On April 1, 2014, Representative Paul Ryan, the chairman of the House Budget Committee, released the chairman's mark of the FY2015 House budget resolution. Additional detail on budgetary objectives and justifications was provided in Chairman Ryan's report entitled The Path to Prosperity: Fiscal Year 2015 Budget Resolution , issued the same day. The House Budget Committee considered the chairman's mark on April 2, 2014, and voted 22-16 to report the budget resolution to the full House. H.Con.Res. 96 was introduced in the House April 4, 2014, and was accompanied by the House Budget Committee Report ( H.Rept. 113-403 ). The Congressional Budget Office (CBO) did not provide an analysis of the health care provisions in the proposed FY2015 budget. The House agreed to H.Con.Res. 96 on April 10, 2014, by a vote of 219-205. A budget resolution, if agreed to by both the House and Senate, sets enforceable budgetary parameters. Among other things, H.Con.Res. 96 expresses the desired levels of spending for government health programs over 10 years (FY2015-FY2024), creates four health care-related reserve funds, and presents policy statements regarding assumptions about future Medicare reforms and replacing the Patient Protection and Affordable Care Act as amended (ACA, P.L. 111-148 , P.L. 111-152 ). H.Con.Res. 96 does not include instructions for reconciliation. A budget resolution is not intended to establish details of spending or revenue policy and does not provide levels of spending for specific agencies or programs. It is not a law and is not signed by the President. Rather, a budget resolution provides the framework for the consideration of subsequent legislation. While the House budget resolution suggests and assumes certain health care-related policy changes, separate legislation would need to be developed by the committees of jurisdiction, passed by Congress, and signed by the President in order for such changes to be made to the affected federally funded health care programs. In general, the budget proposal, as outlined in Chairman Ryan's Path to Prosperity report and in the committee report, suggests a change in the structure of the Medicare and Medicaid programs; the repeal of many (or all) of the provisions in the ACA, including those that establish insurance exchanges; and changes to tort law governing medical malpractice. This CRS report provides a synopsis of the health care-related changes in the House FY2015 budget proposal. This summary is based on the text of the Concurrent Resolution, the committee report, the FY2015 Path to Prosperity report, and the Budget Committee's frequently asked question document entitled Setting the Record Straight . CRS provided similar summaries of the health care changes suggested in the FY2012, FY2013, and FY2014 House budget proposals. Reserve funds provide the chair of the Budget Committee the authority to adjust the budgetary levels in the budget resolution in the future, if certain conditions are met. Typically such conditions consist of legislation dealing with a particular policy being considered on the floor. Once this action has taken place, the Budget Committee chairman submits the revised levels to his respective chamber. Generally, the goal of such a reserve fund is to allow certain policies to be considered on the floor without triggering a point of order for violating levels in the budget resolution. Often, but not always, reserve funds require that the underlying legislative language be deficit-neutral. Typically, such deficit-neutral reserve funds allow for a committee to report specific policy legislation that violates the committee's spending allocation, as long as the excess amount is "offset" by equivalent amounts. H.Con.Res. 96 contains four reserve funds related to federal health care programs. Section 301 of H.Con.Res. 96 would create a reserve fund to allow for the consideration of legislation that would fully repeal the ACA as amended, even if the legislation were projected to increase the deficit. Section 302 would allow for the consideration of legislation that would reform or replace the ACA, as long as the legislation would not increase the deficit over the period of FY2015 through FY2024. Similarly, Section 303 would create a reserve fund to allow for the consideration of legislation that would repeal all or some of the Medicare-related ACA provisions that reduce program spending, as long as the legislation were deficit-neutral for the FY2015-FY2024 period. The fourth reserve fund, created in Section 304, would allow for a deficit-neutral fix to the Medicare physician payment system (see " Short-Term Medicare Changes (FY2015-FY2024) "). While the reserve funds allow for flexibility in considering subsequent legislation affecting federal health care programs, the two health care policy statements in H.Con.Res. 96 , as well as the committee report and the Path to Prosperity and Setting the Record Straight documents, provide more specific assumptions and suggestions of changes to these programs. The following sections of this report describe those specific proposals. Medicare is the nation's federal insurance program that pays for covered health services for most persons 65 years old and older and for most permanently disabled individuals under the age of 65. In FY2014, the program will cover an estimated 54 million persons at an estimated total cost of $618 billion. CBO estimates that federal Medicare spending (after deduction of beneficiary premiums and other offsetting receipts) will be about $518 billion in FY2014, accounting for over 14% of total federal spending and close to 3% of GDP. Medicare is an entitlement program, which means that it is required to pay for covered services provided to eligible persons so long as specific criteria are met. Spending under the program (except for a portion of the administrative costs) is considered mandatory spending and is not subject to the appropriations process. The Medicare program has four parts, each responsible for paying for different benefits, subject to different eligibility criteria and financing mechanisms. Medicare Part A covers inpatient hospital services, skilled nursing care, some home health, and hospice care. Part A services are paid for out of the Hospital Insurance Trust Fund (HI), which is mainly funded by a dedicated payroll tax of 2.9% of earnings of current workers, shared equally between employers and workers. Part B covers physician services, outpatient services, medical equipment, ambulance services, laboratory tests, and some home health services; Part D covers outpatient prescription drugs. Parts B and D benefits are paid for out of the Supplementary Insurance Trust Fund (SMI), which is primarily funded through beneficiary premiums and federal general revenues. High-income beneficiaries pay higher premiums for Parts B and D, and certain low-income beneficiaries may receive assistance from Medicare and/or Medicaid with premiums and cost-sharing. Part C, called Medicare Advantage, is a private health plan option for beneficiaries that covers all Part A and B services, except hospice, and is funded through both the HI and SMI trust funds. Under traditional Medicare, Parts A and B, services are generally paid directly by the government on a "fee-for-service" basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a set monthly per person amount to provide coverage to enrollees, and plan payments are adjusted to reflect the higher relative costs of sicker beneficiaries. Premium amounts may vary, depending on which plan the enrollee selects. Since its enactment in 1965, the Medicare program has undergone considerable change. Because of its rapid growth, both in terms of aggregate dollars and as a share of the federal budget, the Medicare program has been a major focus of deficit reduction legislation passed by Congress. With a few exceptions, reductions in program spending have been achieved largely through freezes or reductions in payments to providers, primarily hospitals and physicians, and by making changes to beneficiary premiums and other cost-sharing requirements. Most recently, the ACA made numerous changes to the Medicare program that modify provider and Medicare Advantage plan reimbursement methodologies, create incentives to improve the quality and efficiency of care, and provide additional program integrity tools and funding. Except in a few instances where the ACA enhanced coverage, it did not make any changes to Medicare benefits. H.Con.Res. 96 suggests total Medicare outlays of $6.8 trillion over the 10-year budget window (FY2015-FY2024). According to estimates provided in the Path to Prosperity document, this level of outlays is about $129 billion less than projected spending based on current policy. Baseline projections are based on current law, and therefore assume the continuation of ACA Medicare plan and provider payment reductions, physician payment reductions under the sustainable growth rate system (SGR) beginning in 2015, and 2% reductions in Medicare benefit spending under Budget Control Act of 2011 sequestration requirements. Therefore, for the proposed spending levels to be attained, the expected reductions under current law, or equivalent reductions, would need to occur. Other policies would also need to be adopted to achieve the additional proposed savings. However, as described later in this section, the budget resolution provides for some flexibility in these spending levels. The committee report suggests several policy options to reduce Medicare spending over the next 10 years. These include (1) additional means-testing of Parts B and D premiums for high-income seniors similar to that proposed in the President's FY2014 budget; (2) medical liability insurance reforms (see the " Medical Malpractice " section of this report); and (3) increased program integrity efforts to reduce improper payments. The Setting the Record Straight document also suggests that savings could be realized through the repeal of the ACA provisions that close the Part D prescription drug benefit "doughnut hole." The proposed restructuring of Medicare, described in the " Long-Term Medicare Changes (FY2024 and Beyond) " section below, would begin in the last year of the 10-year budget window, FY2024.