On March 12, 2013, Representative Paul Ryan, the chairman of the House Budget Committee, released the chairman's mark of the FY2014 House budget resolution. Additional detail on budgetary objectives and justifications was provided in Chairman Ryan's report entitled The Path to Prosperity: A Responsible Balanced Budget , issued the same day. The House Budget Committee considered the chairman's mark on March 13, 2013, and voted 22-17 to report the budget resolution to the full House. H.Con.Res. 25 was introduced in the House March 15, 2013, and was accompanied by the House Budget Committee Report ( H.Rept. 113-17 ). The Congressional Budget Office (CBO) did not provide an analysis of the long-term effects of the proposed FY2014 budget, as they had in prior years. The House agreed to H.Con.Res. 25 on March 21, 2013, by a vote of 221 to 207. The House budget resolution sets general budgetary parameters. Among other things, it expresses the desired levels of spending for government health programs over 10 years (FY2014-FY2023), creates four health care-related reserve funds, and presents a policy statement regarding assumptions about future Medicare reforms. The budget resolution includes instructions for reconciliation to eight committees, which are each instructed to develop and report legislation that would achieve a certain dollar amount of deficit reduction. 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 other 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 these 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 of the provisions in the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 (ACA, P.L. 111-148 , P.L. 111-152 ), including those that establish insurance exchanges; and changes to tort law governing medical malpractice. This CRS report provides a synopsis of the health care related changes in Chairman Ryan's FY2014 budget proposal. This summary is based on the text of the Concurrent Resolution, the committee report, and the FY2014 Path to Prosperity report. The collective details are referred to in this report as the "budget proposal" or Chairman Ryan's proposal. CRS provided similar summaries of the health care changes suggested in the FY2013 and FY2012 House budget 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 FY2013, the program will cover an estimated 52 million persons at an estimated total cost of $598 billion. CBO estimates that federal Medicare spending (after deduction of beneficiary premiums and other offsetting receipts) will be about $508 billion in FY2013, accounting for about 14% of total federal spending and 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; and 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 monthly "capitated" amount to provide coverage to enrollees. Premium amounts may vary depending on which plan the enrollee selects. The capitated payment is adjusted to reflect the higher relative costs of sicker beneficiaries. 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 reimbursements, provide incentives to improve the quality and efficiency of care, and enhance certain Medicare benefits. Under CBO's Medicare baseline, net Medicare outlays are expected to total approximately $6.87 trillion over the next 10 years (FY2014-FY2023). The House Budget Resolution suggests total Medicare outlays of $6.74 trillion over 10 years, which is about 2% less than CBO's baseline over the same period. Because CBO's spending baseline is based on current law, its figures are based on the assumption that the ACA Medicare plan and provider payment reductions are maintained; that scheduled physician payment reductions under the sustainable growth rate system (SGR) will occur beginning in 2014; and that the 2% reduction in Medicare benefit spending under the Budget Control Act of 2011 sequestration requirements, which begin in FY2013, will continue through 2021. Therefore, any reductions that are assumed under the proposed budget would be in addition to spending reductions already scheduled to occur (or to equivalent alternative spending reductions). While the proposal did not suggest specific program changes to reduce Medicare spending to a level lower than CBO's baseline over the 10-year period, the committee report suggests that a portion of the program savings over the next 10 years could come from additional means-testing of Parts B and D premiums for high-income seniors. The budget proposal also assumes a repeal of the Independent Payment Advisory Board (IPAB) created by the ACA (Section 3403, as modified by 10320). Under current law, beginning in 2014, the IPAB is required to develop proposals to reduce the Medicare per capita expenditure growth rate if Medicare spending is projected to exceed a certain target. CBO estimates that the repeal of IPAB would cost $3.1 billion over 10 years. No other ACA Medicare provisions were explicitly mentioned. However, Section 403 of H.Con.Res. 25 would create a reserve fund to allow for the consideration of legislation that would make changes to those Medicare related provisions in ACA originally scored as savings, as long as the legislation were deficit-neutral for the FY2014-FY2023 period. In addition, the committee report notes that the budget accommodates legislation that fixes the Medicare physician payment formula for the next 10 years. Specifically, Section 404 of H.Con.Res. 25 would provide procedural flexibility to allow for the consideration within the framework of the budget resolution of legislation that would reform the sustainable growth rate system, as long as the legislation did not increase the deficit for the period FY2014-FY2023. The proposal did not suggest specific changes to the payment methodology, but indicated that the new system should provide incentives to improve the quality and efficiency of care provided to Medicare beneficiaries. Starting in 2024, the Ryan budget proposal would phase in an increase in the age of eligibility for Medicare and would convert the current Medicare defined benefits program to a fixed federal contribution. Assumptions regarding the broad parameters of the new system are outlined in Section 703, the "Policy Statement on Medicare," of H.Con.Res. 25 . The Path to Prosperity document and the committee report offer more specificity on suggested changes. However, as previously noted, while a budget resolution may suggest broad policy changes, separate legislation would need to be developed by the committees of jurisdiction and enacted into law to effect such changes. As such, the committee report includes these proposals as "Illustrative Policy Options." The budget proposal assumes that in 2024, the age of eligibility for Medicare would gradually increase so that it would eventually correspond to the Social Security retirement age (age 67). Under the Ryan budget proposal, current Medicare beneficiaries and individuals who become eligible for Medicare prior to 2024 (i.e., those who turn 55 in 2013) would remain in the current Medicare program (described earlier). Individuals who become eligible for Medicare beginning in 2024 would be given the option of enrolling in a private insurance plan or a traditional fee-for-service option through a newly established Medicare exchange. These plans would be required to offer standard benefits that are at least actuarially equivalent to traditional fee-for-service benefits, and to accept all people eligible for Medicare who apply regardless of age or health status.