Proposals for a Commission to Address the Federal Government’s Long-Term Fiscal Situation
Released: 2009-12-14T00:00:00

In the 111 th 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. The proposed commissions might as a group be called "fiscal commissions." 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 special legislative procedures to encourage expedited consideration of a commission's recommendations. This report provides an overview of four of these proposals— S. 2853 , S. 1056 , H.R. 1557 , and S. 276 (listed in order of most recent introduction)—and discusses potential, related issues for Congress. Potential issues for Congress include, among others, whether the use of a commission, coupled with expedited consideration of the commission's proposals, may be appropriate for addressing the federal government's long-term fiscal situation; and, if a commission proposal were considered, how a commission proposal might be structured.

The report begins with recent history related to the legislative proposals and brief summaries of the four bills. Next, the report discusses legislative precursors that may help inform assessments of the proposals. Experience with these precursors, which include past commissions and proposals for commissions, appears to have informed how some of the current fiscal commission proposals were designed.

Analyses of potential issues for Congress follow thereafter, including discussion of some advantages and disadvantages of using a commission, potential implications of expedited legislative procedures, and matters related to the structure of proposed commissions. Finally, Appendix A provides a more detailed side-by-side comparison of provisions of each bill. Appendix B discusses the long-term fiscal situation and three major entitlement programs—Social Security, Medicare, and Medicaid—that are widely perceived as important for understanding the federal government's long-term fiscal situation. At the end of the report, a table provides a list of CRS subject matter experts who are available to answer questions related to many aspects of these legislative proposals.

Fiscal Commission Proposals

Recent History Related to Fiscal Commission Proposals

Observers have expressed concerns for decades about the long-term fiscal situation of the federal government. Amid debates over the direction of federal revenue and spending policies, they focused on the overall balance between revenues and spending as well as on long-term trends for entitlement program spending. Congress routinely faces questions of when and how to address such concerns. In recent years, these concerns have been widespread and considerable. According to the Congressional Budget Office (CBO), "[u]nder current law, the federal budget is on an unsustainable path—meaning that federal debt will continue to grow much faster than the economy over the long run."

Procedural and Policy Choices

Shared perception of a problem does not necessarily generate consensus on what should be done to address the problem. Reaching agreement on changes to specific policies is difficult. In addition, policy makers often disagree about the process, sequence, and timing that should be used to make such decisions (e.g., using the regular legislative process or a commission). Matters of process, sequence, and timing are not necessarily neutral. A change of procedures in handling legislative proposals, or in changing the extent of discretion available to the President or agencies, may result in changes to power relationships and the ability to influence which policy choices are implemented.

When deciding when or how to address multi-dimensional policy challenges such as the federal government's overall fiscal situation or the restructuring of multiple policies, programs, and agencies, Congress often considers a variety of procedural strategies. Most often, Congress has used the regular legislative process to address difficult problems like reducing the annual budget deficit or making complex organizational changes after a national emergency. The framers of the Constitution, however, established a relatively cautious system for enacting legislation. Perhaps as a consequence of the U.S. system of government, observers sometimes express frustration with perceptions of Congress and the President not addressing policy problems in a timely or sufficient way.

Less often, Congress has used alternative approaches. One of these alternatives has been to establish what might be called a "blue-ribbon" commission that reviews multiple agencies, operations, or policies. Such commissions may be used to help identify potential solutions for the federal government as a whole or for individual policy areas (e.g., military installations). At the same time, issues of representation may arise, raising questions of whether commission members will fairly represent all of the interests that should be considered. Much more rarely, Congress has provided for expedited legislative consideration of a commission's recommendations.

Congressional Consideration of Fiscal Commission Proposals

In recent Congresses, several legislative proposals have been introduced to establish a special commission whose recommendations could have the effect of addressing some, or all, aspects of the federal government's fiscal balance. The proposals have differed in significant ways. All of them, however, provided for a commission that would review multiple agencies and programs and, in some cases, revenue policies. Such a commission then would make recommendations for changes in government operations, policies, and structure. Some of the proposals would have required a commission's recommendations to be considered by Congress under expedited, or "fast-track," procedures, such as prohibitions of amendments.

In the 111 th Congress, similar legislation has been discussed and introduced. This category of legislation includes a more specific group of measures that were referred to as "bipartisan process" proposals at a November 2009 Senate Budget Committee hearing. These measures also have been called "fiscal commission" and "deficit commission" proposals. Generally speaking, these proposals focus on addressing the federal government's long-term fiscal situation. The proposals call for some or most of a commission's membership to be Members of Congress, 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 bill also provides special legislative procedures to encourage expedited consideration of legislation (i.e., a commission's approved recommendations). The special procedures, among other things, would restrict the amendment process, limit floor consideration or debate, and, in some cases, require a supermajority for final chamber passage. The Senate Budget Committee hearing cited specific legislation in this category of commission-related proposals, including,

from the 111 th Congress, S. 1056 / H.R. 1557 , the Securing America's Future Economy Commission Act (SAFE Commission Act), which would establish the Securing America's Future Economy Commission (SAFE Commission); from the 111 th Congress, S. 276 , the Social Security and Medicare Solvency Commission Act (SSMSC Act), which would establish a National Commission on Entitlement Solvency (NCES); and from the 110 th Congress, S. 2063 / H.R. 3655 , the Bipartisan Task Force for Responsible Fiscal Action Act of 2007 (BTFRFA Act of 2007), which would have established a Bipartisan Task Force for Responsible Fiscal Action (BTFRFA), and which also became known as the "Conrad-Gregg proposal" after its original Senate sponsors.

Senate Budget Committee Chairman Kent Conrad indicated at the November 2009 hearing that he and Ranking Member Judd Gregg soon would release a revised proposal. This measure, S. 2853 , the Bipartisan Task Force for Responsible Fiscal Action Act of 2009 (BTFRFA Act of 2009), was introduced on December 9, 2009.

Member statements and press reports suggest that some Members are seeking a legislative vehicle by which such commission legislation could be enacted. After the new Conrad-Gregg proposal was announced, CongressDaily reported that Senator Conrad "and other Democrats are negotiating with Senate Democratic leaders to attach the bill to the legislation needed to increase the debt limit." A recent Wall Street Journal article reported that the "White House was likely to make its own proposal for a panel, which could have less power than the proposed Conrad-Gregg commission."

Brief Summaries of Current Fiscal Commission Proposals

The following section includes brief summaries of the four fiscal commission bills that are the subject of this report. For more detail, see a side-by-side comparison of the legislation in Appendix A .

S. 2853, Bipartisan Task Force for Responsible Fiscal Action Act of 2009

The Bipartisan Task Force for Responsible Fiscal Action (BTFRFA) Act of 2009 would establish a temporary commission with 18 members. Of the 18 members, two would be appointed by the President (one of whom would be the Secretary of the Treasury), and 16 would be appointed by the House and Senate leadership from among Members of Congress. If S. 2853 were enacted, the sitting President were a Democrat, and both chambers of Congress were controlled by Democrats, 10 commission members would be appointed by Democrats (two by the President, four by the Speaker of the House, and four by the Senate majority leader) and eight would be appointed by Republicans (four each by the minority leader of the House and Senate). Sixteen of the commission members would be Members of Congress.

The bill would direct the commission to review the "fiscal imbalance" of the federal government, identify factors that affect the long-term fiscal imbalance, analyze potential courses of action, and provide recommendations and legislative language to Congress. The commission report would be voted on between November 3, 2010, and November 9, 2010; would need to be approved by 14 of the 18 commissioners; and could include minority opinions and additional views.

S. 2853 would authorize a transfer of $9 million from amounts appropriated or made available and remaining unobligated under Division A of the economic stimulus package that was enacted earlier in 2009. The bill would provide for a staff director, the hiring of additional staff, member travel reimbursements, and contract authority. The bill also would require the public announcement of meeting dates, times, and places; authorize the commission to hold hearings; and prohibit proxy voting. The bill would provide for expedited consideration of the proposed legislation submitted by the commission, including a prohibition on amendments. An affirmative vote of three-fifths of Members, duly chosen and sworn, would be necessary for final chamber passage.

S. 1056, the Securing America's Future Economy Commission Act

The Securing America's Future Economy (SAFE) Commission Act would establish a temporary commission with 18 voting and two non-voting members. Of the 18 voting members, two members would be appointed by the President, while 16 would be appointed by Members of Congress. If S. 1056 were enacted, the sitting President were a Democrat, and Democrats held the majority in both chambers, 10 commission members would be Democrats or would be appointed by Democrats (two presidential appointees, three members each appointed by the Speaker of the House of Representatives and Senate majority leader, and the chairs of the Senate Finance and House Ways and Means Committees), and eight would be Republicans or would be appointed by Republicans (three members each appointed by the Senate and House minority leaders and the ranking members of the Senate Finance and House Ways and Means Committees). Twelve of the commission members would be Members of Congress.

The proposal would direct the commission to study and report to the President and Congress, findings, recommendations, and proposed legislative language to address four specific issues: (1) the balance between long-term spending commitments and revenues, (2) desire for increased net national savings, (3) the implications of foreign ownership of U.S. government debt, and (4) increased emphasis on long-term fiscal issues in the federal budget process. In order to submit a legislative proposal to Congress, at least 13 members would need to vote in favor of doing so.

Unlike S. 2853 or S. 276 , S. 1056 does not include language that would authorize funding for the commission. To fund the commission, an appropriation or transfer authority would be necessary. The proposal would provide for a director of commission staff, the hiring of additional staff, travel reimbursement for certain members of the commission, and the use of contracts for services. The proposal also would require the commission to hold certain public hearings and give the commission the power to administer oaths to testifying witnesses. The proposal would provide for expedited consideration of the proposed legislation submitted by the commission, including a prohibition on amendments. No special requirement is specified for final passage vote (e.g., supermajority voting requirement).

H.R. 1557, the Securing America's Future Economy Commission Act

The House version of the SAFE Commission Act, H.R. 1557 , is substantially similar to the Senate version, S. 1056 . H.R. 1557 , however, varies slightly in some respects. For example, H.R. 1557 would have 16 voting and two non-voting commission members. While the two non-voting members would be the same across both bills, the total number of appointments made by Members of Congress would be fewer in the Senate version. If H.R. 1557 were enacted, the sitting President were a Democrat, and Democrats held the majority in both chambers, 10 commission members would be appointed by Democrats (two presidential appointees plus four members each appointed by the Speaker of the House of Representatives and Senate majority leader), and six would be appointed by Republicans (three members each appointed by the Senate and House minority leaders). Four of the commission members would be Members of Congress.

Like S. 1056 , H.R. 1557 would direct the commission to study and report to the President and Congress, findings, recommendations, and proposed legislative language to address specific issues. H.R. 1557 , however, provides for a different set of criteria than S. 1056 . Under H.R. 1557 , the commission report would address (1) the unsustainable imbalance between long-term federal spending commitments and projected revenue, (2) the increasing net national savings, (3) the implications of foreign ownership of U.S. government debt instruments, and (4) the improvement of the budget process to place a greater emphasis on long-term fiscal issues. The commission, with at least a three-fourths vote, would also be required to submit a legislative proposal to Congress and the president within 60 days of the submission of the commission's report. Amendments would be limited to the introduction of certain "alternatives" (see Appendix A ), and no special requirement is specified for initial passage vote (e.g., supermajority voting requirement).

S. 276, Social Security and Medicare Solvency Commission Act

The Social Security and Medicare Solvency Commission (SSMSC) Act would establish a permanent 15-member commission to study the solvency of Medicare and Social Security. Of the 15 members, the President would appoint seven, including three Democrats (in consultation with Democratic legislative leaders), three Republicans, and one person not affiliated with any political party. The remaining eight members of the commission would be appointed by the Democratic and Republican legislative leaders in the House and Senate (two appointees for each leader). Of the two appointments for each appointing official, one must be a Member of Congress who currently serves on the Senate Finance or House Ways and Means Committees. If congressional leaders appointed commission members of the same political party as each congressional leader, seven Democrats, seven Republicans, and one "unaffiliated" person would be appointed, and at least four members of the commission would be Members of Congress. Commission members initially would serve six-year terms, and subsequent appointees would serve five-year terms.

The bill would require the commission to report not later than one year after the date of enactment and every five years thereafter to the President, Congress, the Commissioner of Social Security, and the Administrator of the Centers for Medicare and Medicaid Services. The report would be required to include findings; recommendations resulting from the commission's review of analyses of the long-term actuarial financial condition of the Social Security and Medicare programs; identification of problems that threaten the programs solvency; analysis of potential solutions; and proposed legislative language to ensure the long-term solvency of the programs. For a finding, conclusion, or recommendation to be included in the report, at least 10 votes would be required.

The bill would provide for an executive director, the hiring of additional staff, travel reimbursement for members of the commission, and the use of contracts for services. The bill would require the commission to hold certain public hearings, and authorize "such sums as necessary" to fund the commission. It also would create special procedures for the consideration of legislation submitted by the commission, including a limitation to only amendments that are "relevant" to the commission's provisions and a time limit for floor consideration. A vote of three-fifths of Members, duly chosen and sworn, would be necessary to proceed to a vote on initial passage.

Precursors to Fiscal Commission Proposals

In the past, Congress has sometimes chosen to establish advisory commissions to study policy problems and report back with advice and legislative recommendations. Over 80 such congressional advisory commissions have been established in the past 20 years. In the realm of commissions that focus on reviewing and restructuring multiple agencies and policies, some previous commissions (and proposals to establish commissions) appear to have informed how some of the fiscal commission proposals that are the subject of this report were designed.

The following sections discuss past commissions and proposals that may have informed the design of fiscal commissions that are the subject of this report. Where commissions are perceived to have succeeded (i.e., accomplished desired goals), Congress might explore the extent to which the reasons for that success could apply to the creation of a commission addressing the federal government's long-term fiscal situation. Where such commissions or proposals are perceived to have failed, Congress might consider whether there are "lessons learned" that might be applied.

In addition, perspectives on the long-term fiscal situation and three major entitlement programs—Social Security, Medicare, and Medicaid—and previous efforts to address entitlement-related issues through commissions may help inform assessments of fiscal commission proposals. The long-term fiscal situation and major entitlement programs are discussed in Appendix B .

Base Realignment and Closure (BRAC) Commissions

A summary of legislative precursors to the commission proposals that are the subject of this report arguably would begin with congressional efforts to reduce the scale and number of U.S. military installations. These efforts resulted in the establishment of commissions to review a relatively narrow area of public policy, compared to the commission proposals examined elsewhere in this report. Base Realignment and Closure (BRAC) commissions have been cited favorably by multiple proponents of the current proposals as a procedural model for accomplishing their desired policy objectives.

In the wake of reduced east-west tensions, the collapse of the Warsaw Pact military threat, and the Soviet Union's breakup from the late 1980s until 1991, most analysts agreed that the Department of Defense's (DOD's) base structure was larger than necessary to meet the department's needs. Nevertheless, there were differences concerning which, if any, additional bases should be closed, at what speed, and what criteria should be used for making those decisions. Significantly, the impact of a specific base closing would be keenly felt in one Member of Congress's state or district, but benefits in terms of savings could be spread widely among all citizens and taxpayers. In combination, these two factors—(1) the narrowly felt pain from an individual base closing and (2) the widely diffused benefits from closing many bases to save taxpayer funds—produced strong incentives for coalitions of Members of Congress to bargain in the legislative process to protect many bases from closure.

At the same time, there were widespread concerns that, absent restrictions and safeguards, DOD might close, or not close, bases for political reasons. In the past, high-level representatives of DOD, in soliciting congressional support for favored programs, reportedly might have implied that if a Member of Congress voted against the program, a base might be closed in the Member's district. For example, former Representative and House Majority Leader Richard K. Armey said,

[t]he fact is, unfortunate as it is, that historically base closings have been used as a point of leverage by administrations, Republican and Democratic administrations, as political leverage over and above Members of Congress to encourage them to vote in a manner that the administration would like.

During the late 1980s, several bills were introduced in Congress to relax statutory restrictions that made closing a base difficult. The first enacted proposal was an elaborate framework prescribed by the Defense Authorization Amendments and Base Closure and Realignment Act (1988). The procedure established under that statute—relying on the services of a commission to draw up the Secretary of Defense's recommendations and a fast-track, no-amendment vote—proved so effective that a later statute, the Defense Base Closure and Realignment Act of 1990, created three subsequent Defense Base Closure and Realignment (BRAC) Commissions that operated in 1991, 1993, and 1995.

This occurred notwithstanding arguments against the legislation on grounds that bases were closed without the legislation, and that the legislation was an abdication of congressional responsibilities to the executive branch. That said, the statute vested considerable power in both executive and legislative branches in the creation of the commission, and transferred that control to the commission itself once it was established.

While the law gave the President the authority to appoint commissioners, it also stated that he "should" consult with the majority and minority leadership in both chambers in appointment of six of its nine members, and all commissioners were subject to the general "advice and consent of the Senate" requirement on all senior political appointees. The statute also spelled out the criteria under which installations were to be evaluated for realignment or closure, and both DOD and the commission were required to adhere to them in crafting their recommendations. The process required the Secretary of Defense to submit his recommendations to the commission by a date certain. The commission was then to review, accept, amend, or reject each of those recommendations and could create recommendations of its own, again by a date certain. The President was authorized only to accept the commission's entire list or return it one time to the commission for reconsideration, stating the basis of his concerns, and the statute placed a deadline on that approval. Upon the commission's resubmittal, the President could reject outright or approve the entire list. Unless Congress passed a joint resolution of disapproval within 45 days of the President's approval, the statute required the Secretary of Defense to implement all approved recommendations by a date certain—six years from the date of presidential approval.

In mid-1997, Secretary of Defense William Cohen called for two new rounds of base closures and realignments. He explained that, while four previous rounds had achieved significant savings, it was important to continue the process of closing underutilized facilities. Despite DOD pressure, most Members of Congress were reluctant to support authorization of new base closure legislation, at least for the foreseeable future.

A single additional round of base closures was authorized in 2001, to be implemented in 2005 under somewhat different procedures. This new authorization retained the basic form, structure, and process of the previous three rounds, but amendments to the governing statute included, among other provisions, an increase in the number of commissioners from eight to nine (to minimize the likelihood of tie votes on individual recommendations) and the requirement for a supermajority of votes in favor of an installation closure.

In addition to providing for a commission and expedited procedures, the BRAC statute required extensive actions to ensure that recommendations were impartial, as objective as possible, and based on expert analysis. It required that the Secretary of Defense turn over documentation used in the drafting of his recommendation list to the commission for its review. It provided for the commission to be supported by a staff of experts, and it also required that the commission's documentation be open for public review.

CARFA and Related Proposals

Legislation that was first introduced in the 107 th Congress by Senator Sam Brownback and Representative Todd Tiahrt also might be viewed as a precursor to the commission bills that are the subject of this report. Generally, the proposals would have established a commission to review multiple agencies and programs, required the commission to make recommendations, and required that the recommendations (in the form of draft legislation) be considered by Congress under expedited procedures. Variations on the bills, with somewhat different scopes and provisions, have been introduced or proposed in subsequent Congresses. They appeared as stand-alone bills, components of budget process reform legislation, and presidential proposals.

In 2002, Senator Brownback and Representative Tiahrt introduced companion bills to establish a Commission on the Accountability and Review of Federal Agencies (CARFA; S. 2488 / H.R. 5090 ). The legislation would have established a commission of presidentially appointed members. In turn, the commission would have been required to review all executive agencies and programs, except for DOD, and make recommendations for the realignment or elimination of agencies and programs according to some general criteria. The commission's recommendations, in the form of draft legislation, then would have been subject to expedited procedures in Congress. The sponsors compared the legislation with the BRAC process. Neither bill received further action in the 107 th Congress, but versions of the legislation attracted considerably more attention in the next two Congresses. Proponents of different versions of CARFA often compared the proposals to the BRAC commissions, except that the proposed CARFA legislation would have focused on most or all agencies and programs of the executive branch of government. Proponents also argued that the mechanism would eliminate ineffective programs. Critics of CARFA and related legislation argued the proposals would constitute abdication of congressional responsibilities, including the ability to amend legislative proposals, and transfer power to the President by delegating congressional responsibilities to presidential appointees or to appointees primarily chosen by members of the political party of a sitting President.

A hearing was held on a Senate version of the legislation in the 108 th Congress ( S. 1668 ). In the 109 th Congress, House leadership reportedly sought to move H.R. 5766 to a floor vote. Floor action was postponed indefinitely, however, reportedly in the face of opposition from Democrats, Republican moderates, and some Republican appropriators. Separately, Senator Judd Gregg, then chairman of the Senate Budget Committee, sponsored S. 3521 (109 th Congress), which included CARFA-like provisions as part of a broader budget reform package. The bill was reported with an amendment in the nature of a substitute. The report argued in support of the provisions, saying that "[p]rudent stewardship of the public's funds requires that Congress make every effort to ferret out wasteful spending and identify redundant activity." During committee markup, then-Ranking Member Kent Conrad proposed amending S. 3521 to strike the CARFA commission language and "[replace] it with the bipartisan membership of the Congressional committees of jurisdiction so that they can do their job," instead of "outsourcing responsibility for our nation's fiscal condition to largely unelected, unaccountable commission members." The amendment was defeated. After being reported, the bill received no further action.

Notably, S. 3521 also included provisions that would have established a National Commission on Entitlement Solvency. The latter provisions were similar in some respects to the provisions that were included in S. 2063 of the 110 th Congress, a predecessor to S. 2853 (111 th Congress, one of the measures that is the subject of this report), and S. 276 (111 th Congress, another of the measures that is the subject of this report). Significant differences between the entitlement commission provisions in S. 3521 (109 th Congress) and "task force" provisions of S. 2063 (110 th Congress) and S. 2853 (111 th Congress) included the "task force" measures' requirements that most commission members be Members of Congress and that a larger supermajority be necessary to report and submit recommendations for legislative consideration.

Comparison Between Precursors and Fiscal Commission Proposals

The federal government's experience with BRAC commissions appears to have informed development of the various fiscal commission proposals. Each bill provides special legislative procedures to encourage expedited consideration of legislation (i.e., a commission's approved recommendations). The special procedures would, among other things, restrict the amendment process and limit floor consideration or debate. A major difference between BRAC and the fiscal commission proposals, however, is the comparative breadth of the fiscal commissions' intended scopes. Most of the fiscal commission proposals include within the commission's scope all policies that may relate to the federal fiscal balance. As such, it is not clear what policy domains, if any, might fall outside a commission's scope, when drafting legislation for commission approval. In view of the potentially far-reaching scope of a commission's recommendations, some of the fiscal commission proposals' requirements for a supermajority approval by commission members and, if a commission's recommendations were considered by Congress, supermajority vote by each chamber of Congress for initial or final chamber passage, might be viewed as controls intended to channel recommendations toward a broader consensus package.

In contrast with BRAC legislation, the various CARFA proposals and related measures were not enacted. Like the fiscal commission proposals that are the subject of this report, the CARFA proposals generally provided for far-reaching scopes, across multiple agencies and programs. The process-related provisions of the CARFA proposals, however, seemed to garner substantial opposition. Some of the criticisms that opponents consistently raised against these proposals were arguments that appointments of commission members would have been substantially subject to the control of the President or to members of one political party. If such arguments were considered to be valid, a combination of the appointment provisions with other process-related provisions, such as simple majority voting by commission members and expedited legislative consideration by Congress, arguably might have had substantial effects on power relationships if the legislation had been enacted. In this light, one of the major differences between the fiscal commission proposals and the CARFA proposals is a movement toward appointment of Members of Congress as commission members, thereby potentially reducing the influence of the President.

Another difference is the use of supermajority voting requirements for the commission's recommendations and also for congressional consideration of the commission's recommendations. The supermajority requirements probably would make it necessary to achieve broader compromise, in order to approve recommendations. As with the CARFA proposals, however, it could be argued that special legislative procedures prohibiting amendments and limiting debate might affect power relationships within Congress. In addition, in comparison with use of the regular legislative process, the use of a commission—even one composed primarily of Members—might raise questions whether commission members would be in a position to represent all of the interests that could be considered in the regular legislative process.

Potential Issues for Congress

Decisions about whether to establish and how to structure a commission may have impacts on both policy outcomes and the public choice process in Congress. The following section surveys three general issues that arise from the proposed fiscal commission legislation. First, what are the strengths and weaknesses of using a commission to address long-term fiscal issues, as opposed to the regular legislative process and the existing legislative committee system? Second, what are some implications of using fast-track procedures in conjunction with commission recommendations? Finally, what issues arise from the structural design of the commissions themselves?

Advantages and Disadvantages of Commissions

Potential Advantages of Commissions

Throughout American history, Congress has occasionally found congressional advisory commissions to be useful tools in the legislative process. Commissions may be established, among other things, to cope with increases in the scope and complexity of legislation, to forge consensus, to draft bills, to promote inter-party communication, to address issues that do not fall neatly within the jurisdictional boundaries of congressional committees, and to bring together recommendations. These potential advantages may be grouped into five categories: expertise, issue and political complexity, consensus building and reducing partisanship, solving collective action problems, and visibility.

Obtaining Expertise

Congress may choose to establish a commission when legislators and their staffs do not currently have sufficient knowledge or expertise in a complex policy area. By assembling experts with backgrounds in particular policy areas to focus on a specific mission, legislators can efficiently obtain insight into complex public policy problems.

Overcoming Issue or Political Complexity

Complex policy issues may cause time management challenges for Congress. Legislators often keep busy schedules and may not have time to deal with intricate or technical policy problems, particularly if the issues require consistent attention over a period of time. A commission can devote itself to a particular issue full-time, and can focus on an individual problem without distraction.

Complex policy issues may also create institutional problems, because they do not fall neatly within the jurisdiction of any particular committee in Congress. By virtue of their ad hoc status, commissions may be able to circumvent such issues. Similarly, a commission may allow particular legislation or policy solutions to bypass the traditional development process in Congress, potentially avoiding some of the impediments inherent in a decentralized legislature.

Consensus Building and Reducing Partisanship

Legislators seeking policy changes may be confronted by an array of interests, some in favor of proposed changes and some opposed. When these interests clash, it may become more challenging to reach consensus in the highly structured political institution of the modern Congress. By creating a commission, Congress may be able to place policy debates in a more flexible environment, where congressional and public attention can be developed over time.

Solutions to policy problems produced within the normal legislative process may be subject to charges of partisanship. Similar charges may be made against investigations conducted by Congress. Commissions are not necessarily immune from such criticisms. However, the potential for a congressional advisory commission to take on a nonpartisan or bipartisan character may make its findings and recommendations less susceptible to such charges and more politically acceptable to diverse viewpoints. A perception of bipartisanship or nonpartisanship may give a commission's recommendations some credibility, both in Congress and among the public, even when dealing with divisive issues of public policy. Commissions may also give factions space to negotiate compromises in good faith, bypassing maneuvers that may accompany more public negotiations. Similarly, because commission members typically are not elected officials, in some circumstances they may be suited to suggesting unpopular policy solutions.

Addressing Collective Action Problems

A commission may allow legislators to address collective action problems, situations in which some legislators individually seek to protect the interests of their own district, despite widespread agreement that the collective result of such interests is something none may prefer. Legislators can use a commission to jointly "tie their hands" in such circumstances, allowing general consensus about a particular policy solution to avoid being impeded by individual concerns about the effect or implementation of the solution. The BRAC commissions typically are cited as examples of politically and geographically neutral bodies that made independent decisions about closures of military bases. The list of bases slated for closure by the commission was required to be either accepted or rejected as a whole by Congress, bypassing the potential for amendments to prevent individual bases from being closed, and potentially protecting individual Members from charges that they didn't "save" their district's base. Nonetheless, such "protection" did not necessarily prevent such charges from being made.

Raising Visibility

By establishing a commission, Congress can often provide a highly visible forum for important issues that might otherwise receive less attention from the public. Commissions often are composed of notable public figures, allowing personal prestige to be transferred to policy solutions. Meetings and press releases from a commission may receive significantly more attention in the media than corresponding information coming directly from members of congressional committees. Upon completion of a commission's work product, public attention may be temporarily focused on a topic that otherwise would receive little attention, thus potentially increasing the probability of congressional action within the policy area.

Potential Disadvantages of Commissions

Congressional advisory commissions have been criticized by both political and scholarly observers. In addition to criticisms outlined above (where one person's perception of an advantage may be another person's perception of a disadvantage), these criticisms chiefly fall into three groups. First, critics often charge that commissions are an "abdication of responsibility" on the part of legislators. Second, they argue that commissions are undemocratic, often replacing elected legislators with appointed decision-makers who may not have interests that represent public constituencies. Third, critics also argue that commissions are financially inefficient; they are expensive, and their findings often ignored by Congress.

Abdicated Responsibility

Some critics of commissions argue that commissions are primarily created by legislators specifically for "blame avoidance." In this view, Congress uses commissions to distance itself from risky decisions when confronted with controversial issues. By creating a commission, legislators may be able to take credit for addressing a topic of controversy without having to take a substantive position on the topic. If the commission's work is ultimately popular, legislators can take credit for the work. If the commission's work product is unpopular, legislators can shift responsibility to the commission itself.

Reduced Democratic Accountability

Critics often charge that commissions are undemocratic. This criticism takes three forms. First, commissions may be unrepresentative of the general population; the members of most commissions are not elected and may not reflect all of the public's diverse interests on an issue. Even if commission members are elected officials, they may represent only a subset of the public and may pursue a correspondingly narrower set of goals than might occur through the regular legislative process. Second, commissions lack popular accountability. Unlike Members of Congress, commission members are often insulated from the pressures of elections and public opinion. Finally, commissions may not operate in public; unlike Congress, their meetings, hearings, and investigations may be held in private. A lack of openness or a perception of narrow representation may undermine the legitimacy of a commission's recommendations.

Financial Inefficiency/Cost

A third potential criticism of commissions is that they have high costs and low returns. Congressional commission costs vary widely, ranging from several hundred thousand dollars to over $10 million. Coupled with this objection is the problem of congressional response to the work of a commission. In most cases, Congress is under no obligation to act, or even respond to the work of a commission. If legislators disagree with the results or recommendations of a commission's work, they may simply ignore it. In addition, there is no guarantee that any commission will produce a balanced product. Commission members may have their own agendas, biases, and pressures. Or they may simply produce a mediocre work product. Finally, some commentators argue that advisory boards may create economic and legislative inefficiency if they function as patronage devices, with Members of Congress using commission positions to pay off political debts.

It is difficult to estimate the overall cost of any commission. Annual budgets for congressional advisory entities and executive branch federal advisory committees range from tens of thousands of dollars to millions of dollars annually. Overall expenses for any individual advisory entity are dependent on a variety of factors, the most important of which are the number of paid staff and the duration and scope of the commission. Many commissions have few or no full-time staff; others employ large numbers, such as the National Commission on Terrorist Attacks Upon the United States (hereafter 9/11 Commission), which had a full-time paid staff of nearly 80. Secondary factors that may affect commission costs include the number of commissioners, how often the commission meets or holds hearings, whether the commission travels or holds field hearings, and the number and size of publications the commission produces.

Use of Expedited Procedures

Expedited or "fast-track" legislative procedures are special procedures that Congress adopts to promote timely committee and floor action on a specifically defined type of bill or resolution. The use of expedited legislative procedures may bring advantages and disadvantages. An observer's policy and procedural objectives may determine whether expedited procedures are advantageous or not. Perceived advantages and disadvantages, therefore, are often in the eye of the beholder.

Often-Cited Rationales for Expedited Procedures

Congress has very rarely provided for the recommendations of a commission to be considered under expedited legislative procedures (e.g., prohibitions on floor amendments). In the case of the BRAC commissions, these instances appear to have been pursued to facilitate action on potentially controversial matters where, nevertheless, there was widespread (1) agreement on the specific nature of needed changes (e.g., closing unneeded military bases); (2) confidence that expert, impartial, and nonpartisan expertise would drive the recommendations; and (3) concern that without expedited procedures, filibusters or vote-trading might undermine the achievement of widely shared congressional goals. Such processes and discrete "decision packages" also may help elected officials to communicate with constituents about difficult trade-offs in a tangible way.

Potential Impacts on Process and Power Relationships

Procedural changes also may result in changes to power relationships among Congress, the President, agencies, and other participants in high-stakes legislative, budget, and policy processes. Use of expedited procedures may affect relationships and opportunities for influence within Congress, as well. As noted in another CRS report, "there are a number of characteristics that typify the legislative process—more or less, and more often than not." In general, expedited procedures are, to greater or lesser degrees, inconsistent with five of these characteristics, including the following: (1) committees generally control their agendas, schedules, and workloads; (2) the House and Senate generally consider only measures that have been approved by their committees; (3) a voting majority of Representatives or Senators generally can determine whether a measure will be considered on the floor; (4) setting the floor agenda and the daily schedule generally is a prerogative of the majority party, acting through its leadership; and (5) the House and Senate generally can set conditions for floor debate and amendment that are appropriate for each measure that they consider. Special procedures contained in the fiscal commission bills may be inconsistent with several or all of these characteristics.

Some Similarities and Differences

All of the bills that are the focus of this report would require the commission or task force to submit proposed legislative language for congressional consideration. Each also would create special procedures to encourage expedited consideration of a commission's proposed legislative language. By including expedited procedures, the commission proposals begin to resemble aspects of the BRAC process for Department of Defense installations, insofar as amendments and floor debate would, for the most part, be prohibited. S. 276 stands out from the other proposals, however, in allowing "relevant" amendments. S. 2853 and S. 276 would require three-fifths votes of Members of Congress, duly chosen and sworn, for final passage or to proceed to a vote on initial passage, respectively. The other two proposals, S. 1056 and H.R. 1557 , by contrast, do not include requirements for supermajorities for initial or final chamber passage.

Commission Structure

The overall structures of each of the proposed commissions are similar in many respects, both to each other and to previous independent advisory entities established by Congress. Specifically, the proposed commissions would all study a particular policy problem, serve in an advisory capacity, and report a work product detailing the findings, conclusions, and recommendations of the commission.

That said, each particular proposed commission has unique elements. This section discusses and compares three aspects of the proposed commissions' structures: (1) their membership and appointment structure, (2) the partisan balance of appointments, and (3) supermajority requirements.

A more detailed comparison of the provisions of each commission is in Appendix A .

Membership and Appointment Structure

Congressionally created commissions use a wide variety of appointment structures. The statutory scheme may designate members of the commission, such as a specific cabinet official or congressional leader. In other cases, selected leaders, often with balance between the parties, appoint commission members. A third common statutory scheme is to have selected leaders, such as committee chairs and ranking members, recommend candidates for appointment to a commission. These leaders may act either in parallel or jointly, and the recommendation may be made either to other congressional leaders, such as the Speaker of the House and President pro tempore of the Senate, or to the President.

The decisions made when devising a commission's appointment structure may be significant, particularly concerning Member participation as commissioners. Inclusion of legislators on such panels ensures that Congress will be able to exercise a certain degree of control over the operations or outcome of the entity concerned. At the same time, service by Members on commissions is arguably antithetical to two of the typical rationales for creating a commission in the first place: to reduce the workload of Congress by delegating certain functions to temporary bodies and to produce independent advice.

Even in the absence of direct membership on a commission, in drafting the particulars of an appointment scheme, legislators can dictate, to some degree, the measure of autonomy a commission enjoys. For example, although the legislation creating the 9/11 Commission did not stipulate that Members of Congress must be included in the commission's membership, it did call for nine of the 10 members of the commission to be selected by congressional leaders, so that Congress would remain influential in shaping the commission. Attention to the proper balance between the number of members appointed by congressional leaders and by other individuals, or to the number of Members of Congress required to be among the appointees, or to the qualifications of appointees, can be significant factors in enabling a commission to fulfill its congressional mandate.

A commission's appointment scheme may affect both the ability of the commission to fulfill its statutory duties and the final work product it produces. For instance, if the appointment scheme includes qualifying provisos so specific that only a small set of private citizens could serve on the panel, the final work product of the commission may represent a narrow range of viewpoints.

In general, each fiscal commission proposal provides for similar appointment structures. Each proposal involves "hybrid" appointments by both Members of Congress and the President instead of just one or the other branch making appointments. In each case, the majority of appointments would be made by Members of Congress, rather than executive branch representatives. However, the relative weight of congressional appointments varies from a bare majority of eight out of 15 ( S. 276 ) to strong majorities of 14 out of 16 ( H.R. 1557 ) and 16 out of 18 ( S. 2853 and S. 1056 ).

Use of Members of Congress as Commission Members

Each proposal would provide for a portion of the commission's membership to be drawn from Members of Congress. This is somewhat unusual. Between the 101 st (1989-1991) and the 110 th Congress (2007-2009), 12 out of approximately 80 congressional advisory commissions have either explicitly required, or otherwise contained language that could allow, Members to serve as commissioners. Using Members of Congress as commission members may complicate one of the potential advantages of the typical commission structure—the use of unelected experts one step removed from the political process.

On the other hand, if a commission has the ability to construct legislative packages that would be subject to expedited congressional consideration, appointment of non-Members to a commission might be viewed as a delegation of legislative power away from Congress. In addition, some proposals for commissions in previous Congresses arguably would have transferred some power to the President. From either perspective, appointment of commissioners who are not Members of Congress might raise questions about Congress delegating power and authority to the President or unelected, nongovernmental interests.

Partisan Balance

As described previously, each of the proposals employs a structure that provides for appointments by both the majority and minority parties in Congress, as well as by the executive branch. One of the proposals, S. 276 , would provide for an even partisan balance of appointments, with an equal number of appointments from majority and minority congressional leaders, as well as a requirement that the seven presidential appointments be three Democrats, three Republicans, and one person who "shall not be affiliated with any political party." S. 2853 and S. 1056 would both provide for an even partisan balance of congressional appointments, but also include two partisan executive branch appointments (the Secretary of the Treasury and one discretionary presidential appointment in S. 2853 ; the Secretary of the Treasury and the Director of OMB in S. 1056 ). H.R. 1557 would provide for a majority advantage in congressional appointments and two partisan executive branch appointments (the Director of OMB and the Secretary of the Treasury). Both H.R. 1557 and S. 1056 would include two non-voting members, the Comptroller General and the Director of the Congressional Budget Office.

Most past congressional commissions have been structured to be bipartisan, with either an even split of appointments between majority and minority or with a one- or two-member advantage for the majority. For example, the 9/11 Commission had an even partisan split of appointments. By achieving a nonpartisan or bipartisan character, congressional commissions may make their findings and recommendations more politically acceptable to diverse viewpoints. The bipartisan or nonpartisan arrangement can give recommendations strong credibility, both in Congress and among the public, even when dealing with divisive issues of public policy. Similarly, a commission bill that is perceived as partisan may have difficulty gathering the necessary support in Congress.

In some cases, however, seeking bipartisanship may reduce the potential legislative coalition for the bill, if supporters believe that the commission's work would be compromised by creating a bipartisan commission. Bipartisanship also can arguably impede a commission's ability to complete its mandate, because consensus among commission members may be more difficult to achieve. In situations where a commission is tasked with studying sensitive issues that are often viewed through a partisan lens—such as oversight of executive branch activities—the appointment of an equal number of majority and minority commissioners may serve to promote partisanship within the commission rather than suppress it.

Supermajority Procedures

Each proposed commission would be tasked with issuing a final report detailing its findings, conclusions, and recommendations. As a permanent entity, S. 276 would also require reports every five years after its initial report. In addition, each of the proposals requires that the commission achieve supermajority support in order to approve recommendations. S. 1056 would require that 13 of 18 members vote in favor of submitting legislative proposals to Congress. H.R. 1557 would require a three-fourths vote. S. 276 would require 10 of 15 commissioners to approve its reports. S. 2853 would require 14 of 18 commissioners to approve a report.

The use of supermajority voting requirements may have a significant effect on the final work product produced by the commission. Commissions with significant supermajority thresholds for approval of final reports may produce work products with fewer specific, concrete findings and more general statements that are unlikely to produce wide dissent. Such requirements also may enhance the ability of minority coalitions of commission members (which would not necessarily be of the same political party) to extract concessions in negotiations. However, while supermajority voting requirements typically require considerable consensus-building in order to advance recommendations, a lack of supermajority procedures does not preclude the achievement of a bipartisan or non-partisan work product from the commission. It is not uncommon for a congressional commission to deliver a work product that is unanimously agreed to by all members. For example, the final reports of both the 9/11 Commission and Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism were unanimously agreed to by all members.

Appendix A. Side-by-Side Comparison of Proposals

Appendix B. Long-Term Fiscal Situation and Major Entitlements

This appendix discusses the long-term fiscal situation of the federal government and three major entitlement programs: Social Security, Medicare, and Medicaid. Although the three programs relate to only some of the federal government's current revenue and spending policies, CBO and many observers focus on projections for these entitlement programs, and particularly Medicare and Medicaid, when assessing the federal government's long-term fiscal situation.

Issues related to these topics may inform assessments whether the use of a commission, coupled with expedited consideration of a commissions' proposals, may be appropriate for addressing the federal government's long-term fiscal situation; and, if a commission proposal were considered, how a commission proposal might be structured.

Long-Term Fiscal Situation and Major Entitlements

Long-Term Outlook

In its August 2009 budget report, CBO identified fiscal challenges related to future health care costs as a major issue affecting the country's long-term budget outlook. Overall, rising health care costs per beneficiary and the nation's aging population seem likely to keep combined Medicare, Medicaid, and Social Security costs rising faster than per capita GDP. For Medicare and Medicaid, "excess cost growth"—the extent to which the increase in health care spending for an average individual exceeds the growth in per capita gross domestic product (GDP)—is the main factor contributing to large projected increases in the two health care programs. Medicare and Social Security provide benefits to individuals who are mostly elderly. Medicaid provides benefits to individuals who are mostly non-elderly low-income people, but the elderly and disabled account for two-thirds of the program's spending.

In a June 2009 report, CBO wrote that "under any plausible scenario," increasing health care costs and the aging of the U.S. population will cause federal spending to rise rapidly under current law. More specifically, "almost all of the projected growth in federal spending other than interest payments on the debt comes from growth in spending on the three largest entitlement programs—Medicare, Medicaid, and Social Security." According to CBO estimates, Medicare and Medicaid will account for 80% of this growth between now and 2035, and 90% between now and 2080. In 2003, CBO's then director Donald Marron testified that "[l]ittle disagreement exists about the cause of [the fiscal] situation.... It stems primarily from federal policies aimed at improving the well-being of retirees, the disabled, and the chronically ill." CBO concluded that the current mix of federal fiscal policies is unsustainable in the long term and that "[s]lowing the growth rate of outlays for Medicare and Medicaid is the central long-term challenge for federal fiscal policy." Nevertheless, CBO separately observed an additional, complicating factor in addressing the long-term fiscal situation. "At this point," according to CBO, "experts do not know exactly how to structure such reforms so as to reduce federal spending on health care significantly in the long run without harming people's health," and furthermore, "many of the specific changes that might ultimately prove most important cannot be foreseen today and could be developed only over time through experimentation and learning."

For purposes of illustrating the issue of sustainability, keeping future federal outlays at 20% of GDP, approximately its current share, and leaving revenue policies unchanged, according to CBO current-law projections, could require either drastic reductions for all spending other than that for Social Security, Medicare, and Medicaid, or reining in the projected cost growth of these three programs. In 2006, the then-acting director of CBO stated that, "by 2030 ... spending for those programs [Social Security, Medicare, and Medicaid] is projected to reach roughly 15 percent of GDP.... If that increase happened ... the rest of the budget would have to be cut by more than half" to keep overall spending close to its current level."

These programs present differing challenges to the long-term fiscal position of the federal government. Estimates of the long-term fiscal gap between Social Security (Old-Age, Survivors and Disability Insurance) outlays and Social Security revenues as a proportion of long-term GDP are generally much smaller than estimates of the long-term fiscal gap between Medicare (Part A, Part B, and Part D) outlays and revenues as a portion of long-term GDP. These long-term estimates of fiscal imbalances are sensitive to changes in assumptions regarding productivity growth and interest rates. Spending projections for Medicare and Medicaid are sensitive to medical inflation. Past projections that medical inflation would slow have proved to be overly optimistic.

Long-term fiscal challenges facing the federal government are complicated by the current state of the U.S. economy. As the economy recovers strength, some may call for stabilizing the government's annual deficit as a percentage of GDP. This would require some combination of lower spending and higher revenues than currently projected and faster economic growth. On the other hand, labor and real estate markets may remain weak for the medium term, and some state and local governments are likely to face severe budgetary challenges in coming years. Some, therefore, may call for additional economic stimulus or a delay before the imposition of more austere fiscal policies.

Views differ about the timing when action is necessary to address the long-term fiscal situation. Significantly postponing spending and revenue adjustments may nevertheless have serious economic consequences. Debt is not free and requires interest payments that strain budgets. High debt levels also could limit the government's flexibility in meeting its obligations or in responding to emerging needs of its citizens.

Major Entitlement Programs

Concerns about entitlement programs, including long-term trends for revenues and spending related to entitlement programs, are not new. Numerous efforts have been pursued to study and address such concerns. Some were pursued through commissions established by Congress or the President, where the commissions were used to tap expertise and facilitate bargaining that involved significant trade-offs and high political risks. Some commissions have focused on entitlements or health care, generally. However, other efforts to study and address policy concerns about entitlements have been pursued by Congress through the regular legislative process, without the involvement of a special commission. For example, in the 111 th Congress, considerable effort has been undertaken to address health care and health insurance reform through the legislative process without the central involvement of a commission.

Several of the fiscal commission proposals that are the subject of this report expressly highlight major entitlement programs. Three programs in particular are the federal government's largest: Social Security, Medicare, and Medicaid. The sections below describe the programs and how commissions have been involved in some past efforts to address entitlement financing, among other issues, generally without the use of expedited legislative procedures.

Social Security

Social Security is one of the largest federal programs, with 159 million covered workers (and their employers) paying into the system and 52 million beneficiaries receiving monthly cash benefits. The program, which began in the 1930s as a social insurance program aimed at improving the economic circumstances of the elderly following the Depression, has been modified by Congress many times over its history. Today, Social Security provides workers and their families protections against the loss of income due to retirement, disability, and death.

Social Security's trust funds, the combined federal Old-Age, Survivors and Disability Insurance (OASDI) trust funds, currently take in more revenue than they pay in benefits. The trust funds' income comes primarily through a 6.2.% payroll tax that is levied separately on employers and employees (for a total payroll tax of 12.4%), with additional income from interest on the trust funds' investments and income taxes paid by some beneficiaries on their benefits. The excess monies are invested in non-marketable obligations of the U.S. government that are held in the trust funds. Starting in 2016, Social Security's annual expenditures on benefits are projected to exceed tax revenue. At that time, Social Security will start to redeem its public debt obligations in order to pay full benefits until the trust fund assets are exhausted, which is projected to occur in 2037. After the trust funds are exhausted, current payroll tax rates are projected to be sufficient to pay 76% of scheduled benefits in 2038, declining to 74% of scheduled benefits by 2083. For the 75-year projection period, the actuarial deficit is projected to be equivalent to about 2 percentage points of Social Security's taxable payroll; in other words, an increase in the payroll tax of roughly 2%, from 12.4% to 14.4%, would close the system's financial shortfall. Social Security's shortfall represents about 0.72% of GDP, on average, over the period from 2009 to 2083.

A number of bipartisan commissions have addressed Social Security's financial and benefit structure, including two commissions within the last 28 years. The National Commission on Social Security Reform was established in 1981 through President Ronald Reagan's Executive Order (E.O.) 12335, in response to projections that the system would run short of funds by mid-1983. A majority of members of the commission, also known as the "Greenspan Commission," agreed on a consensus package of proposals to meet the short-range deficit and about two-thirds of long-range financial requirements. In accordance with the executive order, the commission transmitted its recommendations to the President, the Secretary of Health and Human Services, and both houses of Congress on January 20, 1983. Congress held hearings on the commission's report during early 1983 and incorporated most of the commission's recommendations into P.L. 98-21 , "The Social Security Amendments of 1983," which was signed by President Reagan in April 1983.

A provision of the Social Security Act required that an Advisory Council on Social Security meet every four years beginning in 1969. The last Advisory Council was appointed in late 1994 and released their final report in 1997, which included three different options to address system financing and the adequacy and equity of benefits. The Social Security Administrative Reform Act of 1994 ( P.L. 103-296 ), which created the Social Security Administration as an independent agency, also replaced the Advisory Councils with the Social Security Advisory Board.

The President's Commission to Strengthen Social Security was established in 2001 by President George W. Bush through E.O. 13210. The President directed the commission to meet several principles, including a mandate to include voluntary personal retirement accounts and prohibitions against increasing the payroll tax or changing the benefits of retirees and near-retirees. Chaired by Senator Daniel Patrick Moynihan and Richard Parsons, the commission submitted its findings and recommendations to the President in a final report issued on December 21, 2001. The report put forward three model reform plans, each of which included voluntary personal retirement accounts. The three models differed in how they addressed financing shortfalls and benefit structure.

Health Care Programs: Medicare and Medicaid

Health care costs have increased significantly as a proportion of the U.S. economy over the past decades, from 7.2% of GDP in 1970 to likely more than 17% in 2009. Within the federal government, the costs of federal health insurance programs, and especially the two largest programs Medicare and Medicaid, have grown as well. According to CBO, between FY1975 and FY2008, federal spending for Medicare rose from 0.8% of GDP to 2.7%, in part because of increased enrollment, which climbed from 25 million in 1975 to 45 million in 2008. Over the same period, total spending for Medicaid, including spending by the states, increased from 0.8% of GDP to 2.5%.

Medicare provides federal health insurance for 45 million people who are elderly or disabled (the elderly make up about 85% of enrollees) or who have end-stage renal disease or amyotrophic lateral sclerosis (also known as Lou Gehrig's disease). People become eligible for Medicare on the basis of age when they reach 65; disabled individuals become eligible for Medicare 24 months after they become eligible for benefits under Social Security's Disability Insurance program. Medicare consists of four distinct parts: Part A (Hospital Insurance [HI]); Part B (Supplementary Medical Insurance [SMI]); Part C (Medicare Advantage [MA]); and Part D (prescription drug benefit).

The Part A program, which covers inpatient services provided by hospitals as well as skilled nursing and hospice care, is financed primarily through payroll taxes levied on current workers and their employers, which are credited to the HI trust fund. The HI trust fund has faced a projected shortfall almost from its inception. When observers refer to the pending insolvency of Medicare, they actually are referring to the pending insolvency of the HI trust fund. The HI and SMI trust funds are overseen by a board of trustees that makes annual reports to Congress. The 2009 report projects that under intermediate assumptions, the HI trust fund will become insolvent in 2017, two years earlier than projected in 2008.

The National Bipartisan Commission on the Future of Medicare was established in 1997 and was required to review the long-term financial condition of Medicare, identify problems that threaten the financial integrity of the program's trust funds, and analyze potential solutions. Former Senator John Breaux and Former Representative Bill Thomas jointly chaired the Commission. On March 16, 1999, the commission held its final meeting to consider and vote on a Medicare reform proposal by the commission's co-chairs. On a motion to report to Congress and the President, the commission voted with 10 ayes and 7 nays. Eleven votes were required to make formal recommendations to the Congress and the President. Other proposals for Medicare-related commissions recently have been proposed, including for elevation of the Medicare Payment Advisory Commission (MedPAC) into an executive agency with the authority to set Medicare provider payment rates and make other policy decisions (e.g., S. 1380 ).

Medicaid is a joint, federal-state means-tested entitlement program that finances the delivery of primary and acute care medical services and long-term care for certain low-income populations including children, pregnant women, individuals with serious disabilities and/or multiple chronic conditions, other special needs populations, and the elderly. Medicaid is the largest or second-largest item in most state budgets and is second only to Medicare in terms of federal spending on health care. The federal government's share of Medicaid's spending for benefits varies among the states but averages about 57%.

The Medicaid and CHIP programs act as an health safety net for the low-income population. However, the programs face many challenges. Even prior to the recent economic downturn, the Medicaid program's financing represented a growing share of federal and state budgets. High unemployment levels and financial challenges facing many state governments are likely to exacerbate the issue. A poor economy affects how much money states can dedicate to the programs while at the same time has the potential to vastly increase the number of individuals eligible for coverage. Yet, the programs are targeted at populations that have special health needs, or are at higher risk of being uninsured. The policy debate will likely focus on how to balance Medicaid's and CHIP's rising health costs, both in the short-term with the current economic state and in the long-term, against the health insurance needs of vulnerable populations.

In May 2005, the Secretary of the Department of Health and Human Services, Michael O. Leavitt, established a Medicaid Commission under P.L. 92-463 and the Federal Advisory Committee Act, to advise the Secretary on "ways to modernize the Medicaid program so that it can provide high-quality health care to its beneficiaries in a financially sustainable way." The commission transmitted its reports on September 1, 2005, and December 29, 2006. In the latter report, the commission recorded support of the report's recommendations by a vote of 11 ayes, one nay, and two abstentions, with two commissioners not present.