If you continue with this browser, you may see unexpected results. This section-by-section analysis includes a description of those provisions within the description of the section that was amended.
ProQuest Legislative Insight A federal legislative history database containing compilations of digital full-text publications relevant to enacted U. Includes legislative histories for public laws from the 1st Congress to the current Congress.
ProQuest Congressional U. Congressional publications and information of particular importance to legislative history research.
Publications include: bills, hearings, committee reports, the Congressional Record, the U. Statutes at Large, the U. Code, the Code of Federal Regulations, the Federal Register, compiled legislative histories, Congressional Research Service CRS reports, campaign contribution and financial information, voting record information, and congressional news sources. See the "Content Coverage Chart" link for dates of coverage and update schedule.
Regulations and Guidance from the U. Department of Labor DOL. Gluck; Ezekiel J. Emanuel Call Number: KF A A2 Noble; Michael M. Maddigan Call Number: KF Health Care Reform: Law and Practice. A A15 Legal Practice Implications of the U. Mitchell; Ferd H.
Mitchell Call Number: KF The ACA expanded this program to include general surgeons, from to the end of The ACA includes numerous cost-containment provisions that have been implemented over the years since the law was passed.
An additional opportunity to disenroll from Medicare Advantage and sign up for Part D. The Medicare Advantage disenrollment period allowed seniors drop their Medicare Advantage plan, switch back to Original Medicare , and purchase a Part D plan. As of , it was replaced with the Medicare Advantage Open Enrollment Period , which is a longer window January 1 to March 31 and allows more flexibility for enrollees, as they now also have the option to switch from one Medicare Advantage plan to another during this window.
Learn how plan design and pricing may differ off-exchange. Outside of the annual OEP, individuals who have qualifying life events can enroll during a special enrollment period. These qualifying events include:. In some cases, the applicant must have had minimum essential coverage in place prior to the qualifying event in order to be eligible for a special enrollment period, so some qualifying events only allow for coverage changes as opposed to gaining coverage after being uninsured.
Due to the COVID pandemic and the additional premium subsidies provided by the American Rescue Plan , a one-time special enrollment window has been opened nationwide in It began in early , and in most states, it continues through at least August During this window, in nearly every state, people can newly enroll or switch plans, regardless of whether they experience a qualifying event. The intent of the Affordable Care Act was to cover as many Americans as possible with comprehensive, major medical health insurance plans.
Immigrants can enroll in individual health plans during the open enrollment period , just like any other lawfully present U. However, some states have implemented their own individual coverage mandates. For the most part, coverage needs to be ACA-compliant in order to meet the requirements of an individual mandate, but if you still have a grandmothered or grandfathered health plans neither of which are required to be fully compliant with the ACA , you can keep your plan for as long as it continues to be available.
From the earliest conversations about the Affordable Care Act, the law and its provisions have been vigorously opposed by Congressional Republicans. Consumer advocates note that this opposition has worsened coverage options and driven premiums upward. Steve Anderson , healthinsurance. Steve is also co-founder and editor of medicareresources. In previous lives, he worked as a community journalist, public relations manager and director of public affairs. We do not sell insurance products, but this form will connect you with partners of healthinsurance.
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Learn more about us. The law included major provisions intended to make health coverage on the individual market more affordable — including subsidies which have been enhanced by the American Rescue Plan and expanded Medicaid eligibility. Obamacare included shopping options to improve coverage selection , including online health insurance marketplaces, CO-OPs and the Basic Health Program.
Health reform advocates hailed Obamacare for its many provisions designed to expand coverage and to prohibit discrimination. The law includes numerous provisions designed to reduce Medicare spending, drive down costs and improve coverage for Medicare beneficiaries. Find affordable health plans. Helping millions of Americans since The following is a list of U. The following is a timeline of the implementation dates of key aspects of the Affordable Care Act.
Some of the dates were later changed or delayed; these changes are not reflected in this timeline. According to HealthCare. The law required every individual to obtain health insurance and established fines for those who did not. The fines were designed to be based on the number of months a person went without health insurance in a given year and to increase each year from to The fine schedule was written as follows: [3] [9].
The Internal Revenue Service IRS was given responsibility for collecting the fine, assessed annually as a tax penalty during the income tax filing period. The law established a hardship exemption from the fine for individuals who meet certain qualifications—such as being homeless, being a victim of domestic violence, or filing for bankruptcy. Under the law, medium-sized and large employers could incur fines for not offering affordable health coverage or not offering coverage at all. The law defined affordable as costing employees less than 9.
The law established requirements for employers with at least 50 employees to offer affordable coverage that covers at least 60 percent of costs to at least 95 percent of their workforce. If an employer does not meet these conditions and has at least one employee claim a tax credit to purchase coverage on the exchange, a fine would be incurred. The Affordable Care Act provided for the creation of health insurance exchanges , sometimes referred to as marketplaces, to act as a hub for consumers to browse and purchase health plans.
The exchanges were designed to be accessible via websites, call centers, or in person. The law gave states three options regarding the exchanges: [13] [14]. The law also allowed states to set up more than one exchange to serve residents in different areas within their borders, and multiple states could create a regional exchange.
However, as of August , no state had chosen those options. The majority of states, 28 of them, had federally facilitated marketplaces. Another 17 had state-based exchanges; five of these exchanges were state run while utilizing the federal platform, Healthcare. Six states partnered with the federal government to run their exchanges.
States were given grants from the federal government to support the establishment and early administration of their exchanges. The grants ended on January 1, , after which any state-based exchanges were expected to be self-sustaining. Plans were required to be designed and labeled under one of these four tiers to be sold on the exchanges. Just like other health plans, the portion of costs not covered by the health plan would fall to consumers.
The law created advanced premium tax credits—payments from the federal government to help cover the cost of premiums for those buying from the exchanges—for individuals earning incomes between percent and percent of the federal poverty level FPL. In states that expanded Medicaid to adults with incomes up to percent of the poverty level, eligibility for tax credits was set to begin at percent of the poverty level; individuals were not allowed to be eligible for both Medicaid and health insurance subsidies.
It limited the percentage of income these individuals could be required to pay towards their premiums and calculated credit amounts based on the difference between this percentage and the full premium cost for a benchmark The second-lowest cost silver plan on the applicable exchange. The percentage of income households must pay was indexed to change each year based on premium growth as compared to income growth.
Consumers were given the choice to have their tax credits be paid directly to insurance companies on a monthly basis or claim the total credit on an annual basis when filing taxes. The ACA also established a reduction in cost-sharing responsibilities for individuals earning incomes between percent and percent of the FPL, meaning they could enroll in silver plans that cover up to 94 percent of their costs.
The law restricted eligibility for tax credits and cost-sharing reductions to individuals who purchase a health plan through an exchange. For , the U. Department of Health and Human Services used poverty guidelines to determine tax credit and cost-sharing eligibility: [19] [22] [23]. The law did not make tax credits available for individuals below the poverty level. Childless adults who 1 reside in a state that did not expand Medicaid and 2 earn incomes between their state's Medicaid eligibility threshold and the poverty level could still buy insurance on the exchanges, but would not receive tax credits.
Click 'show' on the tables below to view complete data on incomes and the maximum monthly premium paid for a benchmark plan by poverty level percentage, up to a family of four.
The Affordable Care Act designed a program for the creation of nonprofit health insurance companies called Consumer Operated and Oriented Plans , or co-ops for short.
The law provided federal loans for the start-up of co-op insurance companies and outlined a series of regulations for their operation. The controlling board of a co-op was to include members enrolled in health plans through the company in order to act as a voice for enrollees. The law also stipulated that no representative from an insurance company or association could serve on the co-op boards.
Co-ops could sell individual and small group insurance plans on or off the health insurance exchanges described below. The co-ops were not allowed to accept investment income and could only sell one-third of their plans in the large group employer market. Any profits would be reinvested back into the company. Out of 23 co-ops that were created under the law, four remained in operation as of August The Affordable Care Act prohibited individual market insurers from denying coverage to people with pre-existing conditions.
This policy is known as guaranteed issue. Guaranteed issue regulations had already existed for insurers selling employer-sponsored health plans, and the ACA extended this rule to the individual market as well. The law also required insurers to allow young adults to stay on their parents' health insurance plans until age Insurers were also required to allow people in the individual market to renew their health plans each year unless they did not pay their premiums.
The ACA required individual and small group health plans that were offered both on and off the exchanges to cover services that fall into 10 broad benefits categories, called essential health benefits : [27]. The exact services covered were selected by each state according to the needs of its citizens; the only requirement was that covered benefits fall into each of the 10 broad categories listed above.
All health plans were required to cover percent of the cost of preventive services, such as screenings, as long as the physician providing the service was in the insurance plan's network. All health plans were also required to cover contraception and services related to breastfeeding. The ACA placed restrictions on the way individual and small group insurers set a plan's premium The amount a consumer is required to pay for a health insurance plan.
Premiums are usually paid monthly, quarterly or annually. The law did not place limits on premium variation due to geographic location or the number of individuals covered by a plan. The law prohibited annual and lifetime limits on the amount insurers will pay out for covered benefits. Additionally, if individuals miss premium payments, insurers were required to allow that person to retain coverage for three months, although insurers only had to pay doctors for one month.
If the premium amount was not paid during that time, then coverage could be terminated. The law established a program for reviewing insurance premium rate increases. If a state decided to administer its own program, it was required to meet minimum standards outlined by the U. HHS was given the authority to review state programs, and if they did not meet the standards, federal regulators could take over the rate review process for that state.
States could also cede rate review responsibility to HHS. Insurers were required to submit proposed rate increases of 10 percent or more to either state or federal regulators, whichever was applicable, for review, along with data supporting the increase. The secretary of health and human services was not granted the authority to reject premium increases; however, many state laws allow state regulators to reject or amend premium requests.
A medical loss ratio MLR is the portion of premium revenue that insurers spend on claims, medical care and healthcare quality for their customers. The remaining revenue typically goes toward overhead costs, such as administration, marketing and employee salaries, and then to profit. The Affordable Care Act ACA placed new regulations on insurers' medical loss ratios by limiting the portion of revenue that goes toward overhead and profit: individual and small group insurers were required to maintain a minimum medical loss ratio of 80 percent, while large group insurers were required to maintain a minimum MLR of 85 percent.
This means at least 80 or 85 percent of premium revenue were required be used to pay customer claims and support improvements in health and healthcare quality, such as wellness promotion programs. Each year, insurers were required to publicly report their medical loss ratio and other financial information for each state and market segment.
If their MLR falls below 80 percent or 85 percent, they would be required to notify their customers and provide a rebate the following year. The law exempted insurers serving fewer than 1, individuals in a state. The Affordable Care Act outlined three federal programs that were meant to stabilize the individual market during the first few years of the law and prevent premiums from rising too quickly as insurers adjusted to the new regulations: [37].
The Affordable Care Act expanded eligibility for Medicaid to more individuals. Medicaid was originally limited to pregnant women and young children with household incomes around the federal poverty level, and to disabled people, older children, and parents with household incomes below the federal poverty level.
Each state was allowed to decide whether to also cover able-bodied adults without children or people with slightly higher incomes, though they were previously required to obtain a federal waiver to do this. The ACA provided for the expansion of Medicaid eligibility to cover childless adults whose income amounted to percent of the federal poverty level FPL or below.
Although the law originally required states to expand their Medicaid programs or lose federal Medicaid funding, in , the U. Supreme Court ruled that the federal government could not condition Medicaid funding on an expansion of the program.
The ruling essentially made participation in the expansion voluntary on the part of the states. The provision for expanding Medicaid went into effect nationwide in
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