) coverage. The thresholds are adjusted for eligible retirees, workers in certain high-risk professions, and plans whose demographics differ from the national workforce. This excise tax on...

Revision of the Nutrition Facts Label: Proposed Rules

Congressional Research Service 7-5700 www.crs.gov R43733 Summary High rates of obesity and chronic diseases have prompted federal, state, and local initiatives such as exercise promotion, nutrition education, and food labeling. Nearly two-thirds of U.S. adults are overweight or obese, suggesting that consumers need to be more aware of their calorie intake. Labeling of the nutritional content of foods has been recommended by researchers and policymakers as a tool to address the obesity epidemic. National survey data indicate that the frequency of food label use among consumers has...

H.R. 6: The 21st Century Cures Act

On July 10, 2015, the House passed H.R. 6, the 21st Century Cures Act, on a vote of 344 to 77. Eight amendments were offered; five were approved by voice vote, two failed by recorded vote, and one was withdrawn. The House Energy and Commerce Committee, on May 21, 2015, unanimously ordered to be reported H.R. 6 and the House Committee on Rules published a committee print of the bill on July 2, 2015. On July 7, 2015, H.R. 6 was reported by the Committee on Energy and Commerce (H.Rept. 114-190), and the House Committee on Ways and Means was discharged from further consideration of the bill....

Access to Unapproved Drugs: FDA Policies on Compassionate Use and Emergency Use Authorization

The Food and Drug Administration (FDA) regulates the U.S. sale of drugs and biological products, basing approval or licensure on evidence of the safety and effectiveness for a product’s intended uses. Without that approval or licensure, a manufacturer may not distribute the product except for use in the clinical trials that will provide evidence to determine that product’s safety and effectiveness. Under certain circumstances, however, FDA may permit the sponsor to provide an unapproved or unlicensed product to patients outside that standard regulatory framework. Two such mechanisms are...

Medicaid: An Overview

Medicaid is a means-tested entitlement program that finances the delivery of primary and acute medical services as well as long-term services and supports (LTSS) to an estimated 65 million people at a cost to states and the federal government of $498 billion in FY2014. In comparison, the Medicare program provided health care benefits to nearly 54 million seniors and certain individuals with disabilities in that same year at a cost of roughly $606 billion to the federal government. Because Medicaid represents a large component of federal mandatory spending, Congress is likely to continue...

Specialty Drugs: Background and Policy Concerns

Congressional Research Service 7-5700 www.crs.gov R44132 Summary Specialty drugs are one of the fastest-growing areas of health care spending. There is no one set definition of specialty drugs, although insurers and other health care payers often characterize them as prescription products requiring extra handling or administration that are used to treat complex diseases including hepatitis C, multiple sclerosis, and cancer. High cost can trigger a specialty drug designation. Biologics, or drugs derived from living cells, are often but not always deemed to be specialty drugs. Over the past...

Mass Murder with Firearms: Incidents and Victims, 1999-2013

In the wake of tragedy in Newtown, CT, Congress defined “mass killings” as “3 or more killings in a single incident” (P.L. 112-265). Any consideration of new or existing gun laws that follows mass shootings is likely to generate requests for comprehensive data on the prevalence and deadliness of these incidents. Despite the pathos of mass shootings, only a handful of researchers and journalists have analyzed the principal source of homicide data in the United States—the Supplementary Homicide Reports (SHR) compiled by the Federal Bureau of Investigation (FBI)—to determine whether those...

Older Americans Act: Long-Term Care Ombudsman Program

Quality of care in long-term care settings has been, and continues to be, a concern for federal policymakers. The Long-Term Care (LTC) Ombudsman Program is a consumer advocacy program that aims to improve the quality of care, as well as the quality of life, for residents in LTC settings by investigating and resolving complaints made by, or on behalf of, such residents. Established under Title VII of the Older Americans Act (OAA), the Administration on Aging (AoA) within the Administration for Community Living in the Department of Health and Human Services (HHS) administers the nationwide...

Laws Affecting the Federal Employees Health Benefits (FEHB) Program

For more than 50 years, the Federal Employees Health Benefits (FEHB) Program has been providing health insurance coverage to federal employees, retirees, and their dependents. It is the largest employer-sponsored health insurance program in the country, covering about 8.2 million enrollees each year.

The program was created by the Federal Employees Health Benefits Act of 1959 (FEHBA; P.L. 86-382). FEHBA and its subsequent amendments established the parameters for eligibility; election of coverage; the types of health plans and benefits that may be offered; and the level of the government’s...

U.S. Agency for International Development (USAID): Background, Operations, and Issues

This report provides background information on the institutional makeup and operations of the U.S. Agency for International Development (USAID), the leading international humanitarian and development arm of the U.S. government. The report then discusses in greater depth several aspects of the agency that might be of particular congressional interest.

In FY2015, USAID is responsible for more than $20 billion in appropriations, representing more than one-third of the International Affairs 150 budget function and more than half of total foreign assistance encompassed by the State, Foreign...

Centers for Medicare & Medicaid Services (CMS) Proposed Rule on Medicaid Managed Care: Frequently Asked Questions

On May 26, 2015, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule (CMS-2390-P) laying out the agency’s plan to update the federal regulations pertaining to Medicaid managed care, under which states contract with private health insurers to provide health care to some enrollees. The proposed rule was posted to the Federal Register on June 1, 2015.

The proposed rule would be the first major federal regulation impacting Medicaid managed care since 2002. In the early 1990s, states began turning to managed care to deliver benefits to enrollees. In FY2011, 49.8% of...

Presidential Appointments to Full-Time Positions in Executive Departments During the 113th Congress

The President makes appointments to positions within the federal government, either using the authorities granted by law to the President alone, or with the advice and consent of the Senate. There are some 351 full-time leadership positions in the 15 executive departments for which the Senate provides advice and consent. This report identifies all nominations submitted to the Senate during the 113th Congress for full-time positions in these 15 executive departments.

Information for each department is presented in tables. The tables include full-time positions confirmed by the Senate, pay...

Prospects for Democracy in Hong Kong: The 2017 Election Reforms (Update)

The United States-Hong Kong Policy Act of 1992 (P.L. 102-383) declares that, “Support for democratization is a fundamental principle of U.S. foreign policy. As such, it naturally applies to United States policy toward Hong Kong.” China’s law establishing the Hong Kong Special Administration Region (HKSAR), commonly referred to as the “Basic Law,” declares that “the ultimate aim” is the selection of Hong Kong’s Chief Executive (CE) and Legislative Council (Legco) by universal suffrage. The year 2015 may be a pivotal year for making progress toward the objectives of both of these laws. It...

Medigap: A Primer

Congressional Research Service 7-5700 www.crs.gov R42745 Summary Medicare is a nationwide health insurance program for individuals aged 65 and over and certain disabled individuals. The basic Medicare benefit package (termed “original Medicare” in this report) provides broad protection against the costs of many health care services. However, Medicare beneficiaries may still have significant additional costs, including co-payments, coinsurance, deductibles, and the full cost of services that are not covered by Medicare. To decrease their potential financial liability, some Medicare...

Social Networking and Committee Communications: Use of Twitter and Facebook in the 113th Congress

Communications between congressional committees and constituents and stakeholder groups have changed with the development of social networking services. Many committees now use email, official websites, blogs, YouTube channels, Twitter, Facebook, and other services—technologies that were either nonexistent or not widely available until recently—to communicate with Members of Congress, constituents, and stakeholder groups.

Social networking services have arguably served to enhance the ability of congressional committees to reach Members of Congress, constituents, and stakeholder groups and...

Department of Homeland Security: FY2015 Appropriations

This report analyzes the FY2015 appropriations for the Department of Homeland Security (DHS). While this report makes note of many budgetary resources provided to DHS, its primary focus is on funding approved by Congress through the appropriations process.

The Administration requested $38.332 billion in adjusted net discretionary budget authority for DHS for FY2015, as part of an overall budget of $60.919 billion (including fees, trust funds, and other funding that is not appropriated or does not score against the budget caps). The request amounted to a $0.938 billion, or 2.4%, decrease...

Maps of 2015 Individual Exchange Enrollment by Zip Code

This report presents a tool to examine exchange enrollment information by zip code with additional geographic boundaries.

Selected Issues in Homeland Security Policy for the 114th Congress

In 2001, in the wake of the terrorist attacks of September 11th, “homeland security” went from being a concept discussed among a relatively small cadre of policymakers and strategic thinkers to a broadly discussed issue in Congress. Debates over how to implement coordinated homeland security policy led to the passage of the Homeland Security Act of 2002 (P.L. 107-296) and the establishment of the Department of Homeland Security (DHS). Evolution of America’s response to terrorist threats has continued under the leadership of different Administrations, Congresses, and in a shifting...

Deployable Federal Assets Supporting Domestic Disaster Response Operations: Summary and Considerations for Congress

For most disasters across the nation, the affected local, state, or tribal governments have sufficient capabilities to respond to the incident. However, for disasters with consequences that require unique capabilities or that overwhelm the existing capabilities of a respective state or tribal government, Congress has authorized and appropriated a suite of deployable federal assets to support domestic disaster response operations. This report reviews several key concepts about these federal assets, and highlights possible issues Congress may consider when evaluating their authorization and...

Military Construction, Veterans Affairs, and Related Agencies: FY2015 Appropriations

The Military Construction, Veterans Affairs, and Related Agencies appropriations bill provides funding for the planning, design, construction, alteration, and improvement of facilities used by active and reserve military components worldwide. It capitalizes military family housing and the U.S. share of the NATO Security Investment Program and finances the implementation of installation closures and realignments. It underwrites veterans benefit and health care programs administered by the Department of Veterans Affairs (VA), provides for the creation and maintenance of U.S. cemeteries and...

Genomic Data and Privacy: Background and Relevant Law

Advances in genomics technology and information technology infrastructure, together with policies regarding the sharing of research data, support new approaches to genomic research but also raise new issues with respect to privacy. The development of new genomic sequencing technologies has allowed for the generation of big data, and recent changes in information technology infrastructure have facilitated big data storage and analytics. These developments are expected to support significant changes in health research and, eventually, in health care delivery.

Genetic and genomic research—and...

An Introduction to Health Insurance: What Should a Consumer Know?

Congress has seen a renewed interest in the market for private health insurance since the passage of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended). This report provides an overview of private-sector (as opposed to government-provided) health insurance. It serves as an introduction to health insurance from the point of view of many consumers under the age of 65. No background in health insurance is assumed, and all terms are defined in the body of the report.

A consumer may find the purchase of health care inherently different from some other purchases....

State Children’s Health Insurance Program: An Overview

The State Children’s Health Insurance Program (CHIP) is a means-tested program that provides health coverage to targeted low-income children and pregnant women in families that have annual income above Medicaid eligibility levels but have no health insurance. CHIP is jointly financed by the federal government and states, and the states are responsible for administering CHIP. In FY2013, CHIP enrollment totaled 8.4 million individuals and CHIP expenditures totaled $13.2 billion.

Under the CHIP program, the federal government sets basic requirements for CHIP, but states have the flexibility...

The National Institutes of Health (NIH): Background and Congressional Issues

The National Institutes of Health (NIH) is the focal point for federal health research. An agency of the Department of Health and Human Services (HHS), it uses its $30 billion budget to support more than 300,000 scientists and research personnel working at over 2,500 institutions across the United States and abroad, as well as to conduct biomedical and behavioral research and research training at its own facilities. The agency consists of the Office of the Director, in charge of overall policy and program coordination, and 27 institutes and centers, each of which focuses on particular...

Locate an Agency or Program Within Appropriations Bills

This report provides an alphabetical listing of federal agencies and programs, and it is an aid to identify the major source of their appropriated funding. A listing of House and Senate Appropriations subcommittees is provided. Finding an agency.

Science and Technology Issues in the 114th Congress

Science and technology (S&T) have a pervasive influence over a wide range of issues confronting the nation. Public and private research and development spur scientific and technological advancement. Such advances can drive economic growth, help address national priorities, and improve health and quality of life. The constantly changing nature and ubiquity of science and technology frequently create public policy issues of congressional interest.

The federal government supports scientific and technological advancement directly by funding research and development and indirectly by creating...

SAMHSA FY2016 Budget Request and Funding History: A Fact Sheet

The Substance Abuse and Mental Health Services Administration (SAMHSA), at the U.S. Department of Health and Human Services (HHS), is the lead federal agency for increasing access to behavioral health services. SAMHSA supports community-based mental health and substance abuse treatment and prevention services through formula grants to the states and U.S. territories and through competitive grant programs to states, territories, tribal organizations, local communities, and private entities. SAMHSA also engages in a range of other activities, such as technical assistance, data collection,...

Health Coverage Tax Credit

The report describes the expired eligibility criteria, as well as the types of health insurance to which the tax credit may have been applied. It discusses past federal and state roles in administering the HCTC program, and it summarizes analyses on the credit's effectiveness in reaching targeted populations and related equity and efficiency issues. In addition, the report includes a short discussion of relevant current law and summarizes statutory history of the HCTC program.

Labor, Health and Human Services, and Education: FY2015 Appropriations

This report provides an overview of actions taken by Congress and the President to provide FY2015 appropriations for accounts funded by the Departments of Labor, Health and Human Services, and Education, and Related Agencies (L-HHS-ED) appropriations bill. This bill provides funding for all accounts subject to the annual appropriations process at the Departments of Labor (DOL) and Education (ED). It provides annual appropriations for most agencies within the Department of Health and Human Services (HHS), with certain exceptions (e.g., the Food and Drug Administration is funded via the...

Health Care-Related Expiring Provisions, First Session of the 114th Congress

This report provides a list of selected health-related programs and activities under specified titles of the Social Security Act (SSA), including the Maternal and Child Health Services Block Grant (Title V), General Provisions, Peer Review, and Administrative Simplification (Title XI), Medicare (Title XVIII), Medicaid (Title XIX), and the State Children’s Health Insurance Program (CHIP; Title XXI); the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended); as well as selected provisions from the Public Health Service Act (PHSA) that are scheduled to terminate during...

FY2015 Funding to Counter Ebola and the Islamic State (IS)

In 2014, two major global threats—the Ebola outbreak in West Africa and the Islamic State (IS) in the Middle East—caused serious concern within the Obama Administration and among Members of Congress. In November 2014, the President requested a total of $11.7 billion for responding to the Ebola crisis and combatting the Islamic State.

On November 5, 2014, the President requested $6.18 billion in FY2015 emergency appropriations for Health and Human Services (HHS), the Department of State and international assistance programs, and DOD to address the Ebola crisis domestically and overseas. The...

Veterans’ Medical Care: FY2015 Appropriations

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility criteria. Benefits to veterans range from disability compensation and pensions to hospital and medical care. The VA provides these benefits through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA). This report focuses on funding for the VHA. The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans...

Health Care for Veterans: Traumatic Brain Injury

In recent years, Congress, the Department of Defense (DOD), and the Department of Veterans Affairs (VA) have increased attention to traumatic brain injury (TBI), which is known as a “signature wound” of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Although the early stages of TBI treatment may occur within the military health care system (if the injury occurs during military service), this report focuses on the VA health care system. In FY2015, VA spending for TBI is estimated to be $234 million. The VA projects the 10-year (FY2016–FY2025) costs of TBI to be $2.2 billion...

President’s FY2016 Budget: Centers for Medicare & Medicaid Services (CMS) Legislative Proposals

Federal law requires the President to submit an annual budget request to Congress no later than the first Monday in February. The budget informs Congress of the President’s overall federal fiscal policy based on proposed spending levels, revenues, and deficit (or surplus) levels. The budget request lays out the President’s relative priorities for federal programs, such as how much should be spent on defense, education, health, and other federal programs. The President’s budget also may include legislative proposals for spending and tax policy changes. While the President is not required to...

Anthem Data Breach: How Safe Is Health Information Under HIPAA?

This report discusses the implications of the recent data breach at Anthem Inc., which raised new concerns about the vulnerability of electronic health information. Security experts question whether the Health Insurance Portability and Accountability Act (HIPAA) privacy and security standards are sufficiently protective of sensitive patient information.

Climate Change Adaptation by Federal Agencies: An Analysis of Plans and Issues for Congress

Though Congress has debated the significance of global climate change and what federal policies, if any, should address them, the Government Accountability Office (GAO) since 2013 has identified the changing climate as one of the 30 most significant risks facing the federal government. President Obama established adaptation as a prominent part of his Climate Action Plan in June 2013. The November 2013 Executive Order 13653, Preparing the United States for the Impacts of Climate Change, directed agencies to undertake vulnerability assessments and planning for adaptation. The Administration...

Agriculture and Related Agencies: FY2015 Appropriations

The Agriculture appropriations bill funds the U.S. Department of Agriculture (USDA), except for the Forest Service. It includes the Food and Drug Administration (FDA) and—in the House and in even-numbered enacted fiscal years—the Commodity Futures Trading Commission (CFTC).

The FY2015 Agriculture and Related Agencies appropriation was enacted as Division A of the FY2015 Consolidated Appropriations Act, P.L. 113-235 (December 16, 2014), an omnibus appropriation that included 11 of the 12 appropriations subcommittee bills. Although the fiscal year began under a continuing resolution, the...

U.S. Travel and Tourism: Industry Trends and Policy Issues for Congress

The U.S. travel and tourism industry accounted for 2.6% of gross domestic product (GDP) in 2012 and directly employed nearly 5.4 million people in 2013. Tourism exports reached a record $215 billion in 2013, representing almost a third of total U.S. services exports. The sector has posted an annual trade surplus with the world for more than two decades. The Department of Commerce forecasts foreign visitor volume in the United States will reach nearly 90 million in 2019.

In 1996, Congress stopped funding the United States Travel and Tourism Administration (USTTA), which for 35 years...

Sex Trafficking of Children in the United States: Overview and Issues for Congress

The trafficking of individuals within U.S borders is commonly referred to as domestic human trafficking, and it occurs in every state of the nation. One form of domestic human trafficking is sex trafficking. Research indicates that most victims of sex trafficking into and within the United States are women and children, and the victims include U.S. citizens and noncitizens alike. Recently, Congress has focused attention on domestic sex trafficking, including the prostitution of children, which is the focus of this report.

Federal law does not define sex trafficking per se. However, the...

Border Security: Immigration Inspections at Ports of Entry

About 362 million travelers (citizens and non-citizens) entered the United States in FY2013, including about 102 million air passengers and crew, 18 million sea passengers and crew, and 242 million land travelers. At the same time about 205,000 aliens were denied admission at ports of entry (POEs); and about 24,000 persons were arrested at POEs on criminal warrants.

Within the Department of Homeland Security (DHS), U.S. Customs and Border Protection’s (CBP) Office of Field Operations (OFO) is responsible for conducting immigration inspections at America’s 329 POEs. CBP’s primary...

P.L. 111-3: The Children’s Health Insurance Program Reauthorization Act of 2009

The Children’s Health Insurance Program Reauthorization Act of 2009 (H.R. 2, CHIPRA) was first passed in the House on January 14, 2009, and an amended version was passed in the Senate on January 29, 2009. On February 4, 2009, the House passed H.R. 2 as amended by the Senate and later that day President Obama signed the bill into law as P.L. 111-3. One of the provisions of CHIPRA permits using CHIP as the program’s acronym, instead of SCHIP. This report reflects this change, using CHIP instead of SCHIP.

The overall structure of CHIPRA is similar to its two predecessors, H.R. 976 and H.R....

Federal Benefits and Services for People with Low Income: Programs and Spending, FY2008-FY2013

The Congressional Research Service (CRS) regularly receives requests about the number, size, and programmatic details of federal benefits and services targeted toward low-income populations, and the characteristics of people who participate. This report attempts to identify and provide information about such programs, including their federal spending during FY2008-FY2013. The report does not discuss social insurance programs such as Social Security, Medicare, or Unemployment Insurance, but includes only programs with an explicit focus on low-income people or communities. Tax provisions,...

Health Insurance: A Primer

People obtain insurance to protect themselves against the possibility of financial loss in the future. Health insurance provides protection against the possibility of financial loss due to high health care expenses. Also, people do not know ahead of time exactly what their health care expenses will be, so paying for health insurance on a regular basis helps ease their out-of-pocket spending.

While health coverage continues to be mostly a private enterprise in this country, government plays an increasingly significant role. Government has initiated and responded to dynamics in medicine,...

Presidential Appointments to Full-Time Positions in Executive Departments During the 112th Congress

The President makes appointments to positions within the federal government, either using the authorities granted to the President alone or with the advice and consent of the Senate. There are some 349 full-time leadership positions in the 15 executive departments for which the Senate provides advice and consent. This report identifies all nominations submitted to the Senate during the 112th Congress for full-time positions in these 15 executive departments.

Information for each department is presented in tables. The tables include full-time positions confirmed by the Senate, pay levels...

U.S. Postal Service Retiree Health Benefits and Pension Funding Issues

Congress designed the U.S. Postal Service (USPS) to be a self-supporting government agency. Since 1971, the agency has not relied upon annual appropriations to cover its operating costs. Rather, USPS has funded its operations mostly through the sales of postage and postal products and services.

Since FY2007, however, the agency has run more than $40 billion in deficits and has reached its statutory borrowing limit ($15 billion). The agency does receive an annual appropriation of approximately $90 million per year, which amounts to about 0.1% of USPS’s $65 billion operating budget.

USPS’s...

The ACA Medicaid Expansion

Historically, Medicaid eligibility has generally been limited to certain low-income children, pregnant women, parents of dependent children, the elderly, and individuals with disabilities; however, as of January 1, 2014, states have the option to extend Medicaid coverage to most non-elderly, low-income individuals.

The Patient Protection and Affordable Care Act (ACA; P.L. 111-148 as amended) established 133% of the federal poverty level (FPL) (effectively 138% of FPL with an income disregard of 5% of FPL) as the new mandatory minimum Medicaid income eligibility level for most non-elderly...

Child Welfare: Health Care Needs of Children in Foster Care and Related Federal Issues

Approximately 641,000 children spend some time in foster care each year. Most enter care because they have experienced neglect or abuse by their parents. Between 35% and 60% of children entering foster care have at least one chronic or acute physical health condition that needs treatment. As many as one-half to three-fourths show behavioral or social competency problems that may warrant mental health services. A national survey of children adopted from foster care found that 54% had special health care needs. Research on youth who aged out of foster care shows these young adults are more...

Regulation of Dietary Supplements

Many Americans take dietary supplements (e.g., vitamins, herbs, sports nutrition supplements) with the intention of meeting their nutritional needs, as well as to improve or maintain their overall health. These consumers want accurate information on the effectiveness and proper use of dietary supplements and access to the dietary supplements of their choice. The federal government has an interest in ensuring that the supplements Americans consume are high quality, free from contaminants, and accurately labeled. Because dietary supplements are intended to supplement the diet, their...

Hospital-Based Emergency Departments: Background and Policy Considerations

Hospital-based Emergency Departments (EDs) are required to stabilize patients with emergent conditions regardless of the patients’ ability to pay as a requirement of the Emergency Medical Treatment and Active Labor Act (EMTALA). Given this requirement, EDs play an important part in the health care safety net by serving the uninsured, the underserved, and those enrolled in Medicaid. Open 24 hours a day, EDs provide emergency care, urgent care, primary care, and behavioral health care services in communities where these services are unavailable or unavailable after hours. EDs also play a key...

Preventing the Introduction and Spread of Ebola in the United States: Frequently Asked Questions

Throughout 2014, an outbreak of Ebola virus disease (EVD) has outpaced the efforts of health workers trying to contain it in three West African countries: Guinea, Liberia, and Sierra Leone. (These are often referred to as “affected countries” or “countries with widespread transmission.” In mid-November, 2014, Ebola transmission also occurred for the second time in neighboring Mali. The extent of spread in Mali remains to be seen.) EVD cases have been imported to other countries, including the United States, where two nurses were infected while caring for a patient who had traveled from...

State Marijuana Legalization Initiatives: Implications for Federal Law Enforcement

Marijuana is the most commonly used illicit drug in the United States. In 2013, an estimated 19.8 million individuals in the United States aged 12 or older (7.5% of this population) had used marijuana in the past month. While reported marijuana use is similar to that in 2012, it has generally increased since 2007 when 5.8% of individuals aged 12 or older were current users of marijuana. Mirroring this increase in use, marijuana availability in the United States has also increased. This growth has been linked to factors such as rising marijuana production in Mexico, and increasing marijuana...

Veterans Exposed to Agent Orange: Legislative History, Litigation, and Current Issues

The U.S. Armed Forces used a variety of chemical defoliants to clear dense jungle land in Vietnam during the war. Agent Orange (named for the orange-colored identifying stripes on the barrels) was by far the most widely used herbicide during the Vietnam War. Many Vietnam-era veterans believe that their exposure to Agent Orange caused them to contract several diseases and caused certain disabilities, including birth defects in their children, and now their grandchildren.

The Department of Veterans Affairs (VA) received the first claims asserting conditions related to Agent Orange in 1977....

Federal Proposals to Tax Marijuana: An Economic Analysis

The combination of state policy and general public opinion favoring the legalizing of marijuana has led some in Congress to advocate for legalization and taxation of marijuana at the federal level. The Marijuana Tax Equity Act of 2013 (H.R. 501) would impose a federal excise tax of 50% on the producer and importer price of marijuana. The National Commission on Federal Marijuana Policy Act of 2013 (H.R. 1635) proposes establishing a National Commission on Federal Marijuana Policy that would review the potential revenue generated by taxing marijuana, among other things.

This report focuses...

Childhood Overweight and Obesity: Data Brief

In children and adolescents, obesity is defined as being at or above the 95th percentile of the age- and sex-specific body mass index (BMI); overweight is defined as being between the 85th and 94th percentiles, based on growth charts developed by the Centers for Disease Control and Prevention. Over the past three decades, obesity has become a major public health problem, capturing the interest of health care professionals, policymakers, schools, employers, and the media. Although obesity rates have stabilized over the past decade, almost 32% of U.S. children and adolescents between the...

Treating Ebola Patients in the United States: Health Care Delivery Implications

This report discusses the recent response to Ebola patients in the United States. While the U.S. health care system has the resources to effectively identify and treat Ebola cases, a situation that is novel, emergent, and resource-intensive may test the system's ability to effectively mobilize those resources.

U.S. and International Health Responses to the Ebola Outbreak in West Africa

In March 2014, an Ebola Virus Disease (EVD) outbreak was reported in Guinea, West Africa. The outbreak is the first in West Africa and has caused an unprecedented number of cases and deaths. The outbreak is continuing to spread in Guinea, Sierra Leone, and Liberia (the “affected countries”); it has been contained in Nigeria and Senegal, and has been detected in Mali. As of October 22, 2014, more than 10,000 people have contracted EVD, more than half of whom have died.

Until October 2014, no secondary EVD cases had occurred outside of Africa. That month, health workers in Spain and the...

Federal Funding for Health Insurance Exchanges

Pursuant to the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), a health insurance exchange has been established in each state and the District of Columbia (DC). Exchanges are marketplaces where individuals and small businesses can “shop” for health insurance coverage.

The ACA instructed each state to establish its own state-based exchange (SBE). If a state elected not to create an exchange or if the Secretary of Health and Human Services (HHS) determined a state was not prepared to operate an exchange, the law directed HHS to establish a federally facilitated...

Child Welfare: Funding for Child and Family Services Authorized Under Title IV-B of the Social Security Act

Children depend on adults—usually their parents—to protect, support, and nurture them in their homes. The broadest mission of public child welfare agencies is to strengthen all families in ways that ensure children can depend on their parents to protect their safety, ensure they have a stable and permanent home, and enhance their well-being. More specifically, public child welfare agencies are expected to identify families where children are at risk of abuse or neglect and to provide services to prevent maltreatment. Public child welfare agencies are also expected to identify children who...

Labor, Health and Human Services, and Education: FY2014 Appropriations

This report provides an overview of actions taken by Congress to provide FY2014 appropriations for accounts funded by the Departments of Labor, Health and Human Services, and Education, and Related Agencies (L-HHS-ED) appropriations bill. The L-HHS-ED bill provides funding for all accounts subject to the annual appropriations process at the Departments of Labor (DOL) and Education (ED). It provides annual appropriations for most agencies within the Department of Health and Human Services (HHS), with certain exceptions (e.g., the Food and Drug Administration is funded via the Agriculture...

Beverage Industry Pledges to Reduce Americans' Drink Calories

This report briefly covers recent initiatives by leading beverage companies to curb the obesity epidemic.

Drug Enforcement in the United States: History, Policy, and Trends

The federal government prohibits the manufacturing, distribution, and possession of many intoxicating substances that are solely intended for recreational use (notable exceptions are alcohol and tobacco); however, the federal government also allows for and controls the medical use of many intoxicants. Federal authority to control these substances primarily resides with the Attorney General of the United States.

Over the last decade, the United States has shifted its stated drug control policy toward a comprehensive approach; one that focuses on prevention, treatment, and enforcement. In...

Reauthorizing the Office of National Drug Control Policy: Issues for Consideration

The Office of National Drug Control Policy (ONDCP) is located in the Executive Office of the President and has the responsibility for creating policies, priorities, and objectives for the federal Drug Control Program. This national program is aimed at reducing the use, manufacturing, and trafficking of illicit drugs and the reduction of drug-related crime and violence and of drug-related health consequences. The director of ONDCP has primary responsibilities of developing a comprehensive National Drug Control Strategy (Strategy) to direct the nation’s anti-drug efforts; developing a...

Ebola Virus Disease (Ebola or EVD): Experts List

Ebola virus disease (Ebola or EVD) is a severe, often fatal disease that was first detected near the Ebola River in the Democratic Republic of the Congo (DRC) in 1976. Originating in animals, EVD is spread to and among humans through contact with the blood, other bodily fluids, organs, and corpses of those infected. It is not transmitted through the air. In March 2014, the World Health Organization (WHO) announced that an EVD outbreak had begun in Guinea. The outbreak has since spread to Liberia, Sierra Leone, Nigeria, and Senegal.

Poverty: Major Themes in Past Debates and Current Proposals

This year marks the 50th anniversary of the War on Poverty, but poverty remains a difficult policy challenge. The Obama Administration and some in Congress have offered proposals that seek to address poverty, with the proposals differing considerably in their focus and content. However, the themes reflected in these proposals echo prior efforts to address the issue of poverty.

The terms “poverty” and “welfare” (commonly thought of as cash assistance for the poor) are often intertwined, but federal policies affecting poverty are broader than a single program or set of programs. In fact,...

Rural Development Provisions in the 2014 Farm Bill (P.L. 113-79)

While many legislative proposals introduced in a given Congress may have implications for rural America, Congress has generally expressed concern with economic development of rural communities within the context of periodic omnibus farm bills, most recently in Title VI of the Agricultural Act of 2014 (P.L. 113-79). Congress uses farm bills to address emerging rural issues as well as to reauthorize and/or amend a wide range of rural programs administered by the U.S. Department of Agriculture’s (USDA) three rural development mission agencies: Rural Housing Service, Rural Business-Cooperative...

Federal Financial Conflict of Interest Rules and Biomedical Research: A Legal Overview

Every year the federal government through a host of different agencies spends billions of dollars supporting biomedical research. In addition, the federal government, through the Food and Drug Administration (FDA), continually reviews the biomedical research that supports an application to market certain products, like drugs or medical devices. Collectively, the various federal agencies that either support or oversee biomedical research have a strong interest in ensuring that the underlying research is scientifically rigorous and free of bias. However, if a biomedical researcher has a...

Immigration Policies and Issues on Health-Related Grounds for Exclusion

News of humans infected with Ebola in West Africa, avian influenza in China, polio in the Middle East, and dengue fever in the Caribbean are examples of reports that heighten concerns about the health screenings of people arriving in the United States. Under current law, foreign nationals who wish to come to the United States generally must obtain a visa and submit to an inspection to be admitted. One of the reasons why a foreign national might be deemed inadmissible is on health-related grounds. The diseases that trigger inadmissibility in the Immigration and Nationality Act (INA) are...

Health Insurance Exchanges: Health Insurance “Navigators” and In-Person Assistance

The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148) allows certain individuals and small businesses to buy qualified health insurance through state exchanges. The exchanges are not themselves insurers, but rather are special marketplaces where insurance firms may sell health policies that meet set, federal guidelines. As of July 2014, 14 states and the District of Columbia had secured HHS approval to create and run their own exchanges, 7 to enter into partnership exchanges, 29 to have federally facilitated exchanges, and two to have state-based SHOP/federally...

SAMHSA FY2015 Budget Request and Funding History: A Fact Sheet

The Substance Abuse and Mental Health Services Administration (SAMHSA), at the U.S. Department of Health and Human Services (HHS), is the lead federal agency for increasing access to behavioral health services. SAMHSA supports community-based mental health and substance abuse treatment and prevention services through formula grants to the states and U.S. territories and through competitive grant programs to states, territories, tribal organizations, local communities, and private entities. SAMHSA also engages in a range of other activities such as technical assistance, data collection, and...

Safe at Home? Letting Ebola-Stricken Americans Return

This report examines the U.S. practice of isolation and quarantine for citizens arriving in the country who have been infected with or exposed to a dangerous communicable disease. The report frames this information in the context of the two American healthcare workers who were brought back into the U.S. for treatment after contracting the Ebola virus in West Africa in the Summer of 2014.

Juvenile Victims of Domestic Sex Trafficking: Juvenile Justice Issues

There has been growing concern over sex trafficking of children in the United States. Demand for sex with children (and other forms of commercial sexual exploitation of children) is steady, and profit to sex traffickers has increased. Law enforcement is challenged not only by prosecuting traffickers and buyers of sex with children, but also by how to handle the girls and boys whose bodies are sexually exploited for profit.

Under the Victims of Trafficking and Violence Protection Act of 2000 (TVPA; P.L. 106-386), the primary law that addresses trafficking, sex trafficking of children is a...

The Military Commissions Act of 2009 (MCA 2009): Overview and Legal Issues

On November 13, 2001, President Bush issued a Military Order (M.O.) pertaining to the detention, treatment, and trial of certain non-citizens in the war against terrorism. Military commissions pursuant to the M.O. began in November 2004 against four persons declared eligible for trial, but the Supreme Court in Hamdan v. Rumsfeld invalidated the military commissions as improper under the Uniform Code of Military Justice (UCMJ). To permit military commissions to go forward, Congress approved the Military Commissions Act of 2006 (MCA), conferring authority to promulgate rules that depart from...

The Role of Local Food Systems in U.S. Farm Policy

Presidential Appointments to Full-Time Positions in Executive Departments During the 111th Congress, 2009-2010

This report explains the process for filling positions to which the President makes appointments with the advice and consent of the Senate (also referred to as PAS positions). It also identifies, for the 111th Congress, all nominations to full-time positions requiring Senate confirmation in the 15 executive departments. It excludes appointments to regulatory boards and commissions and independent and other agencies, which are covered in other CRS reports.

The appointment process for advice and consent positions consists of three main stages. The first stage is selection, clearance, and...

Block Grants: Perspectives and Controversies

Block grants are a form of grant-in-aid that the federal government uses to provide state and local governments a specified amount of funding to assist them in addressing broad purposes, such as community development, social services, public health, or law enforcement.

Block grant advocates argue that block grants increase government efficiency and program effectiveness by redistributing power and accountability through decentralization and partial devolution of decision-making authority from the federal government to state and local governments. Advocates also view them as a means to...

Remote Gambling: Industry Trends and Federal Policy

Gambling, once widely outlawed, is now a regulated, taxed activity that is legal in some form—bingo, card games, slot machines, state-run lotteries, casinos, and even online—in all but two states. Like so many other industries, the gambling industry is being transformed by technology that has begun to shift patronage from casinos, bingo halls, or stores selling lottery tickets to desktop computers and tablets connected to the Internet and to mobile devices that may communicate by telephone or direct satellite links. This report discusses remote gambling and the likely implications for the...

Upcoming Rules Pursuant to the Patient Protection and Affordable Care Act: The Spring 2014 Unified Agenda

The Patient Protection and Affordable Care Act (ACA, as amended) was signed into law by President Barack Obama on March 23, 2010. As is often the case with legislation, the ACA granted rulemaking authority to federal agencies to implement many of its provisions. The regulations issued pursuant to the ACA and other statutes carry the force and effect of law. Therefore, scholars and practitioners have long noted the importance of rulemaking to the policy process, as well as the importance of congressional oversight of rulemaking. For example, one scholar noted that the “Constitution’s grant...

Climate Change: CRS Experts

The Number of Veterans That Use VA Health Care Services: A Fact Sheet

This report provides data on the number of veterans and VA health care users, and discusses the allegations of long delays in treatments.

Progress in Combating Neglected Tropical Diseases (NTDs): U.S. and Global Efforts from FY2006 to FY2015

The term “neglected tropical diseases” (NTDs) was coined by the World Health Organization (WHO) in 2003 to describe a set of diseases that are ancient, worsen poverty, and typically impair health and productivity while carrying low death rates. While the use of the term “NTDs” has helped to raise awareness about these long-standing health challenges, its use risks simplifying a complicated health challenge. Some of the diseases are treatable with drugs that can be administered by lay health workers irrespective of disease status, while others require diagnosis and can be treated only by...

Centers for Medicare & Medicaid Services: President’s FY2015 Budget

Federal law requires the President to submit an annual budget to Congress no later than the first Monday in February. The budget informs Congress of the President’s overall federal fiscal policy based on proposed spending levels, revenues, and deficit (or surplus) levels. The budget request lays out the President’s relative priorities for federal programs, such as how much should be spent on defense, education, health, and other federal programs. The President’s budget may also include legislative proposals for spending and tax policy changes. While the President is not required to propose...

S. 2262, Shaheen-Portman Bill 2014: Energy Savings and Industrial Competitiveness Act

S. 2262 has four energy efficiency titles, which address buildings, industry, federal agencies, and certain regulatory measures. Title V would provide a budgetary offset for bill authorizations. The bill was derived directly from S. 1392, often referred to as the Shaheen-Portman bill of 2013. During the first session, floor action on S. 1392 was halted by a push for votes on controversial non-energy amendments. Many energy amendments were also prepared for S. 1392, but floor action stopped before formal consideration.

In the second session, anticipating the potential for further procedural...

Long-Term Services and Supports: In Brief

[Summary will be suppressed] Long-term services and supports (LTSS) refer to a broad range of health and health-related services and supports that are needed by individuals over an extended period of time. The need for LTSS affects persons of all ages and is generally measured by limitations in an individuals ability to perform daily personal care activities (e.g., eating, bathing, dressing, walking) or activities that allow individuals to live independently in the community (e.g., shopping, housework, meal preparation). Most individuals with LTSS needs prefer to remain in their own homes...

Department of Homeland Security: FY2014 Appropriations

This report analyzes the FY2014 appropriations for the Department of Homeland Security (DHS). The Administration requested $39.0 billion in adjusted net discretionary budget authority for DHS for FY2014, as part of an overall budget of $60.0 billion (including fees, trust funds, and other funding that is not appropriated or does not score against the budget caps). Net requested appropriations for major agencies within DHS were as follows: Customs and Border Protection (CBP), $10,833 million; Immigration and Customs Enforcement (ICE), $4,997 million; Transportation Security...

Federal Aid to State and Local Governments: Select Issues Raised by a Federal Government Shutdown

This report explores two grant-administration issues specifically affected by the federal shutdown. It gives an overview of federal aid to state and local governments, characteristics of federal grants and methods for disbursing the funds, grant administration issues affected by a lapse in federal funding, and potential legislative options to reduce the impact of future government shutdowns.

Veterans’ Medical Care: FY2014 Appropriations

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility criteria. Benefits to veterans range from disability compensation and pensions to hospital and medical care. The VA provides these benefits through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA). This report focuses on funding for the VHA. The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans...

Federal Health Centers

The federal health center program is authorized in Section 330 of the Public Health Service Act (42 U.S.C. §§201 et. seq.) and administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services. It awards grants to support outpatient primary care facilities that provide care to primarily low-income individuals or individuals located in areas with few health care providers. Federal health centers are required to provide health care to all individuals regardless of their ability to pay and are required to be located in geographic areas...

Free Exercise of Religion by Secular Organizations and Their Owners: Implications for the Affordable Care Act (ACA)

The Supreme Court’s grant of review in Conestoga Wood Specialties Corp. v. Secretary of U.S. Department of Health and Human Services and Hobby Lobby Stores v. Sebelius, along with recent federal court decisions, has highlighted the ongoing controversy over the scope of the Affordable Care Act’s (ACA’s) contraceptive coverage requirement, which requires an employer to provide certain contraceptive coverage to its employees under its group health plan. Some employers have objected to the requirement, citing objections to the facilitation of the use of contraceptives in conflict with the...

Agriculture and Related Agencies: FY2014 and FY2013 (Post-Sequestration) Appropriations

The annual Agriculture appropriations bill provides funding for all of the U.S. Department of Agriculture (USDA) except the Forest Service, plus the Food and Drug Administration (FDA) and, in even-numbered fiscal years, the Commodity Futures Trading Commission (CFTC).

The FY2014 Agriculture and Related Agencies appropriations bill was included as Division A of the FY2014 Consolidated Appropriations Act, an omnibus appropriation that was enacted on January 17, 2014 (P.L. 113-76). It provides $20.880 billion of discretionary funding for agricultural and related programs. This is $1.165...

Submission of Mental Health Records to NICS and the HIPAA Privacy Rule

Questions about the scope and efficacy of the background checks required during certain firearm purchases have gained prominence following recent mass shootings. These background checks are intended to identify whether potential purchasers are prohibited from purchasing or possessing firearms due to one or more “prohibiting factors,” such as a prior felony conviction or a prior involuntary commitment for mental health reasons. Operationally, such background checks primarily use information contained within the National Instant Criminal Background Check System (NICS) and a particular focus...

The 2014 Farm Bill (P.L. 113-79): Summary and Side-by-Side

Congress periodically establishes agricultural and food policy in a multi-year, omnibus farm bill. The 2008 farm bill governed policy for farm commodity support, horticulture, livestock, conservation, nutrition assistance, trade and international food aid, agricultural research, farm credit, rural development, bioenergy, and forestry. It originally expired in 2012, but the 112th Congress did not complete action and instead extended the law for one year (P.L. 112-240), leaving consideration of a new farm bill to the 113th Congress.

After nearly three years of deliberations, Congress...

TRICARE and VA Health Care: Impact of the Patient Protection and Affordable Care Act (ACA)

The 111th Congress passed, and the President signed into law, the Patient Protection and Affordable Care Act (P.L. 111-148; ACA), which was later amended by the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152; HCERA), and is hereinafter referred to as ACA. In general, ACA did not make any significant changes to the Department of Defense (DOD) TRICARE program or to the Department of Veterans Affairs (VA) health care system. However, many have sought clarification as to whether certain provisions in ACA, such as a mandate for most individuals to have health insurance, or...

Career and Technical Education (CTE): A Primer

Career and Technical Education (CTE), often referred to as vocational education, provides occupational and non-occupational preparation at the secondary, postsecondary, and adult education levels. CTE is an element of the nation’s workforce development system. As such, CTE plays a role in reducing unemployment and the associated economic and social ills. This report provides a primer on CTE to support congressional discussion of initiatives designed to rationalize the workforce development system.

CTE prepares students for roles outside the paid labor market, teaches general employment...

Typhoon Haiyan (Yolanda): U.S. and International Response to Philippines Disaster

This report examines the impact of Typhoon Haiyan (Yolanda), which struck the central Philippines on November 8, 2013, and the U.S. and international response. Haiyan was one of the strongest typhoons to strike land on record. Over a 16 hour period, the “super typhoon,” with a force equivalent to a Category 5 hurricane and sustained winds of up to 195 mph, directly swept through six provinces in the central Philippines. The disaster quickly created a humanitarian crisis. In some of the hardest hit areas, particularly in coastal communities in Leyte province and the southern tip of Eastern...

Medicare Home Health Benefit Primer: Benefit Basics and Issues

The Medicare home health benefit provides coverage for home visits by skilled health care professionals. Medicare Parts A and B provide coverage for home health services. To be eligible for the home health benefit, a beneficiary must meet three different criteria. The beneficiary must (1) be homebound, (2) require intermittent skilled nursing care and/or skilled rehabilitation services, and (3) be under the care of a physician who has established that the home health visits are medically necessary in a 60-day plan of care. A beneficiary who meets these requirements is entitled to a 60-day...

School Resource Officers: Law Enforcement Officers in Schools

Some policymakers have expressed renewed interest in school resource officers (SROs) as a result of the December 2012 mass shooting that occurred at Sandy Hook Elementary School in Newtown, CT. SROs are sworn law enforcement officers who are assigned to work in schools.

For FY2014, the Administration requested $150 million in funding for a Comprehensive Schools Safety Program under the Community Oriented Policing Services (COPS) program. Congress appropriated $75 million for a Comprehensive School Safety Initiative. Congress required the National Institute of Justice (NIJ) to collaborate...

The Role of Patents and Regulatory Exclusivities in Pharmaceutical Innovation

In combination, patents and regulatory exclusivities provide the fundamental framework of intellectual property incentives for pharmaceutical innovation in the United States. Patents, which are administered by the United States Patent and Trademark Office (USPTO), provide their owner with the ability to exclude others from practicing the claimed invention for a limited time. In contrast, regulatory exclusivities are administered by the Food and Drug Administration (FDA). Alternatively known as marketing exclusivities, data exclusivities, or data protection, regulatory exclusivities...

Follow-On Biologics: The Law and Intellectual Property Issues

The term “biologics” refers to a category of medical preparations derived from a living organism. These medicines have added notable therapeutic options for many diseases and impacted fields such as oncology and rheumatology. The biologics industry invests extensively in R&D and contributes to a rapidly expanding market for these treatments. Biologics are often costly, however, in part due to the sophistication of the technologies and the manufacturing techniques needed to make them.

Some commentators have also observed that, in contrast to the generic drugs available in traditional...

Health Care for Rural Veterans: The Example of Federally Qualified Health Centers

This report discusses considerations that may arise during possible attempts to increase collaboration between the Department of Veterans Affairs (VA) and federally qualified health centers (FQHCs) and describes policy levers Congress might use to encourage VA-FQHC collaboration. These approaches might also be employed to encourage collaboration between the VA and other types of facilities that may serve rural veterans.

Food Fraud and “Economically Motivated Adulteration” of Food and Food Ingredients

Food fraud, or the act of defrauding buyers of food or ingredients for economic gain—whether they be consumers or food manufacturers, retailers, and importers—has vexed the food industry throughout history. Some of the earliest reported cases of food fraud, dating back thousands of years, involved olive oil, tea, wine, and spices. These products continue to be associated with fraud, along with some other foods. Although the vast majority of fraud incidents do not pose a public health risk, some cases have resulted in actual or potential public health risks. Perhaps the most high-profile...

Science, Technology, Engineering, and Mathematics (STEM) Education: A Primer

The term “STEM education” refers to teaching and learning in the fields of science, technology, engineering, and mathematics. It typically includes educational activities across all grade levels—from pre-school to post-doctorate—in both formal (e.g., classrooms) and informal (e.g., afterschool programs) settings. Federal policy makers have an active and enduring interest in STEM education, and the topic is frequently raised in federal science, education, workforce, national security, and immigration policy debates. For example, more than 225 bills containing the term “science education”...

Indian Health Care: Impact of the Affordable Care Act (ACA)

On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148). The law, among other things, reauthorizes the Indian Health Care Improvement Act (P.L. 94-437, IHCIA), which authorizes many programs and services provided by the Indian Health Service (IHS). In addition, it makes several changes that may affect American Indians and Alaska Natives enrolled in and receiving services from the Medicare, Medicaid, and State Children’s Health Insurance Program (CHIP)—also called Social Security Act (SSA)...

The Indian Health Care Improvement Act Reauthorization and Extension as Enacted by the ACA: Detailed Summary and Timeline

On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148). Among its provisions, the ACA reenacts, amends, and permanently reauthorizes the Indian Health Care Improvement Act (IHCIA). IHCIA authorizes many specific Indian Health Service (IHS) activities, sets out the national policy for health services administered to Indians, and sets health condition goals for the IHS service population to reduce “the prevalence and incidence of preventable illnesses among, and unnecessary and premature...

Military Medical Care: Questions and Answers

The primary objective of the military health system, which includes the Defense Department’s hospitals, clinics, and medical personnel, is to maintain the health of military personnel so they can carry out their military missions and to be prepared to deliver health care during wartime. The military health system also covers dependents of active duty personnel, military retirees, and their dependents, including some members of the reserve components. The military health system provides health care services through either Department of Defense (DOD) medical facilities, known as “military...

Science and Technology Issues in the 113th Congress

Science and technology (S&T) have a pervasive influence over a wide range of issues confronting the nation. Public and private research and development spurs scientific and technological advancement. Such advances can drive economic growth, help address national priorities, and improve health and quality of life. The constantly changing nature and ubiquity of science and technology frequently create public policy issues of congressional interest.

The federal government supports scientific and technological advancement by directly funding research and development and indirectly by creating...

Interior, Environment, and Related Agencies: FY2013 Appropriations

The Interior, Environment, and Related Agencies appropriations bill includes funding for the Department of the Interior (DOI), except for the Bureau of Reclamation, and for agencies within other departmentsincluding the Forest Service within the Department of Agriculture and the Indian Health Service within the Department of Health and Human Services. It also includes funding for arts and cultural agencies, the U.S. Environmental Protection Agency, and numerous other entities.

Neither the House nor the Senate passed a regular appropriations bill for FY2013 for Interior, Environment, and...

Patient Protection and Affordable Care Act: Annual Fee on Health Insurers

The Patient Protection and Affordable Care Act (P.L. 111-148) and the Reconciliation Act of 2010 (P.L. 111-152) impose an annual fee on certain for-profit health insurers, starting in 2014. The aggregate amount of the ACA fee, to be collected across all covered insurers, will be $8.0 billion in 2014, $11.3 billion in 2015 and 2016, $13.9 billion in 2017, and $14.3 billion in 2018. After 2018, the aggregate fee will be indexed to the overall rate of annual premium growth, as calculated by the Internal Revenue Service.

The annual fee will be apportioned among health insurers, based on (1)...

Cancellation of Nongroup Health Insurance Policies

Congress has expressed interest in health insurance cancellations, in light of media reports stating that individuals have received cancellation letters. While cancellations are not a new industry practice, additional attention has focused on the more recent cancellations given that many of the insurance market reforms included in the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) will become effective beginning in 2014. These cancellations and proposals to address them, including the Administration’s recently announced transitional policy, have been discussed...

Federal Employees Health Benefits Program (FEHBP): Available Health Insurance Options

This report discusses the Federal Employees Health Benefits Program (FEHBP), a program administered by the Office of Personnel Management (OPM), which is statutorily given the authority to contract with qualified carriers offering plans and to prescribe regulations necessary to carry out the statute, among other duties.

The Proposed Drug Quality and Security Act (H.R. 3204)

The proposed Drug Quality and Security Act, H.R. 3204, is the current focus of congressional efforts to protect the public from unsafe, ineffective, or otherwise subquality compounded drugs and from the risks of counterfeit and subquality drugs entering the supply chain between the manufacturer and the dispenser. Majority and minority leadership of the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions announced an agreement on September 25, 2013, following years of bicameral and bipartisan efforts. On September 27, 2013,...

The Shift to Digital Advertising: Industry Trends and Policy Issues for Congress

The United States is the world’s largest advertising market. According to one estimate, domestic advertising revenue totaled $219 billion in 2012, accounting for about 1% of U.S. gross domestic product (GDP). Almost every major medium of information, including the press, entertainment, and online services, depends on advertising revenue. Advertising accounts for 60%-80% of total revenue at many newspapers and magazines and for most revenue at search engines and social networking sites.

Television still remains the main choice for advertisers, with ad revenue at almost $76 billion in 2012....

S. 1392, Shaheen-Portman Bill: Energy Savings and Industrial Competitiveness Act of 2013

S. 1392—the Energy Savings and Industrial Competitiveness Act of 2013—was introduced on July 30, 2013. Often referred to as the Shaheen-Portman bill, it is a trimmed-down version of S. 761. It contains provisions for building energy codes, industrial energy efficiency, federal agencies, and budget offsets. The bill contains voluntary provisions and was designed to be deficit-neutral. To date, virtually all debate related to the bill has been focused on floor amendments.

The bill was reported by the Senate Committee on Energy and Natural Resources (SENR) on a 19-3 vote. On August 1, 2013, a...

Student Bullying: Overview of Research, Federal Initiatives, and Legal Issues

Many Members of Congress have become increasingly concerned about what can be done to address student bullying. This concern has arisen in response to high-profile bullying incidents that have occurred in recent years, and due to a growing body of research on the negative consequences of school bullying. Congress is interested in ensuring that schools are safe, secure places for students, so that they can receive the full benefits of their education. Several bills that address school bullying have already been introduced in the 113th Congress, although none has been enacted as of the date...

Affordable Care Act (ACA) and the Appropriations Process: FAQs Regarding Potential Legislative Changes and Effects of a Government Shutdown

Congress has yet to complete legislative action on any of the 12 regular appropriations bills to fund the routine operations of federal agencies for FY2014, which began on October 1, 2013. Moreover, lawmakers have been unable to agree on a continuing appropriations bill, or continuing resolution (CR), to provide funding for part or all of the new fiscal year. As a result, the federal government has begun a shutdown of programs that lack budget authority to continue operations in FY2014, except in certain circumstances.

Congress is deeply divided over implementation of the Patient...

Issues in Homeland Security Policy for the 113th Congress

With the 10th anniversary of the establishment of the Department of Homeland Security (DHS), many observers have made a fresh assessment of where America’s homeland security enterprise stands today. DHS is currently the third-largest department in the federal government, although it does not incorporate all of the homeland security functions at the federal level. The definition of homeland security remains unsettled, and questions about the effectiveness and efficiency of the department have been raised since it was first proposed. Evolution of America’s response to terrorist threats has...

Private Health Plans Under the ACA: In Brief

This report provides short descriptions of health plans that may be offered inside and outside of exchanges: qualified health plans; child-only plans; multi-state plans; health cooperatives; catastrophic and other high deductible health plans; stand-alone dental plans; nongroup, small group and large group plans; grandfathered plans; self-funded (self-insured) plans; union plans; retiree-only plans; and vision plans, ancillary insurance products, and limited-benefit plans.

In addition, this report indicates the applicability of select ACA market reforms to private health plans. The...

The Family and Medical Leave Act (FMLA): Policy Issues

The Family and Medical Leave Act (FMLA) requires covered employers to allow eligible employees to take up to 12 weeks of leave during any 12-month period to care for a newborn, adopted, or foster child; to care for a family member with a serious health condition; or because of the employee’s own serious health condition. The act allows eligible employees to take up to 12 weeks of leave because of “qualifying exigencies” when a family member who is in the Armed Forces or National Guard is deployed overseas. An employee may also take up to 26 weeks of leave during a single 12-month period to...

Health Workforce Programs in Title VII of the Public Health Service Act

Title VII of the Public Health Service Act (PHSA) supports health professions education and training through grants to and contractual agreements with institutions, and direct assistance to individuals. Institutions may receive Title VII support for such activities as residency programs at medical and dental schools, recruitment and retention initiatives in community-based educational settings, and health workforce data collection and analysis within state health departments. Individuals typically receive direct assistance through scholarships, loans, loan repayments, or fellowships. Title...

Post-Traumatic Stress Disorder and Other Mental Health Problems in the Military: Oversight Issues for Congress

Military servicemembers suffering from post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and depression, as well as military suicides, continue to be a major concern of Congress. Numerous legislative provisions have been enacted over the past years to address these issues. Members will likely seek to offer legislation in the 113th Congress to address this complex set of issues. This report is intended to provide assistance in understanding the issues associated with psychological health in the active duty forces, potential congressional responses, and what questions may...

Military Sexual Assault: Chronology of Activity in Congress and Related Resources

This report focuses on activity in Congress regarding recent high profile incidents of sexual assault in the military. Included are separate sections on the official responses related to these incidents by the Department of Defense (DOD), the Administration, and Congress including legislation in the 113th Congress. The last section is a resource guide for sources in this report and related materials on sexual assault and prevention.

Delay in Implementation of Potential Employer Penalties Under ACA

The Patient Protection and Affordable Care Act (ACA, P.L. 111-148), as amended, attempts to increase access to health insurance coverage, expands federal private health insurance market requirements, and requires the creation of health insurance exchanges to provide certain individuals and small employers with access to insurance. To ensure that employers continue to provide some degree of coverage, ACA includes a “shared responsibility” provision. This provision does not explicitly mandate that an employer offer employees health insurance; instead, ACA imposes penalties on “large”...

Potential Employer Penalties Under the Patient Protection and Affordable Care Act (ACA)

This report describes the potential employer penalties and proposed regulations to implement the Affordable Care Act (ACA) employer provisions.

Rural Broadband: The Roles of the Rural Utilities Service and the Universal Service Fund

Since the initial deployment of broadband in the late 1990s, Congress has viewed broadband infrastructure deployment as a means towards improving regional economic development, and in the long term, to create jobs. According to the National Broadband Plan, the lack of adequate broadband infrastructure is most pressing in rural America, where the costs of serving large geographical areas, coupled with low population densities, often reduce economic incentives for telecommunications providers to invest in and maintain broadband infrastructure and service.

Historically, the federal...

Department of Homeland Security: FY2013 Appropriations

This report describes the FY2013 appropriations for the Department of Homeland Security (DHS). The Administration requested $39.510 billion in adjusted net discretionary budget authority for DHS for FY2013, as part of an overall budget of $59.501 billion (including fees, trust funds, and other funding that is not appropriated or does not score against the budget caps). The request amounted to a $90 million, or 0.2%, decrease from the $39.600 billion enacted for FY2012 through the consolidated appropriations act (P.L. 112-74).

Congress did not enact final FY2013 appropriations legislation...

Veterans’ Medical Care: FY2013 Appropriations

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility criteria. Benefits to veterans range from disability compensation and pensions to hospital and medical care. The VA provides these benefits through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA).

This report focuses on funding for the VHA. The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans...

Budget “Sequestration” and Selected Program Exemptions and Special Rules

“Sequestration” is a process of automatic, largely across-the-board spending reductions under which budgetary resources are permanently canceled to enforce certain budget policy goals. It was first authorized by the Balanced Budget and Emergency Deficit Control Act of 1985 (BBEDCA, Title II of P.L. 99-177, commonly known as the Gramm-Rudman-Hollings Act).

Sequestration is of current interest because it has been triggered as an enforcement tool under the Budget Control Act of 2011 (BCA, P.L. 112-25). Sequestration can also occur under the Statutory Pay-As-You-Go Act of 2010 (Statutory...

Compounded Drugs

Compounding has been traditionally defined as a process where a pharmacist or a physician combines, mixes, or alters ingredients to create a medication tailored to the needs of an individual patient. Traditionally compounded drugs (CDs) are made in response to an individual prescription from a licensed health provider in the context of a pharmacist’s and health care professional’s relationship with a specific patient.

Some have suggested that certain activities not traditionally associated with compounding be considered compounding. Such activities include the large-scale production of...

Public Health, Workforce, Quality, and Related Provisions in ACA: Summary and Timeline

In March 2010, President Obama signed into law a comprehensive health reform bill, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), and a package of amendments to ACA, the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152). Health reform was one of President Obama’s top domestic policy priorities during his first term, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. Improving access to care and controlling rising costs were seen to require changes to both the...

Centers for Medicare & Medicaid Services: President’s FY2014 Budget

Federal law requires the President to submit an annual budget to Congress no later than the first Monday in February. The budget informs Congress of the President’s overall federal fiscal policy based on proposed spending levels, revenues, and deficit (or surplus) levels. The budget request lays out the President’s relative priorities for federal programs, such as how much should be spent on defense, education, health, and other federal programs. The President’s budget may also include legislative proposals for spending and tax policy changes. While the President is not required to propose...

H.R. 1549: Helping Sick Americans Now Act

In March 2010, the 111th Congress passed health reform legislation, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152) and other laws. Among other provisions, ACA increases access to health insurance, expands private health insurance requirements regarding coverage and benefits, and requires the creation of health insurance exchanges to provide individuals and small employers with access to insurance. Many of ACA’s insurance market reforms are already in effect. Remaining reforms...

Labor, Health and Human Services, and Education: FY2013 Appropriations Overview

This report provides an overview of actions taken by Congress to provide FY2013 appropriations for the accounts funded by the Departments of Labor, Health and Human Services, and Education, and Related Agencies (L-HHS-ED) appropriations bill. The L-HHS-ED bill provides funding for all accounts subject to the annual appropriations process at the Departments of Labor (DOL) and Education (ED). It provides annual appropriations for most agencies within the Department of Health and Human Services (HHS), with certain exceptions (e.g., the Food and Drug Administration is funded via the...

Medicare Payment Updates and Payment Rates

Medicare is a federal insurance program that pays for covered health services for most persons 65 years of age and older and for most permanently disabled individuals under the age of 65. Part A of the program, the Hospital Insurance program, covers hospital, post-hospital, and hospice services. Part B, the Supplementary Medical Insurance program, is optional and covers a broad range of complementary medical services including physician, laboratory, outpatient hospital services, and durable medical equipment. Part C provides private plan options for beneficiaries enrolled in both Parts A...

The Independent Payment Advisory Board

In response, in part, to overall growth in Medicare program expenditures and growth in expenditures per Medicare beneficiary, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148, as amended) created the Independent Payment Advisory Board (IPAB, or the Board) and charged the Board with developing proposals to “reduce the per capita rate of growth in Medicare spending.” The Secretary of Health and Human Services (the Secretary) is directed to implement the Board’s proposals automatically unless Congress affirmatively acts to alter the Board’s proposals or to discontinue the...

Public Mass Shootings in the United States: Selected Implications for Federal Public Health and Safety Policy

This report focuses on mass shootings and selected implications they have for federal policy in the areas of public health and safety. While such crimes most directly impact particular citizens in very specific communities, addressing these violent episodes involves officials at all levels of government and professionals from numerous disciplines.

Defining Public Mass Shooting

Policy makers may confront numerous questions about shootings such as the December 2012 incident at Sandy Hook Elementary School in Newtown, CT, that claimed 27 lives (not including the shooter). Foremost, what are...

Long-Term Services and Supports: Overview and Financing

This report provides an overview of Long-term services and supports (LTSS), including who needs LTSS, how need for LTSS is determined, and how much LTSS costs. The report also provides information on who the primary LTSS payers are, how much they spend, and what types of services are purchased.

Medicaid: A Primer

Selected Resources on Federal Oversight of Compounding Pharmacies

An outbreak of a rare, non-contagious form of fungal meningitis in 2012 has sickened over 700 individuals in 20 states. There has been extensive policy discussion and news coverage about the safety of compounded drugs and the role of federal and state governments in regulating compounded drugs and compounding pharmacies. A number of policy questions about Food and Drug Administration authority and resources were raised in congressional hearings held by the Energy and Commerce Committee of the U.S. House of Representatives, and the Health, Education, Labor, and Pensions Committee of the...

Southwest Border Violence: Issues in Identifying and Measuring Spillover Violence

There has been an elevated level of drug trafficking-related violence within and between the drug trafficking organizations in Mexico. This violence has generated concern among U.S. policy makers that the violence in Mexico might spill over into the United States. U.S. federal officials have denied that the increase in drug trafficking-related violence in Mexico has resulted in a spillover into the United States, but they acknowledge that the prospect is a serious concern.

The most recent threat assessment indicates that the Mexican drug trafficking organizations pose the greatest drug...

Qui Tam: The False Claims Act and Related Federal Statutes

Qui tam enlists the public in the recovery of civil penalties and forfeitures. It rewards with a portion of the recovered proceeds those who sue in the government’s name. A creature of antiquity, once common, today qui tam lives on in federal law only in the False Claims Act and in Indian protection laws.

The False Claims Act, expanded by the Fraud Enforcement and Recovery Act of 2009, P.L. 111-21, 123 Stat. 1617 (2009), now proscribes: (1) presenting a false claim; (2) making or using a false record or statement material to a false claim; (3) possessing property or money of the U.S. and...

Funding for the Older Americans Act and Other Aging Services Programs

FY2013 Supplemental Funding for Disaster Relief

On January 29, 2013, the Disaster Relief Appropriations Act, 2013, a $50.5 billion package of disaster assistance largely focused on responding to Hurricane Sandy, was enacted as P.L. 113-2.

In late October 2012, Hurricane Sandy impacted a wide swath of the East Coast of the United States, resulting in more than 120 deaths and the major disaster declarations for 12 states plus the District of Columbia. The Administration submitted a request to Congress on December 7, 2012, for $60.4 billion in supplemental funding and legislative provisions to address both the immediate losses and damages...

Child Well-Being and Noncustodial Fathers

The structure of a family plays an important role in children’s well-being. A contributing factor to the high rates of child poverty over the long term, and the increase in child poverty during the period from 2001-2007, was the increasing likelihood of children living in families headed by a single female. In 2012, about one-third of all children lived in families without their biological father present. According to some estimates, about 50% of children (who are currently under age 18) will spend or have spent a significant portion of their childhood in a home without their biological...

Definition of Income for Certain Medicaid Provisions and Premium Credits in ACA

Under the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended), the definition of income for eligibility for certain Medicaid populations and premium credits in the exchanges is based on modified adjusted gross income (MAGI). The initial intent of using MAGI was to standardize the definition of income for Medicaid eligibility purposes to reduce some of the variability and complexity that exists under the current program and to provide consistency between Medicaid and the health insurance exchange.

The use of MAGI, however, raised some concerns among Congress and the...

The Food and Drug Administration Safety and Innovation Act (FDASIA, P.L. 112-144)

The Food and Drug Administration Safety and Innovation Act (FDASIA), P.L. 112-144, amends the Federal Food, Drug, and Cosmetic Act (FFDCA) to expand the authority of the Food and Drug Administration (FDA) in performing its human drug, biological product, and medical device responsibilities. Frequently referred to as the user fee reauthorization act, FDASIA does include four titles relating to user fees. Titles I and II reauthorize the prescription drug and medical device user fee programs (PDUFA and MDUFA). Titles III and IV authorize new user fee programs for generic drugs (GDUFA) and...

Mental Disorders Among OEF/OIF Veterans Using VA Health Care: Facts and Figures

The mental health of veterans—and particularly veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF)—has been a topic of ongoing concern to Members of Congress and their constituents, as evidenced by hearings and legislation. Knowing the number of veterans affected by various mental disorders and actions the Department of Veterans Affairs (VA) is taking to address mental disorders can help Congress determine where to focus attention and resources.

Using data from the VA, this brief report addresses the number of veterans with (1) depression or bipolar disorder, (2)...

Medicare, Medicaid, and Other Health Provisions in the American Taxpayer Relief Act of 2012

Several policies that would have reduced spending and increased revenues were poised to take effect at the end of 2012; collectively, these were referred to by some as the “fiscal cliff.” Had these policies taken effect, CBO projected that the ensuing fiscal contraction would have resulted in a recession in 2013. On January 2, 2013, the President signed H.R. 8, the American Taxpayer Relief Act of 2012 (ATRA, P.L. 112-240), which prevented most—but not all—of the fiscal cliff policies from going into effect. This Act was passed by the Senate on January 1, 2013 by a vote of 89-8, and by the...

The Unemployed and Job Openings: A Data Primer

New information that adds to the mix of labor market indicators may be useful to Congress. The ratio of unemployed persons per job opening provides information on how many unemployed persons on average there are for every job opening. It adds to the current mix of labor market indicators such as the unemployment rate, which is a measure of the excess supply of workers. In addition, it adds to employment statistics, which measures the demand for workers that have already been met by employers. By dividing the number of unemployed persons with the number of job openings, the ratio gauges the...

Medicaid’s Federal Medical Assistance Percentage (FMAP), FY2014

Medicaid is a means-tested entitlement program that finances the delivery of primary and acute medical services as well as long-term care. Medicaid is jointly funded by the federal government and the states. The federal government’s share of a state’s expenditures is called the federal medical assistance percentage (FMAP) rate. The remainder is referred to as the nonfederal share, or state share.

Generally determined annually, the FMAP formula is designed so that the federal government pays a larger portion of Medicaid costs in states with lower per capita incomes relative to the national...

FY2013 National Defense Authorization Act: Selected Military Personnel Policy Issues

Military personnel issues typically generate significant interest from many Members of Congress and their staffs. Recent military operations in Iraq and ongoing operations in Afghanistan, along with the operational role of the Reserve Components, further heighten interest in a wide range of military personnel policies and issues.

The Congressional Research Service (CRS) has selected a number of the military personnel issues considered in deliberations on the House and Senate versions of the National Defense Authorization Act for FY2013. This report provides a brief synopsis of sections...

Factors Affecting the Demand for Long-Term Care Insurance: Issues for Congress

As the 80 million baby boomers approach retirement, many are concerned they will not have sufficient savings to sustain their standard of living in retirement. Few, however, may be focused on another risk to their retirement security—the potential cost of financing often expensive long-term care services and supports (LTSS). LTSS include help with either functional or cognitive impairment and generally include assistance with activities such as bathing, eating, and dressing. For the majority of older Americans, the cost of obtaining paid help for these services may far exceed their...

Physician Supply and the Affordable Care Act

An adequate physician supply is important for the effective and efficient delivery of health care services and, therefore, for population health and the cost and quality of health care. Assessments of the adequacy of physician supply often focus on three dimensions of the physician population: its size; its composition (e.g., the mix between primary care and specialty physicians); and its geographic distribution. Policies that aim to alter physician supply generally focus on both current and future supply along these three dimensions because physician training is a lengthy process;...

Abortion Services and Military Medical Facilities

In 1993, President Clinton modified the military policy on providing abortions at military medical facilities. Under the change directed by the President, military medical facilities were allowed to perform abortions if paid for entirely with non-Department of Defense (DOD) funds (i.e., privately funded). Although arguably consistent with statutory language barring the use of Defense Department funds, the President’s policy overturned a former interpretation of existing law barring the availability of these services. On December 1, 1995, H.R. 2126, the FY1996 DOD appropriations act, became...

The “Fiscal Cliff” and the American Taxpayer Relief Act of 2012

The federal budget deficit has exceeded $1 trillion in each of the last four fiscal years (FY2009-FY2012). Concern over these large deficits, as well as the long-term trajectory of the federal budget, resulted in significant debate during the 112th Congress over how to achieve meaningful deficit reduction and how to implement a plan to stabilize the federal debt. Numerous expiring provisions, across-the-board spending cuts, and other short-term considerations having a major budgetary impact, were scheduled to take effect at the very end of 2012 or in early 2013. This combination of...

Physician Practices: Background, Organization, and Market Consolidation

A growing number of U.S. physicians are combining their practices; affiliating with hospitals, insurance companies, and specialty management firms; or going to work directly for such organizations. The moves are part of a broader trend toward consolidation in health care, with the overall number of mergers and acquisitions in the sector at the highest level in a decade.

Alterations in physician practice appear to be a response to a number of factors. Younger doctors are more eager than their predecessors to work for an outside institution, such as a hospital, to secure a set schedule and...

The Combating Autism Act: Overview and Funding

Autism spectrum disorder (ASD) and autism are general terms for a group of developmental disabilities that cause impairments in social skills and communication, and are often characterized by certain atypical behaviors. The federal government has a role in the financing (through Medicaid and State Children’s Health Insurance Programs) and delivery (through funding of developmental disabilities programming in schools, Title V Maternal and Child Health funding, and other sources) of treatment for ASD. The number of autism cases and their appropriate diagnosis and treatment affect federal and...

The Hatch-Waxman Act: Over a Quarter Century Later

Congressional interest in health-related issues has refocused attention on legislative efforts to provide both new as well as lower-cost pharmaceuticals for the marketplace. P.L. 98-417, the Drug Price Competition and Patent Term Restoration Act of 1984 (commonly known as the Hatch-Waxman Act), made significant changes to the patent laws as they apply to pharmaceutical products in an attempt to balance the need for innovative new drugs and the availability of less expensive generic products. The act created several practices intended to facilitate the marketing of generic drugs while...

Federal Emergency Management: A Brief Introduction

The federal government plays a significant role in emergency management, which generally refers to activities associated with avoiding and responding to natural and human-caused hazards. Emergency management in the United States is highly decentralized and contextual in nature: activities often involve multiple jurisdictions as well as a vast number of agencies, nongovernmental organizations, and private sector entities. In addition, the number and type of actors involved in an incident will vary tremendously depending on the context and severity of the event. Similarly, the legal...

Federal R&D, Drug Discovery, and Pricing: Insights from the NIH-University-Industry Relationship

Public interest in approaches that might provide prescription drugs at lower cost, particularly for the elderly, has rekindled discussion over the role the federal government plays in facilitating the creation of new pharmaceuticals for the marketplace. In the current debate, some argue that the government’s financial, scientific, and/or clinical support of health-related research and development (R&D) entitles the public to commensurate considerations in the prices charged for any resulting drugs. Others view government intervention in price decisions based upon initial federal funding as...

Drug Patent Expirations: Potential Effects on Pharmaceutical Innovation

Congress has exhibited a strong and ongoing interest in facilitating the development of new, innovative pharmaceuticals for the marketplace while reducing the cost of drugs to consumers. Policies pertaining to funding for research and development (R&D), intellectual property protection, and cooperative ventures have played an important role in the economic success of the pharmaceutical sector. Industry-specific legislation, including the Drug Price Competition and Patent Term Restoration Act of 1984, commonly known as the “Hatch-Waxman Act,” also work to encourage innovation in the...

The Ryan White HIV/AIDS Program

The Ryan White HIV/AIDS Program makes federal funds available to metropolitan areas and states to assist in health care costs and support services for individuals and families affected by the human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). The Ryan White program currently serves more than half a million low-income people with HIV/AIDS in the United States; 29% of those served are uninsured, and an additional 56% are underinsured. The program is administered by the Health Resources and Services Administration (HRSA) of the Department of Health and Human...

Veterans’ Benefits: Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012 (P.L. 112-154)

Congress has in the past enacted legislation providing authority for the Department of Veterans Affairs (VA) to treat certain veterans for specific medical conditions resulting from their exposure to certain toxic substances or environmental hazards while on active military duty.

In the 1980s, officials at Camp Lejeune became aware of the presence of volatile organic compounds (VOCs) in drinking water samples. Camp Lejeune was placed on the National Priorities List by the Environmental Protection Agency in 1989, and the Agency for Toxic Substances and Disease Registry continues to monitor...

The 2012 Farm Bill: A Comparison of Senate-Passed S. 3240 and the House Agriculture Committee’s H.R. 6083 with Current Law

Congress periodically establishes agricultural and food policy in an omnibus farm bill. The 112th Congress faces reauthorization of the current five-year farm bill (the Food, Conservation, and Energy Act of 2008, P.L. 110-246) because many of its provisions expire in 2012. The 2008 farm bill contained 15 titles covering farm commodity support, horticulture, livestock, conservation, nutrition assistance, international trade and food aid, agricultural research, farm credit, rural development, bioenergy, and forestry, among others.

The Senate approved its version of the 2012 omnibus farm...

Child Welfare: Social Security and Supplemental Security Income (SSI) Benefits for Children in Foster Care

Of the more than 400,000 children in foster care on a given day, as many as 24,000 (about 6%) receive Supplemental Security Income (SSI) or other Social Security benefits. Some research suggests that a greater number of children in foster care might be eligible for SSI benefits if this assistance was sought. SSI benefits are available under Title XVI of the Social Security Act for certain disabled children from families with low incomes and minimal assets. Other Social Security benefits may be paid under Title II of the act to the children of workers who have retired, become disabled, or...

Afghanistan: U.S. Foreign Assistance

The U.S. program of assistance to Afghanistan is intended to stabilize and strengthen the Afghan economic, social, political, and security environment so as to blunt popular support for extremist forces in the region. Since 2001, nearly $83 billion has been appropriated toward this effort.

Since FY2002, nearly two-thirds of U.S. assistance—roughly 62%—has gone to the training and equipping of Afghan forces. The remainder has gone to development and humanitarian-related activities from infrastructure to private sector support, governance and democratization efforts, and counter-narcotics...

Federal Programs Related to Indoor Pollution by Chemicals

“Toxic” drywall, formaldehyde emissions, mold, asbestos, lead-based paint, radon, PCBs in caulk, and many other indoor pollution problems have concerned federal policy makers and regulators during the last 30 years. Some problems have been resolved, others remain of concern, and new indoor pollution problems continually emerge. This report describes common indoor pollutants and health effects that have been linked to indoor pollution, federal statutes that have been used to address indoor pollution, key issues, and some general policy options for Congress.

Indoor pollutants are chemicals...

Major Fiscal Issues Before Congress in FY2013

This report provides a brief overview of the major tax and spending policy changes set to take effect under current law at the end of 2012 or early in 2013. Collectively, these policies have been referred to by some as the “fiscal cliff.” Extending current revenue policies (e.g., extending the Bush tax cuts) and changing current spending policies (e.g., not allowing the BCA sequester to take effect) would increase the projected budget deficit relative to current law. The Congressional Budget Office (CBO) estimates that if current law remains in place, the budget deficit will fall by $502...

Small Business and the Expiration of the 2001 Tax Rate Reductions: Economic Issues

At the end of 2010, the lower income tax rates provided in 2001 were to expire. The President had proposed to extend most tax cuts, but to continue higher rates for couples with income over $250,000 and singles with income over $200,000. The most important element of this proposal, as measured by revenue effect, is allowing the top rates of 33% and 35% to expire, when they would have risen to 36% and 36.9%. P.L. 111-312, enacted in December 2010, extended all tax cuts for two years, through 2012, delaying the consideration of which tax cuts to retain.

Some critics of allowing the tax rates...

FDA Regulation of Cosmetics and Personal Care Products

The 1938 Federal Food, Drug, and Cosmetic Act (FFDCA) granted the Food and Drug Administration (FDA) the authority to regulate cosmetic products and their ingredients. The statutory provisions of the FFDCA that address cosmetics include adulteration and misbranding provisions. In addition to the FFDCA, cosmetics are regulated under the Fair Packaging and Labeling Act (FPLA) and related regulations. The cosmetics provisions were amended by the Color Additive Amendments Act of 1960 and the Poison Prevention Packaging Act, but remain basically the same as the provisions in the 1938 FFDCA....

ACA: A Brief Overview of the Law, Implementation, and Legal Challenges

In March 2010, the 111th Congress passed health reform legislation, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152) and other laws. ACA increases access to health insurance coverage, expands federal private health insurance market requirements, and requires the creation of health insurance exchanges to provide individuals and small employers with access to insurance. It also expands Medicaid coverage. The costs to the federal government of expanding health insurance and Medicaid...

Medicaid and the State Children’s Health Insurance Program (CHIP) Provisions in ACA: Summary and Timeline

The President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), on March 23, 2010. Seven days later, a second bill, H.R. 4872, was signed into law by the President to modify ACA. This second law, the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152), was signed into law on March 30, 2010. Together these measures constitute what is referred to as the health care reform law, which makes many significant changes to the private and public markets for health insurance, as well as modifies aspects of the publicly financed...

FDA User Fees and the Regulation of Drugs, Biologics, and Devices: Comparative Analysis of S. 3187 and H.R. 5651

UPDATE: On June 18, 2012, the Senate Committee on Health, Education, Labor, and Pensions and the House Committee on Energy and Commerce distributed the text of an agreement that combined provisions of S. 3187 [ES], as passed by the Senate on May 24, 2012, and H.R. 5651 [EH], as passed by the House on May 30, 2012. The full House passed the new version by voice vote under suspension of the rules on June 20, 2012. On June 25, 2012, the Senate voted for cloture to limit debate on that bill, S. 3187 [EAH], the Food and Drug Administration Safety and Innovation Act of 2012 [hereinafter referred...

FDA’s Authority to Ensure That Drugs Prescribed to Children Are Safe and Effective

Update: On June 20, 2012, the House of Representatives passed, by voice vote and under suspension of the rules, S. 3187 (EAH), the Food and Drug Administration Safety and Innovation Act, as amended. This bill would reauthorize the FDA prescription drug and medical device user fee programs (which would otherwise expire on September 30, 2012), create new user fee programs for generic and biosimilar drug approvals, and make other revisions to other FDA drug and device approval processes. It reflects bicameral compromise on earlier versions of the bill (S. 3187 [ES], which passed the Senate on...

Medical Malpractice: Overview and Legislation in the 112th Congress

As a policy area, medical malpractice involves issues related to its prevalence in the health care system; the market for provider liability insurance; and the resolution of malpractice complaints through the tort system.

Medical malpractice has attracted congressional attention numerous times over the past decades, particularly in the midst of three “crisis” periods for the liability insurance market in the mid-1970s, the mid-1980s, and the early 2000s. These periods were marked by sharp increases in medical liability insurance premiums, difficulties in finding any medical liability...

The Global Challenge of HIV/AIDS, Tuberculosis, and Malaria

The spread of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), tuberculosis (TB), and malaria across the world poses a major global health challenge. The international community has progressively recognized the humanitarian impact of these diseases, along with the threat they represent to economic development and international security. The United States has historically been a leader in the fight against HIV/AIDS, TB, and malaria; it is currently the largest single donor for global HIV/AIDS and has been central to the global response to TB and malaria. In its...

Addressing Medicare Hospital Readmissions

Nearly 20% of Medicare beneficiaries aged 65 and over who were admitted to a hospital in 2005 were readmitted within 30 days following their initial discharge. The Medicare Payment Advisory Commission (MedPAC) estimated that these readmissions cost the Medicare program as much as $15 billion per year and that perhaps as much as two-thirds of these readmissions may be preventable. Many policymakers believe that different care transition programs coupled with payment reforms can constrain hospital readmissions among Medicare’s fee-for-service (FFS) beneficiaries, could improve patient care,...

U.S. Global Health Assistance: Background and Issues for the 112th Congress

U.S. funding for global health has grown significantly over the last decade, from approximately $1.7 billion in FY2001 to $8.8 billion in FY2012. During the George W. Bush Administration, Congress provided unprecedented increases in global health resources, especially in support of multi-agency initiatives targeting infectious diseases, such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI). As support for global health increased, the 110th and 111th Congresses began to emphasize better coordination of all global health programs and...

Domestic Content Legislation: The Buy American Act and Complementary Little Buy American Provisions

Congress has broad authority to place conditions on the purchases made by the federal government or with federal dollars. One of many conditions that it has placed on direct government purchases is a requirement that they be produced in the United States. The most well-known of these requirements is the Buy American Act, which is the major domestic preference statute governing procurement by the federal government. This report summarizes (1) the Buy American Act, what it does and does not cover; (2) the Little Buy American Acts found in permanent law, emphasizing what they govern, major...

Unemployment and the Availability of Health Insurance: Issues for Congress

When workers lose their jobs, they can also lose their health insurance. If that health insurance is family coverage, then a worker’s family members can also become uninsured. For individuals who do not typically use many health care services, loss of insurance might have little impact. However, for individuals who have health problems or who are injured, loss of coverage can be serious. Without insurance, individuals often have difficulty obtaining needed care and problems paying for the care they receive. Unemployed individuals and their family members who cannot postpone care may incur...

Centers for Medicare & Medicaid Services: President’s FY2013 Budget

Federal law requires the President to submit an annual budget to Congress no later than the first Monday in February. The budget informs Congress of the President’s overall federal fiscal policy based on proposed spending levels, revenues, and deficit (or surplus) levels. The budget request lays out the President’s relative priorities for federal programs, such as how much should be spent on defense, education, health, and other federal programs. The President’s budget may also include legislative proposals for spending and tax policy changes. While the President is not required to propose...

Upcoming Rules Pursuant to the Patient Protection and Affordable Care Act: Fall 2011 Unified Agenda

Congress delegates rulemaking authority to agencies for a variety of reasons and in a variety of ways. The Patient Protection and Affordable Care Act (ACA, as amended) is a particularly noteworthy example of congressional delegation of rulemaking authority to federal agencies. A previous CRS report identified more than 40 provisions in ACA that explicitly require or permit the issuance of rules to implement the legislation.

One way for Congress to identify upcoming ACA rules is by reviewing the Unified Agenda of Federal Regulatory and Deregulatory Actions, which is published twice each...

Latin America and the Caribbean: Illicit Drug Trafficking and U.S. Counterdrug Programs

Drug trafficking is viewed as a primary threat to citizen security and U.S. interests in Latin America and the Caribbean despite decades of anti-drug efforts by the United States and partner governments. The production and trafficking of popular illicit drugs—cocaine, marijuana, opiates, and methamphetamine—generate a multi-billion dollar black market in which Latin American criminal and terrorist organizations thrive. These groups challenge state authority in source and transit countries where governments are often fragile and easily corrupted. According to the Department of Justice,...

Medicaid’s Federal Medical Assistance Percentage (FMAP), FY2013

Medicaid is a means-tested entitlement program that finances the delivery of primary and acute medical services as well as long-term care. Medicaid is jointly funded by the federal government and the states. The federal government’s share of a state’s expenditures is called the federal medical assistance percentage (FMAP) rate. The remainder is referred to as the nonfederal share, or state share.

Generally determined annually, the FMAP formula is designed so that the federal government pays a larger portion of Medicaid costs in states with lower per capita incomes relative to the national...

Veterans Affairs: A Preliminary Analysis of the FY2013 Budget Proposal

The Department of Veterans Affairs (VA) provides a range of benefits and services to veterans who meet certain eligibility criteria. These benefits and services include hospital and medical care, disability compensation and pensions, education, vocational rehabilitation and employment services, assistance to homeless veterans, home loan guarantees, administration of life insurance as well as traumatic injury protection insurance for servicemembers, and death benefits that cover burial expenses.

This report provides a preliminary analysis of the President’s budget request for FY2013 for the...

Medicare Advantage Risk Adjustment and Risk Adjustment Data Validation Audits

According to the American Academy of Actuaries, “[h]ealth risk adjustment is the process of adjusting payments to organizations (usually health insurance plans) based on differences in the risk characteristics of people enrolled in each plan.” By adjusting payments to compensate organizations for the relatively higher medical costs associated with an ill individual, plans should, all other things being equal, be indifferent between enrolling the sicker person or the relatively healthier one.

Medicare Advantage (MA) is an alternative way for Medicare beneficiaries to receive covered...

Religious Exemptions for Mandatory Health Care Programs: A Legal Analysis

The Patient Protection and Affordable Care Act (ACA; P.L. 111-148), enacted in 2010, established requirements for employers and individuals to ensure the provision or availability of certain health care coverage. Additionally, the threat of bioterrorism has caused some to consider the possibility of introducing vaccination programs to prevent an outbreak of serious illnesses. Programs like health care coverage and vaccinations have the potential to violate certain religious beliefs and therefore may conflict with the First Amendment. In the continuing debate over issues for which mandatory...

The Congressional Appropriations Process: An Introduction

Congress annually considers several appropriations measures, which provide funding for numerous activities, for example, national defense, education, and homeland security, as well as general government operations. Congress has developed certain rules and practices for the consideration of appropriations measures, referred to as the congressional appropriations process. This report looks at this process as well as the three types of appropriates measures: regular appropriations bills, continuing resolutions, and supplemental appropriations bills.

Preventive Health Services Regulations: Religious Institutions’ Objections to Contraceptive Coverage

Since the enactment of the Patient Protection and Affordable Care Act (ACA) in 2010, controversy has surrounded the applicability of requirements for health plans and health insurers to cover certain recommended preventive health services, including a range of contraceptive services, without cost sharing. The U.S. Departments of Health and Human Services, Labor, and Treasury have issued regulations that provide an exemption from ACA for certain religious employers who have religious objections to contraceptives. The exemption appears to cover churches and church associations, but...

Homeland Security Department: FY2012 Appropriations

This report describes the FY2012 appropriations for the Department of Homeland Security (DHS). The Administration requested a total appropriation (mandatory and discretionary) of $45,015 million in budget authority for FY2012. This amounts to a $1,610 million, or a 3.7%, increase from the $43,405 million enacted for FY2011 through the continuing resolution (P.L. 112-10). Total budget authority, including appropriations, fee revenues, and trust funds in the Administration’s budget request for DHS for FY2012 amounts to $57,079 million as compared to $55,783 million enacted for FY2011.

Net...

Previewing the Next Farm Bill

Congress periodically establishes agricultural and food policy in an omnibus farm bill. The 112th Congress faces reauthorization of the current five-year farm bill (the Food, Conservation, and Energy Act of 2008, P.L. 110-246) because many of its provisions expire in 2012. The 2008 law contained 15 titles covering farm commodity support, horticulture, livestock, conservation, nutrition assistance, international food aid, trade, agricultural research, farm credit, rural development, bioenergy, and forestry, among others. The breadth of farm bills has steadily grown in recent decades to...

The U.S. Foreign-Born Population: Trends and Selected Characteristics

This report offers context for consideration of immigration policy options by presenting data on key geographic, demographic, social, and economic characteristics of the foreign-born population residing in the United States. Interest in the U.S. foreign-born population stems in part from the changing demographic profile of the United States as well as the rapidity of such change, and how both of these trends correspond to U.S. immigration policy. Although the foreign born are relatively small in absolute terms—39.9 million people representing 12.9% of the total U.S. population of 309.3...

Labor, Health and Human Services, and Education: FY2012 Appropriations

This report provides an overview of actions taken by Congress to provide FY2012 appropriations for the accounts funded by the Departments of Labor, Health and Human Services, Education, and Related Agencies (L-HHS-ED) appropriations bill. The L-HHS-ED bill provides funding for all accounts subject to the annual appropriations process at the Departments of Labor and Education. It provides annual appropriations for most agencies within the Department of Health and Human Services, with certain exceptions (e.g., the Food and Drug Administration is funded via the Agriculture appropriations...

Health Care Quality: Enhancing Provider Accountability Through Payment Incentives and Public Reporting

Quality gaps in the care delivered by the U.S health care system result in preventable mortality and morbidity and contribute costs to the system, with multiple indicators showing that quality of care could be improved. Although no single definition of high-quality health care has been agreed upon, the Institute of Medicine (IOM) provided a framework for considering the quality of care, based on six domains: (1) effective, (2) efficient, (3) equitable, (4) patient-centered, (5) safe, and (6) timely. Ongoing congressional interest in enhancing the quality of health care is likely given the...

Interior, Environment, and Related Agencies: FY2012 Appropriations

The Interior, Environment, and Related Agencies appropriations bill includes funding for the Department of the Interior (DOI), except for the Bureau of Reclamation, and for agencies within other departmentsincluding the Forest Service within the Department of Agriculture and the Indian Health Service (IHS) within the Department of Health and Human Services. It also includes funding for arts and cultural agencies, the U.S. Environmental Protection Agency, and numerous other entities.

On December 23, 2011, Congress enacted H.R. 2055, the Consolidated Appropriations Act, 2012 (P.L. 112-74)....

Child Nutrition and WIC Reauthorization: P.L. 111-296

The most recent WIC and child nutrition reauthorization, P.L. 111-296, “Healthy, Hunger-Free Kids Act of 2010,” was signed into law at the end of the 111th Congress on December 13, 2010. Subsequently, Congress plays an oversight role as the U.S. Department of Agriculture promulgates rules, releases guidance, and otherwise implements the legislation. This report features a summary of the legislative history of P.L. 111-296 as well as a section-by-section summary of what was contained within the law. For a brief overview of this periodic reauthorization, see CRS In Focus IF10266, An...

Drivers of Premium Increases and Review of Health Insurance Rates

In general, the premiums charged by health insurance companies represent actuarial estimates of the amount that would be required to cover three main components: (1) the expected cost of the health benefits covered under the plan, (2) the business administrative costs of operating the plan, and (3) a profit. The final premium calculation often is adjusted upward or downward to reflect several factors, such as making up for a previous financial loss, that are often referred to as the “underwriting cycle.”

Health insurance premiums have been trending up, while the value of coverage...

Housing Issues in the 111th Congress

Housing issues related to the recent turmoil in U.S. housing markets, as well as perennial issues related to the housing needs of low-income individuals and families, were prominent in the 111th Congress. The recent recession that was, in part, both a cause and a result of issues in the housing finance system put legislation designed to address current foreclosures and prevent a future crisis on the congressional agenda. At the same time, the 111th Congress faced questions about how best to meet the affordable housing needs of low-income and vulnerable populations, particularly as...

Veterans’ Medical Care: FY2012 Appropriations

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility criteria. Benefits to veterans range from disability compensation and pensions to hospital and medical care. The VA provides these benefits through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA).

This report focuses on the VHA. The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through the...

U.S.-South Korea Free Trade Agreement and Potential Employment Effects: Analysis of Studies

The Obama Administration finalized negotiations with South Korea in early December 2010 on a bilateral free trade agreement. Congress passed the implementing legislation for the U.S.-South Korea free trade agreement on October 21, 2011 (P.L. 112-42). Congress not only plays a direct role in approving legislation that implements the provisions of free trade agreements, but also authorizes and appropriates funding for programs that are meant to provide special assistance to firms and workers that are dislocated as a result of lower barriers to trade. Since the agreement with South Korea...

Mental Health Parity and the Patient Protection and Affordable Care Act of 2010

The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as modified by P.L. 111-152, the Health Care and Education Reconciliation Act of 2010) contains a number of provisions that generally combine to extend the reach of existing federal mental health parity requirements. Prior to 1996, health insurance coverage for mental illness had historically been less generous than that for other physical illnesses. Mental health parity is a response to this disparity in insurance coverage, and generally refers to the concept that health insurance coverage for mental health services should...

Agriculture and Related Agencies: FY2012 Appropriations

The Agriculture appropriations bill provides funding for all of the U.S. Department of Agriculture (USDA) except the Forest Service, plus the Food and Drug Administration (FDA) and, in alternating years, the Commodity Futures Trading Commission (CFTC).

The FY2012 Agriculture Appropriations Act (P.L. 112-55, H.R. 2112) was signed by the President on November 18, 2011, after passing both chambers by more than two-thirds majorities. It was the lead division of a three-bill “minibus” appropriation that also included Commerce-Justice-Science and Transportation-Housing and Urban Development...

Patent Reform: Issues in the Biomedical and Software Industries

The Leahy-Smith America Invents Act, P.L. 112-29, passed Congress following several years of legislative debate over patent reform. This attention to patent policy reflects a recognition of the increasing importance of intellectual property to U.S. innovation. Patent ownership is perceived as an incentive to the technological advancement that leads to economic growth. As such, the number of patent applications and grants has grown significantly, as have the type and breadth of inventions that can be patented.

Along with the expansion in the number and range of patents, there were growing...

The Uninsured by State and Congressional District, 2010

The total U.S. civilian non-institutionalized population in 2010 was estimated to be slightly more than 304 million, of whom 15.5%, or 47.2 million, were estimated by the American Community Survey to be without health insurance or uninsured. The uninsured are far more likely than those with health insurance to report problems getting needed medical care, less likely to follow recommended treatments because of costs, have less access to care, receive less preventive care, and are more likely to be hospitalized for avoidable health problems. Moreover, it is widely believed that the...

Health Insurance Coverage by State and Congressional District, 2010

The total U.S. civilian non-institutionalized population in 2010 was estimated to be slightly more than 304 million. Roughly 84.5% of the U.S. civilian non-institutionalized population had one or more forms of health insurance, while 15.5%, or roughly 47.2 million, were uninsured. The most common form of insurance was employer provided.

This report employs the U.S. Census Bureau’s 2010 American Community Survey (ACS) to describe health insurance coverage and provide estimates of coverage by type of coverage at the national, state, and congressional district level. The ACS survey has a...

Issues in Homeland Security Policy for the 112th Congress

With the tenth anniversary of the September 11th terrorist attacks, many observers are making a fresh assessment of where America’s homeland security enterprise stands today. In the wake of those attacks, Congress made extensive changes to the structure and function of many agencies, establishing a consolidated Department of Homeland Security and dedicating significant additional resources expressly to the security of the homeland. After the initial surge of activity, evolution of America’s response has continued under the leadership of different Administrations, Congresses, and in a...

Financing and Delivery of Behavioral Health Services and the Patient Protection and Affordable Care Act

Behavioral health disorders (including both mental disorders and substance use disorders) affect a large number of people and contribute costs to the health care system, even as indicated treatment is often not received by individuals in need. In the United States, an estimated 26% of non-institutionalized adults experience behavioral health disorders in a given year; over the course of a lifetime, the estimate rises to 46%. One study estimated spending on behavioral health care in 2005 to be $135 billion, of which $40 billion was paid by the federal government (including $10 billion by...

Upcoming Rules Pursuant to the Patient Protection and Affordable Care Act: Spring 2011 Unified Agenda

Congress delegates rulemaking authority to agencies for a variety of reasons and in a variety of ways. The Patient Protection and Affordable Care Act (PPACA; P.L. 111-148) is a particularly noteworthy example of congressional delegation of rulemaking authority to federal agencies. A previous CRS report identified more than 40 provisions in PPACA that require or permit the issuance of rules to implement the legislation.

One way for Congress to identify upcoming PPACA rules is by reviewing the Unified Agenda of Federal Regulatory and Deregulatory Actions, which is published twice each year...

Agriculture and Related Agencies: FY2011 Appropriations

The Agriculture appropriations bill provides funding for all of the U.S. Department of Agriculture (USDA) except the Forest Service, plus the Food and Drug Administration (FDA) and, in some cases, the Commodity Futures Trading Commission (CFTC). Appropriations jurisdiction for the CFTC is split between two subcommittees—the House Agriculture Appropriations Subcommittee and the Senate Financial Services Appropriations Subcommittee.

For the FY2011 Agriculture appropriations bill, no separate floor action and limited formal committee action occurred in the 111th Congress. The full Senate...

The Debt Limit: CRS Experts

Homeland Security Department: FY2011 Appropriations

This report describes the FY2011 appropriations for the Department of Homeland Security (DHS). The Administration requested a net appropriation of $45.0 billion in budget authority for FY2011. This amounts to a $1.1 billion, or a 2.4% increase from the $43.9 billion enacted for FY2010. Total budget authority requested by the Administration for DHS for FY2011 amounts to $52.6 billion as compared to $51.7 billion enacted for FY2010.

Net requested appropriations for major agencies within DHS were as follows: Customs and Border Protection (CBP), $9,809 million; Immigration and Customs...

Public Health Service (PHS) Agencies: Overview and Funding, FY2010-FY2012

Within the Department of Health and Human Services (HHS), eight agencies are designated components of the U.S. Public Health Service (PHS): (1) the Agency for Healthcare Research and Quality (AHRQ), (2) the Agency for Toxic Substances and Disease Registry (ATSDR), (3) the Centers for Disease Control and Prevention (CDC), (4) the Food and Drug Administration (FDA), (5) the Health Resources and Services Administration (HRSA), (6) the Indian Health Service (IHS), (7) the National Institutes of Health (NIH), and (8) the Substance Abuse and Mental Health Services Administration (SAMHSA). This...

Waiving the Restriction of Annual Limits in Private Health Insurance

Considerable congressional attention has been placed on the dollar value of health insurance coverage in terms of out-of-pocket (OOP) costs placed on policyholders. One method that lowers the dollar value of coverage is the use of annual limits on the dollar amount of coverage. Private health insurers use annual limits to require the consumer to assume 100% of the cost of coverage after a certain amount of spending for the year has been reached. While annual limits may be a benefit design feature in any type of health insurance, they are used as the primary method of cost control for...

Temporary Federal High Risk Health Insurance Pool Program

This report briefly describes the temporary federal high risk pool (HRP) program, more commonly known as the Pre-Existing Condition Insurance Plan (PCIP) program. The PCIP program was established by the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148, as amended). Under PPACA, the PCIP program is intended to help individuals with preexisting conditions who have been uninsured for six or more months to obtain health insurance coverage before 2014. In 2014, coverage will be available on a guaranteed issue basis and preexisting condition exclusions will be prohibited.

To be a...

Veterans Medical Care: FY2011 Appropriations

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility criteria. Benefits to veterans range from disability compensation and pensions to hospital and medical care. The VA provides these benefits through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA).

This report focuses on the VHA. The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through the...

Accountable Care Organizations and the Medicare Shared Savings Program

The provision of health care in the United States has been described as fragmented, with patients seeing multiple unrelated providers. Fragmented care has been found to be, among other things, both costly, since provider payments are not linked to performance or outcomes and services can be duplicative, and of lower quality, since providers lack financial incentives to coordinate care. Section 3022 of the Patient Protection and Affordable Care Act (P.L. 111-148, PPACA), as amended, directs the Secretary of Health and Human Services (the “Secretary”) to implement an integrated care delivery...

Japan’s 2011 Earthquake and Tsunami: Food and Agriculture Implications

The March 11, 2011, earthquake and tsunami in Japan caused widespread devastation that affected many of the country’s agricultural and fishery areas. The nuclear crisis that followed at the Fukushima Daiichi Nuclear Plant, and the subsequent detection of radioactive contamination of food produced near the disabled facility, further raised fears about the safety of Japan’s food production systems and its future food exports. Most reports acknowledge that Japan’s current production and supply shortages, along with rising food safety concerns and possible longer-term radiation threats to its...

Health Insurance Agents and Brokers in the Reformed Health Insurance Market

Health insurance agents and brokers, collectively called “producers” by insurance companies, assist consumers and small employers in choosing and enrolling in health insurance products. Producers are licensed and regulated by the states. Traditionally, the federal government has had no role in regulating producer activities outside of federal programs such as Medicare Advantage. The Patient Protection and Affordable Care Act (P.L. 111-148, PPACA), as amended, creates a limited federal role in developing standards for the use of producers in the health insurance exchanges, which are...

Interior, Environment, and Related Agencies: FY2011 Appropriations

The Interior, Environment, and Related Agencies appropriations bill includes funding for the Department of the Interior (DOI), except for the Bureau of Reclamation, and for agencies within other departmentsincluding the Forest Service within the Department of Agriculture and the Indian Health Service (IHS) within the Department of Health and Human Services. It also includes funding for arts and cultural agencies, the Environmental Protection Agency, and numerous other entities.

The FY2011 appropriation for Interior, Environment, and Related Agencies was $29.67 billion, a reduction of $2.65...

Health Insurance Coverage by State and Congressional District, 2009

Roughly 85% of Americans were covered by health insurance in 2009. The insured were more likely to be white or Asian; more educated; higher income; elderly; and female. The uninsured, about 15% of the population, were more likely to be African American or Hispanic; less educated; lower income; non-elderly adult; and male. In general, the uninsured are more likely to report problems getting needed medical care and to be hospitalized for avoidable health problems.

This report employs the U.S. Census Bureau’s 2009 American Community Survey (ACS) to describe health insurance coverage and...

Teen Pregnancy Prevention: Background and Proposals in the 111th Congress

The birth rate for teenagers (ages 15 through 19) in the United States increased in 2006 and 2007 after a steady decline since 1991. In 2008 and 2009, the teen birth rate dropped below the 2007 teen birth rate, reversing the two-year upward trend. In 2009, teen births accounted for 10.1% of all U.S. births and 21.4% of all nonmarital births. In recognition of the negative, long-term consequences associated with teenage pregnancy and births, teen pregnancy prevention is a major goal of this nation.

President Obama’s FY2010 and FY2011 budgets supported state, community-based, and faith-based...

Survey of Federal Laws Containing Goals, Set-Asides, Priorities, or Other Preferences Based on Race, Gender, or Ethnicity

This report provides a broad, but by no means exhaustive, survey of federal statutes that specifically refer to race, gender, or ethnicity as factors to be considered in the administration of any federal program. Such measures may include, but are not limited to, goals, timetables, set-asides, quotas, priorities, and preferences, as those terms are generally (however imperfectly) understood. Based on searches of the LEXIS/NEXIS and WESTLAW legal databases using a variety of search strategies, the compilation seeks to be as comprehensive as possible. With certain noted exceptions, the...

Japan 2011 Disaster: CRS Experts

The Japanese Nuclear Incident: Technical Aspects

Japan’s nuclear incident has engendered much public and congressional concern about the possible impact of radiation on the Japanese public, as well as possible fallout on U.S. citizens. This report provides information on technical aspects of the nuclear incident, with reference to human health.

While some radioactive material from the Japanese incident may reach the United States, it appears most unlikely that this material will result in harmful levels of radiation. In traveling thousands of miles between the two countries, some radioactive material will decay, rain will wash some out...

Labor, Health and Human Services, and Education: FY2011 Appropriations

This report tracks FY2011 appropriations for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (L-HHS-ED). This legislation provides discretionary funds for three major federal departments and 14 related agencies. The report summarizes L-HHS-ED discretionary funding issues but not authorization or entitlement issues.

President Obama requested $172 billion in discretionary L-HHS-ED funds for FY2011, compared to $165 billion provided in the FY2010 Consolidated Appropriations Act (P.L. 111-117, Division D). The House L-HHS-ED Appropriations Subcommittee...

Veterans Affairs Beneficiary Travel Program: Questions and Answers

The Department of Veterans Affairs administers a Travel Beneficiary Program to help alleviate the costs of travel to medical appointments for eligible veterans. Travel benefit eligibility for veterans is based on either the characteristics of the veteran, the type of medical appointment, or a combination of the two. Certain people who are not veterans, including family members or others accompanying veterans to appointments and organ donors, are also eligible for the benefit. Travel costs are reimbursed to beneficiaries, usually after a deductible. Costs covered by the program include a...

Treatment of Noncitizens Under the Patient Protection and Affordable Care Act

The 111th Congress enacted the Patient Protection and Affordable Care Act (P.L. 111-148, PPACA), and amended it a week later by passing the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152). (PPACA refers to P.L. 111-148 as amended by P.L. 111-152.) On January 19, 2011, the House passed H.R. 2, which would repeal PPACA. It is possible that the 112th Congress will examine other legislation to amend parts of PPACA. One issue that may arise during any debate to amend provisions in PPACA is the eligibility of aliens (noncitizens) for some of the key provisions of the act....

Veterans Affairs: A Preliminary Analysis of the FY2012 Appropriations Request

The Department of Veterans Affairs (VA) provides a range of benefits and services to veterans who meet certain eligibility criteria. These benefits and services include hospital and medical care, disability compensation and pensions, education, vocational rehabilitation and employment services, assistance to homeless veterans, home loan guarantees, administration of life insurance as well as traumatic injury protection insurance for servicemembers, and death benefits that cover burial expenses.

This report provides a preliminary analysis of the President’s budget request for FY2012 for the...

Sexual Violence in African Conflicts

Civilians in Africa’s conflict zones—particularly women and children, but also men—are often vulnerable to sexual violence, including rape, assault, mutilation, and sexual slavery. This violence is carried out by a range of actors, including government security forces, rebel groups, militias, and criminal organizations. Some abuses appear to be opportunistic, the product of a larger breakdown in the rule of law and social order that may occur amid conflict. In other cases, attacks appear to be carried out systematically by combatants as a strategic tool to intimidate and humiliate civilian...

Medical Malpractice Insurance and Health Reform

As a policy area, concerns about medical malpractice typically involve issues related to the market for physician liability insurance, the prevalence of malpractice in the health care system, and the resolution of malpractice complaints through the tort system. This report focuses primarily on the private insurance market. Medical malpractice liability insurance has attracted congressional attention numerous times over the past decades, particularly in the midst of three “crisis” periods in the mid-1970s, the mid-1980s, and the early 2000s. These periods were marked by sharp increases in...

Public Health and Medical Emergency Management: Issues in the 112th Congress

Key recent events—the 2001 terrorist attacks, Hurricane Katrina, and the H1N1 influenza (“flu”) pandemic, among others—sharpened congressional interest in the nation’s ability to respond to health threats. For the response to health emergencies, most authority resides with state and local governments, and most capacity resides in the private sector. The federal government plays a key role, however, providing numerous forms of assistance for planning and preparedness, as well as for response and recovery. Previous Congresses passed a number of laws intended to establish clear federal...

The FDA Food Safety Modernization Act (P.L. 111-353)

The 111th Congress passed comprehensive food safety legislation in December 2010 (the FDA Food Safety Modernization Act, or FSMA, P.L. 111-353). Although numerous agencies share responsibility for regulating food safety, this newly enacted legislation focused on foods regulated by the Food and Drug Administration (FDA) and amended FDA’s existing structure and authorities, in particular via the Federal Food, Drug, and Cosmetic Act (FFDCA; 21 U.S.C. §§ 301 et seq.). The new law does not directly affect activities at the U.S. Department of Agriculture (USDA), which oversees the safety of most...

The Family and Medical Leave Act: Current Legislative Activity

This report offers a brief overview of the major features of the Family and Medical Leave Act(FMLA) and its regulations. The various proposals made to amend the Act since its inception are then categorized and discussed. It closes with a review of legislative activity.

Federal Benefits and Services for People with Low Income: Programs, Policy, and Spending, FY2008-FY2009

The federal government spent almost $708 billion in FY2009 on programs for low-income people, and nearly $578 billion the previous year. The increased spending between the two years was largely due to the recession, with almost two-thirds coming from the American Recovery and Reinvestment Act (ARRA, P.L. 111-5), the economic stimulus enacted in February 2009.

Low-income programs discussed in this report are distinct from social insurance programs, such as Social Security or Medicare, which aim to protect American workers universally against lost wages or benefits when they retire, become...

The Post-9/11 Veterans Educational Assistance Improvements Act of 2010, As Enacted

This report identifies and examines selected changes that the Post-9/11 Veterans Educational Assistance Act of 2008 makes to the Post-9/11 GI Bill and other GI Bills, including expanded eligibility.

Health Insurance: State High Risk Pools

In an effort to expand the options for health coverage, 35 states have established high risk health insurance pools. These programs target individuals who cannot obtain or afford health insurance in the private market, primarily because of preexisting health conditions. Also, many states use their high risk pools to comply with the portability and guaranteed availability provisions of the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).

In general, state high risk pools tend to enroll a small percentage of the uninsured. In December 2009, approximately 208,000...

Comparison of the World Trade Center Medical Monitoring and Treatment Program and the World Trade Center Health Program Created by Title I of P.L. 111-347, the James Zadroga 9/11 Health and Compensation Act of 2010

This report compares the current federally-supported medical screening and treatment program offered to various persons affected by the terrorist attacks of September 11, 2001, with the federal program established by Title I of P.L. 111-347, the James Zadroga 9/11 Health and Compensation Act of 2010.

Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary and Timeline

Medicare is a federal program that pays for covered health services for most persons 65 years old and older and for most permanently disabled individuals under the age of 65. The rising cost of health care, the impact of the aging baby boomer generation, and declining revenues in a weakened economy continue to challenge the program’s ability to provide quality and effective health services to its 47 million beneficiaries in a financially sustainable manner.

On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148), as...

The Uninsured by State and Congressional District

The total U.S. civilian non-institutionalized population in 2009 was estimated to be slightly more than 301 million of whom 15.1%, or 45.5 million, were estimated by the American Community Survey to be without health insurance or uninsured. The uninsured are far more likely than those with health insurance to report problems getting needed medical care, less likely to follow recommended treatments because of costs, have less access to care, receive less preventive care, and are more likely to be hospitalized for avoidable health problems. Moreover, it is widely believed that the uninsured,...

Neglected Tropical Diseases: Background, Responses, and Issues for Congress

Over the past decade, global health has become a priority in U.S. foreign policy, and U.S. funding for related efforts has more than tripled. Neglected tropical diseases (NTDs), an important focus of U.S. global health assistance, may come under scrutiny as the 112th Congress debates spending levels for ongoing global health programs. NTDs are a group of 17 diseases that are found primarily among the poorest people in 149 countries and territories. Estimates indicate that some 2 billion people are at risk of contracting an NTD, of whom more than 1 billion people are afflicted with one or...

Critical Infrastructure Security: CRS Experts

The following table provides access to names and contact information for CRS experts on policy concerns relating to critical infrastructure security. Policy areas identified include: mission, magnitude, importance, relationship to departmental mission; policy, organization, and operations across all infrastructures; information disclosure, Freedom of Information Act (FOIA); security services, airport screeners, guards; specific sectors, assessing vulnerabilities, planning and implementation; agriculture; banking and finance; chemical; defense industry; emergency systems; energy;...

Research and Development (R&D) to Enhance Homeland Security: CRS Experts

The following table provides access to names and contact information for CRS experts on policy concerns relating to research and development (R&D) to enhance homeland security. Policy areas identified include: mission, scope, magnitude, relationship to other federal homeland security goals; developing countermeasures policy and strategic plan; access to scientific and technical information; establishing R&D policy and priorities; conducting and coordinating homeland security R&D; Department of Homeland Security; Department of Agriculture; Department of Defense; Department of Health and...

Economic Recovery and Jobs: CRS Experts

U.S. Refugee Resettlement Assistance

In recent years, the United States has admitted an increasingly diverse group of refugees and other humanitarian cases with a diverse set of needs. There seems to be broad consensus that the U.S. refugee resettlement assistance system is not adequately meeting the needs of these new arrivals and is ripe for reform. The National Security Council is leading an interagency review of refugee resettlement, the forthcoming results of which may further energize reform efforts. To help inform possible future efforts to reform the refugee resettlement assistance system, this report discusses...

The Market Structure of the Health Insurance Industry

In March 2010, Congress passed a pair of measures designed to reform the U.S. health care system and address the twin challenges of constraining rapid growth of health care costs and expanding access to high-quality health care. On March 21, the House passed the Patient Protection and Affordable Care Act (H.R. 3590), which the Senate had approved on Christmas Eve, as well as the Health Care and Education Reconciliation Act of 2010 (H.R. 4872). President Obama signed the first measure (P.L. 111-148) on March 23 and the second on March 30 (P.L. 111-152). On November 2, 2009, the House...

Wellness Programs: Selected Legal Issues

Health care costs have risen dramatically in recent years, and employers providing health insurance, as well as other insurance providers, have struggled to find ways to contain costs. This has led to the introduction of incentives to promote healthy behaviors, often referred to as wellness programs. These programs take a myriad of forms from providing a gym at the workplace to subsidizing the co-pays of certain medications and linking health care benefits or discounts to certain healthy lifestyles. In Arkansas, for example, state employees who exercise more frequently or eat healthier...

Seafood Safety: Background and Issues

Although seafood consumption can contribute to a healthy diet, some fish and shellfish can cause foodborne illnesses or contain environmental contaminants. Are current food safety programs sufficiently protecting consumers, and if not, what changes should be considered? A complicating factor is that most of the seafood consumed in the United States is from imports.

The Food and Drug Administration (FDA) within the Department of Health and Human Services plays the lead role in ensuring the safety of both domestic and imported fish and shellfish, but other agencies, including the National...

Presidential Appointments to Full-Time Positions in Executive Departments During the 110th Congress, 2007-2008

The appointment process for advice and consent positions consists of three main stages. The first stage is selection, clearance, and nomination by the President. This step includes preliminary vetting, background checks, and ethics checks of potential nominees. At this stage, the president may also consult with Senators who are from the same party if the position is located in a state. The second stage of the process is consideration of the nomination in the Senate, most of which takes place in committee. Finally, if a nomination is approved by the full Senate, the nominee is given a...

The Developmental Disabilities Act

The Developmental Disabilities Assistance and Bill of Rights Act (commonly known as the DD Act) provides federal financial assistance to states and public and nonprofit agencies to support community-based delivery of services to persons with developmental disabilities. The DD Act defines developmental disabilities (DD) as severe, life-long disabilities attributable to mental and/or physical impairment. The aim of the DD Act is to help individuals with DD maximize their potential through increased independence, productivity, inclusion, and integration into the community.

Title I of the DD...

Substance Abuse and Mental Health Services Administration (SAMHSA): Agency Overview and Reauthorization Issues

The Substance Abuse and Mental Health Services Administration (SAMHSA), within the Department of Health and Human Services (HHS), provides federal funding to support community-based mental health and substance abuse prevention and treatment services. SAMHSA awards formula and competitive grants under its authorities in Title V of the Public Health Service Act (PHSA). The agency also administers the $1.8 billion Substance Abuse Prevention and Treatment (SAPT) block grant and the $420 million Community Mental Health Services (CMHS) block grant, both of which are authorized in PHSA Title XIX....

Legal Issues Relating to the Disposal of Dispensed Controlled Substances

According to the White House Office of National Drug Control Policy, the intentional use of prescription drugs for non-medical purposes is the fastest-growing drug problem in the country and the second-most common form of illicit drug abuse among teenagers in the United States, behind marijuana use. Young adults and teenagers may find their parents’ prescription drugs in unsecured medicine cabinets or other obvious locations in the home, or they may retrieve expired or unwanted medication from the trash. It is believed that properly disposing of unwanted medications would help prevent...

PPACA Requirements for Offering Health Insurance Inside Versus Outside an Exchange

The Patient Protection and Affordable Care Act (PPACA, P.L. 111-148, as amended) establishes new federal private health insurance standards, many of which are not required to be implemented until 2014. In addition, by 2014, states are to establish “American Health Benefit Exchanges.” These exchanges cannot be insurers, but will provide eligible individuals and small businesses with access to insurers’ plans in a comparable way, and will have criteria for permitting plans’ participation in the exchange. This report lists the private health insurance market reforms of the new health reform...

Private Health Insurance Provisions of H.R. 3962

This report summarizes key provisions affecting private health insurance, including provisions to raise revenues, in Division A of H.R. 3962, the Affordable Health Care for America Act, as passed by the House of Representatives on November 7, 2009. H.R. 3962 is based on H.R. 3200, America’s Affordable Health Choices Act of 2009, which was originally introduced on July 14, 2009, and was reported separately on October 14, 2009, by three House Committees—Education and Labor, Energy and Commerce, and Ways and Means.

Division A of H.R. 3962 focuses on reducing the number of uninsured,...

Private Health Insurance Provisions in the Patient Protection and Affordable Care Act (PPACA)

The Patient Protection and Affordable Care Act (P.L. 111-148, PPACA) was signed into law on March 23, 2010. On March 30, 2010, PPACA was amended by P.L. 111-152, the Health Care and Education Reconciliation Act of 2010. This report summarizes the key provisions in PPACA (hereafter referring to PPACA as amended by P.L. 111-152) that affect private health insurance. PPACA imposes new requirements on individuals, employers, and health plans; restructures the private health insurance market; sets minimum standards for health coverage; and provides financial assistance to certain individuals...

State Children’s Health Insurance Program (CHIP): A Brief Overview

The Balanced Budget Act of 1997 (BBA 97; P.L. 105-33) established the State Children’s Health Insurance Program (CHIP) under a new Title XXI of the Social Security Act and provided annual appropriations for CHIP through FY2007. The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA, H.R. 2, P.L. 111-3), which was signed into law on February 4, 2009, provided CHIP appropriations through FY2013 and made other changes.

In general, CHIP allows states to cover targeted low-income children with no health insurance in families with income above Medicaid eligibility levels....

Medicaid Checklist: Considerations in Adding a Mandatory Eligibility Group

All poor American children and pregnant woman are eligible for Medicaid or the State Children’s Health Insurance Program (CHIP), although millions are not enrolled. However, some other populations’ upper income eligibility threshold for Medicaid is often well below the federal poverty level. For working parents of dependent children, for example, the median Medicaid upper income eligibility threshold among the states is 68% of poverty—less than $10,000 a year for a single parent with a child. (For parents who are not working, the median Medicaid upper income eligibility threshold among the...

Stem Cell Research: Ethical and Legal Issues

OMB Controls on Agency Mandatory Spending Programs: “Administrative PAYGO” and Related Issues for Congress

On May 23, 2005, during President George W. Bush’s second term, then-Office of Management and Budget (OMB) Director Joshua B. Bolten issued a memorandum to the heads of agencies. The memorandum announced that OMB would involve itself systematically in some aspects of how agencies execute laws related to mandatory spending. Under the process outlined in the OMB memorandum, if an agency wished to use discretion under current law in a way that would “increase mandatory spending,” the memorandum required the agency to propose the action to OMB. Such actions might include regulations,...

FY2010 Supplemental for Wars, Disaster Assistance, Haiti Relief, and Other Programs

The Administration requested $64.3 billion in FY2010 supplemental appropriations: $5.1 billion to replenish the U.S. Disaster Relief Fund administered by the Federal Emergency Management Agency (FEMA); $33 billion for the Department of Defense (DOD) primarily for deploying 30,000 additional troops to Afghanistan; $4.5 billion in war-related foreign aid; and $2.8 billion for Haiti earthquake-related relief and reconstruction aid; $243 million for activities related to the Deepwater Horizon oil spill; $600 million for border security, and $129 million to reduce backlogs in patent requests;...

The FDA’s Authority to Recall Products

Infringement of Intellectual Property Rights and State Sovereign Immunity

The Eleventh Amendment to the U.S. Constitution provides that “[t]he Judicial Power of the United States shall not be construed to extend to any suit in law or equity, commenced or prosecuted against one of the United States by Citizens of another State, or by Citizens or Subjects of any Foreign State.” Although the amendment appears to be focused on preventing suits against a state by non-residents in federal courts, the U.S. Supreme Court has expanded the concept of state sovereign immunity to reach much further than the literal text of the amendment, to include immunity from suits by...

Health-Related Issues in Russia and Eurasia: Context and Issues for Congress

After the collapse of the Soviet Union in 1991, all the newly independent Eurasian states faced economic dislocations, conflicts and population shifts, and more porous borders that contributed to rising communicable and non-communicable diseases such as HIV/AIDS and drug addiction. At the same time, the inherited healthcare systems were obsolete and unable to cope with existing health problems, let alone new challenges.

Even before the Soviet Union collapsed, the United States provided it with some health assistance to address urgent needs, including vaccines for children. Since then,...

Tax Options for Financing Health Care Reform

Several tax options were proposed to provide financing for health care reform. President Obama initially proposed restricting itemized deductions for high-income taxpayers, along with some narrower provisions. H.R. 3962 passed in the House on November 14, 2009; its largest source of increased revenues was from additional income taxes for higher-income taxpayers. On December 24, 2009, the Senate adopted H.R. 3590, whose revenue provisions are similar to those in the bill reported by the Senate Finance Committee (S. 1796). Taxing insurance companies on high-cost employer plans was the...

Haiti Earthquake: Crisis and Response

The largest earthquake ever recorded in Haiti devastated parts of the country, including the capital, on January 12, 2010. The quake, centered about 15 miles southwest of Port-au-Prince, had a magnitude of 7.0. A series of strong aftershocks have followed. Experts estimate the earthquake caused $8 to $14 billion in damage. Approximately 3 million people, roughly one-third of the overall population, have been affected by the earthquake with estimates ranging from 1.2 to 2 million people displaced. The government of Haiti is reporting an estimated 230,000 deaths and 300,600 injured. In the...

FDA Amendments Act of 2007 (P.L. 110-85)

On September 27, 2007, the Food and Drug Administration Amendments Act of 2007 (FDAAA; H.R. 3580) was signed into law (P.L. 110-85). The comprehensive law reauthorizes four expiring Food and Drug Administration (FDA) programs and expands the agency’s authority to regulate the safety of prescription drugs and biologics, medical devices, and foods. Understanding the way in which FDAAA changed the law governing the agency informs policy discussions aimed at additional FDA reform and reorganization, as well as those related more broadly to the quality, availability, and cost of medical...

Medical Device User Fees and User Fee Acts

FDA Regulation of Follow-On Biologics

On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148). PPACA establishes a new regulatory authority within the Food and Drug Administration (FDA) by creating a licensure pathway for follow-on biologics, also called biosimilars, and authorizing the agency to collect associated fees.

A biologic is a preparation, such as a drug or a vaccine, that is made from living organisms. A follow-on biologic, or biosimilar, is similar to the brand-name (innovator) product made by the...

Noncitizen Eligibility and Verification Issues in the Health Care Reform Legislation

Health care reform legislation raises a significant set of complex issues, and among the thornier for policy makers are the noncitizen eligibility and verification issues. That the treatment of foreign nationals complicates health care reform legislation is not surprising given that reform of immigration policy poses its own constellation of controversial policy options. This report focuses on this nexus of immigration law and health care reform in the major health care reform bills that are receiving action. These are the America’s Affordable Health Choices Act of 2009 (H.R. 3200), as...

Food Safety: Foodborne Illness and Selected Recalls of FDA-Regulated Foods

The 111th Congress is considering legislation to revise the U.S. food safety system, focusing primarily on those laws and programs administered by the Food and Drug Administration (FDA) within the Department of Health and Human Services (HHS). The House has passed a comprehensive bill, H.R. 2749, and the Senate Committee on Health, Education, Labor, and Pensions has reported its comprehensive proposal, S. 510. The ultimate goal of both bills is to reduce the burden of foodborne illness, which is a considerable and persistent public health problem in the United States. However, an...

Economic Impacts of Prison Growth

This report provides an economic overview of the correctional sector as background for the unfolding debate over spending and other policies. It begins with information on the growth in prison populations in public and in private prisons and also briefly explores the economic impacts of prison location. It is not intended a study of the effectiveness of sentencing and other laws, nor of evolving polices aimed at reducing recidivism and prison populations.

CRS Issue Statement on Health Care Reform

Medicaid and CHIP: Changes Made by the Health Care and Education Reconciliation Act of 2010 (HCERA, P.L. 111-152) to the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148)

On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), as passed by the Senate on December 24, 2009, and the House on March 21, 2010. PPACA will, among other changes, modify Medicaid and the Children’s Health Insurance Program (CHIP) statutes. In addition, on March 21, 2010, the House passed an amendment in the nature of a substitute to H.R. 4872, the Health Care and Education Reconciliation Act of 2010 (HCERA, P.L. 111-152). After being passed by the House, HCERA was subsequently amended and passed by the Senate...

Selected Health Funding in the American Recovery and Reinvestment Act of 2009

The American Recovery and Reinvestment Act of 2009 (ARRA), the economic stimulus legislation signed into law on February 17, 2009 (P.L. 111-5), included supplemental FY2009 discretionary appropriations for biomedical research, public health, and other health-related programs within the Department of Health and Human Services (HHS). Generally, the appropriations are to remain available through September 30, 2010. P.L. 111-5 also incorporated new authorizing language to promote health information technology (HIT) and established a federal interagency advisory panel to coordinate comparative...

Medicare: Changes Made by the Reconciliation Act of 2010 to the Patient Protection and Affordable Care Act (P.L. 111-148)

On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148), which would, among other changes, make statutory changes to the Medicare program. The U.S. House of Representatives also passed an amendment in the nature of a substitute to H.R. 4872, the Health Care and Education Affordability Reconciliation Act of 2010, on March 21, 2010 (referred to hereafter as the Reconciliation bill), which would amend the PPACA.

The Reconciliation bill includes two titles. The first title contains...

Public Health, Workforce, Quality, and Related Provisions in the Patient Protection and Affordable Care Act (P.L. 111-148)

On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148). Health care reform has been the Obama Administration’s top domestic priority, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. Improving access to care and controlling rising costs are seen to require changes to both the financing and delivery of health care.

Both the House and the Senate passed comprehensive health care reform bills last...

The Medical Device Approval Process and Related Legislative Issues

Indian Health Care Provisions in H.R. 3962

The 111th Congress has devoted considerable effort to health reform that seeks to increase health insurance coverage for more Americans and help control increasing costs while improving quality and patient outcomes. H.R. 3962, the Affordable Health Care for America Act, was passed by the House of Representatives on November 7, 2009. H.R. 3962 is based on H.R. 3200, America’s Affordable Health Choices Act of 2009, which was originally introduced on July 14, 2009, and was reported separately on October 14, 2009, by three House Committees—Education and Labor, Energy and Commerce, and Ways and...

Public Health, Workforce, Quality, and Related Provisions in H.R. 3962

Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. Improving access to care and controlling rising costs are seen to require changes to both the financing and delivery of health care. Experts point to a growing body of evidence of the health care system’s failure to consistently provide high-quality care to all Americans.

The health reform debate has encompassed a number of proposals to address these challenges and...

Medicare Program Changes in Senate-Passed H.R. 3590

Medicare is a federal program that pays for covered health services for most persons 65 years and older and for most permanently disabled individuals under the age of 65 years. The rising cost of health care, the impact of the aging baby boomer generation, and declining revenues in a weakened economy continue to challenge the program’s ability to provide quality and effective health services to its 45 million beneficiaries in a financially sustainable manner.

On December 24, 2009, the Senate passed its version of health insurance reform, the Patient Protection and Affordable Care Act, in...

Medicare Coverage of Clinical Preventive Services

Congress established the Medicare program in 1965 in response to concerns that many seniors did not have health insurance, or had insurance that only covered hospital inpatient services. Historically, Medicare covered only diagnostic and treatment services, not preventive services provided in the absence of illness. Generally, adding coverage of a preventive service required statutory authority. Since 1980, Congress has established Medicare coverage for several preventive services in law. Recently, Congress gave the Secretary of HHS limited authority to cover new Medicare preventive...

Medicaid and the Children’s Health Insurance Program (CHIP) Provisions in H.R. 3590, as Passed by the Senate

This report summarizes key provisions applicable to Medicaid and the Children’s Health Insurance Program (CHIP) in H.R. 3590, the Patient Protection and Affordable Care Act, as passed by the Senate on December 24, 2009. In general, the bill would expand health insurance coverage to many Americans who currently are uninsured, while attempting to reduce expenditures and offering mechanisms to increase care coordination, encourage more use of health prevention, and improve quality of care. The bill would reform the private health insurance market, impose a mandate for most legal U.S....

Financial Services and General Government (FSGG): FY2010 Appropriations

The Financial Services and General Government (FSGG) appropriations bill includes funding for the Department of the Treasury, the Executive Office of the President (EOP), the judiciary, the District of Columbia, and 26 independent agencies. Among the independent agencies funded by the bill are the General Services Administration (GSA), the Office of Personnel Management (OPM), the Small Business Administration (SBA), the Security and Exchange Commission (SEC), and the United States Postal Service (USPS).

On May 7, 2009, the Obama Administration delivered its FY2010 budget request to...

Health Reform and the 111th Congress

The health reform debate in the 111th Congress continued and expanded upon the work begun in the 110th Congress. On November 12, 2008, the chairman of the Senate Finance Committee, Senator Baucus, released a white paper detailing his principles for health reform. This provided a framework for work within the committee for the 111th Congress. Several bills were introduced when the 111th Congress first convened, and these bills focused on a broad spectrum of approaches to health reform.

On November 7, 2009, the House passed H.R. 3962, the Affordable Health Care for America Act. H.R. 3962 is...

Veterans Health Administration: Community-Based Outpatient Clinics

In the early 1990s, the Veterans Health Administration (VHA)—one of the three administrations of the Department of Veterans Affairs (VA)—began developing a strategy to expand its capacity to provide outpatient primary care, especially for veterans who had to travel long distances to receive care at VA facilities. To facilitate access to primary care closer to where veterans reside, VHA began implementing a system for approving and establishing Community-Based Outpatient Clinics (CBOCs).

A CBOC is a fixed health care site that is geographically distinct or separate from its parent VA...

Reverse Mortgages: Background and Issues

Employer Wellness Programs: Health Reform and the Genetic Information Nondiscrimination Act

Health reform is a major issue on the domestic policy agenda of the 111th Congress. Congress has been considering a number of policy proposals to reform the health delivery system that aim to improve health care quality, reduce health care costs, and expand access to care. A range of proposals have targeted reform of the delivery system through an increased focus on prevention and wellness in an effort to encourage individuals to adopt healthier lifestyles. One prominent policy lever being considered in some health delivery reform proposals is employer wellness programs. Employer wellness...

Labor, Health and Human Services, and Education: Highlights of FY2010 Budget and Appropriations

This report tracks FY2010 appropriations for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (L-HHS-ED). This legislation provides discretionary funds for three major federal departments and 13 related agencies. The report summarizes L-HHS-ED discretionary funding issues but not authorization or entitlement issues.

On May 7, 2009, President Obama submitted the FY2010 budget request to Congress, including $163.8 billion in discretionary L-HHS-ED funds. The comparable FY2009 amount was $160.1 billion, enacted mainly through the Omnibus Appropriations...

Veterans Health Care: Project HERO Implementation

In general, the Department of Veterans Affairs (VA), through the Veterans Health Administration (VHA), provides a majority of medical services to veterans within its health care system. However, in some instances, such as when a clinical service cannot be provided by a VA medical center, when a veteran is unable to access VA health care facilities due to geographic inaccessibility, or in emergencies when delays could lead to life threatening situations, VHA is authorized by law to send the veteran outside of VA’s health care system to seek care. In 2006, the conference report to accompany...

Home Visitation for Families with Young Children

Health care reform legislation passed by the House in November 2009 (H.R. 3962) and in the Senate in December 2009 (H.R. 3590) would authorize and provide funds for grants to states to provide home visiting services, on a voluntary basis, to families with young children. (For a comparison of selected provisions in those proposals, see Table 4). There is no current law program that provides grants to states exclusively for home visiting programs. The Obama Administration requested authorization and funding for such a program as part of its FY2010 budget request. This proposal was not...

Premium Conversion of Health Insurance

Premium conversion allows employees to pay their share of employment-based health insurance premiums on a pre-tax basis. The tax treatment is difficult for people who are not tax experts to understand, as are the rules that limit its use in a manner some consider arbitrary and unfair. Premium conversion is sometimes referred to as “premium only” or “section 125 plans,” causing further confusion.

Premium conversion is authorized by section 125 of the Internal Revenue Code, a section entitled “cafeteria plans.” In general, the section allows taxpayers to choose among taxable and nontaxable...

Brief Summaries of Federal Animal Protection Statutes

This report contains brief summaries of federal animal protection statutes, listed alphabetically. It includes statutes enacted to implement certain treaties, but it does not include treaties. Additionally, this report includes statutes that concern animals but that are not necessarily animal protection statutes. For example, it discusses a statute authorizing the eradication of predators, because one of the statute’s purposes is to protect domestic and “game” animals; and it includes statutes to conserve fish even though the ultimate purpose of such statutes may not be for the benefit of...

Long-Term Care (LTC): Financing Overview and Issues for Congress

This report provides an overview of long-term care (LTC) and an explanation of the nation’s complex financing system of public and private payers. It also describes some of the major challenges facing Congress as it contemplates LTC reform and whether and how to include LTC in health reform legislation.

Federal Tort Claims Act (FTCA)

The Federal Tort Claims Act (FTCA) is the statute by which the United States authorizes tort suits to be brought against itself. With exceptions, it makes the United States liable for injuries caused by the negligent or wrongful act or omission of any federal employee acting within the scope of his employment, in accordance with the law of the state where the act or omission occurred. Three major exceptions, under which the United States may not be held liable, even in circumstances where a private person could be held liable under state law, are the Feres doctrine, which prohibits suits...

U.S. Global Health Assistance: Background, Priorities, and Issues for the 111th Congress

U.S. funding for global health activities has grown significantly over the past decade, from $1.8 billion in FY2001 to $8.5 billion in FY2010. During this time period, Congress has significantly increased funding for responses against infectious disease outbreaks, including the 2009 influenza pandemic (H1N1), H5N1 avian influenza (avian flu), human immunodeficiency/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis (TB), and malaria. U.S. agencies and departments also supplement funds that Congress appropriates for these purposes with funds from their discretionary...

Federal Domestic Illegal Drug Enforcement Efforts: Are They Working?

This report examines the federal drug enforcement data reported annually by key agencies charged with enforcing federal drug control laws. This report provides background and an overview of current federal drug control efforts and outcomes.

An Overview of Proposals to Establish an Independent Commission or Board in Medicare

Current health care reform discussions have included debates about the merits of creating an independent entity in Medicare to make changes in the program. Currently, Medicare policy is made largely by Congress and, to varying degrees, the Centers for Medicare and Medicaid Services (CMS), the federal agency responsible for administering the program. The proposals being debated would essentially create an independent body of experts with the power to set provider payment rates and make other Medicare policy decisions.

Advocates of these types of proposals argue that creating a new...

Veterans Medical Care: FY2010 Appropriations

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility criteria. Benefits to veterans range from disability compensation and pensions to hospital and medical care. The VA provides these benefits through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA).

This report focuses on the VHA. The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through the...

FY2010 Appropriations: District of Columbia

On May 7, 2009, the Obama Administration released its detailed budget requests for FY2010, which included $739.1 million in special federal payments to the District of Columbia. Approximately three-quarters—$544.1 million—of the President’s proposed budget request for the District would be used to support the courts and criminal justice system. The President also requested $109.5 million in support of college tuition assistance and elementary and secondary education initiatives.

On May 12, 2009, the District of Columbia Council passed the city’s FY2010 operating budget. The bill, which was...

CRS Issue Statement on Medicare Reform

CRS Issue Statement on Animal Welfare

This report discusses the questions whether additional measures are needed to protect the health and well-being of animals.

Follow-On Biologics: Intellectual Property and Innovation Issues

Interior, Environment, and Related Agencies: FY2010 Appropriations

The Interior, Environment, and Related Agencies appropriations bill includes funding for the Department of the Interior (DOI), except for the Bureau of Reclamation, and for agencies within other departmentsincluding the Forest Service within the Department of Agriculture and the Indian Health Service (IHS) within the Department of Health and Human Services. It also includes funding for arts and cultural agencies, the Environmental Protection Agency, and numerous other entities.

The Department of the Interior, Environment, and Related Agencies Appropriations Act, 2010 (P.L. 111-88),...

Agriculture and Related Agencies: FY2010 Appropriations

The FY2010 Agriculture appropriations bill provides funding for all of the U.S. Department of Agriculture (USDA) except the Forest Service, plus the Food and Drug Administration (FDA) and the Commodity Futures Trading Commission (CFTC). Appropriations jurisdiction for the Commodity Futures Trading Commission (CFTC) is split between two subcommittees—the House Agriculture appropriations subcommittee and the Senate Financial Services appropriations subcommittee.

The FY2010 Agriculture appropriations bill (P.L. 111-80) was enacted on October 21, 2009. This is the first time that the bill was...

Homeland Security Department: FY2010 Appropriations

This report describes the FY2010 appropriations for the Department of Homeland Security (DHS). The Administration requested a net appropriation of $44.1 billion in budget authority for FY2010. This amounts to a $2.8 billion, or a 6.7% increase over the $41.2 billion enacted for FY2009 (not including supplemental funding). Total budget authority requested by the Administration for DHS for FY2010 amounts to $55.1 billion.

Net requested appropriations for major agencies within DHS were as follows: Customs and Border Protection (CBP), $10,049 million; Immigration and Customs Enforcement...

Proposals for a Commission to Address the Federal Government’s Long-Term Fiscal Situation

In the 111th Congress, Members have introduced several proposals to establish a commission that would make potentially far-reaching recommendations on how to address the federal government’s long-term fiscal situation. Generally speaking, the measures would include Members of Congress as some or most of a commission’s membership, provide for a majority of commission members to be appointed by congressional leaders, have varying degrees of partisan balance in membership, and require supermajority votes of commission members to approve recommendations. Each of the bills also would provide...

The Genetic Information Nondiscrimination Act of 2008: Selected Issues

Medicaid and Children’s Health Insurance Program (CHIP) Provisions in Affordable Health Care for America Act (H.R. 3962)

The 111th Congress has devoted considerable effort to health reform that seeks to increase health insurance coverage for more Americans and help to control costs, while improving quality and patient outcomes. The Affordable Health Choices for America Act (H.R. 3962) was introduced in the House of Representatives on October 29, 2009. H.R. 3962 is based on H.R. 3200, America’s Affordable Health Choices Act of 2009, originally introduced on July 14, 2009, and reported separately on October 14, 2009, by three House Committees—Education and Labor, Energy and Commerce, and Ways and Means. H.R....

Private Health Insurance Provisions of S. 1796, America’s Healthy Future Act of 2009

This report summarizes key provisions affecting private health insurance in S. 1796, America’s Healthy Future Act of 2009, as ordered reported by the Senate Committee on Finance on October 19, 2009.

Title I of the bill imposes new requirements on individuals, employers, and health plans; restructures the private health insurance market; sets minimum standards for health benefits; and provides financial assistance to certain individuals and, in some cases, small employers. Title VI of the bill include a number of new provisions to raise revenues to pay for health care reform. These...

Patent “Evergreening”: Issues in Innovation and Competition

“Patent evergreening” is a potentially perjorative term that generally refers to the strategy of obtaining multiple patents that cover different aspects of the same product, typically by obtaining patents on improved versions of existing products. Although the patent system allows improvement patents to be obtained in any industry, evergreening is said to be most common in the pharmaceutical industry.

Some observers believe that the availability of so-called continuation applications at the U.S. Patent and Trademark Office (USPTO) may promote evergreening practices. USPTO regulations that...

Overview of Provisions in the Amendment in the Nature of a Substitute to H.R. 3962 Offered by Mr. Boehner of Ohio

Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. Improving access to care and controlling rising costs are seen to require changes to both the financing and delivery of health care. Experts point to a growing body of evidence of the health care system’s failure to consistently provide high-quality care to all Americans.

Several comprehensive bills have been introduced on the topic of health reform in the 111th...

Medicare Program Changes in H.R. 3962, Affordable Health Care for America Act

Containing scores of provisions affecting Medicare payments, payment rules, and covered benefits, H.R. 3962, as passed by the House on November 7, 2009, treats the Medicare program as both a funding source for health insurance reform and a tool to shape future changes in the way that health services are paid for and delivered. Estimates from CBO on the bill indicate that, absent interaction effects, net reductions in Medicare direct spending may approach $128.1 billion from 2010 to 2014 and $460.8 billion from 2010 to 2019. Major savings are expected from constraining Medicare’s annual...

The Child Abuse Prevention and Treatment Act (CAPTA): Background, Programs, and Funding

Child abuse and neglect is a significant social concern. Children who experience abuse and/or neglect are more likely to have developmental delays and impaired language or cognitive skills; be identified as “problem” children (with attention difficulties or challenging behaviors); be arrested for delinquency, adult criminality, and violent criminal behavior; experience depression, anxiety, or other mental health problems as adults; engage in more health-risk behaviors as adults; and have poorer health outcomes as adults. Further, data from a nationally representative sample of children in...

Public Health, Workforce, Quality, and Other Provisions in the America’s Healthy Future Act (S. 1796)

Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. But efforts to improve access to care and control rising health care costs also will require changes to the health care delivery system. Experts point to a growing body of evidence of the health care system’s failure to consistently provide high-quality care to all Americans. Major challenges to the delivery of high-quality care include improving patient safety by...

The 2009 Influenza Pandemic: Selected Legal Issues

On June 11, in response to the global spread of a new strain of influenza, the World Health Organization (WHO) raised the level of influenza pandemic alert to phase 6, which indicates the start of an actual pandemic. This change reflected the spread of the new influenza A(H1N1) virus, not its severity. Although currently the pandemic is of moderate severity with the majority of patients experiencing mild symptoms and making a rapid and full recovery, this experience could change. This report provides a brief overview of selected legal issues including emergency measures, civil rights,...

2009 H1N1 "Swine Flu": CRS Experts

This report includes a table which provides access to names and contact information for CRS experts on policy concerns relating to swine influenza A virus (H1N1). Policy areas identified include: Identification, diagnosis, and surveillance of the virus; Treatment and prevention: antiviral drugs (Tamiflu, Relenza) and vaccines; Declarations of emergencies; Official plans and organizational responsibilities; and Restrictions on travel and trade.

Private Health Insurance Provisions of S. 1679

This report summarizes key provisions affecting private health insurance in S. 1679, the Affordable Health Choices Act, as ordered reported by the Senate Committee on Health, Education, Labor and Pensions (HELP) on July 15, 2009.

Title I of the bill focuses on reducing the number of uninsured, restructuring the private health insurance market, setting minimum standards for health benefits, and providing financial assistance to certain individuals and, in some cases, small employers. In general, the Senate HELP bill would require individuals to maintain health insurance and employers to...

Medical Malpractice Insurance: An Economic Introduction and Review of Historical Experience

Insurance is a critical piece of a modern economic system, but it often goes unnoticed until it becomes prohibitively expensive or its availability is curtailed. Such problems occurred in the medical malpractice liability insurance market most recently in the early part of the 2000s. Many physicians experienced substantial increases in insurance premiums, and there were reports of problems with availability of physician services due to doctors retiring or relocating from areas that had seen high premium increases. This was not the first time such a crisis has been proclaimed; similar...

Public Health, Workforce, Quality, and Other Provisions in the Affordable Health Choices Act (S. 1679)

Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. But efforts to improve access to care and control rising health care costs also will require changes to the health care delivery system. Experts point to a growing body of evidence of the health care system’s failure to consistently provide high-quality care to all Americans. Major challenges to the delivery of high-quality care include improving patient safety by...

Public Health, Workforce, Quality, and Other Provisions in H.R. 3200

Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. But efforts to improve access to care and control rising health care costs also will require changes to the health care delivery system. Experts point to a growing body of evidence of the health care system’s failure to consistently provide high-quality care to all Americans. Major challenges to the delivery of high-quality care include improving patient safety by...

Medicaid and Children’s Health Insurance Program (CHIP) Provisions in America’s Affordable Health Choices Act of 2009 (H.R. 3200)

The 111th Congress has devoted considerable effort to health reform that seeks to increase health insurance coverage for more Americans and help to control increasing costs, while improving quality and patient outcomes. Health reform legislation, America’s Affordable Health Choices Act of 2009 (H.R. 3200), was introduced in the House on July 17, 2009, and ordered reported by the Committee on Energy and Commerce on July 31, 2009. H.R. 3200 proposes sweeping reforms of the health care delivery system, which are described in the three major components of H.R. 3200 designated Divisions A, B,...

Quarantine and Isolation: Selected Legal Issues Relating to Employment

On June 11, in response to the global spread of a new strain of influenza, the World Health Organization (WHO) raised the level of influenza pandemic alert to phase 6, which indicates the start of an actual pandemic. This change reflects the spread of the new influenza A(H1N1) virus, not its severity. Although currently the pandemic is of moderate severity with the majority of patients experiencing mild symptoms and making a rapid and full recovery, this experience could change. Questions relating to employment are among the most significant issues raised by a pandemic since if individuals...

The Military Commissions Act of 2006 (MCA): Background and Proposed Amendments

On November 13, 2001, President Bush issued a Military Order (M.O.) authorizing trial by military commission of certain non-citizens suspected of participating in the war against terrorism. The Supreme Court struck down military commissions established pursuant to the M.O. as inconsistent with the Uniform Code of Military Justice (UCMJ). To permit military commissions to go forward, Congress approved the Military Commissions Act of 2006 (MCA), conferring authority to promulgate rules that depart from the strictures of the UCMJ and possibly U.S. international obligations. The Department of...

Health Care Reform: An Introduction

Health care reform is a major issue in the 111th Congress, driven by growing concern about millions of people without insurance coverage, continual increases in cost and spending, and quality shortcomings. Commonly cited figures indicate that more than 45 million people have no insurance, which can limit their access to care and ability to pay for the care they receive. Costs are rising for nearly everyone, and the country now likely spends over $2.5 trillion, more than 17% of gross domestic product (GDP), on health care services and products, far more than other industrialized countries....

Estimating the Number of People Who Are Homeless: Homeless Management Information Systems

In 1998, Congress directed the Department of Housing and Urban Development (HUD) to develop a process for collecting data about homeless persons. Together with local communities, HUD began in 2001 to implement a series of Homeless Management Information Systems (HMIS). Two categories of federal fund recipients are required to participate in HMIS: organizations that receive grants through the Housing Opportunities for Persons with AIDS (HOPWA) program and organizations that receive HUD Homeless Assistance Grants. The HOPWA program provides housing and supportive services for persons living...

Noncitizen Health Insurance Coverage and Use of Select Safety-Net Providers

The 111th Congress has made health reform a priority. As health reform is debated, one possible issue that may surface is the rights and requirements of noncitizens (aliens) under health reform. Because some of the proposals to address health reform in the United States would create a mechanism to provide health insurance to the overwhelming majority of individuals in the nation, this report explores the health insurance coverage of noncitizens, as well as noncitizen use of selected safety-net providers and the impact of unauthorized aliens on the health care system.

Noncitizens are not...

FY2009 Spring Supplemental Appropriations for Overseas Contingency Operations

On June 11, 2009, the House and Senate Appropriations Committees announced a conference agreement on H.R. 2346, a bill providing supplemental appropriations for the remainder of FY2009. The House passed the conference report (226 to 202) on June 16; the Senate passed it (91 to 5) on June 18. President Obama signed it into law (P.L. 111-32) on June 24.

On key issues, the agreement includes: $5 billion, as in the Senate bill, to support U.S. loans to the International Monetary Fund, does not include a Senate provision allowing the Secretary of Defense to exempt photos of military detainees...

Labor, Health and Human Services, and Education: FY2009 Appropriations

This report tracks FY2009 appropriations for the Departments of Labor, Health and Human Services, Education, and Related Agencies (L-HHS-ED). This legislation provides discretionary funds for three major federal departments and 13 related agencies. The report, which will not be further updated, summarizes L-HHS-ED discretionary funding issues but not authorization or entitlement issues.

President George W. Bush’s FY2009 budget request to Congress, including amendments, proposed $147.4 billion in discretionary L-HHS-ED funds; the comparable FY2008 amount was $148.6 billion. The Senate...

Agriculture and Related Agencies: FY2009 Appropriations

The Agriculture appropriations bill includes all of the U.S. Department of Agriculture (USDA) except the Forest Service, plus the Food and Drug Administration (FDA). The Commodity Futures Trading Commission (CFTC) appropriation also has been enacted with the Agriculture appropriations bill, even though jurisdiction in the Senate for CFTC funding moved to the Financial Services appropriations subcommittee in FY2008.

An FY2009 Omnibus Appropriations Act, P.L. 111-8, was enacted on March 11, 2009, more than five months after the beginning of the fiscal year. A continuing resolution had...

Medicaid and the State Children’s Health Insurance Program (CHIP): FY2010 Budget Issues

The President is required each year to submit a comprehensive federal budget proposal to Congress before the first Monday in February. The House and Senate Budget Committees then develop their respective budget resolutions. Based on these budget resolutions, House and Senate Appropriations committees reconcile their budget resolutions and file a joint budget agreement. Although not binding, the resolution provides a framework for consideration of the 12 separate appropriations bills that would fund FY2010 federal spending, beginning October 1, 2009.

In presidential transition years, the...

Employment-Based Health Coverage and Health Reform: Selected Legal Considerations

It is estimated that nearly 170 million individuals have employer-based health coverage. As part of a comprehensive health care reform effort, there has been support (including from the Obama Administration) in enacting comprehensive health insurance reform that retains the employer-based system. This report presents selected legal considerations inherent in amending two of the primary federal laws governing employer-sponsored health care: the Employee Retirement Income Security Act (ERISA) and the Internal Revenue Code (IRC).

Interior, Environment, and Related Agencies: FY2009 Appropriations

The Interior, Environment, and Related Agencies appropriations bill includes funding for the Department of the Interior (DOI), except for the Bureau of Reclamation, and for two agencies within other departmentsthe Forest Service within the Department of Agriculture and the Indian Health Service (IHS) within the Department of Health and Human Services. It also includes funding for arts and cultural agencies, the Environmental Protection Agency, and numerous other entities.

On February 17, 2009, the President signed the American Recovery and Reinvestment Act of 2009 (P.L. 111-5, H.R. 1)....

U.S. Motor Vehicle Industry: Federal Financial Assistance and Restructuring

This report focuses on the current situation faced by the Detroit 3, key aspects of their current crisis, including possible consequences of a failure of one or more companies, and some aspects of legislative actions that have been considered to bridge their financial conditions to a more stable situation.

Direct-to-Consumer Advertising of Prescription Drugs

A phenomenon that has become more and more important over the last decade, direct-to-consumer (DTC) advertising has grown from about $800 million in 1996 to over $4.7 billion in 2007. Its supporters point to more informed consumers who then visit their doctors and become more involved in their own treatment, leading to better and earlier diagnosis of undertreated illnesses. The critics believe that industry’s presentation of the balance of drug benefit and risk information may encourage the inappropriate use of advertised products and lead to higher than necessary spending. In addition to...

War on Drugs: Reauthorization and Oversight of the Office of National Drug Control Policy

Located in the Executive Office of the President, the Director of the Office of National Drug Control Policy (ONDCP) is responsible for overseeing and coordinating the federal War on Drugs, preparing the National Drug Control Strategy, and running certain drug control programs, such as the High Intensity Drug Trafficking Areas (HIDTA) Program, the National Youth Anti-Drug Media Campaign, and the Drug-Free Communities Program.

The Senate Judiciary Committee held a confirmation hearing on the nomination of Seattle police chief R. Gil Kerlikowske to be Director of National Drug Control...

Alert Systems for Missing Adults in Eleven States: Background and Issues for Congress

A patchwork of alert systems to recover vulnerable missing adults is developing through the country. These systems, administered at the state and local levels, are intended to alert law enforcement entities and the public that adults with cognitive impairment or other disabilities are missing and may need assistance. The alerts are activated on behalf of targeted groups of individuals—such as those with cognitive or mental impairment (e.g., Alzheimer’s disease and other forms of dementia), developmental disabilities, or suicidal tendencies—who may be at high risk of going missing and...

Health Care Workforce: National Health Service Corps

The National Health Service Corps (NHSC) was established in the Emergency Health Personnel Act of 1970 (P.L. 91-623) to improve the distribution of health workers in underserved rural areas by providing scholarship support to students in qualified medical professions in exchange for a period of service in a Health Professional Shortage Area (HPSA). The NHSC is authorized in the Public Health Service (PHS) Act, Sections 331, 338A, 338B, and 338I and codified in 42 USC §234. Over the years, Congress has amended and reauthorized these authorities. In 2008, Congress reauthorized the NHSC in...

The Public Health and Medical Response to Disasters: Federal Authority and Funding

When there is a catastrophe in the United States, state and local governments lead response activities, invoking state and local legal authorities to support them. When state and local response capabilities are overwhelmed, the President, acting through the Secretary of Homeland Security, can provide assistance to stricken communities, individuals, governments, and not-for-profit groups to assist in response and recovery. Aid is provided under the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act) upon a presidential declaration. The...

Advance Appropriations for Veterans’ Health Care: Issues and Options for Congress

The Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) operates the Nation’s largest health care delivery system, with about 222,000 employees supporting its mission. It is also the largest provider of health care education and training for medical residents and other health care trainees in the United States. In FY2008, VHA provided medical care to approximately 5.6 million unique patients and spent approximately $43.5 billion for medical care and research.

A coalition of veterans’ service organizations (VSOs) has been calling on Congress to provide VHA with a...

Selected Federal Compensation Programs for Physical Injury or Death

Congress has established a number of programs to compensate or assist victims of certain specific circumstances, including negligence, terrorism, and “acts of God.” Federal compensation programs can be described by certain common attributes. These include aspects of program administration; requirements for and determination of individual eligibility; eligibility of health care providers; types of benefits provided; whether certain diseases are presumed to be eligible for compensation; and the means by which the program is financed.

Though federal compensation programs display considerable...

The U.S. Mental Health Delivery System Infrastructure: A Primer

In the past decade, four federal reports have offered insight into the nation’s mental health care system and recommended a fundamental transformation of the system. According to these reports, transformation of the mental health care system would require timely incorporation of evidence-based practices in routine practice, resolution of workforce shortage issues, removal of financial barriers, coordination of mental health care with general health and social services, and systematic measurement and improvement of the quality of care delivered. While each of these recommendations may...

Emergency Preparedness and Hazard Mitigation: CRS Experts

This report includes a table that provides access to names and contact information for CRS experts on policy concerns relating to emergency preparedness and hazard mitigation. Includes a number of policy areas, such as: emergency preparedness and protection missions, functions, and structures; emergency authorities; preparedness plans; communications networks; warning systems; and state and local homeland security funding, training, and standards.

State Health Reform Strategies

States have taken the initiative to propose and enact health care reforms to address perceived problems related to health insurance coverage, health care costs, and other issues. These reform efforts vary in scope, intent, and target demographic group. While not all members of Congress agree in the need to reform health care, many have expressed interest in learning about these state efforts to inform ongoing debate at the national level.

Each state has implemented a unique set of reform strategies to address concerns about health insurance and the health care delivery system. However,...

The President’s Malaria Initiative and Other U.S. Global Efforts to Combat Malaria: Background, Issues for Congress, and Resources

In 2008, malaria remained a serious problem in 109 countries, although it was eradicated almost 60 years ago in the United States. Malaria sickens an estimated 247 million people every year; of these, nearly 1 million die, mostly children younger than 5 years old. The disease is caused by a parasite that is transmitted to a person through the bite of a particular mosquito. Infection can lead to fever, muscle aches, and, without effective treatment, organ failure and sometimes death. Although approximately 40% of the world’s population is at risk of malaria, most cases and deaths are in...

Setting and Valuing Health Insurance Benefits

This report briefly describes some of the key concepts and policy issues around specifying and valuing health insurance benefits.

Public Health and Medical Preparedness and Response: Issues in the 111th Congress

Key recent events—the 2001 terrorist attacks, Hurricane Katrina, and concerns about an influenza (“flu”) pandemic, among others—sharpened congressional interest in the nation’s systems to track and respond to public health threats. The 109th Congress passed several laws that established, reorganized, or reauthorized key public health and medical preparedness and response programs in the Departments of Health and Human Services (HHS) and Homeland Security (DHS). The 110th Congress was engaged in oversight of the implementation of these laws, focused in particular on such matters as (1) the...

American Recovery and Reinvestment Act of 2009 (ARRA, P.L. 111-5): Title V, Medicaid Provisions

The economy officially was considered in a recession in December 2008, but many forecasters had long recognized the downturn and some believed this economic contraction would be more severe than other post-World War II slowdowns. A combination of factors combined to present policymakers with difficult decisions on how best to stimulate the economy. Troubling instability in the housing and financial services sectors, weak auto manufacturing demand, and high energy costs earlier in 2008 had slowed growth dramatically and forced millions into unemployment. With declining tax revenue and...

CRS Issue Statement on Abortion, Family Planning, and Reproductive Health

The 111th Congress will likely consider a variety of issues involving family planning and reproductive health. Legislation related to family planning and Title X of the Public Health Service Act, including appropriations measures that could affect the funding of Title X family planning initiatives, is expected.

Medicare's Hospice Benefit

This report discusses Medicare's hospice benefit, which was provides care that specializes in the relief of the pain and symptoms associated with a terminal illness and the provision of supportive and counseling services to patients and their families during the final stages of a patient's illness and death.

Medicaid and Schools

As a condition of accepting funds under the Individuals with Disabilities Education Act (IDEA), public schools must provide special education and related services necessary for children with disabilities to benefit from a public education. Generally, states can finance only a portion of these costs with federal IDEA funds. Medicaid, the federal-state program that finances medical and health services for the poor, can cover IDEA required health-related services for enrolled children as well as related administrative activities (e.g., outreach for Medicaid enrollment purposes, medical care...

Homeland Security Department: FY2009 Appropriations

This report describes the FY2009 appropriations for the Department of Homeland Security (DHS). The Administration requested a net appropriation of $38,849 million in budget authority for FY2009. The House Appropriations Committee reported its version of the FY2009 DHS Appropriations bill on June 24, 2008. The bill was filed on September 18, 2008, as H.R. 6947, and the accompanying report has been numbered H.Rept. 110-862. House-reported H.R. 6947 would have provided a net appropriation of $41,137 million in budget authority for DHS for FY2009. This amounted to an increase of $2,288...

Medicare Advantage

Medicare Advantage (MA) is an alternative way for Medicare beneficiaries to receive covered benefits. Under MA, private health plans are paid a per-person amount to provide all Medicare-covered benefits (except hospice) to beneficiaries who enroll in their plan. Eligible individuals may enroll in an MA plan, if one is available in their area. As of January 2009, all Medicare beneficiaries had access to an MA plan and 23% of beneficiaries enrolled in one. Private plans may use different techniques to influence the medical care used by enrollees. Some plans, such as health maintenance...

End-of-Life Care: Services, Costs, Ethics, and Quality of Care

End-of-life care can be broadly defined as health care provided to persons who are very ill, have a prognosis that is likely to worsen, and most likely will die in the near term from their illness. End-of-life care may be in the form of acute care provided in the days or months prior to death or palliative care, which focuses on relieving the patient’s suffering and reducing the severity of disease symptoms as well as improving quality of life. Hospice care is a form of palliative care that delivers comfort care to those who forgo curative treatment and have a life expectancy that can be...

State Children’s Health Insurance Program (CHIP) Legislative History

The Balanced Budget Act of 1997 (P.L. 105-33, BBA-97) established the State Children’s Health Insurance Program (CHIP) under a new Title XXI of the Social Security Act. CHIP builds on Medicaid by providing health care coverage to low-income, uninsured children in families with incomes above applicable Medicaid income standards. This report provides a summary of major changes to the State Children’s Health Insurance Program (CHIP) enacted in public laws beginning with the legislation authorizing the program in 1997. It will be updated as legislative activity warrants.

Medicaid and Graduate Medical Education

This report discusses Medicaid coverage of graduate medical education (GME) costs. GME costs are difficult to determine because teaching occurs in the context of patient care and research. There are direct GME (DGME) costs, which include residents' stipends, payments to supervising physicians, and direct program administration costs.

Medicaid Provisions in the House and Senate American Recovery and Reinvestment Act of 2009 (ARRA, H.R. 1, S.Amdt. 570)

The economy officially was considered in a recession in December 2008, but many forecasters had long recognized the downturn and some believed this economic contraction would be more severe than other post-World War II economic slowdowns. A combination of factors have combined to present policymakers with difficult decisions on how best to stimulate the economy. Troubling instability in the housing and financial services sectors have combined with weak auto manufacturing demand, and high energy costs earlier in the year to slow growth dramatically and force millions into unemployment. With...

Medicaid Citizenship Documentation

Since 1986, the Immigration Reform and Control Act (P.L. 99-603) has mandated Medicaid to have applicants declare under penalty of perjury that they are citizens or nationals of the United States (or that they are aliens in a satisfactory immigration status). Subsequently, §432 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) stated that the Secretary of Health and Human Services must establish procedures for persons applying for federal public benefits to “provide proof of citizenship in a fair and nondiscriminatory manner.” States could accept...

State Medicaid and SCRIP Coverage of Noncitizens

This report focuses on the laws governing noncitizen eligibility for Medicaid and the State Children's Health Insurance Program (SCHIP) and -- to the extent of available data -- implementation of these policies at the state level

U.S. Patent and Trademark Office Reforms: Regulatory Impacts Upon Innovation and Competition

Congressional interest in the patent system has been evidenced by discussion of substantial reform bills in previous sessions. Alongside these congressional proposals, the United States Patent and Trademark Office (USPTO) has engaged in a significant rulemaking effort in recent years. This process culminated in new rules that would make several significant changes to the patent acquisition process.

First, the rules would limit the number of “continued applications” that could be filed, absent a petition and showing by the patent applicant of the need for such applications. Stated...

The Children’s Health Insurance Program Reauthorization Act of 2009

The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA 2009, H.R. 2) was passed in the House on January 14, 2009, and in the Senate on January 29, 2009. The overall structure of CHIPRA 2009 is similar to its two predecessors, H.R. 976 and H.R. 3963 from the 110th Congress.

Most of this report summarizes changes to current law across the major provisions of CHIPRA 2009. Where the provisions of the House and Senate versions are identical, the references in this report will simply be to “CHIPRA 2009.” Where the provisions differ, the House and Senate versions will be...

PEPFAR Reauthorization: Key Policy Debates and Changes to U.S. International HIV/AIDS, Tuberculosis, and Malaria Programs and Funding

The United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25) authorized $15 billion for U.S. global efforts to combat HIV/AIDS, tuberculosis (TB), and malaria from FY2004 through FY2008. It also authorized the Office of the Global AIDS Coordinator (OGAC) to oversee U.S. government efforts to combat HIV/AIDS internationally. This coordinated U.S. government effort to combat HIV/AIDS globally implements the President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year initiative proposed by President Bush in January 2003.

In 2007, President Bush urged...

Health Care for Noncitizens in Immigration Detention

Congressional hearings and press coverage critical of the medical care received by those in the custody of the Department of Homeland Security’s (DHS’s) Immigration and Customs Enforcement (ICE) have raised interest in the subject. The law provides broad authority to detain aliens while awaiting a determination of whether they should be removed from the United States and mandates that certain categories of aliens are subject to mandatory detention by DHS. Aliens not subject to mandatory detention may be detained, paroled, or released on bond.

The medical care required to be provided to...

Family Caregiving to the Older Population: Background, Federal Programs, and Issues for Congress

Family caregiving to older individuals in need of long-term care encompasses a wide range of activities, services, and supports. Caregiving can include assistance with personal care needs, such as bathing, dressing, and eating, as well as other activities necessary for independent living, such as shopping, medication management, and meal preparation. In addition, family caregivers may arrange, supervise, or pay for formal or paid care to be provided to the care recipient.

Family caregivers fulfill the majority of the need for long-term care by older persons with chronic disabilities in the...

Indian Health Service: Health Care Delivery, Status, Funding, and Legislative Issues

The Indian Health Service (IHS), an agency in the Department of Health and Human Services (HHS), provides health care for eligible American Indians/Alaskan Natives through a system of programs and facilities located on or near Indian reservations and in certain urban areas. The IHS health delivery program is organized into 12 regional area offices and 161 local service units, and serves federal reservations, Indian communities, and urban Indians. In general, persons eligible for IHS services must be in IHS service areas and belong to federally recognized tribes.

The IHS-served population...

Abortion Law Development: A Brief Overview

In Roe v. Wade, 410 U.S. 113 (1973), the U.S. Supreme Court determined that the Constitution protects a woman’s decision whether or not to terminate her pregnancy. In a companion case, Doe v. Bolton, 410 U.S. 179 (1973), the Court held further that a state may not unduly burden a woman’s fundamental right to abortion by prohibiting or substantially limiting access to the means of effectuating her decision. Rather than settle the issue, the Court’s decisions kindled heated debate and precipitated a variety of governmental actions at the national, state and local levels designed either to...

Medicaid and Dental Care for Children

According to guidelines published by the American Academy of Pediatric Dentistry, all youth should see a dentist for routine dental screening and preventive care twice a year. Dental care is a mandatory benefit for most Medicaid eligibles under the age of 21, however, nationwide, the majority of low-income children enrolled in Medicaid do not receive any dental services in a given year. There are many beneficiary and provider-related issues that contribute to inadequate access to and delivery of dental care. To address this problem, some states have undertaken new Medicaid initiatives to...

FDA Advisory Committee Conflict of Interest

What Happens to SCHIP After March 31, 2009?

A report about the effects of the end of the State Children's Health Insurance Program (SCHIP).

Health Insurance Reform and the 110th Congress

The Department of Defense Role in Foreign Assistance: Background, Major Issues, and Options for Congress

The Department of Defense (DOD) has long played a role in U.S. efforts to assist foreign populations, militaries, and governments. The use of DOD to provide foreign assistance stems in general from the perception that DOD can contribute unique or vital capabilities and resources because it possesses the manpower, materiel, and organizational assets to respond to international needs. Over the years, Congress has helped shape the DOD role by providing DOD with its mandate for such activities through a wide variety of authorities.

The historical DOD role in foreign assistance can be regarded...

Converting Retirement Savings into Income: Annuities and Periodic Withdrawals

To a worker contemplating retirement, there is perhaps no more important question than "How long will my money last?" Congress has a strong interest in the income security of older Americans because much of their income is either provided directly from public programs like Social Security, or in the case of pensions and retirement accounts, is subsidized through tax deductions and deferrals. This report looks at strategies to help deal with the following risks: longevity, investment, inflation, and unexpected events.

Medicaid Financing

Mental Health Parity: An Overview

FDA FY2009 Appropriations

Food and Drug Administration (FDA) funding for the first five months of FY2009 is provided in the Continuing Appropriations Resolution, 2009 (the CR), which is Division A of the Consolidated Security, Disaster Assistance, and Continuing Appropriations Act, 2009 (P.L. 110-329). It allows most agencies to continue at the same rate of spending as set by the FY2008 appropriations. For FDA, the base includes the mid-year FY2008 supplemental. The CR carries through March 6, 2009. If Congress chooses to continue at that rate for the remainder of FY2009, FDA would receive $2.42 billion, 10.6%...

The 2008 Farm Bill: Major Provisions and Legislative Action

The Food, Conservation, and Energy Act of 2008 (P.L. 110-246, “2008 farm bill”) was enacted into law on June 18, 2008. It contains 15 titles covering support for commodity crops, horticulture and livestock production, conservation, nutrition, trade and food aid, agricultural research, farm credit, rural development, energy, forestry, and other related programs. It also includes provisions that make certain changes to tax laws, in order to offset some new spending initiatives in the final bill. The enacted bill succeeds the most recent 2002 farm bill (P.L. 107-171) and is to guide most...

Phthalates in Plastics and Possible Human Health Effects

Roughly a dozen chemicals known as phthalates are used to make the plastics found in thousands of consumer products, ranging from medical tubing to automotive dashboards to bath toys. These phthalates are not tightly held by the plastics and are released into the environment over time. Congress is concerned about possible human health effects from exposure to six of these chemicals: di-(2-ethylhexyl) phthalate (DEHP), dibutyl phthalate (DBP), benzyl butyl phthalate (BBP), diisononyl phthalate (DINP), diisodecyl phthalate (DIDP), and di-n-octyl phthalate (DnOP). DEHP, DBP, BBP, and (to less...

The Mental Health Parity Act: A Legislative History

Veterans Medical Care: FY2009 Appropriations

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility rules. Benefits to veterans range from disability compensation and pensions to hospital and medical care. The VA provides these benefits through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA). The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through the nation’s largest integrated health...

The Americans with Disabilities Act (ADA): Allocation of Scarce Medical Resources During a Pandemic

The emergence and rapid spread of a new avian influenza virus (H5N1) and its potential for causing a human influenza pandemic have given rise to numerous issues. One of these is the general lack of surge capacity within the U.S. health-care system. Essentially, this means that a severe influenza pandemic could lead to much greater demand for vaccines, antiviral medications, and other medical technology, such as ventilators, than there are supplies. This potential imbalance has led to recommendations for priorities for medical resources for certain categories of individuals, including...

Methamphetamine: Legislation and Issues in the 110th Congress

Food and Agricultural Imports from China

China is now the third largest source of U.S. agricultural and seafood imports. A series of incidents have raised public concerns about the safety of these products. In September 2008, U.S. authorities said they broadened their testing of milk-derived products from China, following reports that melamine-contaminated baby formula has sickened tens of thousands of Chinese children. They also announced a recall of some coffee products that may contain melamine.

Early in 2007, evidence emerged that adulterated pet food ingredients from China had caused the deaths of a large number of dogs and...

Medicare Part D Prescription Drug Benefit: A Primer

Animal Drug User Fee Programs

The Animal Drug User Fee Act of 2003 (ADUFA I, P.L. 108-130) gave the Food and Drug Administration (FDA) initial authority to collect user fees from sponsors for the review of animal drug applications. ADUFA mirrors fee programs for human drugs and medical devices. Program authority sunsets October 1, 2008, and FDA would have to lay off staff in its review program if the program were not reauthorized by then. ADUFA supporters—including companies that make brand-name animal drugs, and livestock producer groups—considered ADUFA reauthorization to be “must pass” legislation in the 110th...

Medicare: A Primer

Public Health and Medical Preparedness and Response: Issues in the 110th Congress

The 2001 terrorist attacks, Hurricane Katrina, and concerns about an influenza ("flu") pandemic have sharpened congressional interest in the nation's systems to track and respond to public health threats. The 109th Congress passed laws that reauthorized public health and medical preparedness and response programs in the Department of Health and Human Services (HHS), and reorganized parts of the Department of Homeland Security (DHS), including the establishment of an Office of Health Affairs (OHA). This report discusses key issues in public health and medical preparedness and response,...

Medicare: Payments to Physicians

Transitional Medical Assistance (TMA) Under Medicaid

This report provides an overview of transitional medical assistance (TMA). While Section 1925 of the Social Security Act outlines the provisions requiring states to provide TMA for up to 12 months, states have considerable flexibility in designing and implementing their TMA programs.

P.L. 110-275: The Medicare Improvements for Patients and Providers Act of 2008

P.L. 110-275, the Medicare Improvements for Patients and Providers Act (MIPPA), is designed to avert a statutory Medicare reduction in payments for physicians and make other changes. MIPPA freezes physician fees at the June 2008 level until January 2009. In January 2009, fees will increase by 1.1%. In 2010, the statutory reduction will again apply, resulting in a 21% reduction in Medicare physician fees, according to the Congressional Budget Office (CBO). CBO estimates that the physician payments provision costs $9.4 billion (over the 2008-2010 period). Other provisions in the Act will...

Abortion Services and Military Medical Facilities

In 1993, President Clinton modified the military policy on providing abortions at military medical facilities. Under the change directed by the President, military medical facilities were allowed to perform abortions if paid for entirely with non-Department of Defense (DOD) funds (i.e., privately funded). Over the last three decades, the availability of abortion services at military medical facilities has been subjected to numerous changes and interpretations.

Medicaid and the State Children’s Health Insurance Program (SCHIP): FY2009 Budget Issues

Each year, the President is required to submit a comprehensive federal budget proposal to Congress no later than the first Monday in February. The House and Senate Budget Committees then develop their respective budget resolutions. House and Senate Appropriations committees then reconcile their budget resolutions and file a joint budget agreement. Although not binding, the resolution provides a framework for consideration of the 12 separate appropriations bills that would fund FY2009 government operations.

The President’s FY2009 budget contained a number of proposals that would affect...

Food Safety Provisions of the 2008 Farm Bill

Food safety re-emerged as an issue in the 110th Congress following a series of widely publicized incidents—including adulterated Chinese seafood and pet food ingredient imports, findings of bacteria-tainted spinach, meat, and poultry produced domestically, and several large food recalls. In 2008, Congress approved a new omnibus farm law that includes, among other provisions, several changes affecting U.S. food safety programs. Changes in the livestock title (Title XI) include subjecting catfish to U.S. Department of Agriculture (USDA) mandatory inspections similar to those for red meat and...

The Prescription Drug User Fee Act: History Through the 2007 PDUFA IV Reauthorization

This report, last updated in June 2008, provides a history of the Prescription Drug User Fee Act through its third reauthorization—as PDUFA IV—in September 2007. As the 112th Congress turns to the law’s next reauthorization—PDUFA V, CRS has prepared another report that describes current law and the PDUFA V proposal (legislative language and the performance goals Agreement between FDA and industry representatives). It also explores the impact of PDUFA on FDA application review time and the agency’s Human Drugs Program budget, and issues that Congress is likely to discuss as it prepares for...

Mental Health Parity: Federal and State Action and Economic Impact

In the 110th Congress, the Senate and House have passed different versions of expanded mental health parity legislation (S. 558 and H.R. 1424). These bills have always been strongly supported by advocates for the mentally ill and have had broad, bipartisan support in Congress. Although employers and health insurance groups opposed the legislation in the past because of concern that it would drive up costs, the provisions in S. 558 now have their support. Expanded parity legislation was introduced in the 107th, 108th, and 109th Congresses, but each time it failed to pass.

Private health...

Child Welfare Issues in the 110th Congress

As the U.S. Constitution has been interpreted, states have the primary obligation to ensure child welfare. However, Congress provides significant federal funds to help states exercise this responsibility ($7.9 billion appropriated in FY2008). Most of this support is provided for children who are in foster care and who meet specific federal eligibility criteria. This report discusses the federal framework for child welfare policy; reviews the scope of activities, and children and families served, by state child welfare agencies; summarizes several child welfare-related hearings that were...

Government Spending on Health Care Benefits and Programs: A Data Brief

In a country where health spending accounts for more than 16% of gross domestic product (GDP), health care costs and spending are often described as a problem for consumers and their families; for employers that provide (or seek to provide) health benefits; and for government, which finances a mix of health care services, health research and training, and health safety programs. To describe government spending on health care benefits and programs, this report presents data from the Office of Management and Budget (OMB), the Congressional Budget Office (CBO), and the Centers for Medicare...

Federal Health Centers Program

This report provides an overview of the federal health center program including its statutory authority, program requirements, and appropriation levels. The report then describes health centers in general, where they are located, their patient population, and some outcomes associated with health center use. It also describes some federal programs available to assist health center operations as well as issues for Congress.

Presidential Appointments to Full-time Positions in Executive Departments During the 109th Congress, 2005-2006

During the 109th Congress, the President submitted to the Senate 283 nominations to executive department full-time positions. Of these 283 nominations, 233 were confirmed; nine were withdrawn; and 41 were returned to him in accordance with Senate rules. For those nominations that were confirmed, an average of 75 days elapsed between nomination and confirmation. The median number of days elapsed was 57. These statistics do not include the days during which the Senate was adjourned for its summer recesses and between sessions of Congress.

President George W. Bush made a total of 13 recess...

Medicare: FY2009 Budget Issues

Safe and Drug-Free Schools and Communities Act: Program Overview and Reauthorization Issues

This report provides information on the Safe and Drug-Free Schools and Communities Act (SDFSCA), the federal government's major initiative to prevent drug abuse and violence in and around schools, and its support for two major grant programs: one for states and one for National Activities. The report also discusses issues of reauthorization for the SDFSCA following the Virginia Tech tragedy, and issues of potential concern to Members of Congress. It includes the Administration's proposal, the recommendations of the Safe and Drug-Free Schools and Communities Act Advisory Board, the...

State Medicaid Program Administration: A Brief Overview

Suicide Prevention Among Veterans

Medicare Clinical Laboratories Competitive Bidding Demonstration

Does Price Transparency Improve Market Efficiency? Implications of Empirical Evidence in Other Markets for the Health Sector

Consumer advocates, proponents of wider use of market incentives in the health care sector, and some policy makers have called for greater price transparency. These measures might include posting prices in an accessible form or regulations constraining price discrimination (different prices charged to different customers). Price transparency implies that consumers can obtain price information easily, so they can usefully compare costs of different choices. Price transparency may also mean consumers understand how prices are set and are aware of price discrimination. In health care markets...

Genetic Discrimination: Overview of the Issue and Proposed Legislation

A key policy issue before Congress is whether the potential for genetic discrimination by employers and insurers merits protections for genetic information that are more extensive than those already in place for health information. For the stated purpose of prohibiting discrimination on the basis of genetic information with respect to health insurance and employment, the Genetic Information Nondiscrimination Act of 2007 (H.R. 493) was introduced in the House on January 16, 2007 and was passed by the House on April 25, 2007. On January 22, 2007, the act was introduced in the Senate (S. 358)...

AIDS Funding for Federal Government Programs: FY1981-FY2009

Federal government spending on HIV (the human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome) is estimated at $23.3 billion in FY2008. Of the total, 63% is for treatment programs; research programs receive 13%; prevention programs receive 14%, and income support programs receive 10%. The Administration’s government-wide request level for all HIV/AIDS programs in FY2009 is $24.1 billion.

AIDS programs within the Department of Health and Human Services (HHS) account for 66% of the total amount spent on HIV/AIDS by the federal government in FY2008, a total of $15.2...

Standardizing State Health Insurance Regulation

H.R. 4460, the Health Care Choice Act, is intended to “harmonize” the state insurance laws that multi-state insurance carriers and other providers of individual health coverage would be subject to. By harmonizing insurance laws across state lines, the bill’s supporters anticipate an increase in the number of health plan choices and a reduction of the cost of plans. Opponents raise concerns that the consequences of reducing states’ regulatory authority over insurance products in each state could include a loss of important patient protections and complicate the enforcement of rules designed...

Public Health Service (PHS) Agencies: Background and Funding

Genetic Ancestry Testing

Homeland Security Department: FY2008 Appropriations

This report describes the FY2008 appropriations for the Department of Homeland Security (DHS). The Administration requested a net appropriation of $35.5 billion in net budget authority for FY2008. The requested net appropriation for major components of the department included the following: $8,783 million for Customs and Border Protection (CBP); $4,168 million for Immigration and Customs Enforcement (ICE); $3,608 million for the Transportation Security Administration (TSA); $8,457 million for the U.S. Coast Guard; $1,399 million for the Secret Service; $1,047 for the National Protection...

P.L. 110-173: Provisions in the Medicare, Medicaid, and SCHIP Extension Act of 2007

On December 29, 2007, the President signed S. 2499, the Medicare, Medicaid, and SCHIP Extension Act of 2007 (P.L. 110-173). This Act was passed by the House on December 19, 2007, and by a voice vote in the Senate on December 18, 2007. The Act makes changes to the nation’s three major health programs, Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP), as well as other federally funded programs.

The most prominent provisions in the Act were to (1) suspend the Medicare physician payment cut scheduled to take effect and (2) provide SCHIP funding through March 2009....

Title VII Health Professions Education and Training: Issues in Reauthorization

In 1963, responding to projections of an impending physician shortage, Congress passed the Health Professions Educational Assistance Act (P.L. 88-129). This act was the first comprehensive legislation to address the supply of health care providers. Relevant programs, authorized in Title VII of the Public Health Service Act (PHSA), have evolved in subsequent reauthorizations, to provide grants to institutions for primary care curriculum and faculty development, scholarships and loans to individuals training in certain health professions, and other programs. Title VII programs are...

Prescription Drug Coverage Under Medicaid

Medicaid is a joint federal-state entitlement program that pays for medical services on behalf of certain groups of low-income persons. It is the third largest social program in the federal budget, exceeded only by Social Security and Medicare and is typically the second largest spending item for states. This report discusses prescription drug policies under the program.

Food Safety: Provisions in the Food and Drug Administration Amendments Act of 2007

This report reviews the food safety provisions of the statute of the Food and Drug Administration Amendments Act of 2007, their history, and certain issues surrounding their passage.

Obesity Among Older Americans

Interior, Environment, and Related Agencies: FY2008 Appropriations

The Interior, Environment, and Related Agencies appropriations bill includes funding for the Department of the Interior (DOI), except for the Bureau of Reclamation, and for two agencies within other departments—the Forest Service within the Department of Agriculture and the Indian Health Service (IHS) within the Department of Health and Human Services. It also includes funding for arts and cultural agencies, the Environmental Protection Agency, and numerous other entities.

The Consolidated Appropriations Act for FY2008 (P.L. 110-161) included $26.89 billion for Interior, Environment, and...

Alcohol Use Among Youth

The Food and Drug Administration: Budget and Statutory History, FY1980-FY2007

Considerable attention has been focused on the ability of the Food and Drug Administration (FDA) to accomplish its mission with the funds provided by congressional appropriations and user fees. FDA regulates a wide range of products valued at more than $1 trillion in the U.S. economy. The agency plays a key public health role. FDA is responsible for the safety of most foods (human and animal) and cosmetics, and it regulates both the safety and the effectiveness of human drugs, biologics (e.g., vaccines), medical devices, and animal drugs.

In congressional hearing testimony and at other...

Veterans’ Medical Care: FY2008 Appropriations

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility rules. Benefits to veterans range from disability compensation and pensions to hospital and medical care. The VA provides these benefits through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA). The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through the nation’s largest integrated...

FY2008 Federal SCHIP Financing

Food Safety: Selected Issues and Bills in the 110th Congress

A series of widely publicized incidents—from adulterated Chinese seafood imports to bacteria-tainted spinach, meat, and poultry produced domestically—have made food safety an issue in the 110th Congress. Numerous proposals were introduced in 2007 that would alter aspects of the current U.S. food safety system; some of these bills could receive consideration in 2008. This report provides an overview of the current system, highlights major issues in the debate to improve it, and describes the bills.

Reorganization of Food Safety Responsibilities. Critics believe that the current system is...

Veterans’ Health Care Issues

The Department of Veterans Affairs (VA) provides services and benefits to veterans who meet certain eligibility criteria. VA carries out its programs nationwide through three administrations and the Board of Veterans Appeals (BVA). The Veterans Health Administration (VHA) is responsible for veterans’ health care programs. The Veterans Benefits Administration (VBA) is responsible for providing compensation, pensions, and education assistance, among other things. The National Cemetery Administration’s (NCA) responsibilities include maintaining national veterans cemeteries.

VHA operates the...

Medicare: FY2008 Budget Issues

Anti-Doping Policies: The Olympics and Selected Professional Sports

Comparative Clinical Effectiveness and Cost-Effectiveness Research: Background, History, and Overview

Comparative clinical effectiveness research has been discussed as a source of information for health care decision makers that may aid them in reaching evidence-based decisions. The premise that “what is newest is not always the best” is the core of the rationale behind comparative effectiveness research. Diverse governmental and non-governmental organizations have publicly expressed their support and reservations about comparative effectiveness research. Many bills have been introduced in the 110th Congress that support comparative effectiveness research, including S. 3, H.R. 2184, H.R....

ERISA Regulation of Health Plans: Fact Sheet

Medicare: Supplementary "Medigap" Coverage

Medicare is a nationwide health insurance program for the aged and certain disabled persons. Although the program provides broad protection against the costs of many, primarily acute care, services, it covers only about one-half of beneficiaries' total health care expenses. Most individuals have some coverage in addition to basic Medicare benefits. Some persons have additional benefits through a managed care plan. Most other individuals have some supplementary coverage through private insurers or public programs such as Medicaid. Private supplementary coverage can be obtained through an...

Health Care Spending: Context and Policy

The Military Commissions Act of 2006: Analysis of Procedural Rules and Comparison with Previous DOD Rules and the Uniform Code of Military Justice

On November 13, 2001, President Bush issued a Military Order (M.O.) pertaining to the detention, treatment, and trial of certain non-citizens in the war against terrorism. Military commissions pursuant to the M.O. began in November 2004 against four persons declared eligible for trial, but proceedings were suspended after a federal district court found that one of the defendants could not be tried under the rules established by the Department of Defense (DOD). The D.C. Circuit Court of Appeals reversed that decision in Rumsfeld v. Hamdan, but the Supreme Court granted review and reversed...

Medicare: Physician Self-Referral (“Stark I and II”)

Health Insurance Basics: Roles for the Market and Government in Providing, Financing, and Regulating Private Insurance Coverage

Both the market and government have important roles in ensuring the availability, affordability, and adequacy of private health insurance. These roles complement one another, but even together the market and government have limitations.

The market provides a variety of insurance products for consumers and employers with different needs and preferences. These products differ on many dimensions, including the breadth of provider networks, amount of beneficiary cost-sharing, and techniques for managing the use of health care services. Large employers, small employers, and individuals have...

FDA Legislation in the 110th Congress: A Guide to S. 1082 and H.R. 2900

Both the House and the Senate have passed comprehensive legislation to reauthorize existing Food and Drug Administration (FDA) programs and expand the agency’s authority to ensure the safety of prescription drugs, medical devices, and biologics. The Senate passed the Food and Drug Administration Revitalization Act (S. 1082) on May 9, 2007. The House passed the Food and Drug Administration Amendments Act of 2007 (H.R. 2900) on July 11, 2007.

At its core, the legislation renews authority for two key user fee programs that are set to expire on October 1, 2007: the Prescription Drug User Fee...

FDA Legislation in the 110th Congress: A Side-by-Side Comparison of S. 1082 and H.R. 2900

Both the House and the Senate have passed comprehensive legislation to reauthorize existing Food and Drug Administration (FDA) programs and expand the agency’s authority to ensure the safety of prescription drugs, medical devices, and biologics. The Senate passed the Food and Drug Administration Revitalization Act (S. 1082) on May 9, 2007. The House passed the Food and Drug Administration Amendments Act of 2007 (H.R. 2900) on July 11, 2007.

At its core, the legislation renews authority for two key user fee programs that are set to expire on October 1, 2007: the Prescription Drug User Fee...

Medicaid Disproportionate Share Payments

Clinical Trials Reporting and Publication

Patents and Drug Importation

Prescription drugs often cost far more in the United States than in other countries. Some consumers have attempted to import medications from abroad in order to realize cost savings. The practice of importing prescription drugs outside the distribution channels established by the brand-name drug company is commonly termed “parallel importation.” Parallel imports are authentic products that are legitimately distributed abroad and then sold to consumers in the United States, without the permission of the authorized U.S. dealer.

Parallel importation may raise significant intellectual property...

Data Security Breaches: Context and Incident Summaries

Personal data security breaches are being reported with increasing regularity. Within the past few years, numerous examples of data such as Social Security, bank account, credit card, and driver’s license numbers, as well as medical and student records have been compromised. A major reason for the increased awareness of these security breaches is a California law that requires notice of security breaches to the affected individuals. This law, implemented in July 2003, was the first of its kind in the nation.

State data security breach notification laws require companies and other entities...

Federal Drug Price Negotiation: Implications for Medicare Part D

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) established a prescription drug benefit for Medicare beneficiaries under Part D, which began on January 1, 2006. One provision of MMA, the “noninterference” clause, expressly forbids the Secretary of Health and Human Services (HHS) from interfering with drug price negotiation between manufacturers and Medicare drug plan sponsors, and from instituting a formulary or price structure for prescription drugs. The framework created by the law emphasizes competition among the Medicare drug plans to obtain price...

Pharmaceutical Costs: A Comparison of Department of Veterans Affairs (VA), Medicaid, and Medicare Policies

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (P.L. 108-173) addressed seniors’ rising out-of-pocket costs of prescription drugs by providing a mechanism for beneficiaries to obtain affordable prescription drug insurance coverage. The Medicare prescription drug benefit, otherwise known as Part D, was designed to take advantage of market competition. In accordance with market competition principles, the drug plans that administer the drug benefit are corporations who may rely on rebate negotiation and price-volume discounts as a way to affect prices.

A...

Alcohol Use Among Youth

Alcohol use by persons under age 21 has been identified as a major public health problem. Studies note that it increases the risks for disability, and may be detrimental to the developing brain. Minors who drink are more likely to commit suicide, break the law, or be victims of violence. Alcohol is implicated in nearly one-third of youth traffic fatalities. The total annual cost of underage drinking is estimated at $62 billion. While most laws intended to prevent underage drinking are passed at the state level, there has been legislative activity and interest at the federal level to...

H.R. 1 (Implementing the 9/11 Commission Recommendations Act of 2007) and S. 4 (Improving America’s Security Act of 2007): A Comparative Analysis

This comparative analysis of H.R. 1 (Implementing the 9/11 Commission Recommendations Act of 2007) and S. 4 (Improving America’s Security Act of 2007) is an assessment of major similarities and differences between the two bills as passed by the House (January 9, 2007) and Senate (March 13, 2007) and under conference consideration.

References to the two bills are to engrossed versions. The presentation is organized to follow the basic construct of the House bill because its coverage remained more stable through the legislative process and as the analyses began. Titles unique to S. 4 follow...

Labor, Health and Human Services, and Education: FY2007 Appropriations

This report tracks FY2007 appropriations for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (L-HHS-ED). This legislation provides discretionary funds for three major federal departments and 14 related agencies. The report, which will be updated, summarizes L-HHS-ED discretionary funding issues but not authorization or entitlement issues.

On February 6, 2006, the President submitted the FY2007 budget request to Congress, including $138.3 billion in discretionary L-HHS-ED funds; the comparable FY2006 amount was $147.3 billion, enacted primarily...

Medicare Prescription Drug Benefit: Low-Income Provisions

Drug Safety: A Side-by-Side Comparison of Bills in the 110th Congress

Members of Congress and the public are increasingly concerned about the ability of the Food and Drug Administration (FDA) to ensure that the drugs sold in the United States are safe and effective. In November 2004, FDA asked the Institute of Medicine (IOM) to assess the current system for evaluating and ensuring drug safety and to make recommendations to improve risk assessment, surveillance, and the safe use of drugs. IOM released The Future of Drug Safety: Promoting and Protecting the Health of the Public in September 2006, and FDA issued its response in January 2007. The following drug...

SCHIP Original Allotments: Description and Analysis

Health Care and Markets

Health care spending is one of the most rapidly growing portions of the federal budget. Projections suggest if the rapid growth in health care costs is not curtailed, governments at all levels will face an uncomfortable choice between significant cuts in other spending priorities or major tax increases. This report examines the economic justification for government intervention and involvement in health care markets.

Many analysts claim market-oriented policies, in certain instances, could lower costs and enhance efficiency in health care. This report discusses the Invisible Hand Theorem,...

Interior, Environment, and Related Agencies: FY2007 Appropriations

The FY2007 Interior, Environment, and Related Agencies appropriations bill includes funding for the Department of the Interior (DOI), except for the Bureau of Reclamation, and for two agencies within other departments—the Forest Service within the Department of Agriculture and the Indian Health Service within the Department of Health and Human Services. It also includes funding for arts and cultural agencies; the Environmental Protection Agency, which was recently transferred to the appropriations subcommittees that deal with Interior and Related Agencies; and numerous other entities and...

Child Welfare: Enactment of the Child and Family Services Improvement Act of 2006 (P.L. 109-288)

The Child and Family Services Improvement Act of 2006 was enacted on September 25, 2006 (P.L. 109-288). As enacted it extends the funding authorization of the Promoting Safe and Stable Families (PSSF) program for five years (FY2007-FY2011) and annually targets the use of $40 million in new funds for the program for two purposes: to support monthly caseworker visits and to improve outcomes for children affected by their parent/caretaker’s abuse of methamphetamine or another substance. As under prior law, states must spend the majority of PSSF funds on four broad categories of child and...

Veterans’ Medical Care: FY2007 Appropriations

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility rules. Benefits to veterans range from disability compensation and pensions to hospital and medical care. VA provides these benefits to veterans through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA). VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through an integrated health care...

Pandemic Influenza: Domestic Preparedness Efforts

In 1997, a new avian influenza (“flu”) virus emerged in Asia and jumped directly from birds to humans, killing six people. The virus has since spread to more than 50 countries in Asia, Europe and Africa, where it has killed millions of birds and infected more than 270 people, killing more than 160 of them. The virus bears some similarity to the deadly 1918 Spanish flu, which caused a global pandemic estimated to have killed more than 50 million people worldwide. The current spread of avian flu raises concerns about another human flu pandemic.

Global pandemic preparedness and response...

The Safe and Drug-Free Schools and Communities Act: Reauthorization and Appropriations

The No Child Left Behind Act (P.L. 107-110) amended and reauthorized through FY2007 the Safe and Drug-Free Schools and Communities Act (SDFSCA) within the Elementary and Secondary Education Act (ESEA) as Part A of Title IV, 21st Century Schools. The act is likely to be considered for reauthorization by the 110th Congress. Funds are authorized for the SDFSC program, which is the federal government’s primary initiative to prevent drug abuse and violence in and around schools. Through the program, state educational agencies, local educational agencies, and outlying areas are awarded grants by...

Importing Prescription Drugs: Objectives, Options, and Outlook

Can purchases from abroad lower the cost of prescription drugs to U.S. consumers? Current law allows pharmacists and wholesalers to import prescription drugs from Canada commercially, and codifies the Food and Drug Administration’s (FDA) current practice of allowing imports of prescription drugs by individuals under certain defined circumstances. There is, however, one proviso. The Secretary of Health and Human Services (HHS) must first certify that the drugs to be imported under the program would “pose no additional risk to the public’s health and safety; and result in a significant...

Drug Safety and Effectiveness: Issues and Action Options After FDA Approval

COX-2 inhibitors and SSRIs—the U.S. public has become more familiar with these technical abbreviations for biochemical processes than one might expect from our general level of science knowledge. Safety concerns about these drugs—used primarily to treat pain and depression—have turned a spotlight on the Food and Drug Administration (FDA) and its approach to protecting the public from drug risks that had not been identified before FDA-approval allowed the drugs on the market.

Two regulatory frameworks exist for the review of prescription drugs. First, in the premarket approval process, FDA...

The Safe and Drug-Free Schools and Communities Program: Background and Context

The No Child Left Behind Act (P.L. 107-110), amended and reauthorized the Safe and Drug-Free Schools and Communities Act (SDFSCA) as Part A of Title IV—21st Century Schools. The act is up for reauthorization in the 110th Congress. The Department of Education (ED) administers SDFSCA through the SDFSC program, which is the federal government’s major initiative to prevent drug abuse and violence in and around schools. State grants are awarded by formula to outlying areas, state educational agencies, and local educational agencies in all 50 states, the District of Columbia and the Commonwealth...

Integrating Medicare and Medicaid Services Through Managed Care

Presidential Appointments to Full-time Positions in Executive Departments During the 108th Congress, 2003-2004

During the 108th Congress, the President submitted to the Senate 166 nominations to executive department full-time positions. Of these 166 nominations, 120 were confirmed; eight were withdrawn; one was returned to the President at the end of the first session; and 37 were returned to him at the end of the second session of the 108th Congress. For those nominations that were confirmed, an average of 98 days elapsed between the time of the nomination and the nomination’s receipt and confirmation. The median number of days elapsed was 83. These statistics do not include the days during which...

Pharmaceutical Costs: An International Comparison of Government Policies

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (P.L. 108-173) addressed the rising costs of prescription drugs for the elderly by providing a mechanism for beneficiaries to obtain affordable prescription drug insurance coverage. The Medicare prescription drug benefit, otherwise known as Part D, was designed to take advantage of market competition. In accordance with market competition principles, the drug plans that administer the drug benefit are private and public corporations (i.e., non-government) that may rely on price negotiating, rebate negotiation,...

U.S. and International Responses to the Global Spread of Avian Flu: Issues for Congress

Influenza A/H5N1 is one of many influenza (flu) strains currently spreading throughout the world. Although it is a bird flu, it has infected some people and killed more than half of those infected. Since 1997, when the first human contracted H5N1 in Hong Kong, the virus has resurfaced and spread to more than 50 countries across Asia, Europe, the Middle East, and Africa—infecting more than 260 people and killing more than 150 of those infected. In February 2006, the virus spread from Asia and central Europe to western Europe. By March 2006, health experts had confirmed new bird flu cases in...

Agriculture and Related Agencies: FY2007 Appropriations

The Agriculture and Related Agencies appropriations bill includes all of USDA (except the Forest Service), plus the Food and Drug Administration and the Commodity Futures Trading Commission. The full House passed the FY2007 agriculture appropriations bill on May 23, 2006 (H.R. 5384, H.Rept. 109-463). On June 22, 2006, the Senate Appropriations Committee reported its version (H.R. 5384, S.Rept. 109-266). The full Senate took up the bill on December 5, 2006, but only to consider a crop disaster amendment, which was defeated. Because a final bill has not been enacted, a continuing resolution...

The Older Americans Act: Programs, Funding, and 2006 Reauthorization (P.L. 109-365)

The Older Americans Act (OAA) is the major vehicle for the delivery of social and nutrition services for older persons. Originally enacted in 1965, the act supports a wide range of social services and programs for older persons. Authorization of appropriations expired at the end of FY2005. The Older Americans Act Amendments of 2006 (P.L. 109-365) reauthorized all programs under the act through FY2011.

The major program under the act, Title III—Grants for State and Community Programs on Aging—authorizes grants to 56 state and 655 area agencies on aging to act as advocates on behalf of, and...

Pay-for-Performance in Health Care

Gulf Coast Hurricanes: Addressing Survivors’ Mental Health and Substance Abuse Treatment Needs

Major disasters such as Hurricanes Katrina, Rita, and Wilma, which struck Gulf Coast states in 2005, have the potential not only to cause mental health problems for individuals, but also to weaken or disable the systems designed to address those individuals’ needs. Striking an appropriate balance of responsiveness, fiscal responsibility, and accountability in the provision of federal assistance programs during and following a disaster remains a difficult goal.

Federal leadership for mental health and substance abuse programs resides in the Substance Abuse and Mental Health Services...

Prison Litigation Reform Act in the Supreme Court’s 2006 Term

When prisoners sue in federal court to challenge the conditions of their confinement, the Prison Litigation Reform Act (PLRA) requires that they first exhaust their available administrative remedies by pursuing to completion the prison’s internal complaint process before moving forward with their civil rights lawsuits. The Court will decide in three consolidated cases, Jones v. Bock (05-7058), Walton v. Bouchard, and Williams v. Overton (05-7142), whether the PLRA’s exhaustion requirement insists that prisoners complete the administrative review process in accordance with applicable...

Homeland Security Department: FY2007 Appropriations

The annual consideration of appropriations bills (regular, continuing, and supplemental) by Congress is part of a complex set of budget processes that also encompasses the consideration of budget resolutions, revenue and debt-limit legislation, other spending measures, and reconciliation bills. In addition, the operation of programs and the spending of appropriated funds are subject to constraints established in authorizing statutes. Congressional action on the budget for a fiscal year usually begins following the submission of the President’s budget at the beginning of each annual session...

Medicaid Managed Care: An Overview and Key Issues for Congress

In terms of federal spending, Medicaid is one of the largest major domestic entitlement programs in the U.S. today. During the 1980s and 1990s, steadily rising Medicaid costs were attributed to the economic incentive to provide more care under the traditional, widespread fee-for-service (FFS) delivery system in which provider payments are made for each unit of service delivered. During that time, following the lead in the employer health insurance market, many states began to turn to managed care for their Medicaid programs. The goal, then and today, is both to rein in Medicaid costs by...

Veterans’ Health Care Issues in the 109th Congress

The Department of Veterans Affairs (VA) provides services and benefits to veterans who meet certain eligibility criteria. VA carries out its programs nationwide through three administrations and the Board of Veterans Appeals (BVA). The Veterans Health Administration (VHA) is responsible for veterans health care programs. The Veterans Benefits Administration (VBA) is responsible for providing compensation, pensions, and education assistance among other things. The National Cemetery Administration’s (NCA) responsibilities include maintaining national veterans cemeteries.

VHA operates the...

Child Welfare: Foster Care and Adoption Assistance Provisions in the Deficit Reduction Act of 2005 (P.L. 109-171)

On February 8, 2006, President Bush signed the Deficit Reduction Act of 2005 into law (P.L. 109-171). As enacted, the Deficit Reduction Act includes two child welfare provisions intended to reduce federal foster care spending under Title IV-E of the Social Security Act. Those provisions, sometimes called the Rosales provision and candidates provision, respectively, would 1) clarify individual eligibility for federal foster care and adoption assistance programs (Title IV-E of the Social Security Act); and 2) limit certain kinds of state claims for federal reimbursement of administrative...

The Information Quality Act: OMB’s Guidance and Initial Implementation

Long-Term Care: Consumer-Directed Services Under Medicaid

Federal Counter-Terrorism Training: Issues for Congressional Oversight

Federal counter-terrorism training programs are varied and are provided by numerous federal agencies and departments. Some of these departments and agencies include the Departments of Defense (DOD), Energy (DOE), Homeland Security (DHS), Health and Human Services (HHS), Justice (DOJ), Transportation (DOT), and the Environmental Protection Agency (EPA). Each department and agency provides specific counter-terrorism training targeted to given categories of recipients. Training recipients include federal, state, and local government personnel, emergency responders, and private and public...

Medical Malpractice: The Role of Patient Safety Initiatives

Medical malpractice and malpractice insurance continue to be issues of great concern to physicians, consumers, legislators, and others. Most of the discussion about rising malpractice insurance premiums has centered on limiting the damage awards in malpractice suits, though some attention also has been given to insurance reforms. A third, related area that has received less consideration in malpractice discussions is patient safety. Patient safety refers to the panoply of rules, practices, and systems related to the prevention of medical injury. Intrinsic to patient safety efforts...

Charitable Choice Rules and Faith-Based Organizations

President Bush's Administration has advanced a "Charitable Choice" agenda aimed at expanding the ability of faith-based organizations to provide federally funded social services and encouraging states to do likewise. Charitable Choice rules are intended to ensure that faith-based organizations participate more fully in federally funded social service programs and offer services without abandoning their religious character or infringing on the religious freedom of applicant/recipients. They deal with issues such as faith-based organizations' ability to remain independent of governmental...

Welfare Reform: Diversion as an Alternative to TANF Benefits

One strategy that states are using to reduce the need for ongoing welfare is referred to as “diversion.” Diversion is typically considered to be a payment, program, or activity that is intended to divert applicants for Temporary Assistance for Needy Families (TANF) benefits from completing the application process and thereby becoming potentially eligible for monthly TANF assistance. Welfare diversion comes in a variety of forms, such as lump sum payments, vendor payments, supportive services, and resource referral. In addition, applicant job search is used by some states as a diversion...

Public Health Service Operating Agencies

Military Medical Care Services: Questions and Answers

Medicaid Issues for the 109th Congress

Medicaid is jointly financed by the federal and state governments, but each state designs and administers its own state program under broad federal guidelines. Accordingly, state variation in eligibility, covered services, and the delivery of, and reimbursement for, services is the rule rather than the exception. How is Congress to respond to the numerous proposals to move Medicaid forward into the near and long term? This report lays out some of these issues, explains the factors underlying them, and provides links to CRS products that can help Members of Congress and their staff prepare...

Cash and Noncash Benefits for Persons with Limited Income: Eligibility Rules, Recipient and Expenditure Data, FY2002-FY2004

More than 80 benefit programs provide aid—in cash and noncash form—that is directed primarily to persons with limited or low income. Such programs constitute the public “welfare” system, if welfare is defined as income-tested or need-based benefits. This definition omits social insurance programs like Social Security and Medicare.

Income-tested benefit programs in FY2004 cost approximately $583 billion: $427 billion in federal funds and $156 billion in state-local funds (Table 1). Spending on these programs represented 18.6% of all federal spending, with medical aid accounting for 9% of...

Proprietary Rights in Pharmaceutical Innovation: Issues at the Intersection of Patents and Marketing Exclusivities

In combination, patents and marketing exclusivities provide the fundamental framework of intellectual property incentives for pharmaceutical innovation in the United States. Patents, which are administered by the United States Patent and Trademark Office (USPTO), provide their owner with the ability to exclude others from practicing the claimed invention for a limited time. In contrast, marketing exclusivities are administered by the Food and Drug Administration (FDA). Alternatively known as “data exclusivity” or “data protection,” a marketing exclusivity prevents generic competitors from...

Labor, Health and Human Services, and Education: FY2006 Appropriations

This report tracks FY2006 appropriations for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (L-HHS-ED). This legislation provides discretionary funds for three major federal departments and 14 related agencies. The report, which will be updated, summarizes L-HHS-ED discretionary funding issues but not authorization or entitlement issues.

On February 7, 2005, the President submitted the FY2006 budget request to Congress, including $141.7 billion in discretionary L-HHS-ED funds; the comparable FY2005 appropriation was $143.5 billion, enacted...

Abortion: Legislative Response

Interior, Environment, and Related Agencies: FY2006 Appropriations

The FY2006 Interior, Environment, and Related Agencies appropriations bill includes funding for the Department of the Interior (DOI), except for the Bureau of Reclamation, and for two agencies within other departments—the Forest Service within the Department of Agriculture and the Indian Health Service within the Department of Health and Human Services. It also includes funding for arts and cultural agencies; the Environmental Protection Agency, which was newly-transferred to the Appropriations subcommittees that deal with Interior and Related Agencies; and numerous other entities and...

Agriculture and Related Agencies: FY2006 Appropriations

The President signed the FY2006 Agriculture Appropriations Act (P.L. 109-97, H.R. 2744) into law on November 10, 2005. The act includes all of the U.S. Department of Agriculture (except the Forest Service), plus the Food and Drug Administration, and the Commodity Futures Trading Commission. The $100.1 billion law is $15.0 billion (+18%) above FY2005 levels, and contains $17.03 billion in discretionary spending and $83.07 billion for mandatory programs. The discretionary amount is $199 million (+1.2%) above FY2005 levels, $201 million (+1.2%) more than the House bill, and $317 million...

Homeland Security Department: FY2006 Appropriations

This report describes the FY2006 appropriations for the Department of Homeland Security (DHS). The Administration requested a net appropriation of $30.6 billion in net budget authority for FY2006, of which $29.6 billion is discretionary budget authority, and $1 billion is mandatory budget authority. P.L. 109-90 was signed into law on October 18, 2005, and provides a net appropriation of $31.9 billion for DHS and $30.8 billion in discretionary budget authority.

The President’s request for appropriations includes the following break out of net budget authority for the four Titles of the DHS...

2005 Gulf Coast Hurricanes: The Public Health and Medical Response

Hurricane Katrina struck the Gulf Coast in late August 2005, causing catastrophic wind damage and flooding in several states, and a massive dislocation of victims across the country. The storm was one of the worst natural disasters in the nation's history. Estimates are that more than 1,200 people were killed and about 2 million displaced. Hurricane Rita, which made landfall along the Gulf Coast in late September 2005, was ultimately less lethal than Katrina, but prompted aggressive preparedness efforts by governments and citizens shaken by the devastation of the earlier storm. In...

Military Health Care: The Issue of "Promised" Benefits

Many military health care beneficiaries, particularly military retirees, their dependents, and those representing their interests, state that they were promised "free health care for life at military facilities" as part of their "contractual agreement" when they entered the armed forces. Efforts to locate authoritative documentation of such promises have not been successful. Congressional report language and recent court decisions have rejected retiree claims seeking 'free care at military facilities' as a right or entitlement. These have stated that the medical benefit structure made up...

Veterans' Medical Care: FY2006 Appropriations

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility rules. Benefits to veterans range from disability compensation and pensions to hospital and medical care. VA provides these benefits to veterans through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA) and the National Cemetery Administration (NCA). VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through an integrated health care system. ...

Stem Cell Research

How Medicaid Works: Program Basics

Hurricane Katrina: Medicaid Issues

Medicaid is jointly financed by the federal and state governments, but each state designs and administers its own version of the program under broad federal guidelines. The complexity of Medicaid can present an enormous challenge in meeting the needs of Hurricane Katrina's victims, especially when evacuees cross state lines. State variation in eligibility, covered services, and the reimbursement and delivery of services is the rule rather than the exception. Furthermore, although Medicaid is targeted at individuals with low income, not all of the poor are eligible, and not all...

U.S. Supreme Court Nominee Samuel A. Alito and the Abortion Opinions of the U.S. Court of Appeals for the Third Circuit

On October 31, 2005, Judge Samuel A. Alito was nominated by President George W. Bush to replace retiring Associate Justice Sandra Day O’Connor. During his tenure with the U.S. Circuit Court of Appeals for the Third Circuit, the court considered a number of abortion cases, including Planned Parenthood of Southeastern Pennsylvania v. Casey , a case that was later heard by the U.S. Supreme Court. This report reviews the Third Circuit’s notable abortion opinions during Judge Alito’s tenure and examines his concurring and dissenting opinions in some of those cases.

California's San Joaquin Valley: A Region in Transition

CRS was requested to undertake a study of the San Joaquin Valley (SJV) and a comparison with another U.S. region. The eight-county San Joaquin Valley, part of California's Central Valley, is home to 5 of the 10 most agriculturally productive counties in the United States. By a wide range of indicators, the SJV is also one of the most economically depressed regions of the United States. This report analyzes the SJV's counties and statistically documents the basis of current socioeconomic conditions. The report further explores the extent to which the SJV shares similarities with and...

AIDS Orphans and Vulnerable Children (OVC): Problems, Responses, and Issues for Congress

Since HIV/AIDS was discovered in 1981, more than 20 million people have lost their lives to the virus. According to the Joint United Nations Program on HIV/AIDS (UNAIDS), nearly 40 million are currently living with HIV/AIDS, including nearly 2.2 million children under the age of 15. In 2004, 4.9 million people acquired the virus, and 3.1 million died from AIDS. Sub-Saharan Africa remains the most affected region with 25.4 million people living with HIV/AIDS at the end of 2004, 1.9 million of whom were children under the age of 15. The United States Agency for International Development...

The Safe and Drug-Free Schools and Communities Act: Reauthorization and Appropriations

This report discusses the approved reauthorization legislation to extend and amend the Elementary and Secondary Education Act (ESEA) and the Safe and Drug-Free Schools and Communities Act (SDFSCA).

AIDS: The Ryan White CARE Act

S. 147/H.R. 309: Process for Federal Recognition of a Native Hawaiian Governmental Entity

S. 147 / H.R. 309 , companion bills introduced in the 109th Congress, represent an effort to accord to Native Hawaiians a means of forming a governmental entity that could enter into government-to-government relations with the United States. This entity would be empowered to negotiate with the State of Hawaii and with the federal government regarding the transfer of land and the exercise of governmental power and jurisdiction. There was similar legislation in the 106th, 107th, and 108th Congresses; the House passed a Native Hawaiian recognition bill, H.R. 4904 , in the 106th Congress....

Safe Harbor for Preclinical Use of Patented Inventions in Drug Research and Development: Merck KGaA v. Integra Lifesciences I, Ltd.

In Merck KGaA v. Integra Lifesciences I, Ltd., __ U.S. __, 125 S. Ct. 2372 (2005), the United States Supreme Court unanimously held that the preclinical use of patented inventions in drug research is exempted from patent infringement claims by the “safe harbor” provision of the Patent Act, 35 U.S.C. § 271(e)(1). (Merck KGaA is a German company unaffiliated with the U.S.-based pharmaceutical company Merck & Co.) This decision potentially may help expedite the development of new medical treatments and lower the cost of some drugs for consumers.

In 2003, the U.S. Court of Appeals for the...

Hurricanes Katrina

Medicaid Eligibility for Adults and Children

Foreign Relations Authorization, FY2006 and FY2007: An Overview

The foreign relations authorization process dovetails with the annual appropriation process for the Department of State, foreign policy, and foreign assistance. Congress is required by law to authorize the spending of appropriations for the State Department and foreign policy activities every two years. The last time Congress passed a stand-alone foreign relations authorization bill was in FY2003 ( P.L. 107-228 ). Foreign assistance authorization measures (such as authorization for the U.S. Agency for International Development, economic and military assistance to foreign countries,...

Agriculture: A Glossary of Terms, Programs, and Laws, 2005 Edition

The complexities of federal farm and food programs have generated a unique vocabulary. Common understanding of these terms (new and old) is important to those involved in policymaking in this area. For this reason, the House Agriculture Committee requested that CRS prepare a glossary of agriculture and related terms (e.g., food programs, conservation, forestry, environmental protection, etc.). Besides defining terms and phrases with specialized meanings for agriculture, the glossary also identifies acronyms, abbreviations, agencies, programs, and laws related to agriculture that are of...

Vaccine Policy Issues

This report’s focus is on vaccination, one of the most cost-effective methods available to prevent infectious diseases. Whether a vaccine’s target is naturally occurring or present because of hostile intent, the issues policy makers must deal with include vaccine development, production, availability, safety, effectiveness, and access. Vaccines are biologics: their basic components begin as living material. They introduce bacteria or dead or weakened viruses into a person or animal to stimulate an immune reaction that the body will remember if assaulted by the same pathogen in the future. ...

The "Superwaiver" Proposal and Service Integration: A History of Federal Initiatives

As part of the continuing debate over welfare reform reauthorization, the Bush Administration has supported a proposal that would enable states to obtain waivers from certain federal rules of various welfare-related programs in order to integrate activities across a wide spectrum of social services. This proposal, often referred to as the "superwaiver," would provide broad waiver authority to executive branch agencies that administer covered programs. The Administration has argued that giving state and local authorities more flexibility to coordinate workforce and family support programs...

Beneficiary Information and Decision Supports for the Medicare-Endorsed Prescription Drug Discount Card

On December 8, 2003 the President signed into law the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA, P.L. 108-173). This legislation establishes a Medicare prescription drug benefit, effective January 1, 2006. In the interim, the legislation requires the Department of Health and Human Services (HHS) to establish a temporary program of Medicare-endorsed prescription drug discount cards. This report discusses the objectives and benefits of this legislation.

Health Care Quality: Improving Patient Safety by Promoting Medical Errors Reporting

In the 108th Congress, the House and Senate passed competing versions of the Patient Safety and Quality Improvement Act ( H.R. 663 , S. 720 ), but the differences between the two measures were never resolved. On March 9, 2005, the Senate Committee on Health, Education, Labor, and Pensions unanimously approved S. 544 , which is identical to S. 720 . The legislation would establish legal protections for data and reports on medical errors in an effort to encourage voluntary reporting of such information. The patient safety bills are in response to the 1999 Institute of Medicine (IOM)...

Genetic Testing: Scientific Background and Nondiscrimination Legislation

Issues surrounding genetic discrimination and privacy in health insurance and employment are currently being debated in the 109th Congress. This report provides a comprehensive overview of the status of genetic testing in the United States.

Appropriations for FY2005: Interior and Related Agencies

The Interior and related agencies appropriations bill includes funds for the Department of the Interior (DOI), except for the Bureau of Reclamation, and for some agencies or programs within three other departments—Agriculture, Energy, and Health and Human Services. It also funds numerous related agencies. H.R. 4568, the Interior and Related Agencies Appropriations bill for FY2005, was passed by the House (334-86) on June 17, 2004. The bill contained $20.03 billion. The Senate companion bill, S. 2804, was reported by the Senate Committee on Appropriations (S.Rept. 108-341) on September 14,...

The Health Insurance Portability and Accountability Act (HIPAA) of 1996: Overview and Guidance on Frequently Asked Questions

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L. 104-191), provided for changes in the health insurance market. It guaranteed the availability and renewability of health insurance coverage for certain employees and individuals, and limited the use of preexisting condition restrictions. The Act created federal standards for insurers, health maintenance organizations (HMOs), and employer-provided health plans, including those that self-insure. It permitted, however, substantial state flexibility for compliance with the requirements on insurers.

HIPAA also...

Medicaid Upper Payment Limits and Intergovernmental Transfers: Current Issues and Recent Regulatory and Legislative Action

In accordance with Medicaid statute, the Secretary of Health and Human Services (HHS) has established, through a series of regulatory actions, upper payment limits (UPLs) for inpatient and outpatient services provided by certain types of facilities. In late 2000, the Secretary determined that regulations in effect at that time created a financial incentive for states to make higher than usual payments for care provided at non-state government facilities, namely, county and city facilities, allowing these states to claim higher federal matching dollars. States require these facilities...

Veterans' Medical Care Funding: FY1995-FY2004

The Department of Veterans Affairs (VA) provides services and benefits such as hospital and medical care, rehabilitation services, and pensions, among other things, to veterans who meet certain eligibility criteria. VA provides these benefits and services through four administrative units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), the National Cemetery Administration (NCA), and the Board of Veterans’ Appeals. VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans...

Child Welfare Issues in the 108th Congress

Child welfare services seek to protect children who have been abused or neglected or who are at risk of maltreatment. An estimated 896,000 children were the victims of child abuse or neglect in the year 2002. Some children who experience maltreatment are removed from their homes with protective custody given to the state. On the last day of FY2003, an estimated 523,000 children were in foster care.

States have the primary responsibility for designing and administering child welfare programs. However, the federal government supports these programs with significant funds and requires...

Appropriations for FY2005: Labor, Health and Human Services, and Education

This report tracks the legislative progress of the FY2005 appropriations for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (L-HHS-ED). This legislation provides discretionary funds for three major federal departments and related agencies. The report summarizes L-HHS-ED discretionary funding issues but not authorization or entitlement issues.

On February 2, 2004, the President submitted the FY2005 budget request to the Congress, including $142.9 billion in discretionary L-HHS-ED funds; the comparable FY2004 appropriation was $139.8 billion, enacted...

War On Drugs: Legislation in the 108th Congress and Related Developments

This report covers significant legislative and oversight activities of the 108th Congress that concern domestic law enforcement aspects of federal anti-drug policy. It also includes an overview of significant executive branch actions and other current developments of likely interest to the congressional audience that follows this issue.

Influenza Vaccine Shortages and Implications

On October 5, 2004, Chiron (pronounced Ki´-ron), a California-based biotechnology company, notified U.S. health officials that British regulatory authorities had suspended production of influenza (“flu”) vaccine in its plant in Liverpool, England, due to vaccine safety concerns. The plant was slated to provide between 46 million and 48 million doses of flu vaccine for the U.S. market for the imminent 2004-2005 flu season, almost half the expected nationwide supply.

The announcement of Chiron’s suspension prompted the Centers for Disease Control and Prevention (CDC) and its Advisory...

Veterans' Medical Care Appropriations and Funding Process

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility rules. Benefits to veterans range from disability compensation and pensions to hospital and medical care. VA provides these benefits to veterans through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA) and the National Cemetery Administration (NCA). VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through an integrated health care system....

Immigration: Foreign Physicians and the J-1 Visa Waiver Program

The Educational and Cultural Exchange Visitor program has become a gateway for foreign medical graduates (FMGs) to gain admission to the United States as nonimmigrants for the purpose of graduate medical education and training. The visa most of these physicians enter under is the J-1 nonimmigrant visa. Under the J-1 visa program, participants must return to their home country after completing their education or training for a period of at least two years before they can apply for another nonimmigrant visa or legal permanent resident (LPR) status, unless they are granted a waiver of the...

Child Welfare: Implementation of the Adoption and Safe Families Act (P.L. 105-89)

In response to rising numbers of children in foster care and concerns about the safety of children that remain with or return to their families after placement in foster care, the 105th Congress enacted the Adoption and Safe Families Act of 1997 (ASFA, P.L. 105-89) with two primary goals: (1) to ensure that consideration of children’s safety is paramount in child welfare decisions, so that children are not returned to unsafe homes; and (2) to ensure that necessary legal procedures occur expeditiously, so that children who cannot return home may be placed for adoption or another permanent...

Medicaid Reimbursement Policy

This report begins with a summary of basic federal requirements applicable to payments for all services and an overview of major developments in federal Medicaid reimbursement policy over the last 20 years. This overview provides a historical context for current policies and highlights some issues that have been perennial concerns for federal and state policymakers. The next four sections of the report provide a detailed discussion of Medicaid reimbursement for four basic categories of services or providers.

Federal Funding for Unauthorized Aliens’ Emergency Medical Expenses

There has been interest in the amount of money spent, as well as the amount of federal funds available to provide emergency medical care to unauthorized (illegal) aliens in the United States. It is extremely difficult to ascertain the amount of money spent for emergency medical care for unauthorized aliens since most hospitals do not ask patients their immigration status. Additionally, prior to the passage of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173) on December 8, 2003 there were no federal funds available for the specific purpose of...

Coverage of Vision Services under the State Children's Health Insurance Program (SCHIP)

A small but significant proportion of children have visual impairments. When detected early, many childhood vision abnormalities are treatable, but the potential for correction and normal visual development diminishes with age. Under SCHIP, states may provide coverage by expanding Medicaid or creating a separate SCHIP program or both. Medicaid and SCHIP provide access to an array of vision-related services, including vision screening services that can help children in low- to moderate-income families overcome these difficulties. Medicaid's mandatory Early, and Periodic, Screening,...

Senate Prescription Drug Importation Legislation: A Side-by-Side Comparison of Current Law, S. 2307, S. 2328, and S. 2493

Senators Grassley, Dorgan, and Gregg have each introduced bills that address Congressional concerns with prescription drug importation that were not resolved by the provisions in the Medicare Prescription Drug, Improvement, and Modernization Act (the MMA, P.L. 108-173 ). S. 2307 , the Reliable Entry for Medicines at Everyday Discounts through Importation with Effective Safeguards Act of 2004, introduced by Senator Grassley on April 8, 2004 [the Grassley bill];
S. 2328 , the Pharmaceutical Market Access and Drug Safety Act of 2004, introduced by Senator Dorgan on April 21, 2004...

Project BioShield: Legislative History and Side-by-Side Comparison of H.R. 2122, S. 15, and S. 1504

Few effective countermeasures currently exist to deal with chemical, biological, radiological, and nuclear terror agents. In early 2003, the Bush administration proposed Project BioShield to stimulate the development of such countermeasures and to procure them for the Strategic National Stockpile (SNS). Congress considered three bills that incorporated much of the administration's proposal: S. 15 (Gregg), H.R. 2122 (Tauzin), and S. 1504 (Gregg). H.R. 2122 passed the House on July 16, 2003. S. 15 passed the Senate on May 25, 2004 in an amended form similar to H.R. 2122 . This...

Medicare Endorsed Prescription Drug Discount Card Program

Charitable Choice, Faith-Based Initiatives, and TANF

This report is one in the series of reports that discusses the Charitable Choice Act of 2001 (Title II of the House bill) and its rules, as well as the charitable choice laws, and other areas of this program.

Africa: Development Issues and Policy Options

Sub-Saharan Africa has been a focus for U.S. development assistance for decades. Many believe that U.S. interests in the region are increasing, partly because of its oil resources and the international terrorist threat. However, at the beginning of the twenty-first century, Africa faces grave challenges that potentially threaten long-term stability, including the world's most serious HIV/AIDS pandemic, widespread rural poverty, and high levels of urban unemployment. In constant dollar terms, incomes in Africa are only about $100 higher than in 1960. Recently, gross domestic product (GDP)...

Appropriations for FY2004: Interior and Related Agencies

The Interior and related agencies appropriations bill includes funds for the Department of the Interior (DOI), except for the Bureau of Reclamation, and for some agencies or programs within three other departments -- Agriculture, Energy, and Health and Human Services. It also funds numerous smaller related agencies. President Bush's FY2004 budget for Interior and related agencies totaled $19.89 billion, $220.5 million (1%) less than enacted for FY2003 ($20.11 billion). On July 17, 2003, the House passed H.R. 2691 (268-152) containing a total of $19.60 billion for Interior and...

Key Benefits Under Medicaid and the State Children's Health Insurance Program (SCHIP) for Children With Mental Health and Substance Abuse Problems

About 18% of all U.S. adolescents received mental health treatment in 2000. Almost $7 billion was spent for such services for teens in 1998. While many youth have used alcohol or other illicit drugs, less than 2% received treatment for substance use in 2000. In 1997, costs for such care for children under 18 totaled $604 million.

In this report, the availability of selected mental health and substance abuse services under Medicaid and SCHIP for low and moderate income children is explored. Under SCHIP, states may provide coverage by expanding Medicaid or creating a separate SCHIP...

Appropriations for FY2004: Foreign Operations, Export Financing, and Related Programs

The annual Foreign Operations appropriations bill is the primary legislative vehicle through which Congress reviews the U.S. foreign aid budget and influences executive branch foreign policy making generally. It contains the largest share -- about two-thirds -- of total U.S. international affairs spending. President Bush asked Congress to appropriate $18.89 billion for FY2004 Foreign Operations. The budget proposal was $2.7 billion, or 16.7% higher than regular (non-supplemental) Foreign Operations appropriations for FY2003. If enacted, the President's recommendation would...

Arizona Emergency Management and Homeland Security Statutory Authorities Summarized

This report is one of a series that profiles the emergency management and homeland security statutory authorities of the 50 states, the District of Columbia, the Commonwealth of the Northern Mariana Islands, the Commonwealth of Puerto Rico, and three territories (American Samoa, Guam, and the U.S. Virgin Islands). Each profile identifies the more significant elements of state statutes, generally as codified. This report focuses on the state of Arizona.

Importation of Prescription Drugs Provisions in P.L. 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003

The new Medicare legislation, the Medicare Prescription Drug, Improvement, and Modernization Act ( P.L. 108-173 ), addresses the importation of prescription drugs for all U.S. consumers, not just for Medicare-eligible individuals. These provisions are rooted in consumer and congressional concern with the high cost of prescription drugs in the United States. International comparisons of drug prices have confirmed that American consumers, particularly the elderly and uninsured, often pay more for prescription drugs than do citizens in other countries. The importation of...

Appropriations for FY2004: Labor, Health and Human Services, and Education

This report tracks the progress of the bill providing FY2004 appropriations for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (L-HHS-ED). This legislation provides discretionary funds for three major federal departments and related agencies. The report summarizes L-HHS-ED discretionary funding issues but not authorization or entitlement issues.

On February 3, 2003, the President submitted the FY2004 budget request to the Congress. The L-HHS-ED request was $135.6 billion in discretionary funds; the comparable FY2003 amount was $134.7...

Medicare Fee-for-Service Modifications and Medicaid Provisions of H.R. 1 as Enacted

On November 22, the House of Representatives voted 220 to 215 to approve the conference report on H.R. 1 , the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The Senate, on November 24, voted 54 to 44 to approve the conference report. Earlier, the conferees of the Medicare prescription drug and modernization legislation announced an agreement on November 16 and the legislative text was released November 20. The legislative language can be downloaded from the House Committee on Ways and Means website at: http://waysandmeans.house.gov . The bill was signed into law...

A CRS Review of 10 States: Home and Community-Based Services — States Seek to Change the Face of Long-Term Care: Indiana

Many states have devoted significant efforts to respond to the desire for home and community-based care for persons with disabilities and their families. Nevertheless, financing of nursing home care, chiefly by Medicaid, still dominates most states’ spending for long-term care today. To assist Congress in understanding issues that states face in providing long-term care services, the Congressional Research Service (CRS) undertook a study of 10 states in 2002. This report, one in a series of 10 state reports, presents background and analysis about long-term care in Indiana.

Cash and Noncash Benefits for Persons with Limited Income: Eligibility Rules, Recipient and Expenditure Data, FY2000-FY2002

More than 80 benefit programs provide aid -- in cash and noncash form -- that is directed primarily to persons with limited income. Such programs constitute the public "welfare" system, if welfare is defined as income-tested or need-based benefits. This definition omits social insurance programs like Social Security and Medicare. Income-tested benefit programs in FY2002 cost $522.2 billion: $373.2 billion in federal funds and $149 billion in state-local funds (Table 1) . Welfare spending represented almost 19% of all federal outlays, with medical aid accounting for 8% of the budget....

FY2004 Supplemental Appropriations for Iraq, Afghanistan, and the Global War on Terrorism: Military Operations & Reconstruction Assistance

In a nationwide address on September 7, 2003, the President announced that he would request an additional $87 billion for ongoing military operations and for reconstruction assistance in Iraq, Afghanistan, and elsewhere. On September 17, the White House submitted a formal request for FY2004 supplemental appropriations of that amount to Congress. Administration officials said they would like to see congressional action completed some time before October 24, when an international donors conference was scheduled to meet in Madrid to seek pledges of economic assistance for Iraq. On October...

A Review of Medical Child Support: Background, Policy, and Issues

Medical child support is the legal provision of payment of medical, dental, prescription, and other health care expenses of dependent children. It can include provisions to cover health insurance costs as well as cash payments for unreimbursed medical expenses. According to 2001 Child Support Enforcement (CSE) data, 93% of medical child support is provided in the form of health insurance coverage. The requirement for medical child support is apart of all child support orders (administered by CSE agencies), and it only pertains to the parent's dependent children. Activities undertaken by...

Public Aid to Faith-Based Organizations (Charitable Choice) in the 107th Congress: Background and Selected Legal Issues

Soon after taking office in 2001, President Bush put forward an agenda "to enlist, equip, enable, empower, and expand the heroic works of faith-based and community groups across American." That agenda included a substantial expansion of tax incentives for charitable giving and an extension of charitable choice to most of the federal government's social services programs. But the 107th Congress refused to adopt these initiatives. The House adopted a modified version of the President's initiative; but H.R. 7 bogged down in the Senate due to concerns about the constitutionality and...

SCHIP Financing Issues for the 108th Congress

Medicare+Choice

Medicare has a long-standing history of offering its beneficiaries an alternative to the traditional fee-for-service program. Health Maintenance Organizations and other types of managed care plans have been allowed to participate in the Medicare program, beginning with private health plans contracts in the 1970s and the Medicare risk contract program in the 1980s. Then, in 1997, Congress passed the Balanced Budget Act of 1997 (BBA, P.L. 105-33 ), replacing the risk contract program with the Medicare+Choice (M+C) program. The M+C program established new rules for beneficiary and plan...

Appropriations for FY2003: VA, HUD, and Independent Agencies

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This Report is a guide to one of the 13 regular appropriations bills that Congress passes each year. It is designed to supplement the information provided by the House and Senate Appropriations Subcommittee on VA, HUD, and Independent Agencies.

Appropriations for FY2003: Labor, Health and Human Services, and Education

This report tracks the legislative progress of the FY2003 appropriations for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (L-HHS-ED). This Act provides discretionary funds for three federal departments and related agencies. The report summarizes L-HHS-ED discretionary funding issues, but not authorization or entitlement issues. On February 4, 2002, the President submitted the FY2003 budget request to the Congress. The L-HHS-ED request is $130.7 billion in discretionary funds; the comparable FY2002 amount was $128.1 billion, enacted...

Presidential Appointments to Full-Time Positions in Executive Departments During the 107th Congress, 2001-2002

During the 107th Congress, 354 nominations to executive department full-time positions were submitted to the Senate. Of these nominations, seven were submitted by President Clinton before he left office and were withdrawn by President Bush on March 19, 2001. President Bush submitted 347 nominations, of which 297 were confirmed, two were withdrawn, 35 were returned to him at the August 2001 recess, one was returned to him at the adjournment of the first session, and 12 were returned to him at the end of the 107th Congress. President Clinton made eight recess appointments during the...

Individuals with Disabilities Education Act (IDEA) and Medicaid

This report begins with an overview of Individuals with Disabilities Education Act (IDEA). It then discusses the distinction made in IDEA between medical services and health services. The report then summarizes the provisions in law that link Medicaid funding to IDEA. Next the report provides an overview of the complexities of Medicaid eligibility and covered services. Following that discussion, the report analyzes possible reasons why Medicaid appears to cover relatively little of IDEA health-related costs. Finally the report outlines possible legislative approaches with respect to...

Medicare Structural Reform: Background and Options

THis report provides a brief overview of major issues underlying the debate about possible structural reforms or improvements to the current Medicare system. Medicare is a nationwide health insurance program for the aged and certain disabled persons.

Ecstasy: Legislative Proposals in the 107th Congress to Control MDMA

Legislation has been proposed in the 107th Congress to combat the use and abuse of Ecstasy (MDMA) and other “club drugs.” In a 2001 survey, 12% of 12th graders reported ever having taken the drug. The Ecstasy Anti-Proliferation Act of 2000, enacted by the 106th Congress, directed the U.S. Sentencing Commission to increase penalties for Ecstasy offenses. As of March 2001, MDMA penalties became more severe than for powder cocaine but less severe than for heroin.

Combating Terrorism: First Emergency Supplemental Appropriations - Distribution of Funds to Departments and Agencies

This report provides background on the 2001 Emergency Supplemental Appropriations Act for Recovery from and Response to Terrorist Attacks on the United States, P.L. 107-38 (H.R. 2888) as well as the criteria for use of the funds developed by The Office of Management and Budget (OMB). It also outlines information about supplemental fund distributions in three tables.

Government Performance and Results Act: Overview of Associated Provisions in the 106th Congress

The Government Performance and Results Act of 1993 (P. L. 103-62, known as GPRA, or the Results Act) established a new framework for performance management and budgeting in federal agencies. In complying with GPRA, agencies must set goals, devise performance measures, and assess results achieved. This report identifies and analyzes provisions in public laws and committee reports from the 106th Congress (1999-2000) relating to GPRA and its implementation, including comparisons to similar provisions in the 104th and 105th Congresses. The purpose of these studies is to review ways in which...

Child Abuse Prevention and Treatment Act: Reauthorization Proposals in the 107th Congress

The Child Abuse Prevention and Treatment Act (CAPTA) expired at the end of FY2001. In 2002 legislation to reauthorize CAPTA passed the House and the Senate Health, Education, Labor and Pensions Committee also approved CAPTA reauthorizing legislation. However no action was taken by the full Senate on CAPTA reauthorization before adjournment of the 107th Congress and each of the CAPTA reauthorizations proposals ( H.R. 3839 , H.R. 5601 , and S. 2998 ) died with the close of that Congress. Despite expiration of its funding authorization, Congress provided FY2002 funding ($81.6 million) for...

Federal Grants to State and Local Governments: Overview and Characteristics

Each fiscal year, Congress appropriates funds for grants to state and local governments to further national goals and assist state and local government operations. Examples of goals include attaining minimum national standards and improving program effectiveness. The federal government provides grants for numerous substantive purposes, such as crime prevention, community development, and transportation. In FY2001, grants to state and local governments totaled $317 billion. Grants can be classified by the substantive purposes they address. This report, however, reviews the...

Supreme Court: Church-State Cases, 2001-2002 Term

Food Safety and Protection Issues in the 107th Congress

Importing Prescription Drugs

Public Health Security and Bioterrorism Preparedness and Response Act (P.L. 107-188): Provisions and Changes to Preexisting Law

Last fall's anthrax attacks, though small in scale compared to the scenarios envisioned by bioterrorism experts, strained the public health system and raised concern that the nation is insufficiently prepared to respond to bioterrorist attacks. Improving public health preparedness and response capacity offers protection not only from bioterrorist attacks, but also from naturally occurring public health emergencies. On June 12, 2002, the President signed into law the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 ( P.L. 107-188 , H.R. 3448 ), which is...

Medicare: Major Prescription Drug Provisions of Selected Bills

Toxic Mold: Insurance and Legal Issues

Allegations of bodily injuries and property damage resulting from toxic mold in home and work environments have triggered litigation across the nation, and, as a result, have prompted insurers and governments to grapple with coverage of risks to property and health resulting from exposure to mold. To minimize their financial exposure to these losses, insurance companies have variously been excluding mold risks from coverage on their standard policy forms, raising premiums, increasing deductibles, and capping coverage. The perils associated with toxic mold coupled with the insurance...

Veterans Issues in the 107th Congress

Appropriations for FY2002: An Overview

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This report is a guide to one of the 13 regular appropriations bills that Congress passes each year.

Appropriations for FY2002: Labor, Health and Human Services, and Education

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This report is a guide to one of the 13 regular appropriations bills that Congress passes each year. It is designed to supplement the information provided by the House and Senate Labor, Health and Human Services, and Education Appropriations Subcommittees.

Bioterrorism: Summary of a CRS/National Health Policy Forum Seminar on Federal, State, and Local Public Health Preparedness

The September 11th attack and subsequent intentional release of anthrax spores via the U.S. postal system have focused policymakers’ attention on the preparedness and response capability of the nation’s public health system. The anthrax attacks put a tremendous strain on the U. S. public health infrastructure, an infrastructure that many experts argue has been weakened by years of neglect and under-funding. To better understand the preparedness gaps that exist, as well as the disparate functions and agencies that define public health in this country, the Congressional Research Service...

Health Insurance: Federal Data Sources for Analyses of the Uninsured

Given the various reasons individuals lack health insurance coverage, analysis of the effectiveness of a proposal to reduce the number of uninsured (such as those discussed above) requires examining characteristics of individuals with and without health insurance coverage. Numerous sources of data have emerged over time that support estimates of the uninsured. However, each data source differs in how it collects information from individuals, as well as the amount of information it collects related to health insurance status. This report outlines the major advantages and limitations of four...

Appropriations for FY2002: Interior and Related Agencies

The Interior and Related Agencies Appropriations bill includes funds for the Department of the Interior (DOI), except the Bureau of Reclamation, and funds for some agencies or programs within three other departments--Agriculture, Energy, and Health and Human Services. It also funds numerous smaller agencies. On April, 9, 2001, President Bush submitted his FY2002 budget for Interior and Related Agencies, totaling $18.19 billion compared to the $19.07 billion enacted for FY2001 ( P.L. 106-291 ). These figures reflect scorekeeping adjustments. (See Table 10 and Table 11 ). Title VIII...

Appropriations for FY2002: District of Columbia

On December 21, 2001, President Bush signed into law the District of Columbia Appropriations Act for FY2002, P.L. 107-96 (formerly H.R. 2944 ). Two weeks earlier, the House on December 6, 2001, and the Senate on December 7, 2001, approved the conference report accompanying H.R. 2944 , after resolving significant differences in the general provisions of their respective versions of the act. The act, which appropriates $408 million in special federal payments, includes $16 million for reimbursement to the District for the cost of providing security for a cancelled World Bank and...

Appropriations for FY2002: VA, HUD, and Independent Agencies (P.L. 107-73)

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This report is a guide to one of the 13 regular appropriations bills that Congress passes each year. It is designed to supplement the information provided by the House and Senate Appropriations Subcommittee on VA, HUD, and Independent Agencies.

Congressional Resources in CRS Research Centers and the La Follette Congressional Reading Room

This report describes types of CRS products and a selection of the most frequently used printed and online reference sources available in the reading room and research centers for use by congressional staff. These deal with legislation and public policy; bills, congressional documents, laws, and regulations; Congress, elections, and politics; the federal government; directories of organizations, associations, corporations, state agencies, educational institutions, and the media; biographical information; data on foreign countries and international affairs; quick facts and statistics; and...

Summit of the Americas III, Quebec City, Canada, April 20-22, 2001: Background, Objectives, and Results

Summit of the Americas III was held in Quebec City, Canada, on April 20-22, 2001, and was attended by 34 democratically elected Presidents and Prime Ministers from the Western Hemisphere, including President George W. Bush. It was President Bush's first international summit, and his first major opportunity to reemphasize the priority his administration places on the Western Hemisphere, given that he visited Mexico in mid-February, spoke at the Organization of American States (OAS) in mid-April, and met with seven hemispheric leaders before he attended the Summit in Canada. The Quebec...

Presidential Appointments to Full-Time Positions in Executive Departments During the 106th Congress, 1999-2000

This report focuses on presidential nominations and Senate confirmations to the 330 full-time positions in the 14 executive departments to which the President makes appointments, with the advice and consent of the Senate. During the 106th Congress, President Clinton submitted 136 nominations and made 18 recess appointments to full-time positions requiring Senate confirmation. The Senate confirmed 108 nominations and returned 24; the President withdrew four nominations. On average, the Senate took 105 days (three and a half months) to confirm a nomination. Sixty-eight nominations (63%)...

Appropriations for FY2001: An Overview

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This report is a broad overview of all appropriations activity and a guide to the CRS Appropriation Product Series that provides analytical perspectives on the 13 annual FY2001 appropriations bills.

Appropriations for FY2001: Labor, Health and Human Services, and Education

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This report is a guide to one of the 13 regular appropriations bills that Congress passes each year. It is designed to supplement the information provided by the House and Senate Appropriations Subcommittees on Labor, Health and Human Services, and Education.

The Cost of Prescription Drugs for the Uninsured Elderly and Legislative Approaches

The purpose of this report is to explain why many of those who are least able to afford high drug costs are those who are most frequently charged the most. This report describes the basic economic theory underlying price differentiation and, in the context of the pharmaceutical market, analyzes the role and behavior of pharmacy benefit managers (PBMs), pharmaceutical manufacturers, and retail pharmacies, respectively. It also looks at a number of the criticisms that have been made of the practice of differential pricing. Finally, this report discusses various policy approaches aimed at...

Medicaid, SCHIP, and Other Health Provisions in H.R. 5661: Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000

While largely comprised of Medicare provisions, the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 ( H.R. 5661 ), a compromise agreement between House and Senate committees and the leadership, includes a number of important changes to Medicaid and the State Children's Health Insurance Program (SCHIP). It also includes major provisions amending other programs. The provisions of H.R. 5661 are incorporated, by reference into H.R. 4577 , the Consolidated Appropriations Act 2001. H.R. 4577 was passed by the House and Senate on December 15, 2000 and was...

Abortion Law Development: A Brief Overview

This report offers an overview of the development of abortion law from 1973 to the present. Beginning with a brief discussion of the historical background, the report analyzes the leading Supreme Court decisions over the past twenty-eight years, emphasizing particularly the landmark decisions in Roe and Doe, the Court’s shift

in direction in Webster v. Reproductive Health Services and Planned Parenthood of Southeastern Pennsylvania v. Casey, and the Court’s most recent decision on abortion, Stenberg v. Carhart. The Court’s decisions on the constitutionality of restricting public funding...

Charitable Choice: Constitutional Issues and Developments Through the 106th Congress

Charitable choice seeks to expand the universe of religious organizations that can participate in publicly funded social service programs. The establishment of religion clause of the First Amendment has long been construed to allow religious organizations to participate in such programs. But in the past it has generally been interpreted to require publicly funded religious social services providers to be incorporated separately from their sponsoring religious institutions, to forego religious activities and proselytizing in the publicly funded programs, and to remove religious symbols from...

Appropriations for FY2001: District of Columbia

On February 7, 2000, President Clinton submitted his budget recommendations for FY2001. The Administration's proposed budget includes $ 445 million in federal payments and assistance to the District of Columbia. On March 13, 2000, D.C. Mayor Anthony Williams submitted his proposed budget for FY2001. The proposed budget included $4.7 billion in general fund expenditures and $695 million in enterprise funds. The District of Columbia Financial Responsibility and Management Assistance Authority (Authority), on June 7, 2000, approved a budget compromise reached by the city council and the...

Prisons: Policy Options for Congress

Appropriations for FY2001: VA, HUD, and Independent Agencies (P.L. 106-377)

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This report is a guide to one of the 13 regular appropriations bills that Congress passes each year. It is designed to supplement the information provided by the House and Senate Subcommittees on VA, HUD and Independent Agencies Appropriations.

Appropriations for FY2001: Interior and Related Agencies

The Interior and Related Agencies Appropriations bill includes funding for agencies and programs in four separate federal departments as well as numerous smaller agencies and diverse programs. The bill includes funding for the Interior Department except the Bureau of Reclamation, but only segments of the funding of the other three departments, Agriculture, Energy, and Health and Human Services. On February 7, 2000, President Clinton submitted his FY2001 budget to Congress. The FY2001 request for Interior and Related Agencies totals $16.32 billion compared to the $14.91 billion enacted...

The National Institutes of Health: An Overview

The National Institutes of Health (NIH) is the focal point for federal health research. An agency of the Department of Health and Human Services, it uses its $17.8 billion budget to support more than 50,000 scientists working at 2,000 institutions across the United States, as well as to conduct biomedical and behavioral research and research training at its own facilities. Components of the agency include 25 institutes and centers, each with a focus on particular diseases or research areas in human health. Recent budget growth has been significant despite caps on discretionary spending....

Supplemental Appropriations for FY2000: Plan Colombia, Kosovo, Foreign Debt Relief, Home Energy Assistance, and Other Initiatives

Early in each new session of Congress, the Administration routinely submits requests for supplemental appropriations for the current fiscal year. By late April 2000, through several submissions to Congress, President Clinton had requested $5 billion in FY2000 supplemental appropriations, including $955 million for a counternarcotics initiative in Colombia and the Andean region, about $2 billion for DOD peacekeeping operations in Kosovo, $600 million for diplomatic support and economic aid related to Kosovo and the Balkans, $210 million for poor country debt relief, $600 million for home...

Olmstead v. L.C.: Implications and Subsequent Judicial, Administrative, and Legislative Actions

The Supreme Court ruled in Olmstead v. L.C. that Title II of the Americans with Disabilities Act (ADA) requires states to transfer individuals with mental disabilities into community settings rather than institutions when a state treatment professional has determined the appropriateness of such an environment, the community placement is not opposed by the individual with a disability, and the placement can be reasonably accommodated. The Health Care Financing Administration (HCFA), as a response to the Supreme Court's decision, sent a letter to states on January 14, 2000 outlining...

Appropriations for FY2000: An Overview

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This report is a guide to one of the 13 regular appropriations bills that Congress passes each year.

Medicare Beneficiary Access to Care: The Effects of New Prospective Payment Systems on Outpatient Hospital Care, Home Health Care, and Skilled Nursing Facility Care

This report discusses the Balanced Budget Act of 1997 (BBA 97), which required that prospective payment systems replace retrospective cost-based reimbursement systems for Medicare beneficiaries receiving care in hospital outpatient departments, from home health care agencies, and in skilled nursing facilities.

Appropriations for FY2000: District of Columbia

On November 29, 1999, President Clinton signed the Consolidated Appropriations Act for FY2000, formerly H.R. 3194 , into law as P.L. 106-113 . The Act appropriates funds for the District of Columbia, Division A of the act, and four other appropriation measures, Division B of the act, including: Commerce, Justice, State, Judiciary; Foreign Operation Appropriations; Interior Appropriations; and Labor, Health and Human Services, and Education Appropriations for FY2000. Division B of P.L. 106-113 , also includes a section governing Miscellaneous Appropriations, and provisions amending the...

Appropriations for FY2000: Labor, Health and Human Services, and Education

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This report is a guide to one of the 13 regular appropriations bills that Congress passes each year. It is designed to supplement the information provided by the House and Senate Appropriations Subcommittees on Labor, Health and Human Services, and Education.

Cash and Noncash Benefits for Persons With Limited Income: Eligibility Rules, Recipient and Expenditure Data, FY1996-FY1998

Eighty benefit programs provide aid -- in cash and noncash form -- that is directed primarily to persons with limited income. Such programs constitute the public "welfare" system, if welfare is defined as income-tested or need-based benefits. This definition excludes social insurance programs (e.g., Social Security and Medicare). Income-tested benefit programs in FY1998 cost $391.7 billion: $277.3 billion in federal funds and $114.4 billion in state-local funds. Total welfare spending rose by 3.1% from its FY1997 level. Higher medical spending accounted for $10.3 billion of the year's...

Appropriations for FY2000: Interior and Related Agencies

The Interior and Related Agencies Appropriations bill includes funding for agencies and programs in four separate federal departments as well as numerous smaller agencies and diverse programs. The bill includes funding for the Interior Department except the Bureau of Reclamation, but only segments of the funding of the other three departments, Agriculture, Energy, and Health and Human Services. On February 1, 1999, President Clinton submitted his FY2000 budget to Congress. The FY2000 request for Interior and Related Agencies totaled $15.266 billion compared to the $14.298 billion enacted...

Medicare: Changes to Balanced Budget Act of 1997 (BBA 97, P.L. 105-33) Provisions

This report summarizes the major provisions of the agreement between the by House and Senate negotiators on the Medicare provisions.

California's Proposition 187: A Brief Overview

On September 13, 1999, a U.S. district judge approved an agreement to end litigation challenging California's Proposition 187, a 1994 ballot initiative to deny illegal aliens state benefits and to require reporting of illegal alien applicants for benefits to federal immigration officials. This agreement effectively continues earlier court-imposed restraints on implementing Prop 187. Meanwhile, federal law enacted in 1996 denies illegal aliens most state-provided benefits funded in part by the federal government and authorizes California to deny illegal aliens many other benefits that...

Appropriations for FY1999: An Overview

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This report is a guide to CRS reports that provide analytical perspectives on the 13 annual appropriations bills, and other related appropriation measures. It does not include a detailed explanation or description of the budget or appropriations processes.

Appropriations for FY1999: An Overview

Nursing Home Evictions of Medicaid Patients Following Voluntary Withdrawal From Medicaid Program: Current Issues and Congressional Response

Nursing facilities that choose to participate in the Medicaid program must comply with specific requirements relating to patients' rights, including transfer and discharge procedures. However, once a facility has voluntarily withdrawn from the Medicaid program, transfer and discharge protections no longer apply to residents in the facility. In 1998, the Vencor Corporation evicted large numbers of Medicaid residents from its nursing homes pursuant to its decision to withdraw from the Medicaid program. Congressional response following the Vencor case included consideration of H.R. 540 and ...

Appropriations for FY1999: Labor, Health and Human Services, and Education

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This report is a guide to one of the 13 regular appropriations bills that Congress passes each year. It is designed to supplement the information provided by the House and Senate Appropriations Subcommittees on Labor, Health and Human Services, and Education.

Appropriations for FY1999: Interior and Related Agencies

The Interior and Related Agencies Appropriations bill includes funding for agencies and programs in five separate federal departments as well as numerous smaller agencies and diverse programs. On February 2, 1998, the President submitted his FY1999 budget to Congress. The request for Interior and Related Agencies totals $14.26 billion compared to the $13.79 billion enacted for FY1998 ( P.L. 105-83 ), an increase of $470 million. The actual increase for Title I and Title II agencies in the FY1999 request is $1.17 billion, offset by a nonrecurring appropriation of $699 million for...

Appropriations for FY1999: Interior and Related Agencies

Appropriations are one part of a complex federal budget process that includes budget resolutions, appropriations (regular, supplemental, and continuing) bills, rescissions, and budget reconciliation bills. This report is a guide to one of the 13 regular appropriations bills that Congress passes each year. It is designed to supplement the information provided by the House and Senate Appropriations Subcommittees on Interior and Related Agencies Appropriations.

Outpatient Mastectomy

Congressional Liaison Offices of Selected Federal Agencies

This is a directory of approximately 150 government agencies designed to assist congressional staff in contacting agencies of the legislative branch, cabinet departments and other executive branch agencies and boards and commissions. This directory contains names of congressional liaison officers, addresses, telephone and fax numbers, and occasionally e-mail addresses. It is regularly updated each spring.

Summit of the Americas II, April 18-19, 1998: Background, Objectives, and Expectations

President William Clinton will attend Summit of the Americas II in Santiago, Chile, on April 18-19, 1998, with 34 democratic Presidents and Prime Ministers from Latin American and Caribbean countries expected to attend. This is a follow up to Summit of the Americas I hosted by President Clinton in Miami in December 1994. The 1994 Miami Summit created a Plan of Action with 23 initiatives in four major areas. Under the leadership of various countries and organizations, these initiatives have been advanced, and major agreements have been concluded and are in the process of being implemented....

AIDS Funding for Federal Government Programs: FY1981-FY1999

This report provides a synopsis of the budget activity related to AIDS from the discovery of the disease in 1981 through FY1999. Funding for AIDS research, prevention and treatment programs within the Department of Health and Human Services (HHS) discretionary budget has increased from $200,000 in FY1981 to an estimated $3.85 billion in FY1999.

Medicaid: 105th Congress

Medicaid: 105th Congress

Medicare: Payments to Physicians

This report discusses payments for physicians services under Medicare that are made on the basis of a fee schedule.

Appropriations for FY1998: Interior and Related Agencies

The Interior and Related Agencies Appropriations bill includes funding for agencies and programs in four separate federal departments as well as numerous smaller agencies and diverse programs. On February 6, 1997, the President submitted his FY1998 budget to Congress. The FY1998 request totals $13.09 billion compared to the $13.14 billion enacted by Congress for FY1997 ( P.L. 104-208 ). It should be noted that the FY1997 amount included $715 million in nonrecurring emergency appropriations. An additional $386 million was appropriated in the recently enacted Emergency Supplemental...

Abortion Procedures

Abortion Procedures

The Partial-Birth Abortion Ban Act of 1997, H.R. 1122 was vetoed by President Clinton on October 10, 1997. This legislation would have made it a federal crime, punishable by fine and/or incarceration, for a physician to perform a partial birth abortion unless it was necessary to save the life of a mother whose life is endangered by

a physical disorder, illness, or injury. The partial-birth abortion legislation has stimulated a great deal of controversy. This report provides a brief overview of the abortion methods currently in use for which data have been published and some positions on...

Managed Health Care: A Primer

Managed Health Care: A Primer

Medicare: Payments to HMOs and Other Private Plans Under the Medicare+Choice Program

This report describes how payments will be calculated under the Medicare+Choice program established under the new law.

Casework in a Congressional Office

Casework in a Congressional Office

This report and its appendices present a general overview of congressional office procedures associated with handling casework and the assistance provided by a Member of Congress to help constituents in their dealings with federal agencies. It discusses options for assisting Members’ constituents and the role of Members and staff in providing casework services.

Medicaid: Recent Trends in Beneficiaries and Spending

This report discusses medicaid and recent trend is beneficiaries and spending.

Abortion: Legislative Control

In 1973, the U.S. Supreme Court held that the Constitution protects a woman's decision whether or not to terminate her pregnancy (Roe v. Wade), and that a State may not unduly burden the exercise of that fundamental right by regulations that prohibit or substantially limit access to the means of effectuating that decision (Doe v. Bolton). However, the issue of a woman's right to an abortion is far from settled. This report discusses the various legislative actions undertaken since 1973 to either nullify these rulings or hinder their effectuation.

Medicare: Physician Payments

This report discusses payments for physicians services under Medicare that are made on the basis of a fee schedule.

Medicare/Medicaid Reimbursement: Selected References

This report is a compilation of selected articles, books, and executive agency and congressional publications on Medicare and Medicaid reimbursement, primarily to health facilities and physicians.

Cash and Non-Cash Benefits for Persons with Limited Income: Eligibility Rules, Recipient and Expenditure Data, FY1981-83

This report summarizes basic eligibility rules, as of May 1984, for more than 70 cash and non-cash programs that benefit primarily persons of limited income. It also gives funding formulas, benefit levels, and, for fiscal years 1981-1983, recipient numbers and expenditure data for each program.

Grace Commission

Health Insurance: The Pro-Competition Proposals

For more than a decade, Congress and the Executive Branch have tried to stem spiraling health care costs through various regulatory actions at the Federal and State levels. Planning laws, for example, focus regulatory attention on the capacity of the health care industry to provide health services. Other laws have created programs to monitor and control the use of services provided to individual patients. Direct wage and price controls were applied to the health industry in the early 1970's and in recent years Congress has debated whether to impose controls over hospital spending in the...

Abortion: Judicial and Legislative Control

In 1973 the U.S. Supreme Court held that the Constitution protects a

woman's decision whether or not to terminate her pregnancy, Roe v. Wade, 410 U.S. 113, and that a State may not unduly burden the exercise of that fundamental right by regulations that prohibit or substantially limit access to the means of effectuating that decision, Doe v. Bolton, 410 U.S. 179. But rather than settling the issue, the Court's rulings have kindled heated debate and precipitated a variety of governmental actions at the national, State and local levels designed either to nullify the rulings or hinder...

Block Grants

This report includes the material on block grants, including a CRS Report on the Omnibus Reconciliation Act of 1981, several articles, and a guide to State block grant implementation. For additional information and assistance, we have also included addresses of people to contact on the Federal (p. 59) and State levels (p. 70-104).

Actions of the Congress and the Federal Government on Smoking and Health

This paper is a history of actions taken by the U.S. Congress and by the various departments and regulatory agencies of the Federal Government on the subject of smoking and health for the period from the mid-1950s to the end of the 95th Congress in 1978.

Congressional Action to Overturn Agency Rules: Alternatives to the "Legislative Veto"

Congress has available a variety of statutory and non-statutory techniques, other than the "legislative veto," that have been used to overturn Federal agency rules, prevent their enforcement, limit their impact, or hinder their promulgation. This survey of the different statutory instruments of congressional control—direct overturn of rules, modification of agency jurisdiction, limitations in authorizing and appropriating statutes, requiring inter-agency consultation, and advance notification to the Congress—discusses a variety of mechanisms that vary in their use and their specificity,...

Development of National Urban Growth and Rural Development Policy: Legislative and Executive Actions in 1970 and 1971

The 1970 Acts require the executive branch to submit the reports on the further development of urban growth policy, the location of Federal facilities, acceleration of the availability of government services and financial assistance (among other subjects) in support of rural community development. This report should assist in the evaluation of these submissions received from the President and executive departments and agencies. The report's basic purpose is to place individual legislative actions in the larger context of interrelated national urban and rural development objectives set...