Affordable Care Act

Affordable Care Act
Great Seal of the United States
Long titleThe Patient Protection and Affordable Care Act
Acronyms (colloquial)ACA, PPACA
NicknamesObamacare, Affordable Care Act, Health Insurance Reform, Healthcare Reform
Enacted bythe 111th United States Congress
EffectiveMarch 23, 2010 (2010-03-23)
Most major provisions phased in by January 2014; remaining provisions phased in by 2020; penalty enforcing individual mandate eliminated starting 2019
Citations
Public law111–148
Statutes at Large124 Stat. 119 through 124 Stat. 1025 (906 pages)
Legislative history
  • Introduced in the House as the "Service Members Home Ownership Tax Act of 2009" (H.R. 3590) by Charles Rangel (DNY) on September 17, 2009
  • Committee consideration by Ways and Means
  • Passed the House on November 7, 2009 (220–215)
  • Passed the Senate as the "Patient Protection and Affordable Care Act" on December 24, 2009 (60–39) with amendment
  • House agreed to Senate amendment on March 21, 2010 (219–212)
  • Signed into law by President Barack Obama on March 23, 2010
Major amendments
Health Care and Education Reconciliation Act of 2010
Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011
Public Law 115-97 proposed as the Tax Cuts and Jobs Act of 2017
United States Supreme Court cases
National Federation of Independent Business v. Sebelius
Burwell v. Hobby Lobby
King v. Burwell

The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act, and commonly known as Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965.[1][2][3][4]

The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered.[5][6] The law also enacted a host of delivery system reforms intended to constrain healthcare costs and improve quality. After it went into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans.[7]

The increased coverage was due, roughly equally, to an expansion of Medicaid eligibility and to changes to individual insurance markets. Both received new spending, funded through a combination of new taxes and cuts to Medicare provider rates and Medicare Advantage. Several Congressional Budget Office reports said that overall these provisions reduced the budget deficit, that repealing ACA would increase the deficit,[8][9] and that the law reduced income inequality by taxing primarily the top 1% to fund roughly $600 in benefits on average to families in the bottom 40% of the income distribution.[10]

The act largely retained the existing structure of Medicare, Medicaid and the employer market, but individual markets were radically overhauled.[1][11] Insurers were made to accept all applicants without charging based on preexisting conditions or demographic status (except age). To combat the resultant adverse selection, the act mandated that individuals buy insurance (or pay a fine/tax) and that insurers cover a list of "essential health benefits".

Before and after enactment the ACA faced strong political opposition, calls for repeal and legal challenges. In National Federation of Independent Business v. Sebelius, the Supreme Court ruled that states could choose not to participate in the law's Medicaid expansion, but upheld the law as a whole.[12] The federal health insurance exchange, HealthCare.gov, faced major technical problems at the beginning of its rollout in 2013. Polls initially found that a plurality of Americans opposed the act, although its individual provisions were generally more popular.[13] By 2017, the law had majority support.[14] President Donald Trump rescinded the federal tax penalty for violating the individual mandate through the Tax Cuts and Jobs Act of 2017, starting in 2019.[15] This raised questions about whether the ACA was still constitutional.[16][17][18]

  1. ^ a b Cite error: The named reference Oberlander2010 was invoked but never defined (see the help page).
  2. ^ Cite error: The named reference Blumenthal2015 was invoked but never defined (see the help page).
  3. ^ Cite error: The named reference CohenEtAl was invoked but never defined (see the help page).
  4. ^ Cite error: The named reference ReutersSCOTUS was invoked but never defined (see the help page).
  5. ^ Cite error: The named reference CBO_Subsidy2016 was invoked but never defined (see the help page).
  6. ^ "Health Insurance Coverage and the Affordable Care Act, 2010–2016". March 2, 2016. Retrieved December 7, 2016.
  7. ^ "Employer Health Benefits 2015". Kaiser Family Foundation. Retrieved November 19, 2016.
  8. ^ Cite error: The named reference CBO50252 was invoked but never defined (see the help page).
  9. ^ Cite error: The named reference CBO22077 was invoked but never defined (see the help page).
  10. ^ Cite error: The named reference CBO_Dist14 was invoked but never defined (see the help page).
  11. ^ Gruber, Jonathan (2011). "The Impacts of the Affordable Care Act: How Reasonable Are the Projections?". National Tax Journal. 64 (3): 893–908. doi:10.17310/ntj.2011.3.06. hdl:1721.1/72971. Retrieved July 23, 2017.
  12. ^ Cite error: The named reference NatLawReview2012 was invoked but never defined (see the help page).
  13. ^ Kirzinger, Ashley; Sugarman, Elise; Brodie, Mollyann (December 1, 2016). "Kaiser Health Tracking Poll: November 2016". Kaiser Family Foundation. Retrieved July 23, 2017.
  14. ^ "Gallup: ObamaCare has majority support for first time". The Hill. Retrieved November 18, 2017.
  15. ^ "The Effect of Eliminating the Individual Mandate Penalty and the Role of Behavioral Factors | Commonwealth Fund". www.commonwealthfund.org.
  16. ^ Pear, Robert. “Without the Insurance Mandate, Health Care’s Future May Be in Doubt”, The New York Times (December 18, 2017).
  17. ^ Sullivan, Peter. “Senate GOP repeals ObamaCare mandate”, The Hill (December 2, 2017).
  18. ^ Jost, Timothy. "The Tax Bill And The Individual Mandate: What Happened, And What Does It Mean?", Health Affairs (December 20, 2017).

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