	Introduction

On April 5, 2011, Representative Paul Ryan, the Chairman of the House Budget Committee, released the Chairman's mark of the FY2012 House budget resolution. Additional detail on budgetary objectives and justifications was provided in Chairman Ryan's report entitled "The Path to Prosperity: Restoring America's Promise," issued the same day. The House Budget Committee considered and amended the Chairman's mark on April 6, 2011 and voted 22-16 to report the budget resolution to the full House. H.Con.Res. 34 was introduced in the House on April 11, 2011, and was accompanied by the House Budget Committee Report, H.Rept. On April 15, 2011, the House passed H.Con.Res. 34 by a vote of 235-193. CBO was asked to provide an analysis of the long-term budgetary impact of Chairman Ryan's budget proposal, and issued its report on April 5, 2011. In general, Chairman Ryan's budget proposal, as outlined in his "Path to Prosperity," in the Committee Report, and in CBO's analysis, suggests a change in the structure of the Medicare and Medicaid programs, the repeal many of the provisions in the Patient Protection and Affordable Care Act (PPACA, P.L. 111-152 ) including those that establish insurance exchanges, and changes to tort law governing medical malpractice. Part D covers prescription drug benefits. None of the four documents (budget resolution, Chairman's "Path to Prosperity" report, the Committee report, or CBO analysis) provided sufficient detail regarding specific provisions that would be repealed or retained to determine the disposition of provisions related to the quality and efficiency of health care (in Title III of PPACA), such as those creating value-based purchasing programs, quality reporting systems, and demonstrations and pilot programs that would test various patient care models including accountable care organizations. CBO indicated, however, that on the basis of specifications provided by House Budget Committee staff, its analysis of the long-term budgetary impacts of the proposal did not include a change in the sustainable growth rate mechanism for payments to physicians under Medicare. Long-Term Medicare Changes (2022 and Beyond)

Starting in 2022, the proposal would phase in an increase in the age of eligibility for Medicare and would convert the current Medicare entitlement program to a fixed federal contribution. Medicaid is jointly funded by the federal government and the states. 112-58 ) suggests restructuring Medicaid from an individual entitlement program to a block grant program, starting in FY2013. Repeal of Certain Private Health Insurance Provisions in PPACA

The budget resolution creates a health care reform reserve fund (Section 303 H.Con.Res.
On April 5, 2011, House Budget Committee Chairman Paul Ryan released the Chairman's mark of the FY2012 House budget resolution together with his report entitled "The Path to Prosperity: Restoring America's Promise," which outlines his budgetary objectives. On the same day, CBO issued an analysis of the long-term budgetary impact of Chairman Ryan's budget proposal based on specifications provided by House Budget Committee staff. The House Budget Committee considered and amended the Chairman's mark on April 6, 2011, and voted to report the budget resolution to the full House. H.Con.Res. 34 was introduced in the House April 11, 2011, and was accompanied by the committee report (H.Rept. 112-158). On April 15, 2011, the House voted 235-193 to pass H.Con.Res. 34.
A budget resolution provides general budgetary parameters; however, it is not a law. Changes to programs that are assumed or suggested by the budget resolution would still need to be passed by separate legislation. Chairman Ryan's budget proposal, as outlined in his report, the committee report, and in the CBO analysis, suggests short-term and long-term changes to federal health care programs including Medicare, Medicaid, and the health insurance exchanges established by the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148).
Within the 10-year budget window (FY2012-FY2021), the budget proposal assumes that certain PPACA provisions would be repealed, including those that provide additional coverage under the Medicare prescription drug benefit, that expand Medicaid coverage to the non-elderly with incomes below 133% of the federal poverty level, and those provisions that establish health insurance exchanges. The proposal would also restructure Medicaid from an individual entitlement program to a block grant program beginning in FY2013.
Beyond the 10-year budget window, beginning in 2022, the budget proposal assumes an increase in the age of eligibility for Medicare, the conversion of Medicare to a fixed federal contribution program, and a restructuring of coverage for the elderly under Medicaid.
This report summarizes the proposed changes to Medicare, Medicaid, and private health insurance as described in H.Con.Res. 34, Chairman Ryan's "Path to Prosperity" report, the House Budget Committee report, and the CBO analysis. Additionally, it briefly examines the potential impact of the proposed changes on health care spending and coverage.