“The Affordable Care Act (ACA) (also known as the Patient Protection and Affordable Care Act or Obamacare) fundamentally changed healthcare coverage, insurance, and regulation in the United States. Due to the strong views in favor of and opposed to the ACA, it was enacted in an unorthodox and controversial process.  An important result of the process used to enact the law is that the ACA is not one single health care bill that became law, but is actually composed of two laws: Patient Protection and Affordable Care Act (ACA) (Pub. L. No. 111-148, 124 STAT. 119) and Health Care and Education Reconciliation Act of 2010 (HCERA) (Pub. L. No. 111-152, 124 Stat. 1029).  

“The ACA was enacted on March 23, 2010. HCERA was enacted on March 30, 2010, to reconcile major differences between the Senate bill and the House version of the health care legislation. Prior to this law, Congressional Democrats had intended to have a conference committee merge the ACA with the “Affordable Health Care for America Act” (H.R. 3962) that had passed the House of Representatives. Due to the election of Republican Scott Brown in a special election to fill the seat vacated by the death of Sen. Edward Kennedy (D-MA), Republicans had the votes needed to filibuster a conference report on the House and Senate bills. Although HCERA significantly amends the ACA, because it is a budget reconciliation bill it could only be used to make budget amendments. However, it was legislatively expedient; and most importantly, a reconciliation bill can be passed with a simple majority and cannot be filibustered under Senate rules, which became the only way to pass it after Senator Brown’s election.

“The ACA is divided into 10 titles and Title X significantly amends the other titles (requiring consolidation of the other titles with their Title X amendments). Thus, understanding the ACA requires knowledge about the amendments made by Title X of the ACA, the changes made by HCERA, and other subsequently enacted amendments.”

• Patient Protection and Affordable Care Act (ACA) (Pub. L. No. 111-148, 124 STAT. 119)
• Health Care and Education Reconciliation Act of 2010 (HCERA) (Pub. L. No. 111-152, 124 Stat. 1029)

Source: Research Guide: Health Law & Policy. University of Minnesota Law Library. Last updated Aug 15, 2019.

According to the website HealthCare.gov, the Affordable Care Act is:

“The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”).
“The law has 3 primary goals:
“• Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.
“• Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.)
“• Support innovative medical care delivery methods designed to lower the costs of health care generally.”

Source: HealthCare.gov Glossary: Affordable Care Act. Last accessed August 15, 2019.

You can also find the full text of the Affordable Care Act through Healthcare.gov.

Fact Items Related To The Affordable Care Act

• Medicaid Enrollment
  “The ACA Medicaid expansion has significantly increased Medicaid enrollment and federal Medicaid expenditures. In FY2017, an estimated 12 million individuals were newly eligible for Medicaid through the ACA Medicaid expansion (i.e., expansion adults), and total Medicaid expenditures for the expansion adults were an estimated $71 billion. Enrollment for the expansion adults is projected to be ...
• How People With Pre-Existing Conditions Were Handled By Insurers Prior to Passage of the ACA
  “Before the ACA, individual insurers in the vast majority of states could collect information on demographic characteristics and medical history, and then deny coverage, charge higher premiums, and/or limit benefits to individuals based on pre-existing conditions. An industry survey found that 34 percent of individual market applicants were charged higher-than-standard rates based on demographic characteristics ...
• Impact of the ACA on Health Insurance Coverage for People with Pre-Existing Conditions
  “• Up to 133 million non-elderly Americans—just over half (51 percent) of the non-elderly population—may have a pre-existing condition. This includes 67 million women and girls and 66 million men and boys. “• The likelihood of having a pre-existing condition increases with age: up to 84 percent of those ages 55 to 64—31 million individuals—have at ...
• Financial Impact of the ACA on Safety Net Hospitals
  “Patient service revenue grew. Largely linked to the growth in patient volumes from insured patients, operating revenues increased for expansion state hospitals (by an average of 17 percent) and, to a lesser extent, for non-expansion state hospitals (11 percent on average) between 2013 and 2015. For expansion state hospitals, this increase came largely from Medicaid. ...
• Effects of the ACA on Safety Net Hospitals
  “Study hospitals (Appendix 2) in states that expanded eligibility for the Medicaid program experienced considerable patient volume increases from Medicaid enrollment expansions, whereas they experienced little volume change from the ACA’s expansion of commercial coverage through the federal and state Marketplaces. Despite concerns that they might lose many newly insured patients to other providers, these ...
• Major Provisions of the Affordable Care Act
  • Established “health exchanges” or “marketplaces” on a statewide basis that sold community-rated individual and family insurance policies that were required to cover ten sets of “essential health benefits.” Policies could be sold in four “metal tiers”, Bronze, Silver, Gold, and Platinum, which cover 60%, 70%, 80%, and 90%, respectively, of typical health expenses. The ...
• Medicaid Expansion Under the ACA
  “Since January 1, 2014, states have had the option to extend Medicaid coverage to most non-elderly, nonpregnant adults with income up to 133% of FPL. Twenty-four states and the District of Columbia implemented the ACA Medicaid expansion at that time. Since then, the following seven states have implemented the expansion: Michigan (April 1, 2014), New ...
• Affordable Care Act and “Shared Responsibility”
  “The Affordable Care Act (ACA), enacted in 2010, established “shared responsibility” between the government, employers, and individuals for ensuring that all Americans have access to affordable and good-quality health insurance. However, health coverage remains fragmented, with numerous private and public sources, as well as wide gaps in insured rates across the U.S. population. The Centers ...
• Health Insurance Coverage In the US Before the ACA
  “Until the major provisions of the ACA went into effect in January 2014, health insurance coverage was always voluntary. About 30% of the population was covered through the two major public programs enacted in 1965: Medicare for seniors (later extended to the disabled) and Medicaid for poorer Americans . Most others received coverage through their employment, ...
• Problems That Hampered Implementation of ACA’s Coverage Provisions
  “Several major problems have hampered the implementation of the coverage provisions of the ACA. First was the troubled debut of the federally run insurance marketplaces and a number of state-run programs. The federal marketplaces now seem to be functioning adequately, and most states with problems have either fixed them or imported solutions from other states ...
• ACA Hampered By Financial Vulnerabilities From the Start
  “The ACA is vulnerable to the availability of resources at many other levels. The United States has a large national deficit for which the federal government must account. The states find themselves with inadequate financial resources. Many states cannot legally run a deficit and this limits their ability to participate in many of the ACA ...
• ACA’s Medicaid Expansion and NFIB v Sebelius
  “As enacted, the ACA Medicaid expansion was a mandatory expansion of Medicaid eligibility to non-elderly adults with incomes up to 133% of the federal poverty level (FPL). However, on June 28, 2012, in National Federation of Independent Business v. Sebelius, the U.S. Supreme Court found that the federal government could not withhold payment for a ...
• Impact on Coverage of Administrative Changes and Repeal of the ACA’s Individual Mandate
  “One would expect to see an uptick in the number of uninsured for two reasons: (1) the financial penalty for being uninsured will be removed beginning in 2019, and (2) premiums will rise due to adverse selection, by an estimated 10%, although most people are protected through rising financial subsidies. Estimates by the Congressional Budget ...
• ACA Policy Changes 2017-2018
  “As noted, despite calls to repeal the ACA ‘on day one,’ the President Trump, even with the support of a Republican Congress, was not able to repeal the legislation – although the vote in the U.S. Senate was very close. (Whether the House of Representatives would have passed the Senate bill is conjectural.) Due to ...
• Impact of Other Proposed Changes to ACA
  “In addition, the administration is proposing other changes that could to lead to the sale of cheaper and less comprehensive policies at a cost of reducing consumer protections. States would gain more flexibility in defining what constitutes essential health benefits. Individuals would be allowed to purchase health insurance across state lines, which would give people in a ...
• Some Proposals To Reform the US Healthcare System and/or Replace the ACA From the 2018 Election Cycle
  “Selected Proposals to Reform the U.S. HealthCare System.“LEFT-LEANING PROPOSALS “Medicare Extra for All”“Example: Proposal by Center for American Progress, “Medicare Extra for All” . Provides universal coverage in part by expanding the Medicare program to anyone who chooses to join, as well as all newborns and individuals turning age 65 – who are automatically enrolled. Employers ...

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Dec. 12, 2020 by Doug McVay, Editor.