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1. Social Security 2. Medicare

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1. Section Titles 2. Promise

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1. GDA-394 PROMISE #1: RESTORE THE FAMILY AS THE CENTERPIECE OF AMERICAN LIFE AND PROTECT OUR CHILDREN. .

2. GDA-457 PROMISE #2: DISMANTLE THE ADMINISTRATIVE STATE AND RETURN SELF-GOVERNANCE TO THE AMERICAN PEOPLE. .

3. GDA-515 PROMISE #3: DEFEND OUR NATION'S SOVEREIGNTY, BORDERS, AND BOUNTY AGAINST GLOBAL THREATS. .

4. GDA-606 PROMISE #4 SECURE OUR GOD-GIVEN INDIVIDUAL RIGHT TO ENJOY "THE BLESSINGS OF LIBERTY." The Declaration of Independence famously asserted the belief of America's Founders that "all men are created equal" and endowed with God-given rights to "Life, Liberty, and the pursuit of Happiness." It's the last --- "the pursuit of Happiness" --- that is central to America's heroic experiment in self-government. .

5. GDA-689 Section One TAKING THE REINS OF GOVERNMENT A merica's Bicentennial, which culminated on July 4, 1976, was a spirited and unifying celebration of our country, its Founding, and its ideals. .

6. GDA-1721 The retirement system that replaced it --- the Federal Employees Retirement System (FERS) --- reduced the cost of federal employee retirement disbursements to 28.5 percent of payroll (including contributions to Social Security and the employer match to the Thrift Savings Plan). .

7. GDA-1904 Section Two THE COMMON DEFENSE W hile the lives of Americans are affected in noteworthy ways, for better or worse, by each part of the executive branch, the inherent importance of national defense and foreign affairs makes the Departments of Defense and State first among equals. .

8. GDA-4564 In many cases, records (including Social Security numbers), were falsified or replaced with notional placeholders, and fingerprints (in many dozens of cases) were never submitted to the Federal Bureau of Investigation for basic background investigations. .

9. GDA-5325 Section Three THE GENERAL WELFARE When our Founders wrote in the Constitution that the federal government would "promote the general Welfare," they could not have fathomed a massive bureaucracy that would someday spend $3 trillion in a single year --- roughly the sum, combined, spent by the departments covered in this section in 2022. .

10. GDA-5327 HHS is home to Medicare and Medicaid, the principal drivers of our $31 trillion national debt. .

11. GDA-5330 The first year that Medicare spending was visible on the books was 1967. .

12. GDA-5331 From that point on through 2020 --- according to the American Main Street Initiative's analysis of official federal tallies --- Medicare and Medicaid combined cost $17.8 trillion, while our combined federal deficits over that same span were $17.9 trillion. .

13. GDA-5332 In essence, our deficit problem is a Medicare and Medicaid problem. .

14. GDA-8136 States should be the primary regulators of the medical profession, and the federal government should not restrict providers' ability to discharge their responsibilities or limit their ability to innovate through government pricing controls or irrational Medicare and Medicaid reimbursement schemes. .

15. GDA-8233 The Ensuring Accurate and Complete Abortion Data Reporting Act of 20239 would amend title XIX of the Social Security Act and Public Health Service Act to improve the CDC's abortion reporting mechanisms by requiring states, as a condition of federal Medicaid payments for family planning services, to report streamlined variables in a timely manner. .

16. GDA-8246 To avoid stifling innovation and access to medical care, the applicable statutes and regulations should be revised to facilitate greater access to such modified tests.12 Finally, the FDA has long held that it has regulatory authority over such tests, while others have argued that they should be considered clinical services regulated by the Centers for Medicare and Medicaid Services (CMS). .

17. GDA-8333 CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) With the goal of being a societal safety net, Medicare and Medicaid touch more American lives than does any other federal program. .

18. GDA-8337 Medicare. .

19. GDA-8338 Medicare should be reformed according to four goals and principles: l Increase Medicare beneficiaries' control of their health care. .

20. GDA-8346 Government's use of non-market-based methods to determine reimbursement leads to overspending on low-value services and products and underpayment for high-value services and products, stifles beneficial innovation, and because of Medicare's size distorts payments throughout the health care system. .

21. GDA-8347 Intermediate entities that can manage financial risk and ensure quality of care are important in transitioning to value-based care within the Medicare program. .

22. GDA-8350 Medicare regulations restrict choice of coverage and care. .

23. GDA-8351 The next Administration should reintroduce and restore regulations and demonstrations from the Trump Administration that were withdrawn, weakened, or never finalized by the Biden Administration, including: l The Medicare Coverage of Innovative Technologies (MCIT) rule; l The Risk Adjustment Data Validation (RADV) rule; l The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration; and l The Global and Professional Direct Contracting (GPDC, rebranded as the Accountable Care Organization Realizing Equity, Access, and Community Health or ACO REACH) model. .

24. GDA-8353 Medicare generally pays more for inpatient hospital procedures and less for the same procedures performed in an outpatient setting. .

25. GDA-8354 Whether a medical service is delivered in a physician's office, a clinic, or a hospital setting, the Medicare payment for that service should be the same. .

26. GDA-8358 The Affordable Care Act (ACA)24 imposed restrictions prohibiting Medicare from reimbursing physician-owned and specialty hospitals. .

27. GDA-8360 These restrictions should be removed so that physician-owned hospitals can compete with other hospitals in serving Medicare patients.25 l Encourage more direct competition between Medicare Advantage and private plans. .

28. GDA-8361 Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America's large and growing cohort of seniors. .

29. GDA-8362 The program provides beneficiaries with a wide range of competitive health plan choices --- a richer set of benefits than traditional Medicare provides and at a reasonable cost. .

30. GDA-8366 Make Medicare Advantage the default enrollment option. .

31. GDA-8367 2. Give beneficiaries direct control of how they spend Medicare dollars. .

32. GDA-8371 6. Remove restrictions on key benefits and services, including those related to prescription drugs, hospice care, and medical savings account plans.26 Legacy Medicare Reform. .

33. GDA-8372 Legislation reforming legacy (non-MA) Medicare should: l Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service. .

34. GDA-8376 l Repeal harmful health policies enacted under the Obama and Biden Administrations such as the Medicare Shared Savings Program28 and Inflation Reduction Act.29 Medicare Part D Reform. .

35. GDA-8377 The Inflation Reduction Act (IRA) created a drug price negotiation program in Medicare that replaced the existing private-sector negotiations in Part D with government price controls for prescription drugs. .

36. GDA-8502 The Emergency Medical Treatment and Active Labor Act (EMTALA)52 prohibits hospitals that receive Medicare funds from "dumping" emergency patients who cannot pay by sending them to other hospitals. .

37. GDA-8504 Hospitals or physicians found to be in violation of the statute could lose all of their federal health funding --- Medicare, Medicaid, CHIP, and other funds --- and face civil penalties of up to nearly $120,000. .

38. GDA-8512 CMS should repromulgate its 2016 decision that CMS could not issue a National Coverage Determination (NCD) regarding "gender reassignment surgery" for Medicare beneficiaries. .

39. GDA-8518 HHS should revive a Trump Administration proposed regulation, "Special Responsibilities of Medicare Hospitals in Emergency Cases and Discrimination on the Basis of Disability in Critical Health and Human Service Programs or Activities,"54 to achieve this end. .

40. GDA-8523 On August 4, 2022, HHS published a proposed rule entitled "Nondiscrimination in Health Programs and Activities."58 This rule addresses nondiscrimination provisions of the Affordable Care Act, known as Section 1557, which is enforced by the Office for Civil Rights and the Centers for Medicare and Medicaid Services. .

41. GDA-8534 CMS should: l Announce nonenforcement of the Biden Administration's COVID-19 vaccination mandate on Medicaid and Medicare hospitals. .

42. GDA-8622 Funding provided under Title IV-B of the Social Security Act --- which provides grants to states for foster care and adoption services --- can also be used for promoting healthy marriage. .

43. GDA-8933 Moffit, "Medicare's Future: Challenges and Opportunities," testimony before the Special Committee on Aging, U.S. .

44. GDA-8934 Senate, November 21, 2022, https://www.heritage.org/testimony/medicares-future-challenges- and-opportunities. .

45. GDA-8943 Moffit, "Reducing Patient Access to New Medications Is the Left's Latest Medicare Price-Fixing Scheme," Heritage Foundation Commentary, July 22, 2022, https://www.heritage.org/medicare/commentary/ reducing-patient-access-new-medications-the-lefts-latest-medicare-price-fixing, and Badger, "How Congress Can Make Real Progress on Drug Prices." 31. .

46. GDA-9007 Department of Health and Human Services, Centers for Medicare and Medicaid Services, Office of Civil Rights, and Office of the Secretary, "Special Responsibilities of Medicare Hospitals in Emergency Cases and Discrimination on the Basis of Disability in Critical Health and Human Service Programs or Activities," draft of Proposed Rule, January 14, 2021, https://www.hhs.gov/sites/default/files/infants-nprm.pdf (accessed March 17, 2023). .

47. GDA-9016 Department of Health and Human Services, Centers for Medicare and Medicaid Services, and Office of the Secretary, "Nondiscrimination in Health Programs and Activities," Notice of Proposed Rulemaking; Notice of Tribal Consultation, Federal Register, Vol. .

48. GDA-9059 Department of Health and Human Services, Centers for Medicare and Medicaid Services, "Coverage of Certain Preventive Services Under the Affordable Care Act," Notice of Proposed Rulemaking, Federal Register, Vol. .

49. GDA-10924 Existing statutory language in the Social Security Act24 does not prohibit non-public organizations from administering the program, nor does it specifically authorize states to do so. .

50. GDA-10927 DOL should approve, pursuant to ยง 303(a)(2) of the Social Security Act, non- public worker organizations as administrators. .

51. GDA-10929 DOL should offer waivers from the standard requirements imposed on unemployment compensation by ยง 303(a) and ยง 303(d) of the Social Security Act to states that propose suitable alternatives. .

52. GDA-10943 (For instance, medical doctors must complete residency training to practice, and because Medicare provides funding for significantly fewer residencies than there are doctors, sizable numbers of MDs are locked out of the job market every year.) Wagner-Peyser Staffing Flexibility. .

53. GDA-11163 24. Social Security Act of 1935, 42 U.S.C. .

54. GDA-11585 Currently, approximately 6.4 million veterans out of 18 million nationally (and out of the 9.1 million who are enrolled) use the VA for health care; the remainder use employer-sponsored plans, Tricare, Medicare, and Medicaid. .

55. GDA-11626 l Require the VHA to report publicly on all aspects of its operation, including quality, safety, patient experience, timeliness, and cost-effectiveness, using standards similar to those in the Medicare Accountable Care Organization program so that the government may monitor and achieve continuous improvement in the VA system more effectively. .

56. GDA-11764 Section Four THE ECONOMY The next Administration must prioritize the economic prosperity of ordinary Americans. .

57. GDA-12371 The 30 percent bracket should begin at or near the Social Security wage base to ensure the combined income and payroll tax structure acts as a nearly flat tax on wage income beyond the standard deduction. .

58. GDA-12376 In addition, intermediate tax reform should repeal all tax increases that were passed as part of the Inflation Reduction Act,19 including the book minimum tax, the stock buyback excise tax, the coal excise tax, the reinstated Superfund tax, and excise taxes on drug manufacturers to compel them to comply with Medicare price controls. .

59. GDA-12617 Other issues of concern include China, cybersecurity, digital assets, digital services taxes, international debt defaults, Iran, Social Security and Medicare Trust Funds and private sector pensions, sanctions policy, and treasury auction and debt issuance. .

60. GDA-14743 Section Five INDEPENDENT REGULATORY AGENCIES In addition to the executive departments and agencies discussed previously, a number of independent commissions exist that are loosely affiliated with the executive branch. .

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Save Metrics with analysis run Project-2025_MFL_FULL-SpecialCharFix.txt 07/14/024 11:47:14 Appended Metrics File

Total Lines: 15842 Blank Lines: Non Blank Lines: 15842 Imperatives: 2799 Shalls: 31 Wills: 519 IsReq:

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Item	Risk	Count	Children	% lines	% imperative	% shall	% will	% isreq	% Norm
Medicare s17s		42		0.26	1.5		8.09
Promise s24s		4		0.02	0.14	12.9	0.77
Section Titles s24s		5		0.03	0.17	16.12	0.96
Social Security s17s		10		0.06	0.35	32.25	1.92
z Mined Objects		60		0.37	2.14		11.56

Rules Total 5
Rules Triggered 5
Rules Not Triggered
Percent of Rules Triggered 100%

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. . . 1. Medicare No Comment Text in this rule.
. . . . . . Rule Summary Name: Medicare Color: GREEN Access Object: Medicare Count Accessed Patterns: CHECKED

. . . 2. Social Security No Comment Text in this rule.
. . . . . . Rule Summary Name: Social Security Color: RED Access Object: Social Security Count Accessed Patterns: CHECKED

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. . . 1. Promise Must use parse option to capture the sections. A different search rule is needed for non-parse option.
. . . . . . Rule Summary Name: Promise Color: BLACK Case Sensitive : CHECKED Access Object: PROMISE \#\d+ Reject Object: \.\.\. Count Accessed Patterns: CHECKED

. . . 2. Section Titles Must use parse option to capture the sections. A different search rule is needed for non-parse option.
. . . . . . Rule Summary Name: Section Titles Color: BLACK Case Sensitive : CHECKED Access Object: Section \w+ TAKING THE REINS OF GOVERNMENT|Section \w+ THE COMMON DEFENSE|Section \w+ THE GENERAL WELFARE|Section \w+ THE ECONOMY|Section \w+ INDEPENDENT REGULATORY AGENCIES Reject Object: \.\.\. Count Accessed Patterns: CHECKED