	Introduction

On March 12, 2013, Representative Paul Ryan, the chairman of the House Budget Committee, released the chairman's mark of the FY2014 House budget resolution. Additional detail on budgetary objectives and justifications was provided in Chairman Ryan's report entitled The Path to Prosperity: A Responsible Balanced Budget , issued the same day. The House Budget Committee considered the chairman's mark on March 13, 2013, and voted 22-17 to report the budget resolution to the full House. H.Con.Res. 25 was introduced in the House March 15, 2013, and was accompanied by the House Budget Committee Report ( H.Rept. 113-17 ). The House agreed to H.Con.Res. 25 on March 21, 2013, by a vote of 221 to 207. The House budget resolution sets general budgetary parameters. In general, the budget proposal, as outlined in Chairman Ryan's Path to Prosperity report and in the committee report, suggests a change in the structure of the Medicare and Medicaid programs; the repeal of many of the provisions in the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 (ACA, P.L. 111-148 , P.L. 111-152 ), including those that establish insurance exchanges; and changes to tort law governing medical malpractice. The collective details are referred to in this report as the "budget proposal" or Chairman Ryan's proposal. Long-Term Medicare Changes (FY2024 and Beyond)24

Starting in 2024, the Ryan budget proposal would phase in an increase in the age of eligibility for Medicare and would convert the current Medicare defined benefits program to a fixed federal contribution. 25 . The Path to Prosperity and the accompanying legislative language proposes to make two significant programmatic changes to the Medicaid program. Conversion of Medicaid to a Block Grant System

Another "illustrative policy option" included in the committee report is the restructuring of Medicaid from an individual entitlement program to a block grant program. Repeal of Certain Private Health Insurance Provisions in ACA

H.Con.Res.
On March 12, 2013, House Budget Committee Chairman Paul Ryan released the chairman's mark of the FY2014 House budget resolution together with his report entitled The Path to Prosperity: A Responsible Balanced Budget, which outlines his budgetary objectives. The House Budget Committee considered and amended the chairman's mark on March 13, 2013, and voted to report the budget resolution to the full House. H.Con.Res. 25 was introduced in the House March 15, 2013, and was accompanied by the committee report (H.Rept. 113-17). H.Con.Res. 25 was agreed to by the House on March 21, 2013.
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 enacted in separate legislation. Chairman Ryan's budget proposal, as outlined in his report and in the committee report, suggests short-term and long-term changes to federal health care programs including to Medicare, Medicaid, and the health insurance exchanges established by the Patient Protection and Affordable Care Act as amended (ACA, P.L. 111-148, P.L. 111-152).
Within the 10-year budget window (FY2014-FY2023), the budget proposal assumes that certain ACA provisions would be repealed, including those that expand Medicaid coverage to the non-elderly with incomes up to 133% of the federal poverty level, and those provisions that establish health insurance exchanges. The proposal also suggests restructuring Medicaid from an individual entitlement program to a block grant program. Beyond the 10-year budget window, beginning in 2024, the budget proposal assumes an increase in the age of eligibility for Medicare and the conversion of Medicare to a fixed federal contribution program.
This report summarizes the proposed changes to Medicare, Medicaid, and private health insurance as described in H.Con.Res. 25, the accompanying committee report, and Chairman Ryan's Path to Prosperity report. Additionally, it briefly examines the potential impact of the proposed changes on health care spending and coverage.