Under the fiscal 2014 budget proposal released April 10, the Centers for Medicare & Medicaid Services would spend $1.3 billion for grants to states to set up online exchange markets to sell health insurance to individuals and small businesses beginning Oct. 1 under the Affordable Care Act.  The proposed budget for the Department of Health and Human Services included about $1.7 billion in exchange grants for fiscal 2012 and another $2.8 billion for fiscal 2013 - bringing the total to $5.8 billion over three years.

The proposed budget also includes nearly $4 billion in outlays for fiscal 2014 for cost sharing reductions for low- and moderate-income people who enroll in qualified health plans (QHPs) that will be sold in the exchanges.

Discretionary funding for HHS would be $80.1 billion, $3.9 billion above the 2012 enacted level. The budget proposal "supports implementation of the Affordable Care Act's health insurance coverage improvements through the operation, with states, of health insurance marketplaces… and the delivery of premium tax credits and cost sharing assistance to make coverage affordable," the HHS budget summary says.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, told BNA in an email that the budget proposal includes "a new surcharge on some Medigap policies that will increase costs for seniors that rely on the financial protection and predictability in out-of-pocket cost that Medigap provides."