Summarizing the Patient Protection and Affordable Care Act – in two pages and 10 titles

You may have heard that the Senate passed a health care bill. It is likely that it will be further amended by the House, and of course there will be challenges, but it is probable that the directives in the bill will be turned into law.

It is conceivable that this bill will have some implications for the future of health care, so it is useful to learn what is in it. It is quite a large bill.

Uwe Reinhardt, a well known health economist, recommended a summary prepared by the Congressional Research Service [1]. Even the summary takes a while to read. One can, however, get a sense of it simply by looking at the headings. I’ve excerpted them below. There are quite a few odd bits in there, but the scope of this bill is occasionally breathtaking.

Patient Protection and Affordable Care Act – Summary of Senate Bill – Library of Congress March 2010

Title I: Quality, Affordable Health Care for All Americans
Subtitle A: Immediate Improvements in Health Care Coverage for All Americans
Subtitle B: Immediate Actions to Preserve and Expand Coverage
Subtitle C: Quality Health Insurance Coverage for All Americans
Part I: Health Insurance Market
Part II: Other Provisions
Subtitle D: Available Coverage Choices for All Americans
Part I: Establishment of Qualified Health Plans
Part II: Consumer Choices and Insurance Competition Through Health Benefit Exchanges
Part III: State Flexibility Relating to Exchanges
Part IV: State Flexibility to Establish Alternative Programs
Part V: Reinsurance and Risk Adjustment
Subtitle E: Affordable Coverage Choices for All Americans
Part I: Premium Tax Credits and Cost-sharing Reductions
Subpart A: Premium Tax Credits and Cost-sharing Reductions
Subpart B: Eligibility Determinations
Part II: Small Business Tax Credit - (Sec. 1421, as modified by section 10105)
Subtitle F: Shared Responsibility for Health Care
Part I: Individual Responsibility
Part II: Employer Responsibilities
Subtitle G: Miscellaneous Provisions

Title II: Role of Public Programs
Subtitle A: Improved Access to Medicaid
Subtitle B: Enhanced Support for the Children's Health Insurance Program
Subtitle C: Medicaid and CHIP Enrollment Simplification
Subtitle D: Improvements to Medicaid Services - (Sec. 2301)
Subtitle E: New Options for States to Provide Long-Term Services and Supports
Subtitle F: Medicaid Prescription Drug Coverage
Subtitle G: Medicaid Disproportionate Share Hospital (DSH) Payments
Subtitle H: Improved Coordination for Dual Eligible Beneficiaries
Subtitle I: Improving the Quality of Medicaid for Patients and Providers
Subtitle J: Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC)
Subtitle K: Protections for American Indians and Alaska Natives
Subtitle L: Maternal and Child Health Services

Title III: Improving the Quality and Efficiency of Health Care
Subtitle A: Transforming the Health Care Delivery System
Part I: Linking Payment to Quality Outcomes under the Medicare Program
Part II: National Strategy to Improve Health Care Quality
Part III: Encouraging Development of New Patient Care Models
Subtitle B: Improving Medicare for Patients and Providers
Part 1: Ensuring Beneficiary Access to Physician Care and Other Services
Part II: Rural Protections
Part III: Improving Payment Accuracy
Subtitle C: Provisions Relating to Part C
Subtitle D: Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans
Subtitle E: Ensuring Medicare Sustainability
Subtitle F: Health Care Quality
Subtitle G: Protecting and Improving Guaranteed Medicare Benefits

Title IV: Prevention of Chronic Disease and Improving Public Health
Subtitle A: Modernizing Disease Prevention and Public Health Systems
Subtitle B: Increasing Access to Clinical Preventive Services
Subtitle C: Creating Healthier Communities - (Sec. 4201, as modified by Sec. 10403)
Subtitle D: Support for Prevention and Public Health Innovation - (Sec. 4301)
Subtitle E: Miscellaneous Provisions - (Sec. 4402)

Title V: Health Care Workforce
Subtitle A: Purpose and Definitions - (Sec. 5001)
Subtitle B: Innovations in the Health Care Workforce - (Sec. 5101, as modified by Sec. 10501)
Subtitle C: Increasing the Supply of the Health Care Workforce
Subtitle D: Enhancing Health Care Workforce Education and Training - (Sec. 5301)
Subtitle E: Supporting the Existing Health Care Workforce - (Sec. 5401)
Subtitle F: Strengthening Primary Care and Other Workforce Improvements- (Sec. 5501, as modified by Sec. 10501)
Subtitle G: Improving Access to Health Care Services - (Sec. 5601)
Subtitle H: General Provisions - (Sec. 5701)

Title VI: Transparency and Program Integrity
Subtitle A: Physician Ownership and Other Transparency - (Sec. 6001, as modified by Sec. 10601)
Subtitle B: Nursing Home Transparency and Improvement
Part I: Improving Transparency of Information - (Sec. 6101)
Part II: Targeting Enforcement - (Sec. 6111)
Part III: Improving Staff Training - (Sec. 6121)
Subtitle C: Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long Term Care Facilities and Providers - (Sec. 6201)
Subtitle D: Patient-Centered Outcomes Research - (Sec. 6301, as modified by Sec. 10602)
Subtitle E: Medicare, Medicaid, and CHIP Program Integrity Provisions - (Sec. 6401, as modified by Sec. 10603)
Subtitle F: Additional Medicaid Program Integrity Provisions - (Sec. 6501)
Subtitle G: Additional Program Integrity Provisions - (Sec. 6601)
Subtitle H: Elder Justice Act - Elder Justice Act of 2009 - (Sec. 6702)
Subtitle I: Sense of the Senate Regarding Medical Malpractice - (Sec. 6801)

Title VII: Improving Access to Innovative Medical Therapies -
Subtitle A: Biologics Price Competition and Innovation
Subtitle B: More Affordable Medicine for Children and Underserved Communities - (Sec. 7101)

Title VIII: Class Act - Community Living Assistance Services and Supports Act or the CLASS Act - (Sec. 8002, as modified by Sec. 10801)

Title IX: Revenue Provisions -
Subtitle A: Revenue Offset Provisions - (Sec. 9001, as modified by section 10901)
Subtitle B: Other Provisions - (Sec. 9021)

Title X: Strengthening Quality, Affordable Health Care for All Americans -
Subtitle A: Provisions Relating to Title I - (Sec. 10101) Revises provisions of or related to Subtitles A, B, and C of Title I of this Act
Subtitle B: Provisions Relating to Title II
Part I: Medicaid and CHIP - (Sec. 10201)
Part II: Support for Pregnant and Parenting Teens and Women - (Sec. 10212)
Part III: Indian Health Care Improvement - (Sec. 10221)

[1] These summaries are written in a programming language for the creation of regulations. The bulk of the omitted material begins with command verbs that tell regulators what to do. I created this summary by regex operations on paragraphs beginning with the command operators which include:

Allows
Amends
Applies
Appropriates
Authorizes
Declares
Directs
Establishes
Excludes
Expands
Expresses the sense
Provides
Reauthorizes
Redesignates
Requires
Revises
Sets forth

It’s a very structured document that resembles generated software code and could indeed be created from a regulatory meta-language.