Federal Law & Regulations Overview

In March 2010, H.R. 3590, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), and H.R. 4872, the Health Care and Education Reconciliation Act of 2010 (HCERA, P.L. 111-152), collectively referred to as the Affordable Care Act, became law.  Provisions in the statutes will affect the financing, access, delivery, quality and virtually every facet of the health care delivery system for many years to come. Health care reform was the top domestic priority for the 111^th Congress, and will remain a major focus for federal agencies as they begin implementation of the provisions through rule and guidance. 

Organizational Structure for Federal Implementation

The Department of Health and Human Services (HHS) as well as the departments of Education, Labor and Treasury will have a role in providing definition to the enacted language. Since HHS will take the lead, restructuring efforts have begun to handle the increase in workload. The Office of Consumer Information and Insurance Oversight (OCIIO) was created within the Office of the Secretary to provide leadership in implementing the provisions of the health reform bill that address private health insurance, and will work with states through their Office of Health Insurance Exchanges in implementing and regulating state-based exchanges. HHS agency activity will also include:

• The Centers for Medicare and Medicaid Services (CMS), which will assume responsibility for implementing the expansion of Medicaid in FY 2014, and continue providing oversight of the Children’s Health Insurance Program (CHIP).

• The Health Resources and Services Administration (HRSA) has oversight of the National Health Service Corps—reauthorized by PPACA through 2015—many of the federal health workforce programs, HIV/AIDS and Maternal Child health grant programs, and rural health issues. A critical component to the success of health reform will be the supply of health professionals and providers of health services.

• The Affordable Care Act created a National Prevention, Health Promotion, and Public Health Council. Many other provisions in the act establish programs focusing on health promotion and disease prevention activities, which will result in the development of a national strategy to improve the public’s health. These other actions will be directed by the Centers for Disease Control and Prevention (CDC).

• The Substance Abuse & Mental Health Services Administration (SAMHSA)—whose major activities focus on improving the quality and availability of prevention, treatment and recovery support services—will participate in the enforcement of prohibitions on preexisting conditions as a condition for coverage, and work to broaden available behavioral health and substance abuse services in the community. Much of its work will include the promotion of evidence-based practices, and the integration of behavioral health and substance abuse services within the community health center framework.

NCSL will be monitoring these and other federal actions to provide legislators and legislative staff information necessary to implement programs within their states. NCSL provides information based on the provisions of the Affordable Care Act that pull together the critical elements of federal directives and guidance through documents, meetings, presentations and Web communications.

For more information, contact  NCSL Staff: Joy Johnson Wilson  |  Rachel Morgan (Washington, D.C.)