American people, and their political representatives, should rightfully demand to know if they are getting their money's worth-in terms of cost and quality, among other metrics. As part of this ongoing health care reform debate, the Patient Protection and Affordable Care Act of 2010 (PPACA) 2 constitutes the latest, largest, and most litigious addition to the patchwork of federal health law and policy. Alternatively lauded and lampooned, the permanence of this most recent and highly politicized

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... health care reform measure within the fabric of U.S. health law remains in question more than a year after its enactment, due in part to challenges to its individual coverage mandate. 3 Despite the controversy and continued uncertainty enveloping PPACA, the legislation's themes stretch far beyond coverage and access, and interweave other, far less controversial and long-standing, strands at the heart of United States health policy. These themes have been stitched into the nation's health policy cloth for at least 25 years, since the enactment of the Health Care Quality Improvement Act of 1986 (HCQIA), 4 and include quality, provider accountability, provider integration, and related governmental oversight. 5 Passed at a time, similar to the present, characterized by "the need to improve the quality of medical care," 6 HCQIA features two key filaments: (1) promotion of meaningful medical peer review, through the provision of procedural due process 7 and qualified immunity related to good faith professional review activities in furtherance of health care quality; 8 and (2) establishment of a national