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CRS paper explores ACA discretionary spending

Posted on October 17, 2012 | No Comments

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Key Developments
Implementation Briefs

The Affordable Care Act (ACA) reauthorized funding for numerous existing discretionary programs and 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. A new report published by the Congressional Research Service (CRS) summarizes all the discretionary spending provisions in ACA.

The ACA permanently reauthorized the federal health centers program and the National Health Service Corps (NHSC), which 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. The ACA also reauthorized and expanded existing health workforce education and training programs under Titles VII and VIII of the Public Health Service Act (PHSA). In addition, the Act 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 nursing workforce development programs.

The ACA authorized several new grant programs with a focus on preventable or modifiable risk factors for disease (e.g., sedentary lifestyle, tobacco use) and leveraged mechanisms to improve the quality of health care, develop and disseminate innovative strategies for improving the quality of health care delivery, and support for care coordination programs.

The Congressional Budget Office (CBO) estimated that ACA’s discretionary spending provisions, if fully funded, would result in appropriations of approximately $100 billion by 2021.

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Several days ago, the Congressional Research Service (CRS) published a report describing how the appropriations impasse and government shutdown will impact the Affordable Care Act (ACA). The report provides background information on the ACA, particularly focusing upon how the law impacts federal spending. This information is followed by an explanation of the various legislative attempts to defund or amend the ACA, as well as legal and procedural considerations in using the appropriations process to attack the law. CRS concludes by examining how the government shutdown would impact ACA implementation. The report found that implementing the ACA would be largely unaffected by the government shutdown, because most of the federal agencies implementing the ACA will be able to rely upon funds outside of discretionary spending and several actions associated with implementing the ACA would be considered exceptions to the Antideficiency Act, the law that bars the federal government from performing certain tasks during a shutdown.
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