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100-524: The Medicare for All Act (abbreviated M4A ), also known as the Expanded and Improved Medicare for All Act or United States National Health Care Act , is a bill first introduced in the United States House of Representatives by Representative John Conyers (D-MI) in 2003, with 38 co-sponsors. In 2019, the original 16-year-old proposal was renumbered, and Pramila Jayapal (D-WA) introduced

200-704: A 1984 case, Davis v. Bandemer , the Supreme Court held that gerrymandered districts could be struck down based on the Equal Protection Clause , but the Court did not articulate a standard for when districts are impermissibly gerrymandered. However, the Court overruled Davis in 2004 in Vieth v. Jubelirer , and Court precedent holds gerrymandering to be a political question . According to calculations made by Burt Neuborne using criteria set forth by

300-488: A 70% higher pension than other federal employees based on the first 20 years of service. They become eligible to receive benefits after five years of service (two and one-half terms in the House). The FERS is composed of three elements: Members of Congress may retire with full benefits at age 62 after five years of service, at age 50 after 20 years of service, and at any age after 25 years of service. With an average age of 58,

400-574: A FEHBP plan upon retirement. The ACA and the final rule do not affect members' or staffers' eligibility for Medicare benefits. The ACA and the final rule also do not affect members' and staffers' eligibility for other health benefits related to federal employment, so members and staff are eligible to participate in FSAFEDS (which has three options within the program), the Federal Employees Dental and Vision Insurance Program, and

500-518: A National Health Program estimated the immediate savings at $ 350 billion per year. Others have estimated a long-term savings amounting to 40% of all national health expenditures due to the extended preventive healthcare and the elimination of insurance company overhead costs. A study estimated the 1999 costs of U.S. health care administration at nearly $ 300 billion, accounting for 30.1% of health care expenses, versus 16.7% in Canada. This study estimated

600-543: A broadly similar, but more detailed, bill, HR 1384, in the 116th Congress . As of November 3, 2019, it had 116 co-sponsors still in the House at the time, or 49.8% of House Democrats. The act would establish a universal single-payer national health insurance system in the United States, the rough equivalent of Canada's Medicare and Taiwan 's Bureau of National Health Insurance , among other examples. Under

700-499: A candidate. Therefore, Article I, Section 5, which permits each House to be the judge of the qualifications of its own members does not permit either House to establish additional qualifications. Likewise a State could not establish additional qualifications. William C. C. Claiborne served in the House below the minimum age of 25. Disqualification: under the Fourteenth Amendment , a federal or state officer who takes

800-700: A degree of financial responsibility on providers in hopes of improving care management and limiting unnecessary expenditures, while providing patients freedom to select their medical service providers. The ACO's model of fostering clinical excellence while simultaneously controlling costs depends on its ability to "incentivize hospitals, physicians, post-acute care facilities, and other providers involved to form linkages and facilitate coordination of care delivery". By increasing care coordination, ACOs were proposed to reduce unnecessary medical care and improve health outcomes, reducing utilization of acute care services. According to CMS estimates, ACO implementation as described in

900-520: A federal statutory requirement since 1967 pursuant to the act titled An Act For the relief of Doctor Ricardo Vallejo Samala and to provide for congressional redistricting . Before that law, general ticket representation was used by some states. States typically redraw district boundaries after each census, though they may do so at other times, such as the 2003 Texas redistricting . Each state determines its own district boundaries, either through legislation or through non-partisan panels. Malapportionment

1000-532: A four-year term, the resident commissioner's role is identical to the delegates from the other territories. The five delegates and resident commissioner may participate in debates; before 2011, they were also allowed to vote in committees and the Committee of the Whole when their votes would not be decisive. States entitled to more than one representative are divided into single-member districts . This has been

1100-461: A maximum sharing rate of 50% in the one-sided model and a higher maximum sharing rate of 60% in the two-sided model, provided that the minimum shared savings rate threshold of 2% was reached. For both models, the shared loss cap increased each year. However, initial feedback raised concerns regarding ACO's financial risk and possible cost savings. On October 20, 2011, DHHS released the final regulations that altered providers' financial incentives. Under

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1200-592: A member requires only a simple majority, and does not remove that member from office. As a check on the regional, popular, and rapidly changing politics of the House, the Senate has several distinct powers. For example, the " advice and consent " powers (such as the power to approve treaties and confirm members of the Cabinet ) are a sole Senate privilege. The House, however, has the exclusive power to initiate bills for raising revenue, to impeach officials, and to choose

1300-428: A minimum savings rate (MSR) that is calculated as a percentage of the benchmark (2%) that ACO savings must exceed in order to qualify for shared savings. The MSR accounts for normal variation in health care spending. While Medicare continued to offer a fee-for-service program, ACOs can choose one of two payment models (one-sided or two-sided model) based on the degree of risk and potential savings they prefer. Initially,

1400-556: A more deliberative upper house, elected by the lower house, that would represent the individual states, and would be less susceptible to variations of mass sentiment. The House is commonly referred to as the lower house and the Senate the upper house , although the United States Constitution does not use that terminology. Both houses' approval is necessary for the passage of legislation . The Virginia Plan drew

1500-412: A one-sided model ACO shared in savings for the first two years and savings or losses during the third year. The maximum sharing percentage for this model was 50%. In a two-sided model, ACOs shared in savings and losses for all three years. In both cases, ACO savings must exceed 2% in order to qualify for shared savings. The maximum sharing percentage for this model was 60%. In both models the shared loss cap

1600-543: A result, the process to gain ballot access varies greatly from state to state, and in the case of a third party in the United States may be affected by results of previous years' elections. In 1967, Congress passed the Uniform Congressional District Act , which requires all representatives to be elected from single-member-districts. Following the Wesberry v. Sanders decision, Congress

1700-631: A shared savings distribution method. The ACO may not participate in other shared savings programs during the period it participates in the MSSP. An ACO may include professionals (e.g., Doctors of Medicine (M.D.) or Doctors of Osteopathic Medicine (D.O.), physician assistants, nurse practitioners , clinical nurse specialists) in group practice arrangements, networks of individual practices, partnerships or joint venture arrangements between hospitals and ACO professionals, hospitals employing ACO professionals, or other Medicare providers and suppliers as determined by

1800-438: A single MRA that can fund any expense—even though each component is calculated individually, the franking allowance can be used to pay for personnel expenses if the member so chooses. In 2011 this allowance averaged $ 1.4 million per member, and ranged from $ 1.35 to $ 1.67 million. The Personnel allowance was $ 944,671 per member in 2010. Each member may employ no more than 18 permanent employees. Members' employees' salary

1900-405: A single-payer system, most medical care would be paid for by the federal government , ending the need for private health insurance and premiums, and re-casting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought. The national system would be paid for in part through taxes replacing insurance premiums, but also by savings realized through

2000-468: A two-year term, with no term limit. In most states, major party candidates for each district are nominated in partisan primary elections , typically held in spring to late summer. In some states, the Republican and Democratic parties choose their candidates for each district in their political conventions in spring or early summer, which often use unanimous voice votes to reflect either confidence in

2100-741: A voice in committees, and can introduce bills on the floor, but cannot vote on the ultimate passage of bills. Presently, the District of Columbia and the five inhabited U.S. territories each elect a delegate. A seventh delegate, representing the Cherokee Nation , has been formally proposed but has not yet been seated. An eighth delegate, representing the Choctaw Nation is guaranteed by treaty but has not yet been proposed. Additionally, some territories may choose to also elect shadow representatives , though these are not official members of

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2200-440: Is calculated based on three components: one for personnel, one for official office expenses and one for official or franked mail. The personnel allowance is the same for all members; the office and mail allowances vary based on the members' district's distance from Washington, D.C., the cost of office space in the member's district, and the number of non-business addresses in their district. These three components are used to calculate

2300-499: Is capped at $ 168,411 as of 2009. Accountable care organization The term accountable care organization was first used by Elliott Fisher in 2006 during a discussion of the Medicare Payment Advisory Commission . In 2009, the term was included in the federal Patient Protection and Affordable Care Act . It resembles the definition of Health Maintenance Organizations (HMO) that emerged in

2400-688: Is no charge for outpatient care if it is provided in the National Capital Region , but members are billed at full reimbursement rates (set by the Department of Defense) for inpatient care. (Outside the National Capital Region, charges are at full reimbursement rates for both inpatient and outpatient care). House members are eligible for a Member's Representational Allowance (MRA) to support them in their official and representational duties to their district. The MRA

2500-468: Is no legislation at the federal level mandating one particular system for elections to the House, systems are set at the state level. As of 2022, first-past-the-post or plurality voting is used in 46 states, electing 412 representatives, ranked-choice or instant-runoff voting in two states (Alaska and Maine), electing 3 representatives, and two-round system in two states (Georgia and Louisiana), electing 20 representatives. Elected representatives serve

2600-543: Is occasionally abbreviated as either "MOC" or "MC" (similar to MP ). However, the abbreviation "Rep." for Representative is more common, as it avoids confusion as to whether they are a member of the House or the Senate . All members of Congress are automatically enrolled in the Federal Employees Retirement System , a pension system also used for federal civil servants , except the formula for calculating Congress members' pension results in

2700-545: Is referred to as the "upper" house, and the House of Representatives as the "lower" house. Since December 2014, the annual salary of each representative is $ 174,000, the same as it is for each member of the Senate . The speaker of the House and the majority and minority leaders earn more: $ 223,500 for the speaker and $ 193,400 for their party leaders (the same as Senate leaders). A cost-of-living-adjustment (COLA) increase takes effect annually unless Congress votes not to accept it. Congress sets members' salaries; however,

2800-610: Is the lower chamber of the United States Congress , with the Senate being the upper chamber . Together, they compose the national bicameral legislature of the United States . The House is charged with the passage of federal legislation , known as bills ; those that are also passed by the Senate are sent to the president for signature or veto . The House's exclusive powers include initiating all revenue bills, impeaching federal officers, and electing

2900-504: Is to have one party govern and the other party watch." The leadership structure of the House also developed during approximately the same period, with the positions of majority leader and minority leader being created in 1899. While the minority leader was the head of the minority party, the majority leader remained subordinate to the speaker. The speakership reached its zenith during the term of Republican Joseph Gurney Cannon , from 1903 to 1911. The speaker's powers included chairmanship of

3000-579: Is unconstitutional and districts must be approximately equal in population (see Wesberry v. Sanders ). Additionally, Section 2 of the Voting Rights Act of 1965 prohibits redistricting plans that are intended to, or have the effect of, discriminating against racial or language minority voters. Aside from malapportionment and discrimination against racial or language minorities, federal courts have allowed state legislatures to engage in gerrymandering to benefit political parties or incumbents. In

3100-414: Is unique in that it holds an all-party primary election on the general Election Day with a subsequent runoff election between the top two finishers (regardless of party) if no candidate received a majority in the primary. The states of Washington and California use a similar (though not identical) system to that used by Louisiana. Seats vacated during a term are filled through special elections , unless

Medicare for All Act - Misplaced Pages Continue

3200-401: Is unprecedented in the world. Under the House version, funding for institutions such as hospitals would be negotiated with regional directors, while individual providers would be paid a fee-for-service . Value-based pay for performance incentives would not be allowed. HHS would have administrative authority to set various details. The Senate proposal sets out a four-year transition plan and

3300-608: The Affordable Care Act . It is the program by which a US ACOs interact with the federal government, and by which ACOs can be created. It is a fee-for-service model. The MSSP had a much larger scope than the Pioneer program. It offered four tracks for ACOs: 1, 1+, 2, and 3. Track 1 was the most popular, with more than 80% of ACOs selecting it; this allowed the ACOs to avoid the possibility of shared loss. The model places

3400-565: The American Political Science Association , only about 40 seats, less than 10% of the House membership, are chosen through a genuinely contested electoral process, given partisan gerrymandering. Article I, Section 2 of the Constitution sets three qualifications for representatives. Each representative must: (1) be at least twenty-five (25) years old; (2) have been a citizen of the United States for

3500-822: The District of Columbia and the U.S. territories of Guam , the U.S. Virgin Islands , the Commonwealth of the Northern Mariana Islands , and American Samoa . A non-voting Resident Commissioner, serving a four-year term, represents the Commonwealth of Puerto Rico . As of the 2020 census , the largest delegation was California , with 52 representatives. Six states have only one representative apiece : Alaska , Delaware , North Dakota , South Dakota , Vermont , and Wyoming . The House meets in

3600-742: The Federal Employees Health Benefits Program (FEHBP), an employer-sponsored health insurance program, and were eligible to participate in other programs, such as the Federal Flexible Spending Account Program (FSAFEDS). However, Section 1312(d)(3)(D) of the Patient Protection and Affordable Care Act (ACA) provided that the only health plans that the federal government can make available to members of Congress and certain congressional staff are those created under

3700-665: The Patient Protection and Affordable Care Act (ACA) authorized the Center for Medicare and Medicaid Services (CMS) to create the Medicare Shared Savings program (MSSP), which allowed for the establishment of ACO contracts with Medicare by January 2012. ACA intended for the MSSP to promote "accountability for a patient population and coordinate[s] items and services under part A and B, and encourage[s] investment in infrastructure and redesigned care processes for high quality and efficient service delivery". The existence of

3800-650: The Twenty-seventh Amendment to the United States Constitution prohibits a change in salary (but not COLA ) from taking effect until after the next election of the whole House. Representatives are eligible for retirement benefits after serving for five years. Outside pay is limited to 15% of congressional pay, and certain types of income involving a fiduciary responsibility or personal endorsement are prohibited. Salaries are not for life, only during active term. Representatives use

3900-450: The Uniform Congressional District Act , sit in single member congressional districts allocated to each state on the basis of population as measured by the United States census , with each district having at least a single representative, provided that that state is entitled to them. Since its inception in 1789, all representatives have been directly elected. Although suffrage was initially limited, it gradually widened, particularly after

4000-694: The president if a presidential candidate fails to get a majority of the Electoral College votes. Both House and Senate confirmation is now required to fill a vacancy if the vice presidency is vacant, according to the provisions of the Twenty-fifth Amendment . The Senate and House are further differentiated by term lengths and the number of districts represented: the Senate has longer terms of six years, fewer members (currently one hundred, two for each state), and (in all but seven delegations) larger constituencies per member. The Senate

4100-556: The size of the House states: "The Number of Representatives shall not exceed one for every thirty Thousand, but each State shall have at Least one Representative." Congress regularly increased the size of the House to account for population growth until it fixed the number of voting House members at 435 in 1911. In 1959, upon the admission of Alaska and Hawaii , the number was temporarily increased to 437 (seating one representative from each of those states without changing existing apportionment), and returned to 435 four years later, after

Medicare for All Act - Misplaced Pages Continue

4200-857: The 1970s. Like an HMO, an ACO is "an entity that will be 'held accountable' for providing comprehensive health services to a population." The model builds on the Medicare Physician Group Practice Demonstration and the Medicare Health Care Quality Demonstration, established by the 2003 Medicare Prescription Drug, Improvement, and Modernization Act . Mark McClellan , Elliott Fisher and others defined three core accountable care organization principles: Medicare approved 32 pioneer accountable care organizations in December 2011; of which 19 remained active through 2015. When

4300-594: The ACA or offered through a health care exchange . The Office of Personnel Management promulgated a final rule to comply with Section 1312(d)(3)(D). Under the rule, effective January 1, 2014, members and designated staff are no longer able to purchase FEHBP plans as active employees. However, if members enroll in a health plan offered through a Small Business Health Options Program (SHOP) exchange, they remain eligible for an employer contribution toward coverage, and members and designated staff eligible for retirement may enroll in

4400-600: The ACO Learning Network, a member-driven network of over 80 members that provides tools for operating ACOs. Led by McClellan and Fisher, Brookings and Dartmouth have worked since 2007 to foster ACO adoption. Premier runs an ACO Implementation and Readiness Collaborative. The American Medical Group Association (AMGA) runs an ACO Development Collaborative and Implementation Collaborative. In 2010, Blue Shield of California , Dignity Health and Hill Physicians Medical Group formed an ACO that covers 41,000 individuals in

4500-461: The ACO Toolkit, a publicly available ACO implementation guide. These pilot programs' results were mixed: some organizations' implementation yielded financial benefits while others experienced trouble balancing costs with savings. ACOs have the potential to improve quality of care while reducing healthcare spending in a nation with high health expenditures. However, several challenges may affect

4600-510: The ACO's level of integration and size, providers may also include health departments, social security departments, safety net clinics and home care services. The various providers within an ACO work to provide coordinated care, align incentives and lower costs. ACOs are different from health maintenance organizations (HMOs) in that they allow providers much freedom in developing the ACO infrastructure. Any provider or provider organization may assume

4700-637: The Affordable Care Act was estimated to lead to an estimated median savings of $ 470 million from 2012 to 2015. The US Department of Health and Human Services (DHHS) proposed the initial set of guidelines for the establishment of ACOs under the Medicare Shared Savings Program (PPACA Section 3201) on March 31, 2011. These guidelines stipulate the necessary steps that physician, hospital and other health care provider groups must complete to become an ACO. Section 3022 of

4800-844: The California Public Employees Retirement System ( CalPERS ). In 2012, Hennepin County Medical Center partnered with NorthPoint Health and Wellness Center, Metropolitan Health Plan, and Hennepin County's Human Services and Public Health Department to form an ACO called Hennepin Health. By February 2013, Hennepin Health had enrolled 6,000 clients. Independent ACO-like initiatives have emerged in Massachusetts, Illinois and California. The Brookings-Dartmouth ACO Learning Network published

4900-564: The Confederation Congress's sanction to "amend the Articles of Confederation". All states except Rhode Island agreed to send delegates. Congress's structure was a contentious issue among the founders during the convention. Edmund Randolph 's Virginia Plan called for a bicameral Congress: the lower house would be "of the people", elected directly by the people of the United States and representing public opinion , and

5000-608: The Contract did not pass Congress, were vetoed by President Bill Clinton , or were substantially altered in negotiations with Clinton. However, after Republicans held control in the 1996 election , Clinton and the Gingrich-led House agreed on the first balanced federal budget in decades, along with a substantial tax cut. The Republicans held on to the House until 2006 , when the Democrats won control and Nancy Pelosi

5100-700: The Federal Long Term Care Insurance Program. The Office of the Attending Physician at the U.S. Capitol provides members with health care for an annual fee. The attending physician provides routine exams, consultations, and certain diagnostics, and may write prescriptions (although the office does not dispense them). The office does not provide vision or dental care. Members (but not their dependents, and not former members) may also receive medical and emergency dental care at military treatment facilities. There

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5200-462: The House and are separate individuals from their official delegates. Representatives and delegates serve for two-year terms, while a resident commissioner (a kind of delegate) serves for four years. A term starts on January 3 following the election in November. The U.S. Constitution requires that vacancies in the House be filled with a special election. The term of the replacement member expires on

5300-399: The House proposal is two years. As of April 2019, the Senate proposal did not include details on how to completely pay for the plan, but Sanders had released a paper listing ideas. As of 13 December 2022: (D-MI) (D-MI) (D-MI) (D-MI) (D-MI) (D-MI) (D-MI) (D-MI) (I-VT) (D-WA) (I-VT) (D-WA) (I-VT) (D-WA) (I-VT) An analysis of the bill by Physicians for

5400-409: The House would have women-only spaces following the election of Sarah McBride . Under Article I, Section 2 of the Constitution , seats in the House of Representatives are apportioned among the states by population, as determined by the census conducted every ten years. Each state is entitled to at least one representative, however small its population. The only constitutional rule relating to

5500-485: The MSSP ensures that ACOs are a permanent option under Medicare. However, the specifics of ACO contracts are left to the discretion of the DHHS Secretary, which allows the ACO design to evolve over time. The Medicare Shared Savings Program is a three-year program during which ACOs accept responsibility for the overall quality, cost and care of a defined group of Medicare Fee-For-Services (FFS) beneficiaries. Under

5600-633: The National Health Care Act as proposed in the 111th Congress (2009–2010) includes the following elements, among others: Pramila Jayapal's Medicare for All Act of 2019, introduced in the House is broadly similar but more detailed than the original Conyers proposal, but the "parallel" proposal by Sanders has significant differences, including a "global budget" system for hospitals. Both proposals contain expansive coverage including long-term care and dental care with no cost-sharing such as coinsurance, deductibles, or premiums, which as of 2019

5700-583: The Secretary of Health and Human Services. ACO's incentive payments are determined by comparing the organization's annual costs relative to CMS-established benchmarks. These benchmarks are based on an estimation of the total fee-for-service expenditures associated with management of a beneficiary based on fee-for-service payment in the absence of an ACO. CMS updates benchmarks by the projected absolute amount of growth in national per capita expenditures as well as by beneficiary characteristics. CMS also establishes

5800-653: The Senate did not hold the balance of power between North and South during the war. The years of Reconstruction that followed witnessed large majorities for the Republican Party , which many Americans associated with the Union's victory in the Civil War and the ending of slavery. The Reconstruction period ended in about 1877; the ensuing era, known as the Gilded Age , was marked by sharp political divisions in

5900-564: The U.S. per-person administrative cost at $ 1,059. Charles Blahouse, who worked as George W. Bush's economic advisor and as a public trustee for medicare and social security, wrote a Mercatus Center study of the 2017 proposal It claims that Sanders' M4A plan will increase federal spending by at least $ 32 trillion (this money is currently going to private healthcare) but that the savings on administrative and other costs could save $ 2 trillion in healthcare costs. However, Blahouse stresses that these savings rely on multiple generous assumptions and that

6000-523: The US House of Representatives is older than comparable chambers in Russia and the other G7 nations. Members of Congress are permitted to deduct up to $ 3,000 of living expenses per year incurred while living away from their district or home state. Before 2014, members of Congress and their staff had access to essentially the same health benefits as federal civil servants; they could voluntarily enroll in

6100-542: The ability of a small number of senior members to obstruct legislation they did not favor. There was also a shift from the 1990s to greater control of the legislative program by the majority party; the power of party leaders (especially the speaker) grew considerably. According to historian Julian E. Zelizer , the majority Democrats minimized the number of staff positions available to the minority Republicans, kept them out of decision-making, and gerrymandered their home districts. Republican Newt Gingrich argued American democracy

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6200-1341: The cost and quality of care they provide. It attempts to reduce inappropriate care and to identify and reward the best-performing providers. VBP Levels 1, 2, & 3 describe the level of risk providers choose to share with the Managed Care Organization . VBP risk levels allow providers to gradually increase the level of risk in their contracts. Levels of risk offer a flexible approach for providers in moving to VBP. Level 1 VBP: FFS with upside-only shared savings available when outcome scores are sufficient. Has only an upside. Receives FFS Payments. Level 2 VBP: FFS with risk-sharing (upside available when outcome scores are sufficient). Has upside and downside risk. Receives FFS Payments. Level 3 VBP (feasible after experience with Level 2; requires mature contractors): Prospective capitation PMPM or Bundle (with outcome-based component). Has upside and downside risk. Prospective total budget payments. CMS established five domains in which to evaluate an ACO's performance. The five domains are "patient/caregiver experience, care coordination, patient safety, preventative health, and at-risk population/frail elderly health". ACOs are composed mostly of hospitals, physicians and other healthcare professionals. Depending on

6300-524: The date that the original member's would have expired. The Constitution permits the House to expel a member with a two-thirds vote. In the history of the United States, only six members have been expelled from the House; in 1861, three were removed for supporting the Confederate states' secession: Democrats John Bullock Clark of Missouri, John William Reid of Missouri, and Henry Cornelius Burnett of Kentucky. Democrat Michael Myers of Pennsylvania

6400-432: The electorate. The Democratic Party and Republican Party each held majorities in the House at various times. The late 19th and early 20th centuries also saw a dramatic increase in the power of the speaker of the House . The rise of the speaker's influence began in the 1890s, during the tenure of Republican Thomas Brackett Reed . "Czar Reed", as he was nicknamed, attempted to put into effect his view that "The best system

6500-435: The final MSSP regulations. The final regulations allowed for broader ACO governance structures, reduced the number of required quality measures and created more opportunities for savings while delaying risk bearing. Under the new regulations, providers' financial incentives were increased. Under the one-sided model, providers have the opportunity to engage in ACOs and any savings above 2% without any financial risk throughout

6600-484: The first Tuesday after the first Monday in November. Pursuant to the Uniform Congressional District Act , representatives must be elected from single-member districts . After a census is taken (in a year ending in 0), the year ending in 2 is the first year in which elections for U.S. House districts are based on that census (with the Congress based on those districts starting its term on the following January 3). As there

6700-500: The implementation and development of ACOs. First, there is a lack of specificity regarding how ACOs should be implemented. In addition, the American Hospital Association estimated that ACO formation would incur high startup costs and large annual expenses. ACOs risk violating antitrust laws if they are perceived to drive up costs through reducing competition while providing lower quality of care. To address

6800-539: The incumbent or the result of bargaining in earlier private discussions. Exceptions can result in so-called floor fights—convention votes by delegates, with outcomes that can be hard to predict. Especially if a convention is closely divided, a losing candidate may contend further by meeting the conditions for a primary election. The courts generally do not consider ballot access rules for independent and third party candidates to be additional qualifications for holding office and no federal statutes regulate ballot access. As

6900-439: The influential Rules Committee and the ability to appoint members of other House committees. However, these powers were curtailed in the "Revolution of 1910" because of the efforts of Democrats and dissatisfied Republicans who opposed Cannon's heavy-handed tactics. The Democratic Party dominated the House of Representatives during the administration of President Franklin D. Roosevelt (1933–1945), often winning over two-thirds of

7000-411: The issue of antitrust violation, the U.S. Department of Justice offered a voluntary antitrust review process for ACOs. Significant challenges confront primary-care physicians who join an ACO via a group practice, hospital-medical practice alignment, or another joint venture—such as an independent practice association (IPA). Physician groups need a robust Electronic Health Record (EHR) system that

7100-573: The land gained during the Mexican–American War . Conflict over slavery and other issues persisted until the Civil War (1861–1865), which began soon after several southern states attempted to secede from the Union. The war culminated in the South's defeat and in the abolition of slavery. All southern senators except Andrew Johnson resigned their seats at the beginning of the war, and therefore

7200-678: The most voting members. Under the Articles of Confederation , the Congress of the Confederation was a unicameral body with equal representation for each state, any of which could veto most actions. After eight years of a more limited confederal government under the Articles, numerous political leaders such as James Madison and Alexander Hamilton initiated the Constitutional Convention in 1787, which received

7300-457: The one-sided and two-sided payment model. Under the March 2011 proposal, ACOs that chose the one-sided model would participate in shared savings for the first two years and assumed shared losses in addition to the shared savings for the third year. In the two-sided model, ACOs shared savings and losses for all three years. Although the ACO assumed less financial risk in the one-sided model, ACOs had

7400-472: The one-sided model, providers no longer assumed any financial risk throughout the three years and continued to share in cost savings above 2%. Under the two-sided model, providers assumed some financial risk, but share in any savings that occur (no 2% benchmark before provider savings accrue). Value-based purchasing (VBP) links provider payments to improved performance by health care providers. This form of payment holds health care providers accountable for both

7500-525: The other (the Senate) would provide equal representation amongst the states. The Constitution was ratified by the requisite number of states (nine out of the 13) in 1788, but its implementation was set for March 4, 1789. The House began work on April 1, 1789, when it achieved a quorum for the first time. During the first half of the 19th century, the House was frequently in conflict with the Senate over regionally divisive issues, including slavery . The North

7600-427: The past seven years; and (3) be (at the time of the election) an inhabitant of the state they represent. Members are not required to live in the districts they represent, but they traditionally do. The age and citizenship qualifications for representatives are less than those for senators . The constitutional requirements of Article I, Section 2 for election to Congress are the maximum requirements that can be imposed on

7700-465: The patient population may also include homeless and uninsured people. Patients may play a role in the healthcare they receive by participating in their ACO's decision-making processes. A range of ACO pilots took place uniting commercial insurers and state Medicaid programs (New Jersey, Vermont, Colorado, etc.) in advance of the Medicare Shared Savings Program. The Brookings Institution and Dartmouth Institute for Health Policy & Clinical Practice run

7800-720: The plan will likely cost significantly more. A 2019 analysis was critical of Sanders' bill for allowing accountable care organizations and failing to include a provision to negotiate budgets with hospitals. According to a 2020 study in The Lancet , the Medicare for All Act was estimated to save 13% in national health-care expenditure (equivalent to more than US$ 450 billion annually), and save more than 68,500 lives every year. United States House of Representatives Minority (213) Vacant (2) [REDACTED] [REDACTED] The United States House of Representatives

7900-629: The prefix " The Honorable " before their names. A member of the House is referred to as a representative , congressman , or congresswoman . Representatives are usually identified in the media and other sources by party and state, and sometimes by congressional district, or a major city or community within their district. For example, Democratic representative Nancy Pelosi , who represents California's 11th congressional district within San Francisco , may be identified as "D–California", "D–California–11" or "D–San Francisco". "Member of congress"

8000-502: The president if no candidate receives a majority of votes in the Electoral College . Members of the House serve a fixed term of two years, with each seat up for election before the start of the next Congress. Special elections also occur when a seat is vacated early enough. The House's composition was established by Article One of the United States Constitution . The House is composed of representatives who, pursuant to

8100-642: The program concluded in the end of 2016, only nine of the original 32 Pioneers remained. As of April 2015, Medicare had approved 404 MSSP ACOs, covering over 7.3 million beneficiaries in 49 states. For the 2014 reporting period, MSSP ACOs saved a combined $ 338 million, or $ 63 per beneficiary. On July 7, 2013, the Centers for Medicare and Medicaid Services announced the results of the pioneer ACO demonstration. According to them, costs for more than 669,000 beneficiaries served by Pioneer ACOs grew by 0.3 percent in 2012. Costs for similar beneficiaries grew by 0.8 percent in

8200-543: The program, ACOs are accountable for a minimum of 5,000 beneficiaries. The provider network is required to include sufficient primary care physicians to serve its enrollees. The ACO must define processes to promote evidence-based medicine and patient engagement, monitor and evaluate quality and cost measures, meet patient-centeredness criteria and coordinate care across the care continuum. Prior to applying to MSSP, an ACO must establish appropriate legal and governance structures, cooperative clinical and administrative systems and

8300-510: The provision of preventive universal health care and the elimination of insurance company overhead and hospital billing costs. On September 13, 2017, Senator Bernie Sanders (I-VT) introduced a parallel bill in the United States Senate , with 16 co-sponsors. The act would establish a universal single-payer health care system in the United States. The laws proposed are not necessarily identical year-over-year. The summary of

8400-591: The ratification of the Nineteenth Amendment and the civil rights movement . Since 1913, the number of voting representatives has been at 435 pursuant to the Apportionment Act of 1911 . The Reapportionment Act of 1929 capped the size of the House at 435. However, the number was temporarily increased from 1959 until 1963 to 437 following the admissions of Alaska and Hawaii to the Union. In addition, five non-voting delegates represent

8500-510: The reapportionment consequent to the 1960 census . The Constitution does not provide for the representation of the District of Columbia or of territories . The District of Columbia and the territories of Puerto Rico , American Samoa , Guam , the Northern Mariana Islands , and the U.S. Virgin Islands are each represented by one non-voting delegate . Puerto Rico elects a resident commissioner , but other than having

8600-532: The requisite oath to support the Constitution, but later engages in rebellion or aids the enemies of the United States, is disqualified from becoming a representative. This post–Civil War provision was intended to prevent those who sided with the Confederacy from serving. However, disqualified individuals may serve if they gain the consent of two-thirds of both houses of Congress. Elections for representatives are held in every even-numbered year, on Election Day

8700-497: The role of running an ACO. Medicare is an ACO's primary payer. Other payers include private insurances and employer-purchased insurance. Payers may play several roles in helping ACOs achieve higher quality care and lower expenditures. Payers may collaborate with one another to align incentives for ACOs and create financial incentives for providers to improve healthcare quality. An ACO's patient population primarily consists of Medicare beneficiaries. In larger and more integrated ACOs,

8800-518: The same period. CMS stated that 19 out of 32 pioneer ACOs produced shared savings with CMS. The Pioneer ACOs earned an estimated $ 76 million. Two Pioneer ACOs generated losses totaling an estimated $ 4 million. According to CMS the savings were due, in part, to reduction in hospital admissions and readmissions. After the Pioneer program launched, the Medicare Shared Savings Program (MSSP) was established by section 3022 of

8900-431: The seats. Both Democrats and Republicans were in power at various times during the next decade. The Democratic Party maintained control of the House from 1955 until 1995. In the mid-1970s, members passed major reforms that strengthened the power of sub-committees at the expense of committee chairs and allowed party leaders to nominate committee chairs. These actions were taken to undermine the seniority system , and to reduce

9000-664: The south wing of the United States Capitol . The rules of the House generally address a two-party system, with a majority party in government, and a minority party in opposition. The presiding officer is the Speaker of the House , who is elected by the members thereof. Other floor leaders are chosen by the Democratic Caucus or the Republican Conference , depending on whichever party has

9100-721: The support of delegates from large states such as Virginia , Massachusetts , and Pennsylvania , as it called for representation based on population. The smaller states, however, favored the New Jersey Plan , which called for a unicameral Congress with equal representation for the states. Eventually, the Convention reached the Connecticut Compromise or Great Compromise, under which one house of Congress (the House of Representatives) would provide representation proportional to each state's population, whereas

9200-634: The system was, in Gingrich's words, "morally, intellectually and spiritually corrupt". Gingrich followed Wright's successor, Democrat Tom Foley , as speaker after the Republican Revolution of 1994 gave his party control of the House. Gingrich attempted to pass a major legislative program, the Contract with America and made major reforms of the House, notably reducing the tenure of committee chairs to three two-year terms. Many elements of

9300-469: The three years. Under the two-sided model, providers will assume some financial risk but will be able to share in any savings that occur (no 2% benchmark before provider savings accrue). In addition, the quality measures required were reduced from 65 to 33, decreasing the monitoring that providers claimed was overwhelming. Community health centers and rural health clinics were also allowed to lead ACOs. The final regulations required ACOs to: CMS introduced

9400-410: The vacancy occurs closer to the next general election date than a pre-established deadline. The term of a member chosen in a special election usually begins the next day, or as soon as the results are certified. Historically, many territories have sent non-voting delegates to the House. While their role has fluctuated over the years, today they have many of the same privileges as voting members, have

9500-468: Was 5% in the first year, 7.5% in the second year, and 10% in the third year. Aspects regarding financial risk and shared savings were altered in the final regulations. After the initial March 2011 regulations, CMS received feedback regarding streamlining the governance and reporting burdens and improving the potential financial return for ACOs willing to make the necessary, and often substantial, investments to improve care. On October 20, 2011, DHHS released

9600-470: Was being ruined by the Democrats' tactics and that the GOP had to destroy the system before it could be saved. Cooperation in governance, says Zelizer, would have to be put aside until they deposed Speaker Wright and regained power. Gingrich brought an ethics complaint which led to Wright's resignation in 1989. Gingrich gained support from the media and good government forces in his crusade to persuade Americans that

9700-435: Was expelled after his criminal conviction for accepting bribes in 1980, Democrat James Traficant of Ohio was expelled in 2002 following his conviction for corruption, and Republican George Santos was expelled in 2023 after he was implicated in fraud by both a federal indictment and a House Ethics Committee investigation. The House also has the power to formally censure or reprimand its members; censure or reprimand of

9800-479: Was motivated by fears that courts would impose at-large plurality districts on states that did not redistrict to comply with the new mandates for districts roughly equal in population, and Congress also sought to prevent attempts by southern states to use such voting systems to dilute the vote of racial minorities. Several states have used multi-member districts in the past, although only two states (Hawaii and New Mexico) used multi-member districts in 1967. Louisiana

9900-580: Was much more populous than the South , and therefore dominated the House of Representatives. However, the North held no such advantage in the Senate, where the equal representation of states prevailed. Regional conflict was most pronounced over the issue of slavery. One example of a provision repeatedly supported by the House but blocked by the Senate was the Wilmot Proviso , which sought to ban slavery in

10000-443: Was subsequently elected by the House as the first female speaker. The Republicans retook the House in 2011 , with the largest shift of power since the 1930s. However, the Democrats retook the house in 2019 , which became the largest shift of power to the Democrats since the 1970s. In the 2022 elections, Republicans took back control of the House, winning a slim majority. In November 2024, House Speaker Mike Johnson announced that

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