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1 [1] (November 25, 2014)

handle is hein.crs/crsmthaaayj0001 and id is 1 raw text is: CRS Insights Congress Faces Calls to Address Expiring ACA Appropriations C. Stephen Redhead, Specialist in Health Policy (credheadacrs~Ioc~g , 7-2261) Elayne J. Heisler, Specialist in Health Services (ehpisler crsocaov, 7-4453) Noebr 25, 2014 (IN10185) The Affordable Care Act (ACA), enacted in March 2010, appropriated billions of dollars of mandatory funds to support grant programs and other activities authorized by the law. For example, it appropriated a total of $16 billion to support three tepraryr for targeted groups prior to the exchanges becoming operational, and provided an open-ended amount for state grants through 2014 to plan andestablish exchan=. The ACA also appropriated five years of funding for homevisitatlion and other maternal and child health (MCH) programs. And it included $11 billion over five years for the Federal Health Centers program and the National Health Service Corps (NHSC). The Primary Care Cliff Advocates for the nation's primary care system are urging Congress to extend ACA funding for health centers and the NHSC. Those funds expire this year (i.e., FY2015), setting up what the advocates are calling a primary care cliff that will result in a significant drop in funding for primary care programs that deliver services, place primary care providers in underserved areas, and train future providers. The Health Centers and NHSC programs are cornerstones of the government's efforts to expand access to primary care. The Health Centers program helps support more than 1300 i centers operating over 9,200 delivery sites across the country. Health centers provide care to medically underserved populations regardless of their ability to pay. The NHSC program awards scholarships and loan repayment to certain health professionals who agree to practice in shortage areas, often at health centers. The ACA established the (CHCF) to help support the Health Centers and NHSC programs, and gave it a total of $11 billion in annual appropriations over the five-year period FY2011-FY2015. CHCF funding was intended to supplement the discretionary funds that the two programs receive through the regular appropriations process. However, the CHCF has partially replaced the Health Center program's annual discretionary appropriations, which have been reduced since FY2010 (see Table 1). In FY2014, CHCF funding represented about 60% of the Health Center program's funding. In the case of the NHSC program, Congress eliminated its annual discretionary appropriation entirely. Since FY2012 the program has relied solely on CHCF funding (see Table 1). Table 1. Health Centers and NHSC Funding (Millions of Dollars, by Fiscal Year) 2011 2010 2012 2013 2014 2015 Health Centers Discretionary 2,141 1,481 1,472 1,391 1,400 TBD CHCF NA 1,000 1,200 1,465 2,145 3,600 % CHCF 0% 40.3% 48.3% 51.3% 60.5% TBD NHSC Discretionary 141 25 0 0 0 TBD CHCF NA 290 295 285 283 287 % CHCF 0% 92.1% 100% 100% 100% TBD

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