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Tuesday, September 14, 2010

Public Health, Workforce, Quality, and Related Provisions in PPACA: Summary and Timeline

C. Stephen Redhead, Coordinator
Specialist in Health Policy

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

In March 2010, President Obama signed into law a comprehensive health reform bill, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148), and a package of amendments to PPACA, the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152). Health reform had been the Obama Administration's top domestic priority, driven by concerns about the growing ranks of the uninsured and the unsustainable growth in spending on health care and health insurance. Improving access to care and controlling rising costs were seen to require changes to both the financing and delivery of health care. This report, one of a series of CRS products on PPACA, as amended by HCERA, focuses on the new law's workforce, public health, health care quality, and related provisions. It includes summaries of these provisions, explores some of their implications for health policy, and contains an associated timeline. 

PPACA includes numerous provisions intended to increase the primary care and public health workforce, promote preventive services, and strengthen quality measurement, among other things. It amends and expands many of the existing health workforce programs authorized under Title VII (health professions) and Title VIII (nursing) of the Public Health Service Act (PHSA); creates a Public Health Services Track to train health care professionals emphasizing team-based service, public health, epidemiology, and emergency preparedness and response; and makes 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 new law also establishes a national commission to study projected health workforce needs. 

In addition, PPACA creates an interagency council to promote healthy policies and prepare a national prevention and health promotion strategy. It establishes a Prevention and Public Health Fund to boost funding for prevention and public health; increases access to clinical preventive services under Medicare and Medicaid; promotes healthier communities; and funds research on optimizing the delivery of public health services. Funding also is provided for maternal and child health services, including abstinence education and a new home visitation program. PPACA also establishes a national strategy for quality improvement; creates an interagency working group to advance quality efforts at the national level; develops a comprehensive repertoire of quality measures; and formalizes processes for quality measure selection, endorsement, data collection, and public reporting of quality information. It creates and funds a new private, nonprofit comparative effectiveness research institute. 

Other key provisions in PPACA 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 nutrition labeling requirements for chain restaurant menus and vending machines; 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. 

HCERA amends several of the PPACA provisions discussed in this report. Those provisions address funding for community health centers and the National Health Service Corps, 340B drug pricing, and taxes on prescription drugs and medical devices.

Date of Report: September 2, 2010
Number of Pages: 141
Order Number: R41278
Price: $29.95

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