When was the aca passed

The sources below provide coverage about various litigation involving the ACA:. It looks like you're using Internet Explorer 11 or older. This website works best with modern browsers such as the latest versions of Chrome, Firefox, Safari, and Edge. 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 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 The federal government provided percent of funding to cover newly eligible enrollees through , dropping this funding level to 95 percent in and to 90 percent in and thereafter.

The law did not provide for tax credits for adults with household incomes lower than the federal poverty level, because the law had intended to cover these people under Medicaid. In states that didn't expand Medicaid, these adults neither qualified for Medicaid nor for federal tax credits to purchase health insurance. As of August , a total of 38 states and Washington, D. The map below provides information on Medicaid expansions by state; for states that expanded, hover over the state to view the political affiliation of the governor at the time of expansion.

The Affordable Care Act enacted a temporary increase for Medicaid's reimbursements to primary care physicians, matching Medicare levels during and The law provided states with federal funding for the purpose.

States were not required to maintain the higher reimbursement rates after The law also established the requirement that states accept multiple forms of enrollment applications, including online applications.

The law reduced reimbursements to private Medicare Advantage plans, which are health plans for Medicare beneficiaries administered by private insurers and financed by the federal government. The law also reduced payments to healthcare providers. In addition, prior to the ACA, Medicare required beneficiaries at a certain level of income to pay higher monthly premiums for coverage.

The income threshold was indexed to increase annually with inflation. The ACA suspended this indexing through , meaning over time, more beneficiaries would be required to pay the higher premiums. The ACA also required higher-income beneficiaries to begin paying higher premiums for prescription drug coverage. If the projected rate of growth in Medicare spending exceeded a target amount, IPAB would be required to craft a proposal to reduce Medicare spending.

IPAB's decisions would be binding and would require a three-fifths super-majority from Congress in order to be overturned. The Department of Health and Human Services would automatically implement its recommendations unless overridden by Congress. However, the law stipulated that IPAB could not ration healthcare, raise premiums or restrict eligibility. Writing in the Wall Street Journal , Sarah Palin argued that the Affordable Care Act "implicitly endorses the use of 'death panel'-like rationing by way of the new Independent Payments Advisory Board—making bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will and especially will not be reimbursed under Medicare.

The law closed the doughnut hole of Medicare prescription drug coverage Part D. The ACA established coverage for a portion of the costs for drug spending in this range. The ACA outlined a pilot program to test the effect of bundled payments for Medicare.

A bundled payment is the delivery of one single payment to providers for the entire range of services used to treat a condition. By contrast, under traditional fee-for-service reimbursement, doctors are paid separately for each service provided. For the Medicare program, the law allowed providers to voluntarily group together to enter into the payment arrangement with Medicares.

The ACA also included a shift from volume-based purchasing—paying for the number of services provided—to value-based purchasing—paying for the quality of services provided.

Since , hospitals have received a 1 percent reduction in Medicare payments to fund a reward program providing bonuses to hospitals that meet standards of high quality, efficient care. Additionally, the law included four provisions related to primary care: [26] [52]. The Affordable Care Act included provisions outlining a system of accountable care organizations ACOs as a model for Medicare providers.

An accountable care organization ACO is a group of doctors, hospitals, or other healthcare providers that work together with the stated purpose of delivering high-quality care at a lower cost. The formation of ACOs was made voluntary for providers. Under the model outlined by the ACA, if an ACO generated savings on the cost of care for a Medicare patient, the federal government would give the providers a portion of the savings.

If not, the group would have to take a loss on the cost of care provided. ACOs could be formed by physicians, hospitals or—in the private market—insurers. According to the journal Health Affairs , as of September , the majority of the Medicare patients accounted for 7.

The following is a list of taxes and fees included in the Affordable Care Act as written. This list may not be exhaustive and changes to the tax code in subsequent years may have impacted some of these provisions. September 14, Commenting on the apparent change of position among Republican senators who voted against Obamacare repeal, Senator Ben Sasse R-Neb.

Read Ballotpedia's fact check ». The Affordable Care Act was subject to a number of lawsuits challenging some of its provisions, such as the individual mandate and the requirement to cover contraception. Four of these lawsuits were heard by the United States Supreme Court , resulting in changes to the law and how it was enforced. In addition, since the law's enactment, lawmakers in Congress have introduced and considered legislation to modify or repeal parts or all of the Affordable Care Act.

Finally, between and , voters in eight states considered ballot measures related to the law. This section summarizes the lawsuits, legislation, and state ballot measures that attempted to change, repeal, or impact enforcement of parts of the law.

Pursuant to the U. Supreme Court's decision in Burwell v. Hobby Lobby , religious organizations and closely-held for-profit companies became eligible for an exemption from the Affordable Care Act's contraception mandate. This new law aimed to improve access to healthcare in the U. These relate especially to coverage for preexisting conditions including pregnancy , children on parental plans, and help for small businesses to have their employees insured.

Since , insurance companies have not been allowed to raise the premiums for infants or children due to a preexisting health condition or disability. Adults who previously could not get coverage due to a preexisting condition and those who had had no insurance for 6 months or longer would now get insurance.

The Pre-existing Condition Insurance Plan was aimed at adults who could not get coverage because of a preexisting condition, such as diabetes or cancer. From , the ACA made access available to them. Currently, health insurers cannot deny or cancel coverage for someone with a preexisting health condition.

The insurance must also cover that condition, and insurers cannot charge someone more for having that condition. Insurers still consider pregnancy to be a preexisting condition, so insurance now covers all prenatal care and the birth from the first day of coverage. The Supreme Court have been considering whether or not to uphold this. A decision is expected in This is considered a special enrollment period.

It means that they can sign up for a new plan without having to wait for open enrollment at the end of the year. Small businesses can receive help in funding the cost of providing health insurance. New tax credits make it more affordable for them to buy health insurance for their employees. Since , more people in the U.

People with Medicare also became eligible for mammograms, colonoscopies, and some other preventive services. All new health policies have to offer these types of screening and preventive service free of charge. Learn more about the costs of Medicare Part D here. The Trump administration have introduced a number of changes to the law. The sections below will look at these in more detail.

When the law first came into effect, people who could afford to pay for health insurance but chose not to purchase a plan could face a tax penalty on their yearly income taxes.