Public Health, Workforce, Quality, and Related Provisions in H.R. 3590, as Passed by the Senate

C. Stephen Redhead, Coordinator
Acting Section Research Manager

Erin D. Williams, Coordinator
Specialist in Public Health and Bioethics

Health care reform is at the top of the domestic policy agenda for the 111th Congress, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in health care spending. Improving access to care and controlling rising costs will require changes to both the financing and delivery of health care. Experts point to a growing body of evidence showing that the health care system fails to provide high-quality care to all Americans. 

On December 24, 2009, by a vote of 60-39, the Senate passed a comprehensive health reform bill, the Patient Protection and Affordable Care Act (H.R. 3590, as amended). The legislation is an amalgam of separate measures reported by the Committee on Finance and the Committee on Health, Education, Labor, and Pensions (HELP). The House is preparing to vote on H.R. 3590, as passed by the Senate, and on an accompanying reconciliation bill (H.R. 4872), which would change several controversial elements in H.R. 3590 and otherwise amend it to meet the reconciliation instructions in the budget resolution. This report, one of a series of CRS products on H.R. 3590, discusses the bill's workforce, prevention, quality, and related provisions. 

H.R. 3590, as passed by the Senate, includes numerous provisions intended to increase the primary care and public health workforce, promote preventive services, and strengthen quality measurement, among other things. It would amend and expand on many of the existing health workforce programs authorized under Title VII (health professions) and Title VIII (nursing) of the Public Health Service Act (PHSA); create a Public Health Services Track to train health care professionals emphasizing team-based service, public health, epidemiology, and emergency preparedness and response; and make a number of changes to the Medicare graduate medical education (GME) payments to teaching hospitals, in part to encourage the training of more primary care physicians. The bill also would establish a national commission to study projected health workforce needs. 

In addition, Senate-passed H.R. 3590 would create an interagency council to promote healthy policies and prepare a national prevention and health promotion strategy. It would establish a Prevention and Public Health Fund to boost funding for prevention and public health; increase access to clinical preventive services under Medicare and Medicaid; promote healthier communities; and fund research on optimizing the delivery of public health services. Funding would be provided for maternal and child health services, including abstinence education and a new home visitation program. The bill also would establish a national strategy for quality improvement; create an interagency working group to advance quality efforts at the national level; develop a comprehensive repertoire of quality measures; and formalize processes for quality measure selection, endorsement, data collection and public reporting of quality information. It would establish and fund a new private, nonprofit comparative effectiveness research institute. 

Other key provisions in H.R. 3590, as passed by the Senate, include programs to prevent elder abuse, neglect, and exploitation; a new regulatory pathway for licensing biological drugs shown to be biosimilar or interchangeable with a licensed biologic; new requirements for the collection and reporting of health data by race, ethnicity, and primary language to detect and monitor trends in health disparities; and electronic format and data standards to improve the efficiency of administrative and financial transactions between health care providers and health plans.


Date of Report: March 20, 2010
Number of Pages: 109
Order Number: R40943
Price: $29.95

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