	Introduction

On March 23, 2010, President Obama signed into law a comprehensive health reform law, the Patient Protection and Affordable Care Act (ACA). The following week, on March 30, 2010, the President signed the Health Care and Education Reconciliation Act of 2010 (HCERA), which amended numerous health care and revenue provisions in ACA. In addition to changes to private insurance and these federal health programs, ACA includes numerous provisions intended to increase the primary care and public health workforce, promote preventive services, and strengthen quality measurement, among other things. Implementing ACA also is likely to affect discretionary spending, which is provided in and controlled by annual appropriations acts. It also reauthorized funding for many existing discretionary grant programs. Report Overview

This report—one in a series of CRS products summarizing ACA that were issued after the law's enactment—describes the law's workforce, public health, quality, and related provisions. The summaries of the ACA provisions are grouped and discussed under the following section headings: (1) Health Centers and Clinics; (2) Health Workforce; (3) Prevention and Wellness; (4) Maternal and Child Health; (5) Teen Pregnancy Prevention and Adoption Support; (6) Quality; (7) Nursing Homes and Other Long-Term Care Facilities and Providers; (8) Comparative Effectiveness Research; (9) Health Data Collection; (10) Health Information Technology; (11) Emergency Care; (12) Pain Care Management; (13) Elder Justice; (14) Biomedical Research and Medical Products; (15) Biosimilars; (16) Nutrition Labeling; (17) 340B Drug Pricing; and (18) Medical Malpractice and Liability Reform. Each section of the report begins with a brief overview of the ACA provisions to be summarized and includes some discussion of relevant policies in place at the time of ACA's enactment as well as the intent, and, where available, projected impact, of the law. Finally, ACA modifies Medicare graduate medical education (GME) payment policy. ACA's changes to GME payments, along with a new health center grant program and a number of other provisions, are intended to promote primary care training in nonhospital settings. It amends PHSA Sec. 271 establishes a science track at academic sites selected by the Secretary, to award degrees that emphasize team-based service, public health, epidemiology, and emergency preparedness and response. Health Workforce Evaluation and Assessment

ACA establishes a National Health Care Workforce Commission to undertake comprehensive workforce planning. National Prevention, Health Promotion and Public Health Council

This section, as amended by Sec. Prevention and Public Health Fund

The stated purpose of this section is to establish a Prevention and Public Health Fund "to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs." It creates a new PHSA Sec. P.L. P.L. ACA aimed to take steps to address these issues by including a series of five provisions focusing on the development of a national strategy, priorities, and strategic plan to improve health care quality; coordination of health care quality activity at the federal level; measure development and endorsement; public reporting of quality data; and the coordinated selection of measures for use in federal quality programs through a pre-rulemaking process. The general functions of this Center include, among others (1) identifying providers that deliver consistently high-quality, efficient health care services and employ best practices that are adaptable and scalable to diverse health care settings; (2) assessing research, evidence, and knowledge about what strategies and methodologies are most effective in improving health care delivery; (3) finding ways to translate such information rapidly and effectively; (4) creating strategies for quality improvement through the development of tools, methodologies, and interventions that can successfully reduce variation in the delivery of health care; and (5) building capacity at the state and community level to lead quality and safety efforts through education, training and mentoring programs. 1171-1179) instructed the Secretary to adopt electronic format and data standards for nine specified administrative and financial transactions between health care providers and health plans. Subpart A—Elder Justice Coordinating Council and Advisory Board on Elder Abuse, Neglect, and Exploitation. 351 to create a new regulatory pathway for the FDA approval of biosimilars.
In March 2010, President Obama signed into law a comprehensive health reform bill, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), and a package of amendments to ACA, the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152). Health reform was one of President Obama's top domestic policy priorities during his first term, 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 ACA, as amended—focuses on the 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.
This report is primarily for reference purposes. The material in it is intended to provide context to help the reader better understand the intent of ACA's individual provisions at the time of enactment. The report does not track or discuss ongoing ACA-related regulatory and other implementation activities.
ACA 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, ACA 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. ACA 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 ACA include 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; 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.