Discretionary Spending in the Patient
Protection and Affordable Care Act (ACA)
C. Stephen Redhead, Coordinator
Specialist in Health Policy
Kirsten J. Colello
Specialist in Health and Aging Policy
Elayne J. Heisler
Analyst in Health Services
Sarah A. Lister
Specialist in Public Health and Epidemiology
Amanda K. Sarata
Specialist in Health Policy
October 1, 2012
Congressional Research Service
7-5700
www.crs.gov
R41390
CRS Report for Congress
Pr
epared for Members and Committees of Congress

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Summary
The Patient Protection and Affordable Care Act (ACA) reauthorized funding for numerous
existing discretionary grant programs and other activities. ACA also created multiple new
discretionary grant programs and provided for each an authorization of appropriations. Funding
for all these discretionary programs is subject to action by congressional appropriators. This
report summarizes all the discretionary spending provisions in ACA. A companion product, CRS
Report R41301, Appropriations and Fund Transfers in the Patient Protection and Affordable
Care Act (PPACA), summarizes all the mandatory appropriations in the law.
Among the provisions that are intended to strengthen the nation’s health care safety net and
improve access to care, ACA permanently reauthorized the federal health centers program and the
National Health Service Corps (NHSC). The NHSC provides scholarships and student loan
repayments to individuals who agree to a period of service as a primary care provider in a
federally designated Health Professional Shortage Area. In addition, ACA addressed concerns
about the current size, specialty mix, and geographic distribution of the health care workforce. It
reauthorized and expanded existing health workforce education and training programs under
Titles VII and VIII of the Public Health Service Act (PHSA). Title VII supports the education and
training of physicians, dentists, physician assistants, and public health workers through grants,
scholarships, and loan repayment. ACA created several new programs to increase training
experiences in primary care, in rural areas, and in community-based settings, and provided
training opportunities to increase the supply of pediatric subspecialists and geriatricians. It also
expanded the nursing workforce development programs authorized under PHSA Title VIII to
bolster undergraduate and graduate nursing education and training.
As part of a comprehensive framework for federal community-based public health activities,
including a national strategy and a national education and outreach campaign, ACA authorized
several new grant programs with a focus on preventable or modifiable risk factors for disease
(e.g., sedentary lifestyle, tobacco use). The new law also leveraged a number of mechanisms to
improve the quality of health care, including new requirements for quality measure development,
collection, analysis, and public reporting; programs to develop and disseminate innovative
strategies for improving the quality of health care delivery; and support for care coordination
programs such as medical homes, patient navigators, and the co-location of primary health care
and mental health services. Additionally, ACA authorized funding for programs to prevent elder
abuse, neglect, and exploitation; grants to expand trauma care services and improve regional
coordination of emergency services; and demonstration projects to implement alternatives to
current tort litigation for resolving medical malpractice claims, among other provisions.
The Congressional Budget Office estimated that ACA’s discretionary spending provisions, if fully
funded by future appropriations acts, would result in appropriations of approximately $100 billion
over the 10-year period FY2012-FY2021. Most of that funding would be for grant programs that
existed prior to, and whose funding was reauthorized by, ACA. Few new programs created by
ACA received funding in FY2011 or FY2012. ACA also appropriated $1 billion to cover the
administrative costs associated with implementing the new law. All those funds will have been
obligated by the end of FY2012. The President’s FY2013 budget requested more than $1 billion
in discretionary funding for ongoing ACA administrative costs, though it is unclear whether
congressional appropriators will provide any of these funds.

Congressional Research Service

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Contents
Introduction...................................................................................................................................... 1
Discretionary Spending in ACA ...................................................................................................... 3
ACA Administrative Costs and Funding ................................................................................... 4
Mandatory Appropriations in ACA.................................................................................................. 5
Impact of Spending Cuts Under the Budget Control Act................................................................. 6
BCA Background....................................................................................................................... 6
FY2013 Nondefense Discretionary Spending Reductions ........................................................ 7

Tables
Table 1. ACA Discretionary Spending: Health Centers and Clinics................................................ 9
Table 2. ACA Discretionary Spending: Health Care Workforce.................................................... 10
Table 3. ACA Discretionary Spending: Prevention and Wellness ................................................. 21
Table 4. ACA Discretionary Spending: Maternal and Child Health .............................................. 24
Table 5. ACA Discretionary Spending: Health Care Quality......................................................... 25
Table 6. ACA Discretionary Spending: Nursing Homes................................................................ 29
Table 7. ACA Discretionary Spending: Health Disparities Data Collection.................................. 30
Table 8. ACA Discretionary Spending: Emergency Care and Trauma Services............................ 31
Table 9. ACA Discretionary Spending: Elder Justice .................................................................... 32
Table 10. ACA Discretionary Spending: Biomedical Research..................................................... 34
Table 11. ACA Discretionary Spending: Biologics........................................................................ 34
Table 12. ACA Discretionary Spending: 340B Drug Pricing ........................................................ 35
Table 13. ACA Discretionary Spending: Medical Malpractice...................................................... 35
Table 14. ACA Discretionary Spending: Pain Care Management ................................................. 36
Table 15. ACA Discretionary Spending: Medicaid........................................................................ 36
Table 16. ACA Discretionary Spending: Medicare........................................................................ 37
Table 17. ACA Discretionary Spending: Private Health Insurance ............................................... 37

Contacts
Author Contact Information........................................................................................................... 38
Acknowledgments ......................................................................................................................... 38
Key Policy Staff............................................................................................................................. 38

Congressional Research Service

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Introduction
The Patient Protection and Affordable Care Act (ACA)1 makes significant changes to the way
health care is financed, organized, and delivered in the United States. Among its many provisions,
ACA restructures the private health insurance market, sets minimum standards for health
coverage, and, beginning in 2014, mandates that most U.S. residents obtain health insurance
coverage or pay a penalty. The law provides for the establishment by 2014 of state-based health
insurance exchanges for the purchase of private health insurance. Qualifying individuals and
families will be able to receive federal subsidies to reduce the cost of purchasing coverage
through the exchanges.
In addition to expanding private health insurance coverage, ACA, as enacted, requires state
Medicaid programs to expand coverage to all eligible nonelderly, non-pregnant individuals under
age 65 with incomes up to 133% of the federal poverty level (FPL), or risk losing their existing
federal Medicaid matching funds. Under ACA, the federal government will initially cover 100%
of the expansion costs, phasing down to 90% of the costs by 2020. In National Federation of
Independent Business v. Sebelius, the U.S. Supreme Court found that the Medicaid expansion
violated the Constitution by threatening states with the loss of their existing federal Medicaid
matching funds. The Court precluded the Secretary of Health and Human Services (HHS) from
penalizing states that choose not to participate in the Medicaid expansion (see text box below).
ACA also amends the Medicare program in an effort to reduce the rate of its projected growth;
imposes an excise tax on insurance plans found to have high premiums; and makes many other
changes to the tax code, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP),
and other federal programs.
Implementation of ACA is projected to have a significant impact on federal revenues and direct
(also referred to as mandatory) spending.2 The law includes direct spending to subsidize the
purchase of health insurance coverage through the exchanges, as well as increased outlays for the
expansion of the Medicaid program. ACA also includes numerous mandatory appropriations to
fund temporary programs to increase access and funding for targeted groups, provide funding to
states to plan and establish exchanges, and support many other research and demonstration
programs and activities (see discussion below under “Mandatory Appropriations in ACA”). The
costs of expanding public and private health insurance coverage and other mandatory spending
are offset by revenues from new taxes and industry fees, and by savings from payment and health
care delivery system reforms designed to slow the growth in spending on Medicare and other
federal health care programs.3

1 ACA was signed into law on March 23, 2010 (P.L. 111-148, 124 Stat. 119). A week later, on March 30, 2010, the
President signed the Health Care and Education Reconciliation Act (HCERA; P.L. 111-152, 124 Stat. 1029), which
amended multiple health care and revenue provisions in ACA. Several other bills that were subsequently enacted
during the 111th and 112th Congresses made more targeted changes to specific ACA provisions. All references to ACA
in this report refer to the law as amended. Note that previous CRS reports on the Patient Protection and Affordable
Care Act used the acronym PPACA to refer to the law. CRS is now using the more common acronym ACA.
2 Direct, or mandatory, spending generally refers to budget authority (i.e., the authority to incur financial obligations
that result in government expenditures, such as purchasing services or awarding grants) that is provided in laws other
than the annual appropriations acts. Mandatory spending includes entitlement authority (e.g., Medicare, Social
Security).
3 For more information on ACA’s provisions and its projected impact on federal revenues and direct spending, see CRS
Report R41664, ACA: A Brief Overview of the Law, Implementation, and Legal Challenges, coordinated by C. Stephen
Redhead.
Congressional Research Service
1

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

U.S. Supreme Court Decision on ACA (June 28, 2012)
In National Federation of Independent Business v. Sebelius (NFIB) the Court ruled on the constitutionality of both the
individual mandate, which requires most U.S. residents (beginning in 2014) to carry health insurance or pay a penalty,
and the Medicaid expansion. The Court upheld the individual mandate as a constitutional exercise of Congress’s
authority to levy taxes. The penalty is to be paid by taxpayers when they file their tax returns and enforced by the
Internal Revenue Service.
In a separate opinion, the Court found that compelling states to participate in the ACA Medicaid expansion—which
the Court determined to be essential y a new program—or risk losing their existing federal Medicaid matching funds
was coercive and unconstitutional under the Spending Clause of the Constitution and the Tenth Amendment. The
Court’s remedy for this constitutional violation was to prohibit HHS from penalizing states that choose not be
participate in the expansion by withholding any federal matching funds for their existing Medicaid program. However,
if a state accepts the new ACA expansion funds (initial y a 100% federal match), it must abide by al the expansion
coverage rules.
Under NFIB, all other provisions of ACA remain fully intact and operative.
ACA implementation affects not only direct spending and revenues but also discretionary
spending, which is subject to the annual appropriations process.4 The law includes numerous
discretionary spending provisions that authorize the appropriation of funds to implement grant
programs and other activities. These provisions are of two kinds:
• Authorizations of appropriations for new discretionary grant and other programs
created by ACA.
• Authorizations of appropriations for existing programs, primarily ones
authorized under the Public Health Service Act (PHSA). In most instances, the
appropriation authorizations for these established programs expired prior to their
reauthorization by ACA. However, almost all of them continued to receive an
annual appropriation.5
Many of the ACA discretionary spending provisions authorize annual appropriations of specified
amounts for one or more fiscal years to carry out the program or activity. Other provisions
authorize the appropriation of specified amounts for FY2010 or FY2011 and unspecified
amounts—such sums as may be necessary, or SSAN—for later years. A few provisions authorize
multi-year appropriations, available for obligation for a period in excess of one fiscal year (e.g.,
for the period FY2011 through FY2014). Numerous other provisions simply authorize the
appropriation of SSAN, in a few cases without specifying any fiscal years.
Funding for all discretionary programs in ACA depends on actions taken by congressional
appropriators, a process that may lead to greater or smaller amounts than the sums authorized by
the law. With Congress now operating under discretionary spending limits set by the Budget
Control Act, it may prove difficult to secure funding for new programs and activities (see
discussion below under “Impact of Spending Cuts Under the Budget Control Act”). Even

4 Discretionary spending refers to outlays from budget authority that is provided in and controlled by annual
appropriations acts.
5 ACA also reauthorized the Indian Health Care Improvement Act (IHCIA), which includes many discretionary Indian
Health Service (IHS) programs and services. It extended indefinitely the authorizations of appropriations for those
programs and services. For more information on ACA’s Indian health provisions, which are not included in this report,
see CRS Report R41630, The Indian Health Care Improvement Act Reauthorization and Extension as Enacted by the
ACA: Detailed Summary and Timeline, by Elayne J. Heisler.
Congressional Research Service
2

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

maintaining current funding levels for existing programs with an established appropriations
history may prove a challenge under growing pressure to reduce federal discretionary spending.
This report, which is periodically revised and updated to reflect important legislative and other
developments, summarizes all the discretionary spending provisions in ACA that authorize (or
reauthorize) appropriations for grant programs and other activities. It also includes a brief
discussion of funding for ACA’s administrative costs and some analysis of the potential impact of
sequestration triggered by the Budget Control Act on ACA discretionary spending in FY2013.
Discretionary Spending in ACA
The law’s discretionary spending provisions are organized by general topic in a series of tables
with the following headings: Health Centers and Clinics (Table 1); Health Care Workforce (Table
2); Prevention and Wellness (Table 3); Maternal and Child Health (Table 4); Health Care Quality
(Table 5); Nursing Homes (Table 6); Health Data Collection (Table 7); Emergency Care (Table
8); Elder Justice (Table 9); Biomedical Research (Table 10); Biologics (Table 11); 340B Drug
Pricing (Table 12); Medical Malpractice (Table 13); Pain Care Management (Table 14);
Medicaid (Table 15); Medicare (Table 16); and Private Health Insurance (Table 17).
Each table row provides information on a specific ACA provision, organized across four columns.
The first column shows the ACA section or subsection number. The second column indicates
whether the provision is freestanding (i.e., new statutory authority that is not amending an
existing statute) or amendatory (i.e., amends an existing statute such as the PHSA, either by
adding a new program or amending an existing one). The name of the administering agency or
office within HHS is also included, if known. The third column provides a brief description of the
program or activity, including the types of entities and/or individuals eligible for funding.6 The
fourth column gives details of the authorization of appropriations, along with the FY2011 and
FY2012 amounts for programs and activities that received funding, and, if applicable, the
FY2013 funding request.7 The federal government currently is operating under a six-month
continuing resolution (see discussion below under ““ACA Administrative Costs and Funding”).
Note that in several of the larger tables with multiple entries (i.e., Tables 1, 2, 3, 5 and 8), the
ACA provisions are grouped based on whether they reauthorize funding for existing programs or
authorize funding for new programs. Where available, the table entry includes the Catalog of
Federal Domestic Assistance (CFDA) number for the grant program.8 Unless otherwise stated, all
references in the tables to the Secretary refer to the HHS Secretary.
The Congressional Budget Office (CBO) estimated that ACA’s discretionary spending provisions,
if fully funded by future appropriations acts, would result in appropriations of almost $100 billion
over the period FY2012-FY2021.9 However, much of that funding—about $85 billion—would be

6 Not applicable if the funding is to support programs and activities carried out by a federal agency.
7 The FY2011, FY2012, and FY2013 (request) funding amounts are taken from HHS agency FY2013 congressional
justification documents, available at http://www.hrsa.gov/about/budget/index.html.
8 CFDA is a government-wide compendium of federal grant and other assistance programs. Each program is assigned a
unique five-digit number, XX.XXX, where the first two digits represent the funding agency and the second three digits
represent the program. Programs funded by the Department of Health and Human Services begin with the number 93.
For more information, see https://www.cfda.gov.
9 U.S. Congress, House Committee on Energy and Commerce, Subcommittee on Health, “CBO’s Analysis of the Major
(continued...)
Congressional Research Service
3

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

for three programs that were in existence prior to, and were reauthorized by, ACA; namely, the
National Health Service Corps, the federal health centers program, and the Indian Health Service
(IHS).
Most, though not all, of the existing grant
Acronyms Used in the Tables in
programs that were reauthorized under ACA
This Report
received a discretionary appropriation for
FY2011 and FY2012, as well as a FY2013
Agency for Healthcare Research and Quality (AHRQ)
request for continued funding. In contrast, few
Centers for Disease Control and Prevention (CDC)
of the new grant programs authorized under
Centers for Medicare and Medicaid Services (CMS)
ACA have received annual discretionary
appropriations.10 However, several of the new
Community Health Center Fund (CHCF)
programs have received mandatory funds
Federal Food, Drug, and Cosmetic Act (FFDCA)
from ACA’s Prevention and Public Health
Food and Drug Administration (FDA)
Fund (see discussion below under “Mandatory
Health Resources and Services Administration (HRSA)
Appropriations in ACA”).
Indian Health Service (IHS)
National Institutes of Health (NIH)
ACA Administrative Costs and
Office of Personnel Management (OPM)
Funding
Office of the Secretary (OS)
In addition to the costs of fully funding ACA’s
Prevention and Public Health Fund (PPHF)
discretionary grant programs and other
Public Health Service Act (PHSA)
activities, CBO projected that both HHS and
Substance Abuse and Mental Health Services
the Internal Revenue Service (IRS) will incur
Administration (SAMHSA)
substantial administrative costs to implement
the law’s private health insurance reforms and
Social Security Act (SSA)
its changes to the federal health care
programs. CBO estimated that the costs to the IRS of implementing the eligibility determination,
documentation, and verification processes for the health insurance subsidies will probably total
between $5 billion and $10 billion over 10 years. It further estimated that the costs to HHS of
implementing the changes in Medicare, Medicaid, and CHIP, as well as some of the reforms to
the private insurance market, will require similar amounts over 10 years.11
The Health Care and Education Reconciliation Act (HCERA) established, and appropriated $1
billion to, the Health Insurance Reform Implementation Fund (HIRIF)—one of many sources of
mandatory funding for ACA programs and activities (see discussion below under “Mandatory

(...continued)
Health Care Legislation Enacted in March 2010,” Statement of Douglas W. Elmendorf, Director, 112th Cong., 1st sess.,
March 30, 2011. Available at http://www.cbo.gov/ftpdocs/121xx/doc12119/03-30-HealthCareLegislation.pdf. See p.
16. CBO’s estimate of ACA discretionary spending includes (1) amounts specified in ACA, plus estimated amounts for
subsequent years (adjusted for anticipated inflation) where ACA specified an amount for the first year (FY2010 or
FY2011) and authorized SSAN for subsequent years; and (2) estimated amounts for subsequent years (adjusted for
anticipated inflation) where there is an appropriation for FY2010 under prior law and ACA authorized the
appropriation of SSAN for later years. The CBO estimate does not include new ACA programs for which the law
provided only an authorization for the appropriation of SSAN.
10 Examples include CDC’s congenital heart disease and breast health awareness programs (see Table 3) and the Cures
Acceleration Network (CAN) program at NIH (see Table 10).
11 CBO, May 11, 2010, see footnote 9.
Congressional Research Service
4

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Appropriations in ACA”).12 HIRIF funds are for administrative expenses associated with
implementing the new law. While HHS is using the HIRIF to cover its own ACA administrative
costs, a significant portion of HIRIF funding has been transferred to the IRS. HHS projects that
all the HIRIF funds will have been obligated by the end of FY2012. Thereafter, ACA
administrative costs will have to be funded through annual discretionary appropriations.
The President’s FY2013 budget requested more than $1 billion in new discretionary funding for
HHS and the IRS to pay for ongoing administrative costs associated with ACA implementation. It
remains unclear whether congressional appropriators will provide any or all of those funds in
FY2013. Congress has yet to complete action on any of the FY2013 appropriations bills and has
instead passed, and the President has signed, a continuing resolution (H.J.Res. 117) to provide
temporary funding authority for the first six months of FY2013. The requested ACA
administrative funding was not included in H.J.Res. 117.13
Mandatory Appropriations in ACA
Separate from the discretionary spending authorizations summarized in the tables in this report,
ACA included numerous mandatory appropriations that provide billions of dollars to fund new
and existing grant programs and activities within HHS.14
Of particular note, ACA established two multi-billion dollar funds that are helping support several
of the discretionary grant programs authorized (or reauthorized) under ACA:
• The Community Health Center Fund (CHCF) will provide a total of $11
billion over the period FY2011-FY2015 for the federal health centers program
and the National Health Service Corps (NHSC).15 While CHCF funds have so far
been used to supplement annual discretionary appropriations for the health
centers program, the NHSC program received no discretionary funding for
FY2012 and is relying entirely on CHCF funds (see Table 1 and Table 2). Note:
A separate ACA appropriation provided $1.5 billion for health center
construction and renovation (see Table 1).16
• The Prevention and Public Health Fund (PPHF), for which ACA provided a
permanent annual appropriation, is intended to fund prevention, wellness, and

12 HCERA Section 1105; see footnote 1.
13 The Continuing Appropriations Resolution, 2013 (P.L. 112-175, 126 Stat. 1313), funds government operations at an
annualized rate of $1.047 trillion in discretionary budget authority, which equals the FY2013 discretionary spending
cap set by the BCA. It increases funding for most federal agencies and programs by 0.612% over the FY2012 levels.
P.L. 112-175 does not incorporate any of the new ACA-related policies or funding that were included in the President’s
FY2013 budget.
14 All these mandatory spending provisions are summarized in a companion product, CRS Report R41301,
Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act (PPACA), by C. Stephen
Redhead.
15 ACA Section 10503(a)-(b). The CHCF provides the following amounts for health center operating grants: FY2011 =
$1 billion; FY2012 = $1.2 billion; FY2013 = $1.5 billion; FY2014 = $2.2 billion; and FY2015 = $3.6 billion. It also
provides the following amounts for the National Health Service Corps: FY2011 = $290 million; FY2012 = $295
million; FY2013 = $300 million; FY2014 = $305 million; and FY2015 = $310 million.
16 ACA Section 10503(c).
Congressional Research Service
5

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

other public health-related programs and activities authorized under the PHSA.17
PPHF funds have been used to support at least six new discretionary grant
programs authorized under ACA.18 In addition, PPHF funds are supplementing,
and in some cases supplanting, annual discretionary appropriations for several
established programs that were reauthorized by the law (see Table 2, Table 3,
and Table 5).
Impact of Spending Cuts Under the Budget Control
Act
On January 2, 2013, pursuant to the Budget Control Act of 2011 (BCA), the President will order
across-the-board spending cuts—a process known as sequestration—for all nonexempt direct and
discretionary spending programs, unless Congress and the President enact legislation to modify or
repeal the BCA. As discussed below, a FY2013 sequestration would significantly impact ACA
discretionary spending.
BCA Background
The BCA authorized the President to increase the nation’s debt limit by at least $2.1 trillion (and
up to $2.4 trillion under certain conditions) in three installments and established procedures
designed to reduce future federal spending by a comparable amount.19 To achieve the spending
reductions, the law placed enforceable limits, or caps, on discretionary spending for each of
FY2012 through FY2021. CBO estimated that adhering to these limits, which grow by
approximately 2% each year, would reduce federal spending by $917 billion through FY2021,
compared to the projected level of spending if annual appropriations were to grow at the rate of
inflation.20
In addition, the BCA created a Joint Select Committee on Deficit Reduction (Joint Committee)
and instructed it to develop deficit-reduction legislation for Congress to consider under expedited
floor procedures. If, by January 15, 2012, Congress and the President failed to enact a Joint

17 ACA Section 4002. As originally enacted, ACA appropriated the following amounts to the PPHF: FY2010 = $500
million; FY2011 = $750 million; FY2012 = $1 billion; FY2013 = $1.25 billion; FY2014 = $1.5 billion; and FY2015
and each fiscal year thereafter = $2 billion. The Middle Class Tax Relief and Job Creation Act of 2012 (P.L. 112-96,
Sec. 3205) amended Section 4002 and reduced the amounts appropriated over the period FY2013-FY2021 by a total of
$6.25 billion. The reduced appropriations for each of those fiscal years are as follows: FY2013 = $1 billion; FY2014 =
$1 billion; FY2015 = $1 billion; FY2016 = $1 billion; FY2017 = $1 billion; FY2018 = $1.25 billion; FY2019 = $1.25
billion; FY2020 = $1.5 billion; and FY2021 = $1.5 billion.
18 Those programs include (1) Sec. 5208, Nurse-Managed Health Clinics, see Table 1; (2) Sec. 5306, Mental and
Behavioral Health Education and Training Grants, see Table 2; (3) Sec. 5102, State Health Care Workforce
Development Grants, see Table 2; (4) Sec. 4201, Community Transformation Grants, see Table 3; (5) Sec. 10408,
Small Business Workplace Wellness Grants, see Table 3; and (6) Sec. 10501(g), National Diabetes Prevention
Program, see Table 3.
19 P.L. 112-25, 125 Stat. 240. For a more detailed examination of all the provisions in the BCA, see CRS Report
R41965, The Budget Control Act of 2011, by Bill Heniff Jr., Elizabeth Rybicki, and Shannon M. Mahan. The President
has exercised the authority provided him in the BCA and raised the debt ceiling by a total of $2.1 trillion, from $14.294
trillion to $16.394 trillion.
20 U.S. Congressional Budget Office, Analysis of Budget Control Act, August 1, 2011. Available at
http://www.cbo.gov/publication/41626.
Congressional Research Service
6

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Committee bill reducing the deficit by an amount greater than $1.2 trillion over the period
FY2012-FY2021, then automatic annual spending reductions would be triggered beginning in
FY2013. The November 21, 2011, announcement by the Joint Committee that it was unable to
agree on a deficit-reduction bill means that automatic spending reductions totaling $1.2 trillion
are all but certain to take effect, absent the enactment of new legislation to modify or repeal the
BCA.
Based on the formula in the BCA, the automatic spending reductions would cut the same
amount—$54.7 billion—from both defense and nondefense spending for each fiscal year over the
period FY2013-FY2021. The annual spending reduction in each category—defense and
nondefense—would be divided proportionately between discretionary spending and nonexempt
direct spending. In FY2013, both the discretionary and the direct spending reductions would be
achieved through sequestration—a largely across-the-board cancellation of budgetary resources in
nonexempt accounts. In each of the remaining fiscal years through FY2021, discretionary
spending reductions would be achieved through a downward adjustment of the BCA spending
limits, while direct spending reductions would continue to be executed through sequestration.
Under the sequestration rules, reductions in Medicare payments to health care providers and
health plans (which account for most of Medicare spending) are capped at 2%. Many other
federal direct spending programs, accounting for most of the government’s entitlement and other
direct spending (excluding Medicare), are exempt from sequestration altogether.21
Discretionary spending reductions in FY2013 also would be achieved through a sequestration of
nonexempt discretionary appropriations. The sequestration rules exempt some discretionary
spending, notably for veterans’ health care and Pell grants.22 For each of the remaining fiscal
years (i.e., FY2014-FY2021), however, discretionary spending reductions would be achieved by
lowering the BCA discretionary spending caps. There would be no across-the-board cuts through
sequestration. Instead, the Appropriations Committees would decide how to apportion the cuts
within the reduced cap.
The BCA requires the OMB to calculate, and the President to order, a sequestration of nonexempt
discretionary appropriations for FY2013 and nonexempt direct spending for each of FY2013
through FY2021. As already noted, the sequestration for FY2013 is to occur on January 2, 2013.
The sequestrations for subsequent fiscal years are to occur at the time of the President’s annual
budget submission in early February.
FY2013 Nondefense Discretionary Spending Reductions
On September 14, 2012, OMB released a report on the potential impact of a sequestration
triggered by the failure of the Joint Committee to propose, and Congress and the President to
enact, legislation to reduce the deficit by an amount greater than $1.2 trillion.23 The OMB report
provides a breakdown of exempt and nonexempt budget accounts, and includes estimates of the
FY2013 funding reductions in nonexempt accounts. OMB calculated that sequestration would

21 For more information, see CRS Report R42050, Budget “Sequestration” and Selected Program Exemptions and
Special Rules, coordinated by Karen Spar.
22 Ibid. Note that all veterans programs, mandatory and discretionary, are exempt from sequestration.
23 U.S. Office of Management and Budget, OMB Report Pursuant to the Sequestration Transparency Act of 2012 (P.L.
112-155), http://www.whitehouse.gov/sites/default/files/omb/assets/legislative_reports/stareport.pdf.
Congressional Research Service
7

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

result in an 8.2% reduction in nonexempt nondefense discretionary spending. That reduction
would generally apply to the discretionary spending summarized in the tables in this report.24
OMB emphasized that the estimates and budget account classifications in the report are
preliminary. The agency noted that “[i]f the sequestration were to occur, the actual results would
differ based on changes in law and ongoing legal, budgetary, and technical analysis.”25
Importantly, the reductions in nondefense (and defense) discretionary spending under the BCA
would largely occur in the first year (i.e., FY2013) through sequestration, rather than phasing in
gradually over the entire period. In each subsequent fiscal year (i.e., FY2014-FY2021), the level
of nondefense (and defense) discretionary spending would be tied to the adjusted (i.e., lowered)
cap, which would actually grow by about 2% annually over that period.

24 For more discussion and analysis of the potential impact of spending reductions triggered by the BCA, see CRS
Report R42051, Budget Control Act: Potential Impact of Sequestration on Health Reform Spending, by C. Stephen
Redhead.
25 Ibid., p. 1.
Congressional Research Service
8

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Table 1. ACA Discretionary Spending: Health Centers and Clinics
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
Health Centers: Existing Program
5601 Reauthorizes
Health centers. Permanently reauthorizes funding for the program
$3.0 billion for FY2010, $3.9 billion for FY2011, $5.0 billion for FY2012,
PHSA Sec. 330
that provides operating grants to health centers serving federally
$6.5 billion for FY2013, $7.3 billion for FY2014, and $8.3 billion for
(HRSA)
designated medical y underserved populations and furnishing
FY2015; amounts in subsequent years based on previous year’s funding,
comprehensive primary care services, referrals, and other services
subject to adjustment.
needed to facilitate access to such care, regardless of ability to pay.
Eligible grantees include community, migrant, public housing, and
FY2011 funding = $2.6 billion (includes $1.0 billion from the CHCF),
homeless health centers that meet the statutory requirements of PHSA
FY2012 funding = $2.8 billion (includes $1.2 billion from the CHCF),
Sec. 330.
FY2013 request = $3.1 billion (includes $1.5 billion from the
CHCF).a [CFDA 93.224, 93.527]

Note: ACA Sec. 10503(c) appropriated $1.5 billion for the period
FY2011 through FY2015 for health center construction and renovation;
see CRS Report R41301.
Health Centers and Clinics: New Programs
4101(b)
New PHSA Sec.
School-based health centers (SBHCs). Requires the Secretary to
SSAN for each of FY2010 through FY2014.
399Z-1 (HRSA)
award grants to fund the management and operation of SBHCs that
provide comprehensive physical and behavioral health services to
Note: ACA Sec. 4101(a) appropriated a total of $200 million for SBHC
children and adolescents, subject to parental consent. SBHCs that meet
construction and renovation; see CRS Report R41301.
certain specified criteria and match 20% of the grant amount with non-
federal funds (unless waived). Preference may be given to SBHCs serving
children and adolescents who have limited access to or difficulty
accessing health care.
5208
New PHSA Sec.
Nurse-managed health clinics (NMHCs). Requires the Secretary to $50 million for FY2010, and SSAN for each of FY2011 through FY2014.
330A-1 (HRSA)
award grants to fund the operation of NMHCs—associated with
schools, col eges, federally qualified health centers (FQHCs), or
Note: This new program received $15 million in FY2010 funds from the
nonprofit health/social services agencies—that provide comprehensive
PPHF but has not received any funding since that time. [CFDA 93.515]
primary health care and wellness services to vulnerable or underserved
populations regardless of income or insurance status. At least one
advanced practice nurse must hold an executive management position in
the NMHC.
CRS-9

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
10504 New
authority
Access to affordable care demonstration program. Within six
SSAN (no years specified).
(HRSA)
months of enactment, requires the Secretary to establish a three-year
demonstration project in up to 10 states—each state may receive up to
$2 million—to provide access to comprehensive health care services to
the uninsured. Eligible grantees must be state-based, nonprofit, public-
private partnerships that provide access to comprehensive health care
services to the uninsured at reduced fees.
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
FY2011, FY2012 and requested FY2013 funding amounts are taken from HRSA’s FY2013 budget justification document for Congress, available at http://www.hrsa.gov/
about/budget/index.html.
a. Annual funding totals for health centers include the fol owing amounts for the Federal Tort Claims Act (FTCA) program: FY2011 = $100 million; FY2012 = $95 million;
FY2013 request = $95 million. Under the FTCA, health center employees and contractors are considered federal employees immune from medical malpractice
lawsuits while acting within the scope of their employment. The federal government assumes responsibility for such malpractice claims.

Table 2. ACA Discretionary Spending: Health Care Workforce
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
National Health Service Corps (NHSC)
5207 Reauthorizes
NHSC scholarships and loan repayments. Permanently
$320 million for FY2010, $414 million for FY2011, $535 million for
PHSA Title III,
reauthorizes funding for the NHSC program. In exchange for a
FY2012, $691 million for FY2013, $893 million for FY2014, and $1,155
Part D, Subpart III commitment to work in a federally designated Health Professional
billion for FY2015; amounts in subsequent years based on previous
(HRSA)
Shortage Area (HPSA), the program provides (1) scholarships to
year’s funding, subject to adjustment.
students training in a primary care discipline to cover tuition, fees, other
educational costs, and a stipend; and (2) student loan repayments of up
FY2011 funding = $315 million (includes $290 million from the
to $50,000 a year to primary care and mental health clinicians. To be
CHCF), FY2012 funding = $295 million (all CHCF), FY2013 request
eligible for a scholarship, a student must be accepted or enrolled in a
= $300 million (all CHCF). [CFDA 93.162, 93.288, 93.547]
training program for medicine, dentistry, family nurse practitioner, nurse
midwife, or physician assistant, and agree to two to four years of service
in an NHSC-approved site in a HPSA. Loan repayments are for primary
care, dental, and mental health clinicians who agree to at least two years
of service in an NHSC-approved site in a HPSA.
CRS-10

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
Physicians: Existing Program
5301 Amends
and
Primary care training and enhancement program. (1) Authorizes For both grant programs, $125 million for FY2010, and SSAN for each
reauthorizes
five-year grants to public and nonprofit private hospitals, medical
of FY2011 through FY2014. Note: 15% of the amount appropriated must
PHSA Sec. 747
schools, academically affiliated physician assistant training programs, and
be use for physician assistant training programs.
(HRSA)
other public and nonprofit private entities to support training programs
in primary care. Funds are to be used to plan, develop and operate
A separate authorization of $750,000 for each of FY2010 through
accredited training programs, including residency and internship
FY2014 is provided for capacity building grants to integrate academic
programs, in family medicine, general internal medicine, and general
units.
pediatrics and to provide financial assistance (e.g., traineeships). (2)
FY2011 funding = $39 million, FY2012 funding = $39 million, FY2013
Authorizes five-year grants to medical schools for primary care capacity
request = $51 million. [CFDA 93.510, 93.514, 93.884]
building. Funds are to be used to create academic units or programs that
improve clinical teaching in the primary care fields, and (in a separate
Note: For FY2010, this program received $198 million in PPHF funds in
authorization) to integrate academic units to enhance interdisciplinary
addition to its annual discretionary appropriation of $39 million.
recruitment, training, and faculty development. Funding priority given to
entities proposing innovative approaches to primary care training and
with a record of training primary care providers, among other things.
Physicians: New Programs
5203
New PHSA Sec.
Pediatric specialist loan repayment program. Requires the
$30 million for each of FY2010 through FY2014 for loan repayments to
775 (HRSA)
Secretary to implement a loan repayment program that pays up to
pediatric specialists and surgeons; $20 million for each of FY2010
$35,000 for each year of service (for a maximum of three years) to
through FY2013 for loan repayments to mental health providers.
practicing or in-training pediatric specialists and surgeons, as well as
child and adolescent mental health specialists, who agree to at least two
FY2013 request = $5 million.
years of service in a HPSA.
5508(a)
New PHSA Sec.
Teaching health centers development grants. Authorizes three-
$25 million for FY2010, $50 million for each of FY2011 and FY2012, and
749A (HRSA)
year grants of up to $500,000 to FQHCs, rural health clinics, Indian
SSAN for each fiscal year thereafter.
health centers, and entities receiving PHSA Title X (family planning)
funds that establish or expand a primary care residency training
program.
10501(l)
New PHSA Sec.
Rural physician training grants. Requires the Secretary to (1) award
$4 million for each of FY2010 through FY2013.
749B (HRSA)
grants medical schools for recruiting students most likely to practice in
underserved rural communities and for providing rural-focused training
and experience; and (2) within 60 days of enactment, by regulation,
define underserved rural communities. Priority is given to entities that
train students to practice in rural communities, that have established
partnerships with rural community health centers, or who submit a long-
term plan for tracking where graduates practice. [Note: HRSA published
an interim final rule on May 26, 2010 (75 Federal Register 29447).]
CRS-11

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
Nursing: Existing Programs
5309(a) Amends
and Nurse education, practice, quality, and retention program.
SSAN for each of FY2010 through FY2014. See also ACA Sec. 5312
reauthorizes
Authorizes grants or contracts to expand enrol ment in baccalaureate
below, which reauthorized appropriations for several Title VIII nursing
PHSA Sec. 831
nursing programs; provide training in new technologies; develop cultural
education programs, including Sec. 831.
(HRSA)
competencies; expand nursing practice arrangements in non-institutional
settings; and support nurse retention programs that offer career
FY2011 funding = $40 million, FY2012 funding = $39 million, FY2013
advancement for nursing personnel, enhance col aboration among nurses request = $39 million. [CFDA 93.359, 93.503]
and other health professionals, and promote nurse involvement in
clinical decision making. Eligible grantees include nursing schools, health
care facilities (including NMHCs), or partnerships of the two.
5311(a) Amends
and Nursing faculty loan program. Authorizes loans to nursing school
SSAN for each of FY2010 through FY2014.
reauthorizes
students pursuing advanced degrees to become qualified nursing faculty.
PHSA Sec. 846A
Sets the annual loan limit at $35,500 for FY2010 and FY2011; for
FY2011 funding = $25 million, FY2012 funding = $25 million, FY2013
(HRSA)
subsequent fiscal years, the loan limit is subject to a cost-of-attendance
request = $25 million. [CFDA 93.264]
adjustment. Students who go on to serve as nursing school faculty may
have up to 85% of their loan repayment cancelled.
5312 Amends
PHSA
Authorization of appropriations. Reauthorizes funding for the
For PHSA Secs. 811, 821, 831, and new 831A (see ACA Sec. 5309(b)
Sec. 871;
fol owing PHSA Title VIII nursing workforce programs:
below), $338 million for FY2010, and SSAN for each of FY2011 through
previously Sec.
FY2016.
841 (HRSA)
1. Advanced nursing education (PHSA Sec. 811) – grants to accredited
programs for advanced nurse education including combined registered
Sec. 811: FY2011 funding = $64 million, FY2012 funding = $64
nurse masters degree programs, authorized nurse practitioner
million, FY2013 request = $84 million (includes $20 million in PHS
programs, accredited nurse midwifery programs, and accredited nurse
evaluation funds).a [CFDA 93.124, 93.247, 93.358, 93.513]
anesthesia programs.
Sec. 821: FY2011 funding = $16 million, FY2012 funding = $16
2. Nursing workforce diversity (PHSA Sec. 821) – grants to nursing
million, FY2013 request = $16 million. [CFDA 93.178]
schools, academic health centers, state or local governments, and other
appropriate public or private nonprofit entities for stipends and
Sec. 831: see ACA Sec. 5309(a) above for funding amounts.
scholarships so as to increase nursing education opportunities for
disadvantaged individuals.
3. Nurse education, practice, quality, and retention (PHSA Sec. 831) –
see ACA Sec. 5309(a) above.
Note: ACA did not reauthorize funding for the nursing education loan
repayment and scholarship programs authorized under PHSA Sec. 846.b
CRS-13

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
Nursing: New Programs
5309(b)
New PHSA Sec.
Nurse retention program. New authority that largely duplicates the
SSAN for each of FY2010 through FY2012. See also ACA Sec. 5312
831A (HRSA)
nurse retention grant program authorized under PHSA Sec. 831; see
above.
ACA Sec. 5309(a) above.
5311(b)
New PHSA Sec.
Nursing faculty loan repayment program. Authorizes a loan
SSAN for each of FY2010 through FY2014.
847 (HRSA)
repayment program for qualified nursing students or graduates who
agree to serve as nursing faculty for four to six years. Sets the annual
loan limit for FY2010 and FY2011 at $10,000 for individuals with a
master’s or equivalent degree in nursing ($20,000 for those with a
doctorate or equivalent degree in nursing), and an aggregate loan limit of
$40,000 for individuals with a master’s or equivalent degree in nursing
($80,000 for those with a doctorate or equivalent degree in nursing).
Thereafter, the annual and aggregate loan limits are subject to a cost-of-
attendance adjustment.
5316 New
authority
Family nurse practitioner demonstration program. Requires the
SSAN for each of FY2011 through FY2014.
Secretary to award three-year demonstration grants to FQHCs and
NMHCs, not to exceed $600,000 a year, for programs to train nurse
practitioners as primary care providers (as defined in ACA Sec. 5208).
Preference given to bilingual individuals.
Geriatrics and Long-Term Care: Existing Program
5305(c) Amends
and Geriatric nursing education and training. Provides grants for
SSAN for each of FY2010 through FY2014.
reauthorizes
traineeships for individuals preparing for advanced degrees in geriatric
PHSA Sec. 865;
nursing or other nursing areas that specialize in elder care. Eligible
FY2011 funding = $5 million, FY2012 funding = $4 million, FY2013
previously Sec.
grantees include nursing schools, health care facilities, programs leading
request = $4 million. [CFDA 93.265]
855 (HRSA)
to certification as a certified nurse assistant, and partnerships of such
schools, facilities, and programs.
Geriatrics and Long-Term Care (LTC): New Programs
5302
New PHSA Sec.
Direct care worker training. Requires the Secretary to establish a
$10 million for the period FY2011 through FY2013.
747A (HRSA)
grant program to provide new training opportunities, such as tuition and
fee assistance, for direct care workers employed in LTC settings.
Individuals who receive assistance are required to work in the field of
geriatrics, disability services, LTC services and supports, or chronic care
management for a minimum of two years. Eligible grantees include
institutions of higher education that have an established partnership with
an LTC entity, as specified.
CRS-14

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
5305(a) Amends
PHSA
Geriatric workforce development; geriatric career incentive
(1) $10.8 million for the period FY2011 through FY2014. (2) $10 million
Sec. 753 by
awards. (1) Requires the Secretary to award no more than 24 grants or for the period FY2011 through FY2013.
adding new
contracts for $150,000 to entities that operate geriatric education
subsections (d)-
centers to support short-term intensive courses on geriatrics and LTC,
Note: Funding for the three existing geriatric education and training
(e) (HRSA)
and support training for family caregivers and direct care workers.
programs under PHSA Sec. 753(a)-(c) is as fol ows: FY2011 funding =
Eligible grantees include accredited schools of al ied health, medicine,
$34 million; FY2012 funding = $31 million, FY2013 request = $31
nursing, dentistry, osteopathic medicine, optometry, podiatric medicine,
mil ion. [CFDA 93.156, 93.250, 93.969]
veterinary medicine, public health, or chiropractic care; accredited
graduate programs in clinical psychology, clinical social work, health
administration, marriage and family therapy, and counseling; and
physician assistant programs. (2) Requires the Secretary to award grants
or contracts to advance practice nurses, clinical social workers,
pharmacists, and psychologists pursuing an advanced degree in geriatrics
or a related field, in return for agreeing to teach or practice in the field
of geriatrics, LTC, or chronic care management for a minimum of five
years upon completion of the degree.
Pain Care: New Program
4305(c)
New PHSA Sec.
Education and training in pain care. Authorizes a grant program to
SSAN for each of FY2010 through FY2012, to remain available until
759 (HRSA)
train health professionals in pain care. Eligible grantees include health
expended.
professions schools, hospices, and other public and private entities.
Applicants must agree to include training and education on recognizing
the signs and symptoms of pain; applicable laws and policies on
controlled substances; interdisciplinary approaches to pain care delivery;
barriers to care in underserved populations; and recent developments in
pain care. [See also Table 14.]
Public Health: Existing Programs
10501(m)(2) Amends
PHSA
Public health and preventive medicine programs. Reauthorizes
$43 million for FY2011, and SSAN for each of FY2012 through FY2015.
Sec. 770 (HRSA)
funding for the public health workforce programs authorized under
PHSA Secs. 765-769. They include grants for public health training
FY2011 funding = $30 million (includes $20 million from the PPHF),
centers; tuition, fees, and stipends for traineeships in public health and in FY2012 funding = $33 million (includes $25 million from the PPHF),
health administration; and residency programs in preventive medicine
FY2013 request = $20 million (includes $10 million from the PPHF).
and dental public health. Several programs mention preference for
[CFDA 93.117, 93.249, 93.516, 93.964]
underserved communities or underrepresented minorities. Eligible
grantees include accredited academic institutions, as well as state, local
and tribal public health departments.
CRS-15

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
Public Health: New Programs
5204
New PHSA Sec.
Public health workforce loan repayment program. Requires the
$195 million for FY2010, and SSAN for each of FY2011 through FY2015.
776 (HRSA)
Secretary to establish a student loan repayment program that pays up to
$35,000 a year, or one-third of total debt, whichever is less, to increase
the supply of public health professionals. Eligible individuals must agree
to work for at last three years in a public health agency or related
training fel owship.
5206(b)
New PHSA Sec.
Public health and allied health scholarship program. Authorizes
$60 million for FY2010, and SSAN for each of FY2011 through FY2015.
777 (HRSA)
grants to accredited institutions for scholarships to help support the
training of mid-career professionals in public health and allied health.
Available grant funds are to be divided 50:50 between supporting public
health and allied health professionals.
5313
New PHSA Sec.
Community health worker (CHW) program. Requires CDC to
SSAN for each of FY2010 through FY2014.
399V (CDC)
award grants to promote healthy behaviors and outcomes for
populations in medical y underserved communities through programs of
training and supervision of CHWs. Eligible grantees include states and
subdivisions, health departments, free clinics, hospitals, and FQHCs.
Priority is to be given to applicants that target areas with a high
proportion of uninsured or underinsured individuals, or with high rates
of chronic illness or infant mortality.
5314
New PHSA Sec.
CDC training fellowships. Authorizes the Secretary to expand
$39.5 million for each of FY2010 through FY2013 ($24.5 million for EIS,
778 (CDC)
existing CDC training fellowships in epidemiology, laboratory science,
and $5 million each for epidemiology, laboratory science, and
and informatics; the Epidemic Intelligence Service (EIS); and other
informatics).
training programs that meet similar objectives. Participants may be
placed in state and local health agencies, and states can receive federal
assistance for loan repayment programs for such participants. [CFDA
93.065]
5315
New PHSA Title
United States Public Health Sciences Track. Authorizes the
Requires the Secretary to transfer SSAN from the Public Health and
II, Part D – Secs.
establishment of a science track at academic sites selected by the
Social Services Emergency Fund for FY2010 and each fiscal year
271-274 (U.S.
Secretary to award degrees that emphasize team-based service, public
thereafter. Note: P.L. 112-10 prohibited any such transfer of funds.c
Surgeon General)
health, epidemiology, and emergency preparedness and response. Funds
may be used for program development and for tuition and stipends for
student who meet a service obligation, including in the United States
Public Health Service (USPHS) Commissioned Corps.
CRS-16

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
5210 Amends
PHSA
USPHS Commissioned Corps. Establishes a Ready Reserve Corps
$17.5 million for each of FY2010 through FY2014 ($5 million for
Sec. 203 (U.S.
of officers who are subject to involuntary call to active duty (including
recruitment and training, $12.5 million for the Ready Reserve Corps).
Surgeon General)
for training) by the Surgeon General, in order to bolster the available
workforce for both routine and emergency public health missions.
Workforce Diversity, Health Disparities, Cultural Competency: Existing Programs
5307(a) Amends
and Cultural competency, prevention, public health, disparities, and SSAN for each of FY2010 through FY2015.
reauthorizes
individuals with disability training. Authorizes grants, contracts, or
PHSA Sec. 741
cooperative agreements under PHSA Title VII (Health Professions
(HRSA)
Education) for the development and evaluation of research,
demonstration projects, and model curricula that provide training in
cultural competency, prevention, public health proficiency, reducing
health disparities, and aptitude for working with individuals with
disabilities. The Secretary is required to coordinate this program with
the one authorized under PHSA Sec. 807.
5307(b) Amends
and Cultural competency, prevention, public health, disparities, and SSAN for each of FY2010 through FY2015.
reauthorizes
individuals with disability training. Authorizes grants, contracts, or
PHSA Sec. 807
cooperative agreements under PHSA Title VIII (Nursing Workforce
(HRSA)
Development) for the development and evaluation of research,
demonstration projects, and model curricula that provide training in
cultural competency, prevention, public health proficiency, reducing
health disparities, and aptitude for working with individuals with
disabilities. The Secretary is required to coordinate this program with
the one authorized under PHSA Sec. 741.
5401 Amends
and
Centers of excellence (COE). Requires the Secretary to fund COEs
$50 million for each of FY2010 through FY2015, and SSAN for each
reauthorizes
at health professions schools that recruit, enroll and graduate
subsequent fiscal year.
PHSA Sec. 736
underrepresented minorities or that recruit underrepresented
(HRSA)
minorities serving in faculty or administrative positions.
FY2011 funding = $24 million, FY2012 funding = $23 million, FY2013
request = $23 million. [CFDA 93.157]
CRS-17

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
5402 Amends
PHSA
Authorization of appropriations. Reauthorizes funding for the
For Sec. 737, $51 million for FY2010, and SSAN for each of FY2011
Sec. 740 (HRSA)
fol owing PHSA Title VII workforce diversity programs:
through FY2014. For Sec. 738, $5 million for each of FY2010 through
FY2014. For Sec. 739, $60 million for FY2010, and SSAN for each of
1. Scholarships for disadvantaged students (PHSA Sec. 737) – grants
FY2011 through FY2014.
to health professions schools for awarding scholarships to students from
disadvantaged backgrounds with financial need.
Sec. 737: FY2011 funding = $49 million, FY2012 funding = $47
million, FY2013 request = $47. [CFDA 93.925]
2. Faculty loan repayment program (PHSA Sec. 738) – loan repayment
program for health profession graduates from disadvantaged
Sec. 738: FY2011 funding = $1 million, FY2012 funding = $1 million,
backgrounds who serve as faculty at an eligible health professions col ege FY2013 request = $1 million. [CFDA 93.923]
for at least two years.
Sec. 739: FY2011 funding = $22 million, FY2012 funding = $15
3. Health careers opportunity program (PHSA Sec. 739) – grants to
million, FY2013 request = $0. [CFDA 93.822]
health professions schools and other educational institutions to improve
recruitment and academic preparation of students from disadvantaged
backgrounds.
5403(a) Amends
and Area Health Education Centers (AHECs). Requires the Secretary
$125 million for each of FY2010 through FY2014; funds may be carried
reauthorizes
to award grants (with a matching requirement) to medical and nursing
over for up to three fiscal years.
PHSA Sec. 751
schools of at least $250,000 to (1) plan, develop, and operate AHEC
(HRSA)
programs; and (2) to maintain and improve the effectiveness of existing
FY2011 funding = $33 million, FY2012 funding = $27 million, FY2013
AHEC programs. AHECs recruit, train, and prepare individuals from
request = $0. [CFDA 93.107, 93.824]
minority populations or from disadvantaged or rural backgrounds to
work in medically underserved areas.
Workforce Diversity, Health Disparities, Cultural Competency: New Program
5403(b)
New PHSA Sec.
Continuing educational support for health professionals serving $5 million for each of FY2010 through FY2014, and SSAN for each
752 (HRSA)
in underserved communities. Requires the Secretary to award
subsequent fiscal year.
grants to enhance education through distance learning, continuing
education, col aborative conferences, and telehealth, with a focus on
primary care. Eligible grantees include health professions schools,
academic health centers, state or local governments, or other public or
nonprofit entities participating in training activities. [CFDA 93.189]
CRS-18

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
Mental and Behavioral Health: New Program
5306 Redesignates
Mental and behavioral health education and training grants.
$35 million for the period of FY2010 through FY2013 ($8 million for
PHSA Sec. 756 as
Authorizes grants for the recruitment and education of students in
training in social work, $12 million for training in graduate psychology,
Sec. 757, and
social work, interdisciplinary psychology training, and internships or
$10 million for training in professional child and adolescent mental
adds a new Sec.
other field placement programs related to child and adolescent mental
health, and $5 million for training in paraprofessional child and
756 (HRSA)
health. Priority for social work grants given to schools of social work
adolescent mental health).
meeting certain criteria such as recruiting from and placing graduates
into areas with a high-need and high-demand population. Priority for
FY2012 funding = $10 million from the PPHF, FY2013 request = $5
psychology grants given to institutions that focus on the needs of
million in PHS evaluation funds.a [CFDA 93.732]
specified vulnerable groups. Priority for grants to train professional and
Note: The existing graduate psychology education program received $3
paraprofessional child and adolescent mental health workers given to
million in FY2011 and in FY2012; the FY2013 request is for the same
applicants that can, among other things, assess workforce needs and that amount.
have programs designed to increase the number of child and adolescent
mental health workers serving high-priority populations.
Policy and Planning: Existing Program
5103 Amends
and
Health care workforce program assessment. Requires the
For the National Center, $7.5 million for each of FY2010 through
reauthorizes
Secretary to establish a National Center for Health Care Workforce
FY2014; for state and regional centers, $4.5 million for each of FY2010
PHSA Sec. 761
Analysis, award grants to support state and regional centers for health
through FY2014; and for longitudinal evaluations, SSAN for FY2010
(HRSA)
workforce analysis, and increase funding for longitudinal evaluations of
through FY2014.
specified individuals who have received education, training, or financial
assistance from programs under PHSA Title VII.
FY2011 funding = $3 million, FY2012 funding = $3 million, FY2013
request = $10 million. Note: Includes funding for Sec. 792 (health
professions data) and Sec. 806 (nursing grant program data). FY2013
request is all PHS evaluation funds.a [CFDA 93.300]
Policy and Planning: New Programs
5101 New
authority
National Health Care Workforce Commission. Establishes a 15-
SSAN (no years specified).
member commission focused on evaluating and meeting the need for
health care workers in the United States. The commission is required to
conduct studies, produce annual reports beginning in 2011, and make
recommendations on high-priority topics related to the health care
workforce.
CRS-19

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
5102 New
authority
State health care workforce development grants. Establishes a
For planning grants, $8 million for FY2010, and SSAN for each
(HRSA)
matching grants program for state partnerships to plan and implement
subsequent fiscal year. For implementation grants, $150 million for
activities leading to coherent and comprehensive health care workforce
FY2010, and SSAN for each subsequent fiscal year.
development strategies at the state and local levels. Planning grants of up
to $150,000 are for up to one year and require a 15% match.
Note: This program received $6 million in FY2010 funds from the PPHF.
Implementation grants are for up to two years (with up to one
[CFDA 93.509]
additional year of funding) and require a 25% match.
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
FY2011, FY2012 and requested FY2013 funding amounts are taken from HHS FY2013 budget justification documents for Congress, available at http://www.hrsa.gov/about/
budget/index.html.
a. PHSA Sec. 241 authorizes the Secretary to use a portion of the funds appropriated for PHSA programs to evaluate their implementation and effectiveness. Under this
authority a number of HHS agencies and offices are subject to a budget tap, called the PHS Program Evaluation Set-Aside. The tapped evaluation funds are
redistributed and used for evaluation and other specific programs within HHS.
b. The nursing education loan repayment program repays 60% of a registered nurse’s educational loans in return for a two-year commitment to work in a health care
facility with a critical shortage of nurses. Participants may have an additional 25% of their loan repaid in exchange for one more year of service. The nurse scholarship
program offer scholarships to individuals attending nursing school in exchange for at least two years working in a health care facility with a critical shortage of nurses.
Together the two programs, authorized under PHSA Sec. 846, received $94 million in FY2010 and $93 million in FY2011. The authorization of appropriations for Sec.
846 expired at the end of FY2007 and was not reauthorized by ACA.
c. The Department of Defense and Ful -Year Continuing Appropriations Act, 2011 (P.L. 112-10, Div. B, Sec. 1828) prohibited the transfer of funds from the Public Health
and Social Services Emergency Fund (PHSSEF) to support the U.S. Public Health Sciences Track. The PHSSEF is an HHS account administered by the Secretary.
Congress has historical y used the PHSSEF to provide one-time funding for non-routine activities. Each fiscal year, Congress appropriates amounts to the PHSSEF for
specified purposes. ACA did not authorize or appropriate funds to the PHSSEF.
CRS-20

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Table 3. ACA Discretionary Spending: Prevention and Wellness
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
Community-Based Prevention: Existing Programs
3509/3511
New PHSA Secs.
Offices on Women’s Health. Establishes or reauthorizes offices of
For most offices, SSAN for each of FY2010 through FY2014. For NIH
229 (OS), 310A
women’s health in OS, CDC, AHRQ, HRSA, FDA, NIH, and SAMHSA.
and SAMHSA offices, SSAN (no years specified).
(CDC), 925
Grants, agreements, or contracts may be awarded for activities of the
(AHRQ); new
OS office to establish an information center and coordinating
OS Office on Women’s Health: FY2011 funding = $34 million,
SSA Sec. 713
committee. Activities of other offices include recommendations
FY2012 funding = $34 million, FY2013 request = $29 million.
(HRSA); and new
regarding grant-making through other agency accounts, not direct grant-
NIH Office of Research on Women’s Health: FY2011 funding = $42
FFDCA Sec. 1011
making.
million, FY2012 funding = $42 million, FY2013 request = S42
(FDA).
million.
Reauthorizes
PHSA Secs.
486(a) (NIH) and
501(f) (SAMHSA).
4003 Amends
PHSA
Clinical and community preventive services task forces.
SSAN for each fiscal year to carry out the activities of the USPSTF and
Sec. 915(a)
Reauthorizes and expands the authority for the U.S. Preventive Services
the TFCPS.
(AHRQ). New
Task Force (USPSTF) to review and recommend effective clinical
PHSA Sec. 399U
preventive services. Provides explicit statutory authority for the existing
USPSTF: Funding for each of FY2011, FY2012, and the FY2013
(CDC).
Task Force on Community Preventive Services (TFCPS) to review and
request = $11 million (includes $7 million from the PPHF).
recommend effective community-based interventions.
4102(b) Amends
PHSA
School-based dental sealant program. Amends the existing school-
Authority expired at end of FY2005; ACA does not authorize new
Sec. 317M(c)
based dental sealant grant program, which was discretionary, by
funding.
(CDC, HRSA)
requiring the Secretary to award grants to the 50 states and to Indian
tribes for school-based dental sealant programs.
Funding for all CDC’s existing oral health programs under Sec.
317M: FY2011 = $15 million; FY2012 = $15 million, FY2013 request
= $15 million.
4204 Amends
PHSA
Immunization programs. Provides explicit authority for states to
SSAN for each of FY2010 through FY2014 for demonstration grants;
Sec. 317 and adds
purchase vaccines at prices negotiated by Secretary. Permanently
SSAN (no years specified) for other authorities.
a new subsection
reauthorizes state immunization grants. Requires new immunization
(m) (CDC)
demonstration grants.
Funding for the Sec. 317 vaccination program: FY2011 = $589
million (includes $100 million from the PPHF), FY2012 = $620
million (includes $190 million from the PPHF), FY2013 request =
$562 million (includes $72 million from the PPHF). [CFDA 93.185,
93.268, 93.533, 93.539]
CRS-21

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
10334 Amends
PHSA
Offices of Minority Health. Elevates the existing OS Office of
SSAN for each of FY2011 through FY2016 for OS office.
Sec. 1707 (OS)
Minority Health and NIH National Center on Minority Health and
and PHSA Title IV Health Disparities (NCMHD); instructs the OS office to award grants
NIMHD: FY2011 funding = $276 million, FY2012 funding = $276
(NIH)
and undertake other activities to improve minority health status; and
million, FY2013 request = $279 million.
gives the new NIH National Institute on Minority Health and Health
OS Office of Minority Health: FY2011 funding = $56 million,
Disparities (NIMHD) responsibility for minority health disparities
FY2012 funding = $56 million, FY2013 request = $41 million.
research and other health disparities research at NIH.
10412 Reauthorizes
Rural access to emergency devices. Reauthorizes a program of
$25 million for each of FY2003 through FY2014.
PHSA Sec. 312
grants to community partnerships for the purchase and distribution of
(HRSA)
automatic external defibrillators (AEDs) in rural communities, and to
FY2011 funding = $236,000, FY2012 funding = $1 million, FY2013
support AED training for first responders.
request = $0. [CFDA 93.259]
Community-Based Prevention: New Programs
4004 New
authority
Education and outreach regarding prevention. Requires the
SSAN for each fiscal year; no more than $500 million total.
Secretary to carry out various specified communications activities
regarding health promotion and disease prevention, for common and
serious chronic health problems. They include establishing, within one
year of enactment, a national media campaign on health promotion and
disease prevention.
4102(a)
New PHSA Secs.
Oral health activities. Requires CDC, subject to appropriations, to
SSAN (no years specified).
399LL, 399LL-1,
fund a five-year national oral health education campaign, and award
and 399LL-2
grants to community-based providers of dental services for dental caries
(CDC)
disease management programs, among other things.
4102(c) Amends
PHSA
Oral health infrastructure. Requires the Secretary to enter into
SSAN for FY2010 through FY2014.
Sec. 317M by
cooperative agreements with states and tribal entities to establish oral
adding a new
health leadership and programs to improve oral health.
subsection (d)
(CDC)
4102(d) New
authority
Oral health surveillance. Requires the Secretary to expand the
SSAN (no years specified) for PRAMS; SSAN for each of FY2010
(CDC, AHRQ)
following surveillance systems to include more information on oral
through FY2014 for NOHSS; no explicit authorization of appropriations
health: Pregnancy Risk Assessment Monitoring System (PRAMS);
for NHANES/MEPS expansion.
National Health and Nutrition Examination Survey (NHANES); National
Oral Health Surveillance System (NOHSS); and Medical Expenditure
Panel Survey (MEPS).
CRS-22

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
4201 New
authority
Community transformation grants. Requires CDC to fund
SSAN for each of FY2010 through FY2014.
(CDC)
competitive grants for the implementation, evaluation, and dissemination
of evidence-based community preventive health activities.
FY2011 funding = $145 million, FY2012 funding = $226 million,
FY2013 request = $146 million; all funds are from the PPHF. [CFDA
93.531]
4202(a) New
authority
Community wellness pilot program. Requires CDC to award
SSAN for each of FY2010 through FY2014.
(CDC)
grants state and local health departments, and to Indian tribes, for five-
year pilot programs to provide community prevention interventions,
screenings, and clinical referrals for individuals between 55 and 64 years
of age.
4206 Amends
PHSA
Individualized wellness plan demonstration program. Requires
SSAN (no years specified).
Sec. 330 by
the Secretary to establish a pilot program in not more than 10
adding a new
community health centers to test the impact of providing at-risk
subsection (s)
individuals who use the centers with individualized wellness plans.
4304
New PHSA Sec.
Epidemiology and laboratory capacity grants. Codifies existing
$190 million for each of FY2010 through FY2013 (at least $95 million
2821 (CDC)
grant programs to strengthen national epidemiology, laboratory, and
for epidemiology, $60 million for information management, and $32
information management capacity for the response to infectious diseases million for laboratories).
and other conditions of public health importance.
Funding for Epidemiology and Laboratory Capacity (ELC) and
Emerging Infections Program (EIP): FY2011 = $49 million (includes
$40 million from the PPHF), FY2012 = $53 million (includes $40
million from the PPHF), FY2013 request = $53 million (includes $40
million from the PPHF.
10407 New
authority
Diabetes activities. Requires CDC to conduct several diabetes
SSAN (no years specified).
(CDC)
prevention activities including state assessments, vital statistics, physician
education, and funding of an Institute of Medicine (IOM) report.
10411
New PHSA Secs.
Congenital heart disease programs. Authorizes CDC to establish a
SSAN for each of FY2011 through FY2015 for both the surveillance
399V-2 (CDC)
National Congenital Heart Disease Surveillance System (NCHDSS), or
system and the expanded research program.
and 425 (NIH)
to award one grant to establish such a system. Authorizes NIH to
expand and coordinate research on congenital heart disease.
FY2012 funding = $2million, FY2013 request amount not specified.
10413
New PHSA Sec.
Young women’s breast health awareness. Among other things,
$9 million for each of FY2010 through FY2014.
399NN (OS,
requires CDC to conduct an education campaign and award grants for a
CDC)
media campaign regarding breast health in young women, and to conduct FY2011 funding = $5 million, FY2012 funding = $5 million, FY2013
prevention research; requires the Secretary to award grants to provide
request = $5 million.
education and assistance to young women diagnosed with breast disease.
CRS-23

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
10501(g)
New PHSA Sec.
National diabetes prevention program. Among other things,
SSAN for each of FY2010 through FY2014.
399V-3 (CDC)
requires the Secretary to award grants for community-based diabetes
prevention program model sites.
FY2011 funding = $10 million, FY2012 funding = $10 million (all
PPHF), FY2013 request = $10 million (all PPHF).
Workplace Wellness: New Program
10408 New
authority
Small business wellness program. Requires the Secretary to award
$200 million for the period of FY2011 through FY2015, to remain
(CDC)
grants to employers to provide their employees with access to
available until expended.
comprehensive workplace wellness programs. Eligible employers are
those with fewer than 100 employees, who work at least 25 hours per
FY2011 funding = $10 million, FY2012 funding = $10 million, FY2013
week.
request = $4 million; all funds are from the PPHF.
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
FY2011, FY2012 and requested FY2013 funding amounts are taken from HHS FY2013 budget justification documents for Congress, available at http://www.hrsa.gov/about/
budget/index.html.

Table 4. ACA Discretionary Spending: Maternal and Child Health
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
2952(b)
New SSA Sec.
Services to individuals with a postpartum condition. Authorizes
$3 million for FY2010, and SSAN for each of FY2011 and FY2012.
512 (HRSA)
grants to establish, operate and coordinate effective and cost-efficient
systems for the delivery of essential services to individuals with, or at
risk of, postpartum depression and their families. Eligible grantees
include public or nonprofit private entities, state or local government
public-private partnerships, recipients of Healthy Start grants, public or
nonprofit private hospitals, community-based organizations, hospices,
ambulatory care facilities, community health centers, and primary care
centers.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).

CRS-24

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Table 5. ACA Discretionary Spending: Health Care Quality
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
Quality Measure Development, Analysis, and Public Reporting: New Programs
3013(a)&(c)
New PHSA 931
Quality measure development. Requires the Secretary, in
$75 million for each of FY2010 through FY2014, to remain available until
(AHRQ)
consultation with AHRQ and CMS, to (1) identify gaps where no quality
expended. At least 50% of the amounts appropriated must be used
measures exist or where existing measures need improvement, updating
pursuant to SSA Sec. 1890A(e), as added by ACA Sec. 3013(b). See
or expansion consistent with the National Strategy for Quality
below.
Improvement; and (2) fund or enter into agreements with eligible
entities that have demonstrated expertise in measure development to
develop, improve, update or expand quality measures in areas identified
as gap areas.
3013(b)
Amends new SSA
Quality and efficiency measures development. Requires CMS, in
See ACA Sec. 3013(a)&(c) above.
Sec. 1890A, as
consultation with AHRQ, through contracts, to develop quality and
added by ACA
efficiency measures as determined appropriate for use under the SSA.
Sec. 3014(b), by
adding a new
subsection (e)
(CMS)
3015
New PHSA Sec.
Collection and analysis of data for quality and resource use
SSAN for each of FY2010 through FY2014.
399II
measures. Requires the Secretary to establish and implement an
overall strategic framework to carry out the public reporting of
performance information. Requires the Secretary to collect and
aggregate consistent data on quality and resource use measures, and
authorizes the Secretary to award grants or contracts for this purpose.
Authorizes the Secretary to award grants or contracts to multi-
stakeholder entities to support new, or improve existing, efforts to
collect and aggregate quality and resource use measures.
3015
New PHSA Sec.
Public reporting of performance information. Requires the
SSAN for each of FY2010 through FY2014.
399JJ
Secretary to make available to the public, through standardized websites,
performance information summarizing data on quality measures. The
information must include clinical conditions to the extent such data is
available and, where appropriate, be provider-specific and sufficiently
disaggregated and specific to meet the needs of patients with different
clinical conditions.
CRS-25

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
Quality Improvement Research, Training, and Implementation: New Programs
3501
New PHSA Sec.
Health care delivery system research. Requires AHRQ to (1)
$20 million for FY2010 through FY2014.
933 (AHRQ)
identify, develop, evaluate, and disseminate innovative strategies for
quality improvement practices in the delivery of health care services that
represent best practice; (2) support research on health care delivery
improvement and facilitate adoption of best practices; and (3) make the
research findings available to the public; among other specified functions.
3501/3511
New PHSA Sec.
Quality improvement technical assistance and implementation. SSAN (no years specified).
934 (AHRQ)
Requires AHRQ to award grants (with a matching requirement) to
eligible entities for providing technical support to health care providers
in order to help them understand, adapt, and implement the models and
practices identified by the research conducted by the agency. Grantees
must have demonstrated expertise in providing information and
technical support and assistance to health care providers regarding
quality improvement.
3508/3511 New
authority Quality and patient safety training. Authorizes the Secretary to
SSAN (no years specified).
award demonstration grants (with a matching requirement) to eligible
health professions schools or consortia to develop and implement
academic curricula that integrate quality improvement and patient safety
into clinical education of health professionals.
Health Care Coordination: Existing Program
3510 Amends
and
Patient navigator program. Prohibits the Secretary from awarding a
$3.5 million for FY2010, and SSAN for each of FY2011 through FY2015.
reauthorizes
grant to an entity under this section unless the entity provides
PHSA Sec. 340A
assurances that patient navigators recruited, assigned, trained, or
FY2011 funding = $5 million, FY2012 funding = $0, FY2013 request
(HRSA)
employed using these grant funds meet certain minimum core
= $0. [CFDA 93.191]
proficiencies. Eligible grantees include public or nonprofit private health
centers (including an FQHCs), IHS facilities, hospitals, cancer centers,
rural health clinics, academic health centers, and nonprofit entities that
partner or coordinate referrals with such a facility to provide patient
navigator services.
CRS-26

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
5405
New PHSA Sec.
Primary care extension program. Requires the Secretary to
$120 million for each of FY2011 and FY2012, and SSAN for each of
399V-1 (AHRQ)
establish a Primary Care Extension Program to award state planning and
FY2013 and FY2014.
implementation grants for Primary Care Extension Program State Hubs,
consisting of the state health department and other specified entities.
State hubs must contract with and provide grant funds to county and
local entities to serve as Primary Care Extension Agencies that assist
primary care providers in implementing patient-centered medical homes
and develop and support primary care learning communities, among
other functions.
5604
New PHSA Sec.
Co-locating primary and specialty care in community-based
$50 million for FY2010, and SSAN for each of FY2011 through FY2014.
520K (SAMHSA)
mental health settings. Requires the Secretary to fund
demonstration projects for providing coordinated and integrated
Note: SAMHSA’s Primary & Behavioral Health Care Integration (PBHCI)
services to individuals with mental il ness and co-occurring chronic
program, authorized under PHSA Sec. 520A, predates ACA and has
diseases through the co-location of primary and specialty care services in received the following amounts: FY2011 funding = $63 million (includes
community-based mental and behavioral health settings.
$35 million from the PPHF), FY2012 = $68 (includes $35 million from
the PPHF), FY2013 request = $28 million (al PPHF).
10333
New PHSA Sec.
Community-based collaborative care network program.
SSAN for each of FY2011 through FY2015.
340H
Authorizes the Secretary to award grants to support community-based
collaborative care networks (CCN). An eligible CCN is a consortium of
health care providers with a joint governance structure that provides
comprehensive coordinated and integrated health care services (as
defined by the Secretary) for low-income populations. CCNs must
include a safety net hospital and all FQHCs in the community, as
specified.
10410
New PHSA Sec.
Centers of excellence for depression. Requires SAMHSA to award
$100 million for each of FY2011 through FY2015, and $150 million for
520B (SAMHSA)
five-year grants (with a matching requirement) on a competitive basis to
each of FY2016 through FY2020.
eligible institutions of higher education or research institutions to
establish national centers of excel ence for depression. One grantee is to
be designated as the coordinating center and required to establish and
maintain a national database. Centers of excellence may receive a grant
of up to $5 million; the coordinating center may receive a grant of up to
$10 million.
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
FY2011, FY2012 and requested FY2013 funding amounts are taken from HHS FY2013 budget justification documents for Congress, available at http://www.hrsa.gov/about/
budget/index.html.

CRS-28

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Table 6. ACA Discretionary Spending: Nursing Homes
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
6112 New
authority
National independent monitor demonstration program.
SSAN (no years specified); a monitored chain must contribute a portion
Requires the Secretary, within one year of enactment, to implement a
of costs of the demonstration, as determined by the Secretary.
two-year demonstration to develop, test, and implement an independent
monitoring program to oversee interstate and large intrastate chains of
skilled nursing facilities (SNFs) and nursing facilities (NFs).
6114 New
authority
Culture change and information technology demonstration
SSAN (no years specified).
programs. Requires the Secretary, within one year of enactment, to
award one or more competitive grants to support each of the following
two three-year demonstration projects for SNFs and NFs: (1) develop
best practices for culture change (i.e., patient-centric models of care);
and (2) develop best practices for the use of health information
technology.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
CRS-29

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Table 7. ACA Discretionary Spending: Health Disparities Data Collection
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
4302(a)
New PHSA Title
Health disparities data collection and analysis. Not later than two
SSAN for each of FY2010 through FY2014; however, data may not be
XXXI; new Sec.
years after enactment, requires federally conducted and supported
col ected unless funds are directly appropriated for such purpose.
3101
health programs and surveys, to the extent practicable, to col ect and
report data on race, ethnicity, sex, primary language, and disability
status, as well as other demographic data on health disparities as
deemed appropriate by the Secretary. Requires the Secretary to adopt
standards for the measurement and collection of such data. Requires the
Secretary to analyze the data col ected on health disparities; provide for
the public reporting and dissemination of the data and analyses; and
safeguard the privacy of the information. [Note: On October 31, 2011,
HHS published final standards for collecting and reporting health
disparities data. See http://minorityhealth.hhs.gov/templates/
browse.aspx?lvl=2&lvlid=208.]
5605 New
authority
Key national indicators. Establishes a Commission on Key National
$10 million for FY2010, and $7.5 mil ion for each of FY2011 through
Indicators composed of eight members appointed by Congress. [Note:
FY2018, with amounts appropriated to remain available until expended.
The Commission members were appointed in Dec. 2010. See
http://www.stateoftheusa.org/content/commission-on-key-national-
ind.php.] Requires the commission to contract with the National
Academy of Sciences to review available public and private sector
research on key national indicator set selection and determine how best
to establish a key national indicator system, among other things.
Mandates a Government Accountability Office (GAO) study of previous
efforts by public, private, or foreign entities to develop best practices for
a key national indicator system. [Note: GAO released its study in March
2011. See http://www.gao.gov/new.items/d11396.pdf.]
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
CRS-30

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Table 8. ACA Discretionary Spending: Emergency Care and Trauma Services
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
Emergency Care and Trauma Services: Existing Programs
3505(a) Amends
and Trauma care centers. Requires the Secretary to establish separate
$100 million for FY2009, and SSAN for each of FY2010 through FY2015.
reauthorizes
grant programs for IHS and tribal trauma care centers to (1) help defray
PHSA Secs. 1241-
substantial uncompensated care costs, (2) further the core missions of
1245 (HRSA)
trauma care centers, and (3) provide emergency relief to ensure the
continued availability of trauma services.
5603 Amends
and
Children’s emergency medical services demonstration grants.
$25 million for FY2010, $26.3 mil ion for FY2011, $27.6 million for
reauthorizes
Expands emergency services for children who need treatment for
FY2012, $28.9 million for FY2013, and $30.4 million for FY2014.
PHSA Sec. 1910
trauma or critical care by lengthening the period for demonstration
(HRSA)
grants to four years (with an optional fifth year).
FY2011 funding = $21 million, FY2012 funding = $21 million, FY2013
request = $21 million. [CFDA 93.127]
Emergency Care and Trauma Services: New Programs
3504(a)
New PHSA Sec.
Regional systems for emergency care. Requires the Assistant
$24 million for each of FY2010 through FY2014.
1204 (OS)
Secretary for Preparedness and Response to award at least four multi-
year contracts or grants (with matching requirement) to states and
Note: This provision reauthorized funding for several existing trauma
Indian tribes for pilot projects to improve regional coordination of
care grant programs in PHSA Title XII Parts A and B (i.e., Secs. 1202,
emergency services. Priority given to entities that serve a medically
1203, and 1211-1222), as well as for the new program (i.e., Sec. 1204).
underserved population.
3504(b)
New PHSA Sec.
Emergency medicine research. Requires the Secretary to expand
SSAN for each of FY2010 through FY2014.
498D (NIH,
and accelerate basic, translational, and service delivery research on
AHRQ, HRSA,
emergency medical care systems and emergency medicine, including
CDC)
pediatric emergency medical care. Also requires the Secretary to
support research on the economic impact of coordinated emergency
care systems.
3505(b)
New PHSA Secs.
Trauma service availability grants. Requires the Secretary to award $100 million for each of FY2010 through FY2015.
1281-1282
grants to states for the purpose of supporting trauma-related physician
specialties and broadening access to and availability of trauma care
services. States must use at least 40% of the funds for grants to safety
net trauma centers.
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
FY2011, FY2012 and requested FY2013 funding amounts are taken from HRSA’s FY2013 budget justification document for Congress, available at http://www.hrsa.gov/
about/budget/index.html.
CRS-31

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Table 9. ACA Discretionary Spending: Elder Justice
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
6703(a)
New SSA Sec.
Elder Justice Coordinating Council. Establishes an Elder Justice
SSAN (no years specified). See also new SSA Sec. 2024 below.
2021 (OS)
Coordinating Council to include the Secretary as chair and the U.S.
Attorney General, as well as the head of each federal department or
agency, identified by the chair, as having administrative responsibility or
administering programs related to elder abuse, neglect, and exploitation.
6703(a)
New SSA Sec.
Advisory Board on Elder Abuse, Neglect, and Exploitation.
SSAN (no years specified). See also new SSA Sec. 2024 below.
2022
Establishes an advisory board to create a short- and long-term
multidisciplinary plan for development of the field of elder justice and to
make recommendations to the Elder Justice Coordinating Council.
6703(a)
New SSA Sec.
Authorization of appropriations. Authorizes funding for new SSA
$6.5 million for FY2011, and $7.0 million for each of FY2012 through
2024
Secs. 2021 (Coordinating Council), 2022 (Advisory Board), and 2023
FY2014.
(human subject protection guidelines for researchers).
6703(a)
New SSA Sec.
Forensic centers and expertise. Requires the Secretary to award
$4 million for FY2011, $6 million for FY2012, and $8 million for each of
2031
grants to eligible entities to establish and operate stationary and mobile
FY2013 and FY2014.
forensic centers and to develop forensic expertise pertaining to elder
abuse, neglect, and exploitation.
6703(a)
New SSA Sec.
Incentives for LTC staffing. Requires the Secretary to award grants
For new SSA Sec. 2041: $20 million for FY2011, $17.5 million for
2041(a)
to LTC facilities for them to offer continuing training and varying levels
FY2012, and $15 million for each of FY2013 and FY2014.
of certification to employees providing direct care to residents, and to
improve management practices so as to promote retention of direct
care workers.
6703(a)
New SSA Sec.
Certified EHR technology grant program. Authorizes grants to
See above authorization of appropriations for SSA Sec. 2041.
2041(b)
LTC facilities for specified activities that would assist such entities in
offsetting costs related to purchasing, leasing, developing, and
implementing certified electronic health record technology.
6703(a)
New SSA Sec.
Standards for transactions involving clinical data by LTC
See above authorization of appropriations for SSA Sec. 2041.
2041(c)
facilities. Requires the Secretary to adopt electronic standards for the
exchange of clinical data by LTC facilities and, within 10 years, to have in
place procedures to accept the optional electronic submission of clinical
data by LTC facilities pursuant to such standards.
6703(a)
New SSA Sec.
Adult protective service functions. Requires the Secretary to
$3 million for FY2011, and $4 million for each of FY2012 through
2042(a)
undertake various activities with respect to adult protective services,
FY2014.
including providing funding, collecting and disseminating data on elder
abuse, disseminating information on best practices and training,
conducting research, and providing technical assistance to states and
other entities.
CRS-32

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
6703(a)
New SSA Sec.
Grants to enhance provision of adult protective services.
$100 million for each of FY2011 through FY2014.
2042(b)
Requires the Secretary to award formula grants to states to enhance
adult protective services programs provided by states and local
governments.
6703(a)
New SSA Sec.
Adult protective services demonstration grants. Requires the
$25 million for each of FY2011 through FY2014.
2042(c)
Secretary to fund state demonstration programs for adult protective
services that test methods to prevent and detect elder abuse.
6703(a)
New SSA Sec.
Long-term care ombudsman program grants. Requires the
$5 million for FY2011, $7.5 million for FY2012, and $10 million for each
2043(a)
Secretary to award grants to improve the capacity of state LTC
of FY2013 and FY2014.
ombudsman programs to address abuse and neglect complaints, conduct
pilot programs, and provide support for such programs.
6703(a)
New SSA Sec.
Ombudsman training programs. Requires the Secretary to establish $10 million for each of FY2011 through FY2014.
2043(b)
programs to provide and improve ombudsman training with respect to
elder abuse, neglect, and exploitation for national organizations and state
LTC ombudsman programs.
6703(b) New
authority
National Training Institute for Surveyors. Requires that the
$12 million for the period of FY2011 through FY2014.
Secretary enter into a contract with an entity to establish and operate a
National Training Institute for Federal and State Surveyors to provide
and improve training of surveyors investigating allegations of abuse in
programs and LTC facilities that receive payments under Medicare or
Medicaid.
6703(b) New
authority
Grants to state survey agencies. Requires the Secretary to award
$5 million for each of FY2011 through FY2014.
grants to state survey agencies that perform surveys of Medicare or
Medicaid participating nursing facilities to design and implement
complaint investigation systems.
6703(c) New
authority
National nurse aide registry study and report. Requires the
SSAN (no years specified) to carry out these activities, with funding not
Secretary, in consultation with appropriate government agencies and
to exceed $500,000.
private sector organizations, to conduct a study on establishing a
national nurse aide registry and report on its findings.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
CRS-33

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Table 10. ACA Discretionary Spending: Biomedical Research
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
10409 Amends
PHSA
Cures Acceleration Network (CAN). Establishes a CAN program
$500 million for FY2010, and SSAN for subsequent fiscal years. Other
Secs. 402(b) and
within the Office of the NIH Director to award grants, contracts, or
funds appropriated under the PHSA may not be allocated to CAN.
499(c); new
cooperative agreements to support the development of treatments for
PHSA Sec. 402C
diseases or conditions that are rare, and for which market incentives are FY2012 funding = $10 million, FY2013 request = $50 million.
(NIH)
inadequate. Eligible grantees include public or private entity, which may
include a private or public research institution, an institution of higher
education, a medical center, a biotechnology company, a pharmaceutical
company, a disease advocacy organization, a patient advocacy
organization, or an academic research institution.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).

Table 11. ACA Discretionary Spending: Biologics
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
7002 Amends
PHSA
FDA approval of follow-on biologics. Creates an abbreviated
SSAN for each of FY2010 through FY2012.
Sec. 351 (FDA)
regulatory pathway for approving biological products that are
demonstrated to be biosimilar to, or interchangeable with, an FDA-
licensed biological product. Provides for the collection of user fees,
subject to congressional authorization, to cover regulatory costs
beginning in FY2013. [Note: On February 9, 2012, FDA released three
guidance documents to assist industry in developing biosimilar products
and submitting them to the agency for approval. See http://www.fda.gov/
Drugs/DevelopmentApprovalProcess/
HowDrugsareDevelopedandApproved/ApprovalApplications/
TherapeuticBiologicApplications/Biosimilars/default.htm.]
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
CRS-34

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Table 12. ACA Discretionary Spending: 340B Drug Pricing
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
7102 Amends
PHSA
Improvements to 340B program integrity. Requires the Secretary
SSAN for FY2010 and each succeeding fiscal year.
Sec. 340B(d)
to develop systems to improve compliance and program integrity to (1)
(HRSA)
increase transparency and strengthen monitoring, oversight, and
FY2011 funding = $4 million, FY2012 funding = $4 million, FY2013
investigation of the prices that manufacturers charge covered entities;
request = $6 million (proposed new user fee program).
and (2) ensure covered entities do not divert drugs or obtain multiple
discounts. Further requires the Secretary to establish a new
administrative dispute resolution process to mediate and resolve
covered entity overpayment claims and manufacturer claims against
covered entities for drug diversion or multiple discounts.
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
FY2011, FY2012 and requested FY2013 funding amounts are taken from HRSA’s FY2013 budget justification document for Congress, available at http://www.hrsa.gov/
about/budget/index.html.

Table 13. ACA Discretionary Spending: Medical Malpractice
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agent)
Summary of Provision
Funding (FY2011-FY2013)
10607
New PHSA Sec.
Liability reform demonstration program. Authorizes five-year
$50 million for the period FY2011 through FY2015.
399V-4 (HRSA)
demonstration grants to states for the implementation and evaluation of
alternatives to current tort litigation for resolving disputes over injuries
allegedly caused by health care providers or organizations. Planning
grants of up to $500,000 may be awarded to states for the development
of demonstration project applications. To receive a grant, a state must
develop an alternative system that allows for the resolution of disputes
caused by health care providers or organizations, and reduces medical
errors by encouraging the collection and analysis of patient safety data
related to the resolved disputes.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
CRS-35

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Table 14. ACA Discretionary Spending: Pain Care Management
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
4305(a) New
authority
Conference on pain. Requires the Secretary, within one year of
SSAN for each of FY2010 and FY2011.
appropriating funds, to contract with the IOM to convene a Conference
on Pain for the purpose of assessing the public health impact of pain,
reviewing pain research, care, and education, and identifying barriers to
improved pain care. A report summarizing the Conference’s findings
must be submitted to Congress by June 30, 2011. [Note: IOM released
its report on June 29, 2011. See http://painconsortium.nih.gov/.]
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).

Table 15. ACA Discretionary Spending: Medicaid
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
2705 New
authority
Global payment system demonstration program. Requires the
SSAN (no years specified).
(CMS)
Secretary, in coordination with the Center for Medicare and Medicaid
Innovation, to fund up to five Medicaid demonstrations during the
period FY2010 through FY2012 under which a participating state will
adjust payments made to a large safety net hospital system or network
from a fee-for-service model to a global capitated payment model.
2706 New
authority
Pediatric accountable care organization demonstration
SSAN (no years specified).
(CMS)
program. Requires the Secretary to conduct a five-year Medicaid
demonstration (Jan. 1, 2012 through Dec. 31, 2016) under which a
participating state is allowed to recognize pediatric providers as an
accountable care organization (ACO) for the purpose of receiving
incentive payments. Eligible pediatric providers must meet certain
performance guidelines established by the Secretary to be recognized as
an ACO, and must achieve a specified minimum level of Medicaid savings
to receive an incentive payment.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
CRS-36

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Table 16. ACA Discretionary Spending: Medicare
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
3129 Amends
and
Rural hospital flexibility grant program. Extends authorization of
SSAN for each of FY2011 and FY2012, to remain available until
reauthorizes SSA
appropriations for the rural hospital flexibility (Flex) grants that support
expended.
Sec. 1820 (HRSA) a range of performance and quality improvement activities at small rural
hospitals. Permits the funding to be used to help rural hospitals
FY2011 funding = $41 million, FY2012 funding = $41 million, FY2013
participate in delivery system reform programs authorized under ACA.
request = $26 million. [CFDA 93.241]
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
FY2011, FY2012 and requested FY2013 funding amounts are taken from HRSA’s FY2013 budget justification document for Congress, available at http://www.hrsa.gov/
about/budget/index.html.

Table 17. ACA Discretionary Spending: Private Health Insurance
Statutory
ACA
Authority
Authorization of Appropriations
Section
(Agency)
Summary of Provision
Funding (FY2011-FY2013)
1334 New
authority
Multi-state health plans. Requires OPM to contract with health
SSAN (no years specified).
(OPM)
insurers to offer at least two multi-state health plans (at least one
nonprofit) through exchanges in each state. Authorizes OPM to prohibit
multi-state plans that do not meet standards for medical loss ratios,
profit margins, and premiums. Requires multi-state plans to cover
essential health benefits and meet all the requirements of a qualified
health plan.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended).
CRS-37

Discretionary Spending in the Patient Protection and Affordable Care Act (ACA)

Author Contact Information

C. Stephen Redhead, Coordinator
Sarah A. Lister
Specialist in Health Policy
Specialist in Public Health and Epidemiology
credhead@crs.loc.gov, 7-2261
slister@crs.loc.gov, 7-7320
Kirsten J. Colello
Amanda K. Sarata
Specialist in Health and Aging Policy
Specialist in Health Policy
kcolello@crs.loc.gov, 7-7839
asarata@crs.loc.gov, 7-7641
Elayne J. Heisler

Analyst in Health Services
eheisler@crs.loc.gov, 7-4453

Acknowledgments
Pamela W. Smith provided extensive editorial comments during the development of the initial version of
this report.

Key Policy Staff
Area of Expertise
Name
Phone
E-mail
Health Centers and Clinics
Elayne J. Heisler
7-4453
eheisler@crs.loc.gov
C. Stephen Redhead
7-2261
credhead@crs.loc.gov
Health Care Workforce
Elayne J. Heisler
7-4453
eheisler@crs.loc.gov
Bernice Reyes-Akinbileje
7-2260
breyes@crs.loc.gov
Long-Term Care
Kirsten J. Colel o
7-7839
kcolello@crs.loc.gov
Prevention and Wel ness
Sarah A. Lister
7-7320
slister@crs.loc.gov
Maternal and Child Health
Emilie Stoltzfus
7-2324
estoltzfus@crs.loc.gov
Amalia Corby-Edwards
7-0423
acorbyedwards@crs.loc.gov
Health Care Quality
Amanda K. Sarata
7-7641
asarata@crs.loc.gov
Nursing Homes
Cliff Binder
7-7965
cbinder@crs.loc.gov
Health Disparities
Amalia Corby-Edwards
7-0423
acorbyedwards@crs.loc.gov
Emergency Care
Elayne J. Heisler
7-4453
eheisler@crs.loc.gov
Elder Justice
Kirsten J. Colel o
7-7839
kcolello@crs.loc.gov
Biomedical Research
Pamela W. Smith
7-7048
psmith@crs.loc.gov
Biologics
Judith A. Johnson
7-7077
jajohnson@crs.loc.gov
340B Drug Pricing
Cliff Binder
7-7965
cbinder@crs.loc.gov
Medical Malpractice
Vivian S. Chu
7-4576
vchu@crs.loc.gov
Pain Care Management
Kirsten J. Colel o
7-7839
kcolello@crs.loc.gov
Medicaid Cliff
Binder
7-7965
cbinder@crs.loc.gov
Medicare Sibyl
Tilson
7-7368
stilson@crs.loc.gov
Private Health Insurance
Bernadette Fernandez
7-0322
bfernandez@crs.loc.gov

Congressional Research Service
38