On March 23, 2010, President Obama signed into law a comprehensive health reform law, the Patient Protection and Affordable Care Act (ACA). The following week, on March 30, 2010, the President signed the Health Care and Education Reconciliation Act of 2010 (HCERA), which amended numerous health care and revenue provisions in ACA. Among its many provisions, ACA restructures the private health insurance market, sets minimum standards for health coverage, and, beginning in 2014, will require most U.S. residents to 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 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). Under ACA, the federal government will initially cover 100% of the expansion costs, phasing down to 90% of the costs by 2020. Medicaid law allows the Secretary of Health and Human Services (HHS) to withhold existing federal Medicaid matching funds if states refuse to comply with the expansion. However, 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 HHS Secretary from penalizing states that choose not to participate in the Medicaid expansion (see text box). 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, and the State Children's Health Insurance Program (CHIP). In addition to changes to private insurance and these federal health programs, ACA includes numerous provisions intended to increase the primary care and public health workforce, promote preventive services, and strengthen quality measurement, among other things. ACA is projected to have a significant impact on federal direct spending and revenues. 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 state Medicaid programs. ACA also includes numerous mandatory appropriations that provide billions of dollars 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. The costs of expanding public and private health insurance coverage and other spending are offset by revenues from new taxes and 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. Implementing ACA also is likely to affect discretionary spending, which is provided in and controlled by annual appropriations acts. The law established numerous new discretionary grant programs and provided for each an authorization of appropriations. It also reauthorized funding for many existing discretionary grant programs. While the authorizations of appropriations for most of these existing programs expired prior to ACA's enactment, typically they continued to receive an annual appropriation. Funding for all these discretionary programs, both new and existing, is subject to action by congressional appropriators. This report—one in a series of CRS products summarizing ACA that were issued after the law's enactment—describes the law's workforce, public health, quality, and related provisions. ACA is composed of 10 titles (see Table 1 ). The provisions summarized in this report are for the most part found in Title II (Medicaid, maternal and child health); Title III (Medicare, quality of care); Title IV (prevention and wellness); Title V (health workforce); Title VI (comparative effectiveness research, elder justice); Title VII (drugs and biologics); and Title IX (revenues). Title X, which was added as a manager's amendment to the underlying bill, amended (and in some cases repealed) numerous existing provisions in Titles I through IX and added several new provisions. As already noted, ACA was further amended by the companion reconciliation legislation, HCERA. Table A-1 in Appendix A at the end of the report, shows which of the ACA sections discussed in this report were amended by Title X and/or HCERA. The summaries of the ACA provisions are grouped and discussed under the following section headings: (1) Health Centers and Clinics; (2) Health Workforce; (3) Prevention and Wellness; (4) Maternal and Child Health; (5) Teen Pregnancy Prevention and Adoption Support; (6) Quality; (7) Nursing Homes and Other Long-Term Care Facilities and Providers; (8) Comparative Effectiveness Research; (9) Health Data Collection; (10) Health Information Technology; (11) Emergency Care; (12) Pain Care Management; (13) Elder Justice; (14) Biomedical Research and Medical Products; (15) Biosimilars; (16) Nutrition Labeling; (17) 340B Drug Pricing; and (18) Medical Malpractice and Liability Reform. Each section of the report begins with a brief overview of the ACA provisions to be summarized and includes some discussion of relevant policies in place at the time of ACA's enactment as well as the intent, and, where available, projected impact, of the law. ACA specifies numerous dates for new or expiring legal authorities, for the initiation or completion of key administrative and regulatory activities, and for the establishment or termination of commissions and other statutory bodies. Table A-1 in Appendix A provides a detailed timeline of all such dates. Unless otherwise stated, all references in this report to "the Secretary" refer to the Secretary of Health and Human Services (HHS). A list of all the acronyms used in the report is provided in Appendix B . PHSA Sec. 330 authorizes the health centers program, administered by the Health Resources and Services Administration (HRSA), which provides grants to community health centers, migrant health centers, health centers for the homeless, and health centers for residents of public housing. Health centers are a key component of the nation's health care safety net and are required to furnish comprehensive and affordable primary care to the community residents they serve. Health centers also often provide case management, health education, and other supportive services to meet the needs of their patients. Health centers must be located in (or serve) medically underserved communities or populations. Approximately half of all health centers serve rural populations. In order to ensure that services are accessible to the entire community, health centers must treat all patients without regard to their ability to pay. Centers offer sliding-scale fee arrangements based on patients' financial circumstances. Prior to the ACA, there were more than 1,100 health centers operating over 7,500 service delivery sites in every U.S. state and territory. According to HRSA, in FY2008 these facilities served more than 17 million unique patients and responded to over 67 million patient visits. A substantial body of evidence shows that health centers increase access to primary health care services. This helps improve the health of the community by lowering infant mortality, reducing racial and ethnic disparities in health and increasing access to health care, and lowering spending by averting more expensive emergency room visits. At the time of enactment some thought that health centers could provide access to care to those who would become newly insured under the ACA. ACA provides a total of $11 billion in supplemental funding for community health centers over the five-year period FY2011 through FY2015. The law creates a multi-billion Community Health Center Fund, from which the Secretary is required to transfer $9.5 billion for center operations and patient services. A separate appropriation provides the remaining $1.5 billion, which is for health center construction and renovation. These ACA funds add to the $2 billion in FY2009 supplementary funds that were provided for the health centers program in the American Recovery and Reinvestment Act (ARRA; P.L. 111-5 ). The ARRA funds included $1.5 billion for health center construction and renovation, and $500 million for center operations and patient services. In addition to the supplemental appropriations, ACA increases the amounts authorized to be appropriated for health centers under the regular annual appropriations process and permanently authorizes the health centers program. The program had been authorized through the end of FY2012. ACA also appropriates funds for a grant program to establish school-based health centers (SBHCs) and authorizes grants for the operation of such centers. SBHCs are not explicitly authorized in the PHSA, but have been established pursuant to the general authority to establish community health centers. Another ACA provision establishes a grant program to fund the operation of nurse-managed health clinics to provide primary health care to vulnerable and underserved populations. Funding for this program is subject to future action in annual appropriations bills. Two additional ACA provisions are summarized at the end of this section. Neither specifically mentions health centers or clinics, though both address access to care among the medically underserved. The first authorizes state grants to health care providers who treat the medically underserved, and the second creates a state demonstration program to provide the uninsured with access to health care. This section amends PHSA Sec. 330 by authorizing to be appropriated for the health center program the following amounts: $2,988,821,592 for FY2010; $3,862,107,440 for FY2011; $4,990,553,440 for FY2012; $6,448,713,307 for FY2013; $7,332,924,155 for FY2014; and $8,332,924,155 for FY2015.