Congress has its responsibility: payment of bills that the United States incurs because Congress passes bills that incur those debts.

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However, beginning in 2014, businesses with 50 or more full-time employees (or full-time equivalents) that do not offer affordable health insurance that provides a minimum level of coverage to substantially all of their full-time employees (and their dependents) may be subject to an employer shared responsibility payment if at least one of their full-time employees receives a premium tax credit to purchase coverage in an insurance Marketplace.

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In June, GM said it will offer 42, 000 white-collar retirees in the U.S. a lump-sum payment in lieu of their monthly pension check and will transfer pension responsibility for 76, 000 others to a group annuity plan managed by Prudential Insurance.

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While there are several proposed bundled payment types, including retrospective and prospective types, the onus of financial responsibility is shifting to the ACO.

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It is their responsibility to ensure economies are competitive, productive and not vulnerable to financial shocks via excessive debts, deficits or balance of payment crises.

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