	Introduction

On April 1, 2014, Representative Paul Ryan, the chairman of the House Budget Committee, released the chairman's mark of the FY2015 House budget resolution. Additional detail on budgetary objectives and justifications was provided in Chairman Ryan's report entitled The Path to Prosperity: Fiscal Year 2015 Budget Resolution , issued the same day. The House Budget Committee considered the chairman's mark on April 2, 2014, and voted 22-16 to report the budget resolution to the full House. H.Con.Res. 96 was introduced in the House April 4, 2014, and was accompanied by the House Budget Committee Report ( H.Rept. 113-403 ). The House agreed to H.Con.Res. 96 on April 10, 2014, by a vote of 219-205. A budget resolution, if agreed to by both the House and Senate, sets enforceable budgetary parameters. 96 expresses the desired levels of spending for government health programs over 10 years (FY2015-FY2024), creates four health care-related reserve funds, and presents policy statements regarding assumptions about future Medicare reforms and replacing the Patient Protection and Affordable Care Act as amended (ACA, P.L. 111-148 , P.L. 111-152 ). It is not a law and is not signed by the President. 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 (or all) of the provisions in the ACA, including those that establish insurance exchanges; and changes to tort law governing medical malpractice. Long-Term Medicare Changes (FY2024 and Beyond)

The budget assumes that the current Medicare defined benefits program will be changed into a fixed federal contribution ("premium support") system beginning in 2024 for newly eligible beneficiaries. In addition to these programmatic changes, the budget proposal suggests significant reductions to federal Medicaid funding. 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 Private Health Insurance Provisions in ACA

As described earlier, H.Con.Res.
On April 1, 2014, House Budget Committee Chairman Paul Ryan released the chairman's mark of the FY2015 House budget resolution together with his non-binding report entitled The Path to Prosperity: Fiscal Year 2015 Budget Resolution, which outlines his budgetary objectives. The House Budget Committee considered and amended the chairman's mark on April 2, 2014, and voted to report the budget resolution to the full House. H.Con.Res. 96 was introduced in the House April 4, 2014, and was accompanied by the committee report (H.Rept. 113-403). H.Con.Res. 96 was agreed to by the House on April 10, 2014.
Once it is agreed to by both chambers of Congress, a budget resolution provides enforceable 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 (FY2015-FY2024), the budget allows for the full repeal of the ACA or just certain provisions, including those that reduce Medicare spending, 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. Committee documents also suggest restructuring Medicaid from an individual entitlement program to a block grant program. In addition, beginning in 2024, the budget assumes the conversion of Medicare to a fixed federal contribution ("premium support") program.
This report summarizes the proposed changes to Medicare, Medicaid, and private health insurance as described in H.Con.Res. 96 and accompanying documents, including the committee report and Chairman Ryan's Path to Prosperity report.