Budget “Sequestration” and Selected Program Exemptions and Special Rules
Released: 2013-06-13T00:00:00

Introduction

"Sequestration" is a process of automatic, largely across-the-board spending reductions to meet or enforce certain budget policy goals. It was first established by the Balanced Budget and Emergency Deficit Control Act of 1985 (BBEDCA, Title II of P.L. 99-177 , 2 U.S.C. 900-922) to enforce deficit targets. In the 1990s, sequestration was used to enforce statutory limits on discretionary spending and a pay-as-you-go (PAYGO) requirement on direct spending and revenue legislation. After effectively expiring in 2002, sequestration was reestablished by the Statutory Pay-As-You-Go Act of 2010 ( P.L. 111-139 ) to enforce a modified PAYGO requirement on direct spending and revenue legislation.

Most recently, under the Budget Control Act of 2011 (BCA, P.L. 112-25 ), sequestration was tied to enforcement of new statutory limits on discretionary spending and achievement of the budget goal established for the Joint Select Committee on Deficit Reduction. A sequestration was triggered by the Joint Committee's failure to achieve its goal and was originally scheduled to occur on January 2, 2013, to affect spending for FY2013. Congress enacted legislation that delayed the effective date of this sequester until March 1, 2013 (American Taxpayer Relief Act of 2012, P.L. 112-240 ).

In general, sequestration entails the permanent cancellation of budgetary resources by a uniform percentage. This uniform percentage reduction is applied to all "programs, projects, and activities" (PPAs) within a budget account. However, the current sequestration procedures, as in previous iterations of such procedures, provide for exemptions and special rules. That is, certain programs and activities are exempt from sequestration, and certain other programs are governed by special rules regarding the application of a sequester. This report provides an overview of those exemptions and special rules, which are generally found in Sections 255 and 256 of BBEDCA, as amended (2 U.S.C. 905 and 906). While the report makes references to the sequestration currently in effect, triggered by failure of the Joint Committee process under the BCA, it discusses exemptions and special rules in general and should not be viewed as a comprehensive examination of the current or any future sequestration under either the BCA or the Statutory PAYGO Act.

Current Sequestration Triggers

As noted above, sequestration is tied to certain budget goals established in the Budget Control Act of 2011, as well as in the Statutory PAYGO Act of 2010. To provide some context for the exemptions and special rules applicable to these sequestration procedures, brief descriptions of the budget goals that may be enforced by sequestration are provided below. Readers also may wish to consult the following CRS reports:

CRS Report R41965, The Budget Control Act of 2011 , by [author name scrubbed], [author name scrubbed], and [author name scrubbed] CRS Report R42949, The American Taxpayer Relief Act of 2012: Modifications to the Budget Enforcement Procedures in the Budget Control Act , by [author name scrubbed] CRS Report R42972, Sequestration as a Budget Enforcement Process: Frequently Asked Questions , by [author name scrubbed] CRS Report R42675, The Budget Control Act of 2011: Budgetary Effects of Proposals to Replace the FY2013 Sequester , by [author name scrubbed] CRS Report R42051, Budget Control Act: Potential Impact of Sequestration on Health Reform Spending , by [author name scrubbed] CRS Report R42994, The Budget Control Act, Sequestration, and the Foreign Affairs Budget: Background and Possible Impacts , by [author name scrubbed] CRS Report R43021, Proposed Cuts to Air Traffic Control Towers Under Budget Sequestration: Background and Considerations for Congress , by [author name scrubbed] CRS Report R43065, Sequestration at the Federal Aviation Administration (FAA): Air Traffic Controller Furloughs and Congressional Response , by [author name scrubbed], [author name scrubbed], and [author name scrubbed] CRS Report R42506, The Budget Control Act of 2011: The Effects on Spending and the Budget Deficit , by [author name scrubbed] and [author name scrubbed] CRS Report R41157, The Statutory Pay-As-You-Go Act of 2010: Summary and Legislative History , by [author name scrubbed]

Sequestration Triggers Under the Budget Control Act (BCA)

The Budget Control Act of 2011 (BCA) was enacted on August 2, 2011. It provided for increases in the debt limit and established procedures designed to reduce the federal budget deficit. The BCA has two primary components that can trigger a sequestration of discretionary and/or mandatory (or direct) spending:

Title I of the BCA established discretionary spending limits, or caps, for each of FY2012-FY2021. If Congress appropriates more than allowed under these spending limits in any given year, the automatic reduction process of sequestration would cancel the excess amount. For FY2012 and FY2013, the spending limits were divided into "security" and "nonsecurity" categories, with security defined broadly to include the Departments of Veterans Affairs (VA), Homeland Security (DHS), and State, in addition to the Department of Defense and certain other activities. For FY2014 and subsequent years, no distinction was made between security and nonsecurity, and Title I of the law established a single discretionary spending limit for each year. Title IV of the BCA established a bipartisan Joint Select Committee on Deficit Reduction. Failure by Congress to enact legislation by January 15, 2012, developed by the Joint Committee and reducing the deficit by at least $1.2 trillion, would trigger a series of automatic spending reductions intended to achieve that level of savings over the FY2013-FY2021 period. These automatic reductions include sequestration of mandatory spending for each of FY2013-FY2021, a one-year sequestration of discretionary spending for FY2013, and lower discretionary spending limits for each of FY2014-FY2021. Spending reductions would be divided equally between security and nonsecurity. However, these terms are redefined , so that "security" consists only of budget function 050 (effectively, the Department of Defense), and "nonsecurity" includes all other government spending (including the VA, DHS, and State). The distinction between security and nonsecurity ( as redefined ) remains for each of FY2014-FY2021.

The security-nonsecurity distinction is significant because sequestration is imposed within these categories. In other words, if Congress appropriated more than allowed for either category in a given year, the excess spending would be canceled in the category where the breach occurred. As noted above, security was defined broadly under Title I and spending was divided between the two categories originally for FY2012 and FY2013. However, under the automatic procedures triggered by failure of the Joint Committee, security is defined more narrowly and the separate security and nonsecurity categories remain in effect for each year through FY2021.

Because the Joint Committee did not, in fact, develop legislation to achieve the specified level of deficit reduction ($1.2 trillion) by the deadline set in the BCA, and Congress did not subsequently enact such legislation by January 15, 2012, the automatic budget enforcement procedures provided by the law were triggered. The first fiscal year these procedures were intended to affect was FY2013; sequestration for that fiscal year (as outlined in the second bullet above) was originally scheduled to happen on January 2, 2013. Legislation was enacted, however, that delayed this sequester until March 1, 2013, and also reduced the total amount to be sequestered by $24 billion (American Taxpayer Relief Act of 2012, P.L. 112-240 ). Under the law as amended, BCA now requires a cancellation of budgetary resources equal to $85 billion in FY2013, equally divided between defense (i.e., the narrow definition of security) and nondefense.

Office of Management and Budget (OMB) Calculation of March 2013 Sequestration

On March 1, 2013, President Obama signed the sequestration order triggered by failure of the Joint Committee process under the BCA, and the Office of Management and Budget (OMB) issued a report containing the percentages by which budgetary resources must be reduced in order to achieve the necessary spending reductions in FY2013. OMB calculated that, in order to cancel the requisite $85 billion, annualized spending levels for each nonexempt account must be reduced by the percentages shown below in Table 1 .

OMB noted that the spending reductions for FY2013 must be achieved over a seven-month period rather than the full fiscal year, thus making the effective percentage reductions higher than those shown in the table. According to OMB, the effective reductions are approximately 13% for nonexempt defense spending and 9% for nonexempt nondefense spending. Since the FY2013 appropriations process was still ongoing as of March 1, OMB generally based its calculations on the assumption that discretionary programs would be funded at the annualized level provided under the continuing appropriations resolution for FY2013 that was in effect on March 1 ( P.L. 112-175 ), plus amounts provided in the Hurricane Sandy supplemental appropriations ( P.L. 113-2 ), plus any funding enacted as advance appropriations for FY2013. In determining the amount of mandatory spending subject to sequestration, OMB used the current law baseline amounts in the President's FY2013 budget, adjusted for any relevant legislation enacted since transmittal of the budget in February 2012.

Readers are referred to the OMB report for an explanation of the methodology used in making calculations, and to the report's appendix for an itemized list of budget accounts that include spending subject to sequestration, the dollar amounts that are subject to sequestration, the percentage by which they are reduced, and the dollar amount of the reduction. Readers should note, however, that OMB identifies budget accounts and not "programs, projects and activities" within these accounts. The law requires sequestration to be applied uniformly at the PPA level; these applications are made by federal agencies under guidance from OMB.

OMB Calculation of FY2014 Sequestration

On April 10, 2013, OMB issued a report to Congress on the automatic spending reductions for FY2014 under the terms of the BCA. The law requires that $109 billion in spending—divided equally between defense and nondefense—must be reduced in FY2014 (and each subsequent fiscal year through FY2021) as a result of the failure of the Joint Committee process. As explained in the second bullet on p. 3 of this report, spending reductions in FY2014 through FY2021 will occur through a reduction of the discretionary spending limits established under Title I of the BCA and a sequestration of nonexempt mandatory spending.

Accordingly, the OMB report indicates that the $109 billion in spending reductions for FY2014 will be achieved through lowering the discretionary spending limits by about $91 billion ($53.9 billion in the defense category and $36.6 billion in the nondefense category) and sequestering $18 billion in nonexempt mandatory spending. OMB calculates the FY2014 sequestration percentages will equal 2% for nonexempt Medicare spending, 7.2% for nonexempt nondefense mandatory spending, and 9.8% for nonexempt defense mandatory spending. As noted above, sequestration in FY2014 and later years will affect mandatory spending only, unless the lowered discretionary spending limits are breached. Because defense spending is largely discretionary, sequestration in FY2014 will primarily affect nondefense spending.

Readers may consult the OMB report's appendix for an itemized list of budget accounts that include mandatory spending that would be subject to sequestration in FY2014, the dollar amounts that would be subject to sequestration (based on OMB's current law baseline), the percentage by which they would be reduced, and the dollar amount of the reduction.

Sequestration Trigger Under Statutory PAYGO

The Statutory Pay-As-You-Go Act of 2010 was enacted on February 12, 2010, as Title I of P.L. 111-139 . It established a permanent budget enforcement mechanism intended to prevent mandatory (i.e., direct) spending and revenue legislation that would increase the deficit from being passed and signed into law. (Statutory PAYGO does not apply to discretionary spending.) The act requires various scorekeeping procedures, including 5-year and 10-year scorecards that track costs and savings associated with enacted legislation. At the end of each congressional session, OMB generally must determine whether the net effect of direct spending and revenue legislation enacted during the session has increased the deficit, and if so, a sequestration will be triggered. Certain costs and savings are not counted toward Statutory PAYGO, including designated emergency spending, debt service costs, costs associated with a shift in timing of certain outlays, and net savings from the CLASS Act.

Program Exemptions and Special Rules for Sequestration

Certain programs are exempt from sequestration, and special rules govern the sequestration of others. For the most part, these provisions are found in Sections 255 and 256 of the Balanced Budget and Emergency Deficit Control Act (BBEDCA), as amended. These provisions apply to sequestration orders that occur under either the BCA or the Statutory PAYGO Act. However, the application of these rules for certain programs might differ, depending on the specific provision that triggers the sequestration.

Questions about the impact of sequestration on any particular program or account cannot be answered strictly from reading the relevant provisions of law. As noted earlier, under a sequestration, all nonexempt "programs, projects, and activities" must be reduced by a uniform percentage (unless provided otherwise under special rules; see " Section 256 Special Rules "). However, numerous factors potentially affect the sequestration process, including the amount of budgetary resources subject to sequestration and the interpretation of statutory requirements as they apply to specific programs and activities.

Section 255 of BBEDCA (codified at 2 U.S.C. 905) identifies programs that are exempt from sequestration, and Section 256 of BBEDCA (codified at 2 U.S.C. 906) establishes special rules. Readers should note that these sections have been amended as recently as February 2010 under the Statutory PAYGO Act; however, until the most recent action on March 1, an actual sequestration had not occurred since the early 1990s. CRS cannot say with certainty how these provisions will be interpreted and applied in any particular sequestration, or how potential ambiguities in language may be resolved. The following should be considered as a general description of the law and not an attempted interpretation. Ultimately, the execution and impact of any automatic spending reduction triggered under provisions of the BCA or Statutory PAYGO depend in large part on the legal interpretations and actions taken by OMB.

As noted above, OMB issued a report on March 1, which identifies budget accounts that include spending subject to sequestration in FY2013 under the BCA. In addition, OMB's September 2012 report, issued in response to the Sequestration Transparency Act, gave preliminary information on the "sequestrable" or "exempt" classification of budgetary resources, and provided citations for the provisions in BBEDCA that determined these classifications. Readers are referred to those documents for more specific information on OMB's interpretation and implementation of the law in the case of the March 1 Joint Committee- triggered sequester. However, readers should note that the sequester percentages and amounts shown in the September 2012 OMB report are obsolete, since that report was prepared before the American Taxpayer Relief Act of 2012 ( P.L. 112-240 ) delayed the FY2013 sequestration from January 2 to March 1, 2013 , and reduced the amount of resources to be sequestered .

Section 255 Program Exemptions23

Section 255 contains a list of programs and activities that are exempt from sequestration. Most are mandatory, although a few are discretionary, most notably programs administered by the Department of Veterans Affairs (VA). In many cases, specific budget accounts are provided, so readers are referred to the statute for precise identification of exempted programs and activities (see Appendix ). While the law provides a list of programs and types of spending that are exempt from sequestration, it provides no definitive list of programs or types of spending that absolutely are subject to sequestration. As stated above, the impact of sequestration on any given program depends on the actions and interpretations of OMB. The following are selected programs and types of spending identified in Section 255 as exempt from sequestration:

Social Security benefits (old-age, survivors, and disability) and Tier 1 Railroad Retirement benefits. All programs administered by the VA, and special benefits for certain World War II veterans. Net interest (budget function 900). Payments to individuals in the form of refundable tax credits. Unobligated balances, carried over from prior years, for nondefense programs. At the President's discretion (subject to notification to Congress), military personnel accounts may be exempt entirely, or a lower sequestration percentage may apply. A list of "other" budget accounts and activities; readers should consult the statute for a complete list. A few selected examples include activities resulting from private donations, bequests or voluntary contributions, or financed by voluntary payments for good or services; advances to the Unemployment Trust Fund; payments to various retirement, health care, and disability trust funds; certain Tribal and Indian trust accounts; and Medical Facilities Guaranty and Loan Fund. Specified federal retirement and disability accounts and activities (consult the statute for the complete list). Prior legal obligations of the federal government in specified budget accounts (consult the statute for the complete list). Low-income programs, including Academic Competitiveness/Smart Grant Program; mandatory funding under the Child Care and Development Fund; Child Nutrition Programs (including School Lunch, School Breakfast, Child and Adult Care Food, and others, but excluding Special Milk); Children's Health Insurance Program (CHIP); Commodity Supplemental Food Program; Temporary Assistance for Needy Families (TANF) and the TANF Contingency Fund; Family Support Programs; Federal Pell Grants; Medicaid; Foster Care and Permanency Programs; Supplemental Nutrition Assistance Program (SNAP, formerly food stamps); and Supplemental Security Income (SSI). Medicare Part D low-income premium and cost-sharing subsidies; Medicare Part D catastrophic subsidy payments; and Qualified Individual (QI) premiums. Specified economic recovery programs, including GSE Preferred Stock Purchase Agreements, the Office of Financial Stability, and the Special Inspector General for the Troubled Asset Relief Program. The following "split-treatment" programs, to the extent that the programs' budgetary resources are subject to obligations limitations in appropriations bills: Federal Aid-Highways; Highway Traffic Safety Grants; Operations and Research NHTSA and National Driver Register; Motor Carrier Safety Operations and Programs; Motor Carrier Safety Grants; Formula and Bus Grants; and Grants-in-Aid for Airports.

Section 256 Special Rules

In addition to the exemptions in Section 255 of BBEDCA, Section 256 establishes special rules for sequestration of certain programs or types of spending. Most Section 256 special rules apply to mandatory programs, although some discretionary programs are included (e.g., certain health programs). Once again, the effect of sequestration on any given program is subject to the interpretation of the law's provisions by OMB. The discussions below provide some information on interpretations made in implementing the March 1 sequestration order.

The following is a list of programs included in Section 256 (they are discussed in greater detail below):

student loans under Title IV-B and IV-D of the Higher Education Act; Medicare; community and migrant health centers, Indian health services and facilities, and veterans' medical care; Child Support Enforcement; federal pay; federal administrative expenses; Unemployment Compensation; and Commodity Credit Corporation.

Student Loans33

Special sequestration rules (Section 256(b)) apply to federal student loans made under the William D. Ford Federal Direct Loan program during the period when a sequestration order is in effect. Origination fees on Direct Loans made during a period of sequestration must be increased by the uniform percentage specified in the sequestration order. Loan origination fees are calculated as a proportion of the loan principal borrowed and are deducted proportionately from each disbursement of the loan proceeds to the borrower. The origination fee helps offset the costs of federal loan subsidies.

Four types of federal student loans are made under the Direct Loan program: Direct Subsidized Loans, Direct Unsubsidized Loans, Direct PLUS Loans, and Direct Consolidation Loans. In general, for Direct Loans made on or after July 1, 2010, the origination fee on Direct Subsidized Loans and Direct Unsubsidized Loans is 1%, and the origination fee on Direct PLUS Loans is 4%. The Department of Education (ED) does not currently charge an origination fee on Direct Consolidation Loans.

Under a sequestration order applicable to direct spending programs, origination fees on Direct Loans made during the sequestration period are required to be increased by the uniform percentage amount. As illustrated in Table 1 , OMB has calculated a uniform percentage amount of 5.1% for nonexempt nondefense mandatory programs, under the March 1, 2013, sequestration triggered by the BCA. Thus, the 1% origination fee on Direct Subsidized Loans and Direct Unsubsidized Loans and the 4% origination fee on Direct PLUS Loans will each be increased by 5.1%. The Department of Education has announced that it will implement the origination fee increase for loans on which the first disbursement is made on or after July 1, 2013. According to ED, for these loans the loan origination fee will be 1.051% for Direct Subsidized Loans and Direct Unsubsidized Loans, and will be 4.204% for Direct PLUS Loans.

Medicare37

Enacted in 1965, the Medicare program provides hospital and supplementary medical insurance to Americans age 65 and older and to certain disabled persons, including those with end-stage renal disease. Medicare enrollment has increased from 19 million in 1966 to about 52 million beneficiaries in FY2013. CBO estimates that by 2023, the number of Medicare enrollees will increase by about a third, to almost 69 million.

Medicare consists of two parts financed through separate trust funds. Hospital Insurance (Part A) pays health care providers for inpatient care that beneficiaries receive at hospitals; it also pays for care at skilled nursing facilities, some home health care, and hospice services. Supplementary Medical Insurance (Parts B and D) pays for physicians' services, outpatient services at hospitals, home health care, and outpatient prescription drugs. (Payments to private insurance plans under Part C are financed by a blend of funds from the two trust funds.) Medicare is administered by the Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services (HHS).

CBO estimates that in FY2013 gross Medicare outlays will reach $592 billion. Most of this spending (about 99%) is comprised of mandatory spending that is primarily used to cover benefit payments (i.e., payments to health care providers for their services). CBO projects that spending on Medicare benefits will increase from $583 billion in FY2013 to about $1 trillion in FY2023, an annual growth rate of about 6%.

About 0.5% of Medicare mandatory outlays are used for administrative purposes, such as funding quality improvement organizations, for certain activities against fraud and abuse, and payments of Part B premiums for Qualifying Individuals. A small portion of Medicare spending is discretionary (about $6 billion in FY2013). This portion is used almost entirely for program management activities, such as payments to contractors to process providers' claims, funding for beneficiary outreach and education, and the maintenance of Medicare's information technology (IT) infrastructure.

Sequestration Rules for Medicare

Section 256(d) of BBEDCA contains special rules for the Medicare program in case of a sequestration. However, while BBEDCA ordinarily limits reduction of certain Medicare spending to 4% under a sequestration order (which would apply in the case of a Statutory PAYGO sequestration), the BCA limits the size of this reduction to 2%.

As stated earlier, sequestration requires that all nonexempt programs must be reduced by a uniform percentage. This percentage is calculated by OMB, based on the necessary amount of spending reduction that must occur overall. Under a sequestration triggered by the BCA, if the uniform percentage is less than 2%, it will be applied to all nonexempt accounts, including Medicare. If the percentage is greater than 2%, then a 2% reduction will be made in Medicare spending, and the uniform reduction percentage for the remaining programs will be recalculated and increased by the amount necessary to achieve the total level of reductions needed. If sequestration were triggered by Statutory PAYGO, the process would be the same but Medicare sequestration would be limited to 4%.

As explained earlier in this report, OMB has calculated that the uniform reduction percentage for nondefense mandatory spending under the March 1 BCA sequester is more than 2%; thus, Medicare sequestration is limited to 2% and remaining nondefense mandatory spending is being reduced by 5.1%. CBO estimates that Medicare benefit spending will be reduced by about $90 billion over the nine-year sequestration period.

Under sequestration, Medicare's benefit structure generally remains unchanged (i.e., beneficiaries will not see a change in their Medicare coverage). Additionally, spending for certain Medicare programs and activities is exempt from sequestration and is therefore not reduced under a sequestration order. These include (1) Part D low-income subsidies; (2) the Part D catastrophic subsidy (reinsurance); and (3) Qualified Individual (QI) premiums.

For Medicare Parts A and B services or discharges occurring on or after April 1, 2013, the percentage reductions are to be made to individual payments to providers for services (e.g., hospital and physician services). According to guidance provided by CMS, the provider payment adjustments are to be made to claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payer adjustments. In other words, the 2% reduction only applies to the portion of the payment paid to providers by Medicare; the beneficiary cost-sharing amounts, and amounts paid by other insurance, are not reduced.

In the case of inpatient services, the services are considered to be furnished on the date of the individual's discharge from the inpatient facility. For services paid on a reasonable cost basis, the reduction is to be applied to payments for such services incurred at any time during each cost reporting period during the sequestration period, for the portion of the cost reporting period that occurs during the effective period of the order. For Part B services provided under assignment, the reduced payment is to be considered payment in full and the Medicare beneficiary will not pay higher copayments to make up for the reduced amount.

In the case of Parts C and D, reductions are to be made to the monthly payments to the private plans that administer these parts of Medicare. Reductions are to be made at a uniform rate and are not to exceed 2%. CMS has indicated that Medicare Advantage Organizations (MAOs) and Prescription Drug Plan sponsors may not modify their current benefit or cost-sharing structures, including increasing premiums or cost sharing, to offset lower payments resulting from sequestration. CMS also provided instructions regarding the treatment of contract and non-contract providers who provide services under Parts C and D. Specifically, "whether and how sequestration might affect an MAO's payments to its contracted providers are governed by the terms of the contract between the MAO and the provider." Similarly, a Part D plan sponsor's payment to its network pharmacy providers is governed by the payment terms in their contracts. Non-contracted providers, however, must accept as payment in full the fee-for-service payment amounts; therefore, MAOs may be able to reduce payments to non-contracted providers by 2%.

Section 256(d) of BBEDCA specifies that the Secretary may not take into account any reductions in payment amounts under sequestration for purposes of computing any adjustments to Medicare payment rates, including the Part C growth percentage, the Part D annual growth rate, and the determination of Medicare Part D risk corridors. In other words, annual provider and plan payment updates are to be determined as if the reductions under sequestration had not taken place.

Special Considerations Regarding Medicare

The budgetary baseline that must be used in implementing a sequestration has special implications with regard to Medicare. For direct spending, the baseline is to be calculated by assuming that the laws providing or creating direct spending will operate in the manner specified, and that funding for entitlement authority is adequate to make all required payments.

Specifically, CBO's May 2013 projections of Medicare spending incorporated the assumption that Medicare spending would be constrained beginning in 2014 by the sustainable growth rate (SGR) mechanism used to calculate the fees paid for physicians' services. Those fees are scheduled to be reduced by about 24% beginning in January 2014 and by additional amounts in subsequent years; however, in prior years Congress has almost always taken action to prevent these cuts from occurring. CBO estimates that it would cost at least $139 billion over the next 10 years to eliminate these reductions.

There have been some concerns that although Medicare benefits are not to be reduced under sequestration, reductions in provider payments could discourage some providers from accepting Medicare patients. For instance, there have been reports of cancer clinics turning away Medicare patients because of the impact of sequestration on Medicare's reimbursement for chemotherapy drugs. Additionally, there is concern that costs could be shifted to other third-party payers or beneficiaries to make up for the additional decrease in payments. For instance, private payers could see increased costs or Medicare Advantage or Prescription Drug Sponsors could design their plans in future years so that Medicare enrollees pay higher premiums and/or increased cost sharing. Finally, some of the administrative functions, including fraud and abuse and quality oversight activities, that do not qualify as "Medicare benefits" are subject to reductions higher than 2% (5.0% and 5.1% for discretionary and mandatory funding respectively in FY2013). There is some concern that reduced funding for such activities could result in increased costs to the program and/or reduced quality of care.

Health Centers, Indian Health, and Veterans' Medical Care

Health Centers57

Community and migrant health centers are two types of federally funded health centers: nonprofit entities that receive grants to provide primary care to people who experience financial, geographic, cultural, or other barriers to health care. They are administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS). In addition to these two types of health centers, HRSA provides grants to support health centers for the homeless and health centers for residents of public housing.

Section 256(e) of BBEDCA limits the amount of funding that can be reduced from community and migrant health centers under a sequestration to 2%. At the time of BBEDCA's enactment in 1985, there were four separate health center programs administered by HRSA and funded under HRSA's budget account. The Health Centers Consolidation Act of 1996 ( P.L. 104-299 ) combined the four health center programs—community health centers, migrant health centers, health centers for the homeless, and health centers for residents of public housing—into Section 330 of the Public Health Service Act, which receives a single discretionary appropriation as part of the HRSA budget.

With regard to the sequester that took effect March 1, 2013, OMB determined that this special rule for community and migrant health centers applies only to mandatory health center funds (i.e., funds appropriated for the health center program under the ACA from FY2011 through FY2015). It further determined that the 2% limit applies to that portion (90.1%) of the mandatory appropriation that is allocated specifically for community and migrant health centers. The remaining 9.9% of the mandatory appropriation and the discretionary portion of health centers funding is subject to the full sequestration amount (5.1% for nondefense mandatory and 5.0% for nondefense discretionary spending).

Indian Health Service59

The Indian Health Service (IHS) in HHS is responsible for providing comprehensive medical and environmental health services for approximately 2.0 million American Indians and Alaska Natives who belong to 566 federally recognized tribes. Health care is provided through a system of facilities and programs operated by IHS, tribes and tribal groups, and urban Indian organizations. IHS is funded by two discretionary budget accounts—Indian Health Services and Indian Health Facilities. However, IHS also receives reimbursements from Medicare, Medicaid, and CHIP for services provided at IHS facilities for beneficiaries eligible for these programs, and IHS also receives mandatory appropriations for diabetes programs.

Under Section 256(e) of BBEDCA, sequestration may only reduce funding for the two IHS accounts by 2% in any fiscal year. With regard to the sequester that took effect on March 1, 2013, however, OMB determined that this special rule (i.e., the 2% limit) applies only to mandatory funds that IHS receives (i.e., diabetes program funding). The IHS discretionary appropriation thus is fully sequestrable. OMB did not include reimbursements that IHS receives from other federal programs, or rent that IHS receives from renting staff quarters in the amount that could be sequestered from the IHS budget (i.e., it exempted these amounts from sequestration).

Veterans' Medical Care63

The VA, through the Veterans Health Administration (VHA), operates the nation's largest integrated direct health care delivery system. Veterans' medical care is a discretionary program, and eligibility for VA medical care is based on veteran status, presence of service-connected disabilities or exposures, income, and/or other factors, such as status as a former prisoner of war or receipt of a Purple Heart.

Under current law, and as originally enacted, Section 256(e) of BBEDCA allows a maximum 2% reduction in budget authority for VA medical care for any fiscal year. However, Section 255 of BBEDCA, as amended in 2010 ( P.L. 111-139 ), specifically excludes from sequestration all programs administered by the VA, which includes veterans' medical care. This apparent discrepancy between the two sections of the law raised questions about whether VA will be totally exempt from sequestration or whether medical care will be subject to a maximum permissible 2% reduction in budget authority, under a BCA-triggered sequestration. On April 23, 2012, OMB issued a letter stating that "all programs administered by the VA, including Veterans' Medical Care, are exempt from sequestration under Section 255(b)." In its report issued pursuant to the Sequestration Transparency Act, OMB further clarified that administration accounts (which include, among others, construction projects, general administration, and information technology systems) are exempt. In other words, all accounts of the Department of Veterans Affairs are exempt from sequestration.

Child Support Enforcement68

The Child Support Enforcement (CSE) program is a mandatory spending program that seeks to enhance the well-being of children by obtaining child support, including financial and medical support, from noncustodial parents through services and activities that locate noncustodial parents, establish paternity, establish child support obligations, and collect and monitor child support payments. The CSE program is a federal-state program, administered by HHS. The federal government reimburses each state for 66% of all expenditures on CSE activities and also provides states with an incentive payment to encourage them to operate effective CSE programs.

Section 256(f) of BBEDCA stipulates that any required reduction in CSE program expenditures or CSE incentive payments must be accomplished by reducing the federal matching rate for state CSE program costs. However, subsequent to enactment of this provision, Section 255 was amended (in 1997, by P.L. 105-33 ), and specifically excludes from sequestration Family Support Programs, which include the CSE program.

Federal Pay69

In general, for purposes of sequestration, Section 256(g) provides that federal pay under a statutory pay system—the General Schedule (GS), Foreign Service (FS) pay schedule, and Department of Medicine and Surgery at the Department of Veterans Affairs (VA) pay schedule—is subject to reduction in the same manner as other administrative expense components of the federal budget (see " Federal Administrative Expenses ," immediately below). Likewise, elements of military pay are subject to such reduction. Such an order may not, however, reduce or have the effect of reducing the rate of pay an employee is entitled to under the GS, FS, or VA pay systems or any increase in special pay rates authorized by 5 U.S.C. Section 5305. The order also may not reduce or have the effect of reducing the rate of any element of military pay an individual is entitled to or any increase in rates of pay authorized by 37 U.S.C. Section 1009, or any other provision of law.

The conference report (H. Rept. 99-433) that accompanied the original BBEDCA explained the provision as follows:

The conference agreement provides that rates of pay for civilian employees (and rates of basic pay, basic subsistence allowances and basic quarters allowances for members of the uniformed services) may not be reduced pursuant to a sequestration order. The agreement retains the House position that a scheduled pay increase may not be reduced pursuant to an order and the Federal pay be treated as other components of administrative expenses. The conferees urge program managers to employ all other options available to them in order to achieve savings required under a sequestration order and resort to personnel furloughs only if other methods prove insufficient.

An employee may experience a pay cut when placed "in a temporary nonduty, nonpay status because of lack of work or funds, or other nondisciplinary reasons." This action occurs under an administrative furlough that "is a planned event by an agency which is designed to absorb reductions necessitated by downsizing, reduced funding, lack of work, or any other budget situation other than a lapse in appropriations."

In another matter related to federal pay, an OMB Memorandum issued by Controller Danny Werfel on February 27, 2013, advised executive department and agency heads that "issuing discretionary monetary awards to employees ... should occur only if legally required until further notice."

Federal Administrative Expenses75

In general, under Section 256(h) of BBEDCA, federal administrative expenses are subject to sequestration, regardless of whether they are incurred in connection with a program, project, activity, or account that is otherwise exempt or subject to a special rule. As an example, while Supplemental Security Income (SSI) is exempt from sequestration, the federal administrative expenses associated with this program would generally not be exempt. With regard to the sequester that took effect on March 1, 2013, however, OMB determined that the special rule for federal administrative expenses applies only to mandatory funds and not discretionary funds. This means, according to OMB, that mandatory administrative expenses for an otherwise exempt program are subject to sequestration, but that discretionary administrative expenses for an exempt program are not. Therefore, since federal administrative expenses for SSI are discretionary (although program benefits are mandatory), they are not subject to sequestration under the Joint Committee-triggered automatic reduction provisions, despite the special rule described above.

Section 256 also states that federal payments to state and local governments that match or reimburse these governments for their administrative costs are not considered "federal administrative expenses" and are subject to sequestration only to the extent that the relevant federal program is subject to sequestration. In other words, if a program is exempt under Section 255, then federal payments to states for the costs of administering that program also are exempt. (However, certain unemployment compensation payments are not covered by this provision, as noted below.)

Unemployment Compensation79

Section 256(i) of BBEDCA reiterates the exemption from sequestration (provided under Section 255) of federal loans to the states for payment of unemployment benefits. Additionally, Section 256(i) exempts regular unemployment compensation (UC) benefits from sequestration. This exemption is extended to UC for former federal workers (UCFE) and UC for former servicemembers (UCX). Generally, these benefits have a duration of up to 26 weeks and are paid by state unemployment taxes. However, Section 256 specifically does not exempt administrative grants to the states and the federal share of the permanently authorized extended benefit (EB) program from sequestration. States are required to continue to pay their share of EB payments. If a state's unemployment insurance law allows it, the state may reduce the EB benefit amount by a percentage that does not exceed the percentage by which the federal share of EB has been reduced. The authorization of the temporary emergency unemployment compensation (EUC08) benefit ends at the end of calendar year 2013; the EUC08 benefit is subject to sequestration.

On March 8, 2013, the U.S. Department of Labor released the details on how the sequester reductions to administrative grants, unemployment benefits, and other types of unemployment benefit expenditures will occur. The reductions to UI expenditures will generally begin the week beginning on or after March 31, 2013. No unemployment benefits already paid to individuals will be recovered to satisfy the sequestration reductions.

Commodity Credit Corporation82

The Commodity Credit Corporation (CCC) is the funding mechanism for the mandatory spending of the U.S. Department of Agriculture (USDA) for farm commodity support and certain conservation programs. The CCC is a wholly owned government corporation that has the legal authority to borrow up to $30 billion at any one time from the U.S. Treasury. Its borrowing authority is replenished annually in the Agriculture appropriations bill by a "such sums as are necessary" appropriation. Most spending for these programs was authorized by the 2008 farm bill ( P.L. 110-246 ).

Section 256(j) says that sequestration should not restrict the CCC's authority to discharge its primary duties. Specifically, it states that commodity loan contracts entered into before the sequestration order shall not be reduced. Section 256 says, though, that loan contracts after the sequestration order shall be reduced. The farm commodity programs have evolved to include other support mechanisms than the loan program, and the loan program is no longer the primary outlay.

In fact, the Joint Committee sequestration applies to many CCC-funded programs, including the direct payment program, disaster payments, the Milk Income Loss Contract (MILC) program, and conservation programs (except the Conservation Reserve Program), as well as other farm bill programs that use CCC funds. Outlays of the federal crop insurance program are not funded under the CCC but instead have their own mandatory funding mechanism, addressed in Section 255, that exempts the prior legal obligations of the Federal Crop Insurance Fund from sequestration.

Appendix. Section 255 of the Balanced Budget and Emergency Deficit Control Act, as Amended

SEC. 255. (2 U.S.C. 905) EXEMPT PROGRAMS AND ACTIVITIES.

(a) SOCIAL SECURITY BENEFITS AND TIER I RAILROAD RETIREMENT

BENEFITS.—Benefits payable under the old-age, survivors, and disability insurance program established under title II of the Social Security Act (42 U.S.C. 401 et seq.), and benefits payable under section 231b(a), 231b(f)(2), 231c(a), and 231c(f) of title 45 United States Code, shall be exempt from reduction under any order issued under this part.

(b) VETERANS PROGRAMS.—The following programs shall be exempt from reduction under any order issued under this part:

All programs administered by the Department of Veterans Affairs.

Special Benefits for Certain World War II Veterans (28–0401–0–1–701).

(c) NET INTEREST.—No reduction of payments for net interest (all of major functional category 900) shall be made under any order issued under this part.

(d) REFUNDABLE INCOME TAX CREDITS.—Payments to individuals made pursuant to provisions of the Internal Revenue Code of 1986 establishing refundable tax credits shall be exempt from reduction under any order issued under this part.

(e) NON-DEFENSE UNOBLIGATED BALANCES.—Unobligated balances of budget authority carried over from prior fiscal years, except balances in the defense category, shall be exempt from reduction under any order issued under this part.

(f) OPTIONAL EXEMPTION OF MILITARY PERSONNEL.—

(1) IN GENERAL.—The President may, with respect to any military personnel account, exempt that account from sequestration or provide for a lower uniform percentage reduction than would otherwise apply.

(2) LIMITATION.—The President may not use the authority provided by paragraph (1) unless the President notifies the Congress of the manner in which such authority will be exercised on or before the date specified in section 254(a) for the budget year.

(g) OTHER PROGRAMS AND ACTIVITIES.—

(1)(A) The following budget accounts and activities shall be exempt from reduction under any order issued under this part:

Activities resulting from private donations, bequests, or voluntary contributions to the Government.

Activities financed by voluntary payments to the Government for goods or services to be provided for such payments.

Administration of Territories, Northern Mariana Islands Covenant grants (14–0412–0–1–808).

Advances to the Unemployment Trust Fund and Other Funds (16–0327–0–1–600).

Black Lung Disability Trust Fund Refinancing (16–0329–0–1–601).

Bonneville Power Administration Fund and borrowing authority established pursuant to section 13 of Public Law 93–454 (1974), as amended (89–4045–0–3–271).

Claims, Judgments, and Relief Acts (20–1895–0–1–808).

Compact of Free Association (14–0415–0–1–808).

Compensation of the President (11–0209–01–1–802).

Comptroller of the Currency, Assessment Funds (20–8413–0–8–373).

Continuing Fund, Southeastern Power Administration (89–5653–0–2–271).

Continuing Fund, Southwestern Power Administration (89–5649–0–2–271).

Dual Benefits Payments Account (60–0111–0–1–601).

Emergency Fund, Western Area Power Administration (89–5069–0–2–271).

Exchange Stabilization Fund (20–4444–0–3–155).

Farm Credit Administration Operating Expenses Fund (78–4131–0–3–351).

Farm Credit System Insurance Corporation, Farm Credit Insurance Fund (78–4171–0–3–351).

Federal Deposit Insurance Corporation, Deposit Insurance Fund (51–4596–0–4–373).

Federal Deposit Insurance Corporation, FSLIC Resolution Fund (51–4065–0–3–373).

Federal Deposit Insurance Corporation, Noninterest Bearing Transaction Account Guarantee (51–4458–0–3–373).

Federal Deposit Insurance Corporation, Senior Unsecured Debt Guarantee (51–4457–0–3–373).

Federal Home Loan Mortgage Corporation (Freddie Mac).

Federal Housing Finance Agency, Administrative Expenses (95–5532–0–2–371).

Federal National Mortgage Corporation (Fannie Mae).

Federal Payment to the District of Columbia Judicial Retirement and Survivors Annuity Fund (20–1713–0–1–752).

Federal Payment to the District of Columbia Pension Fund (20–1714–0–1–601).

Federal Payments to the Railroad Retirement Accounts (60–0113–0–1–601).

Federal Reserve Bank Reimbursement Fund (20–1884–0–1–803).

Financial Agent Services (20–1802–0–1–803).

Foreign Military Sales Trust Fund (11–8242–0–7–155).

Hazardous Waste Management, Conservation Reserve Program (12–4336–0–3–999).

Host Nation Support Fund for Relocation (97–8337–0–7–051).

Internal Revenue Collections for Puerto Rico (20–5737–0–2–806).

Intragovernmental funds, including those from which the outlays are derived primarily from resources paid in from other government accounts, except to the extent such funds are augmented by direct appropriations for the fiscal year during which an order is in effect.

Medical Facilities Guarantee and Loan Fund (75–9931–0–3–551).

National Credit Union Administration, Central Liquidity Facility (25–4470–0–3–373).

National Credit Union Administration, Corporate Credit Union Share Guarantee Program (25–4476–0–3–376).

National Credit Union Administration, Credit Union Homeowners Affordability Relief Program (25–4473–0–3–371).

National Credit Union Administration, Credit Union Share Insurance Fund (25–4468–0–3–373).

National Credit Union Administration, Credit Union System Investment Program (25–4474–0–3–376).

National Credit Union Administration, Operating fund (25–4056–0–3–373).

National Credit Union Administration, Share Insurance Fund Corporate Debt Guarantee Program (25–4469–0–3–376).

National Credit Union Administration, U.S. Central Federal Credit Union Capital Program (25–4475–0–3–376).

Office of Thrift Supervision (20–4108–0–3–373).

Panama Canal Commission Compensation Fund (16–5155–0–2–602).

Payment of Vietnam and USS Pueblo prisoner-of-war claims within the Salaries and Expenses, Foreign Claims Settlement account (15–0100–0–1–153).

Payment to Civil Service Retirement and Disability Fund (24–0200–0–1–805).

Payment to Department of Defense Medicare-Eligible Retiree Health Care Fund (97–0850–0–1–054).

Payment to Judiciary Trust Funds (10–0941–0–1–752).

Payment to Military Retirement Fund (97–0040–0–1–054).

Payment to the Foreign Service Retirement and Disability Fund (19–0540–0–1–153).

Payments to Copyright Owners (03–5175–0–2–376).

Payments to Health Care Trust Funds (75–0580–0–1–571).

Payment to Radiation Exposure Compensation Trust Fund (15–0333–0–1–054).

Payments to Social Security Trust Funds (28–0404–0–1–651).

Payments to the United States Territories, Fiscal Assistance (14–0418–0–1–806).

Payments to trust funds from excise taxes or other receipts properly creditable to such trust funds.

Payments to widows and heirs of deceased Members of Congress (00–0215–0–1–801).

Postal Service Fund (18–4020–0–3–372).

Radiation Exposure Compensation Trust Fund (15–8116–0–1–054).

Reimbursement to Federal Reserve Banks (20–0562–0–1–803).

Salaries of Article III judges.

Soldiers and Airmen's Home, payment of claims (84–8930–0–7–705).

Tennessee Valley Authority Fund, except nonpower programs and activities (64–4110–0–3–999).

Tribal and Indian trust accounts within the Department of the Interior which fund prior legal obligations of the Government or which are established pursuant to Acts of Congress regarding Federal management of tribal real property or other fiduciary responsibilities, including but not limited to Tribal Special Fund (14–5265–0–2–452),

Tribal Trust Fund (14–8030–0–7–452),

White Earth Settlement (14–2204–0–1–452), and Indian Water Rights and Habitat Acquisition (14–5505–0–2–303).

United Mine Workers of America 1992 Benefit Plan (95–8260–0–7–551).

United Mine Workers of America 1993 Benefit Plan (95–8535–0–7–551).

United Mine Workers of America Combined Benefit Fund (95–8295–0–7–551).

United States Enrichment Corporation Fund (95–4054–0–3–271).

Universal Service Fund (27–5183–0–2–376).

Vaccine Injury Compensation (75–0320–0–1–551).

Vaccine Injury Compensation Program Trust Fund (20–8175–0–7–551).

(B) The following Federal retirement and disability accounts and activities shall be exempt from reduction under any order issued under this part:

Black Lung Disability Trust Fund (20–8144–0–7–601).

Central Intelligence Agency Retirement and Disability System Fund (56–3400–0–1–054).

Civil Service Retirement and Disability Fund (24–8135–0–7–602).

Comptrollers general retirement system (05–0107–0–1–801).

Contributions to U.S. Park Police annuity benefits, Other Permanent Appropriations (14–9924–0–2–303).

Court of Appeals for Veterans Claims Retirement Fund (95–8290–0–7–705).

Department of Defense Medicare-Eligible Retiree Health Care Fund (97–5472–0–2–551).

District of Columbia Federal Pension Fund (20–5511–0–2–601).

District of Columbia Judicial Retirement and Survivors Annuity Fund (20–8212–0–7–602).

Energy Employees Occupational Illness Compensation Fund (16–1523–0–1–053).

Foreign National Employees Separation Pay (97–8165–0–7–051).

Foreign Service National Defined Contributions Retirement Fund (19–5497–0–2–602).

Foreign Service National Separation Liability Trust Fund (19–8340–0–7–602).

Foreign Service Retirement and Disability Fund (19–8186–0–7–602).

Government Payment for Annuitants, Employees Health Benefits (24–0206–0–1–551).

Government Payment for Annuitants, Employee Life Insurance (24–0500–0–1–602).

Judicial Officers' Retirement Fund (10–8122–0–7–602).

Judicial Survivors' Annuities Fund (10–8110–0–7–602).

Military Retirement Fund (97–8097–0–7–602).

National Railroad Retirement Investment Trust (60–8118–0–7–601).

National Oceanic and Atmospheric Administration retirement (13–1450–0–1–306).

Pensions for former Presidents (47–0105–0–1–802).

Postal Service Retiree Health Benefits Fund (24–5391–0–2–551).

Public Safety Officer Benefits (15–0403–0–1–754).

Rail Industry Pension Fund (60–8011–0–7–601).

Retired Pay, Coast Guard (70–0602–0–1–403).

Retirement Pay and Medical Benefits for Commissioned Officers, Public Health Service (75–0379–0–1–551).

Special Benefits for Disabled Coal Miners (16–0169–0–1–601).

Special Benefits, Federal Employees' Compensation Act (16–1521–0–1–600).

Special Workers Compensation Expenses (16–9971–0–7–601).

Tax Court Judges Survivors Annuity Fund (23–8115–0–7–602).

United States Court of Federal Claims Judges' Retirement Fund (10–8124–0–7–602).

United States Secret Service, DC Annuity (70–0400–0–1–751).

Voluntary Separation Incentive Fund (97–8335–0–7–051).

(2) Prior legal obligations of the Government in the following budget accounts and activities shall be exempt from any order issued under this part:

Biomass Energy Development (20–0114–0–1–271).

Check Forgery Insurance Fund (20–4109–0–3–803).

Credit liquidating accounts.

Credit reestimates.

Employees Life Insurance Fund (24–8424–0–8–602).

Federal Aviation Insurance Revolving Fund (69–4120– 0–3–402).

Federal Crop Insurance Corporation Fund (12–4085–0–3–351).

Federal Emergency Management Agency, National Flood Insurance Fund (58–4236–0–3–453).

Geothermal resources development fund (89–0206–0–1–271).

Low-Rent Public Housing—Loans and Other Expenses (86–4098–0–3–604).

Maritime Administration, War Risk Insurance Revolving Fund (69–4302–0–3–403).

Natural Resource Damage Assessment Fund (14–1618–0–1–302).

Overseas Private Investment Corporation, Noncredit Account (71–4184–0–3–151).

Pension Benefit Guaranty Corporation Fund (16–4204–0–3–601).

San Joaquin Restoration Fund (14–5537–0–2–301).

Servicemembers' Group Life Insurance Fund (36–4009–0–3–701).

Terrorism Insurance Program (20–0123–0–1–376).

(h) LOW-INCOME PROGRAMS.—The following programs shall be exempt from reduction under any order issued under this part:

Academic Competitiveness/Smart Grant Program (91–0205–0–1–502).

Child Care Entitlement to States (75–1550–0–1–609).

Child Enrollment Contingency Fund (75–5551–0–2–551).

Child Nutrition Programs (with the exception of special milk programs) (12–3539–0–1–605).

Children's Health Insurance Fund (75–0515–0–1–551).

Commodity Supplemental Food Program (12–3507–0–1–605).

Contingency Fund (75–1522–0–1–609).

Family Support Programs (75–1501–0–1–609).

Federal Pell Grants under section 401 Title IV of the Higher Education Act.

Grants to States for Medicaid (75–0512–0–1–551).

Payments for Foster Care and Permanency (75–1545–0–1–609).

Supplemental Nutrition Assistance Program (12–3505–0–1–605).

Supplemental Security Income Program (28–0406–0–1–609).

Temporary Assistance for Needy Families (75–1552–0–1–609).

(i) ECONOMIC RECOVERY PROGRAMS.—The following programs shall be exempt from reduction under any order issued under this part:

GSE Preferred Stock Purchase Agreements (20–0125–0–1–371).

Office of Financial Stability (20–0128–0–1–376).

Special Inspector General for the Troubled Asset Relief Program (20–0133–0–1–376).

(j) SPLIT TREATMENT PROGRAMS.—Each of the following programs shall be exempt from any order under this part to the extent that the budgetary resources of such programs are subject to obligation limitations in appropriations bills:

Federal-Aid Highways (69–8083–0–7–401).

Highway Traffic Safety Grants (69–8020–0–7–401).

Operations and Research NHTSA and National Driver Register (69–8016–0–7–401).

Motor Carrier Safety Operations and Programs (69–8159–0–7–401).

Motor Carrier Safety Grants (69–8158–0–7–401).

Formula and Bus Grants (69–8350–0–7–401).

Grants-In-Aid for Airports (69–8106–0–7–402).

(j) IDENTIFICATION OF PROGRAMS.—For purposes of subsections (b), (g), and (h), each account is identified by the designated budget account identification code number set forth in the Budget of the United States Government 2010–Appendix, and an activity within an account is designated by the name of the activity and the identification code number of the account.

SEC. 256. (2 U.S.C. 906) [excerpt]

(7) EXEMPTIONS FROM SEQUESTRATION.—In addition to the programs and activities specified in section 255, the following shall be exempt from sequestration under this part:

(A) PART D LOW-INCOME SUBSIDIES.—Premium and cost-sharing subsidies under section 1860D–14 of the Social Security Act.

(B) PART D CATASTROPHIC SUBSIDY.—Payments under section 1860D–15(b) and (e)(2)(B) of the Social Security Act.

(C) QUALIFIED INDIVIDUAL (QI) PREMIUMS.—Payments to States for coverage of Medicare cost-sharing for certain low-income Medicare beneficiaries under section 1933 of the Social Security Act.