Introduction to the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010

Introduction to the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010

Professor Timothy S. Jost   By Timothy S. Jost, Robert L. Willett Family Professor of Law, Washington and Lee University School of Law

The health care reform legislation adopted by Congress consists of the (originally) 2409 page Senate "Patient Protection and Affordable Care Act," (PPACA), signed into law by President Obama on March 23, 2010, and the much shorter Health Care Education Reconciliation Act of 2010, signed into law by the President on March 30, 2010. The PPACA was a substitute amendment for HR 3590, which originated in the House as a bill to provide first-time homebuyer's credits for members of the armed forces. The PPACA is an amalgam created by the Senate leadership from separate bills prepared by the Senate Finance and Health, Education, Labor, and Pensions Committee, supplemented by a nearly 400 page long manager's amendment adopted on the floor. The provisions of the manager's amendment, which made substantial changes in the underlying bill, were not integrated into the bill, but rather added to the end of the nine-title bill as title X. One must, therefore, read the text of the legislation with the manager's amendment in hand, as many of the provisions that still appear in the bill were eliminated or substantially changed by the manager's amendment. The provisions of the PPACA were also, of course, further amended by the reconciliation act. This synopsis of the legislation will incorporate its discussion of Title X and the reconciliation act into its discussion of titles 1 through IX of the bill, and not discuss Title X separately.

The titles of the legislation cover:

   Title I, Quality, Affordable Health Care for All Americans (health insurance reforms)

   Title II, Role of Public Programs (Medicaid and the Children's Health Insurance Program)

   Title III, Improving the Quality and Efficiency of Health Care (Medicare amendments, primarily to encourage quality and control cost, but including some benefit enhancements and provider payment reductions)

   Title IV, Prevention of Chronic Disease and Improving Public Health (reducing barriers to clinical preventive care and encouraging wellness programs)

   Title V, Health Care Workforce (additional support for educating and training health care workers and for community health centers)

   Title VI, Transparency and Program Integrity (fraud and abuse and conflict of interest disclosure provisions as well as provision for outcomes research)

   Title VII, Improving Access to Innovative Therapies (provision for the approval of biosimilars (generic biologics) and the expansion of the affordable medicines program)

   Title VIII, the CLASS Act (a national voluntary insurance program for purchasing community living assistance services and support)

   Title IX, Revenue Provisions

   Title X, Strengthening Quality, Affordable Health Care for All Americans (the manager's amendment)

This synopsis of the legislation will provide a section-by-section analysis of Titles I, VI, and VII, the titles of the bill that should be of most interest to attorneys. It will provide only brief synopses of titles III, IV, V, VIII, and IX. The provisions of Title X and of the reconciliation bill that are relevant to material that is discussed will be incorporated into that discussion.

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Timothy S. Jost holds the Robert L. Willett Family Professorship of Law at the Washington and Lee University School of Law. He is a co-author of a casebook, Health Law, used widely throughout the United States in teaching health law, and of a treatise and hornbook by the same name. He is also the author of Health Care Coverage Determinations: An International Comparative Study; Disentitlement? The Threats Facing our Public Health Care Programs and a Rights-Based Response; and Readings in Comparative Health Law and Bioethics, the second edition of which appeared this spring.

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