Question

Do some light research about the current status of the Affordable Care Act. It has changed since its original enactment. Write one double-spaced page discussing

(1) some of the major changes

(2) why it is important for businesses to have an understanding of the Affordable Care Act

Answer 1

Definition of Affordable Care Act (ACA)

The Affordable Care Act (ACA) is the comprehensive healthcare reform signed into law by President Barack Obama in March 2010. Formally known as the Patient Protection and Affordable Care Act—and simply Obamacare—the law includes a list of health-related provisions intended to extend health-insurance coverage to millions of uninsured Americans.

The Act expanded Medicaid eligibility, created health insurance exchanges, and prevents insurance companies from denying coverage (or charging more) due to pre-existing comdition. It also allows children to remain on their parents' insurance plan until age 26.

KEY POINTS

The Affordable Care Act—also known as Obamacare—was signed into law in March 2010. It was designed to extend health insurance coverage to millions of uninsured Americans.

The Act expanded Medicaid eligibility and created a Health Insurance Marketplace. It prevents insurance companies from denying coverage due to pre-existing conditions and requires plans to cover a list of essential health benefits.

Lower-income families can qualify for extra savings on health insurance plans through premium tax credits and cost sharing reduction

Changed since it's original Enactment

The Affordable Care Act (ACA) has been the subject of congressional debate since President Barack Obama first signed it into law in March 2010, and a significant change came about in 2019 with regard to the associated tax penalty for not maintaining coverage. Subsidy eligibility remains the same, at least for the time being, but the individual mandate penalty is behind us.

Additionally, changes to previous rules now allow short-term plans to compete with ACA-approved coverage.

List of changes made to the Affordable Care Act

The Patient Protection and Affordable Care Act of 2010, also known as the Affordable Care Act (ACA) or Obamacare, was signed into law on March 23, 2010. Since that time, the law has undergone several changes to its provisions and implementation, either through actions taken by the administration, legislation passed by Congress, or rulings from the United States Supreme Court.

Extensions of grandmothered health plans

Many of the Affordable Care Act's (ACA's) major provisions went into effect in January 2014. Health plans that were created between 2010 and 2014 and were not compliant with the ACA's requirements, now called "grandmothered" plans, were originally supposed to come into compliance with the law at the beginning of 2014. In October 2013, many individually insured people began receiving letters from their insurance carriers notifying them of the impending cancellation of their plans. The plans were canceled because they did not meet new minimum coverage requirements set by the law.

Under pressure from Democratic members of Congress, in November 2013, the administration delayed for the first time the requirement that these health plans come into compliance, allowing insurers to continue offering these plans until 2015. The administration delayed this requirement for a second time in March 2014, allowing insurers to continue offering these plans until 2017.

Employer mandate delays

The ACA stipulates that employers with 50 or more full-time employees must provide affordable health coverage to full-time employees beginning January 1, 2014. The administration delayed enforcement of this requirement for the first time in July 2013. The announcement from the Department of the Treasury stated that such employers would have until 2015 to provide coverage to their employees.

The administration delayed enforcement of this requirement for a second time in February 2014. The announcement stated that midsize employers with 50 to 99 full-time employees would have until January 1, 2016, to offer health coverage. Additionally, for large employers with 100 or more full-time employees, the requirements would be phased in: they would be required to offer health coverage to 70 percent of employees by January 1, 2015, and to 95 percent by January 1, 2016. The administration considers 95 percent "substantially all" of a business' full-time employees.

Individual mandate delay

The ACA requires every individual to enroll in health insurance beginning in 2014. If a person is uninsured for three consecutive months in a year, he or she will be assessed a penalty. The first open enrollment period for purchasing health plans on the exchanges ran from October 1, 2013, until March 31, 2014. To avoid being uninsured for the first three months of the year and facing a penalty, individuals would have had to sign up by February 15, 2014. On October 28, 2013, the administration announced that it would grant a hardship exemption to individuals who signed up after February 15, essentially waiving the penalty these individuals would have otherwise faced.

Supreme Court ruling on Medicaid expansion

Prior to the passage of the ACA, most states did not offer Medicaid to low-income childless adults. Most also restricted the eligibility of low-income parents to those with incomes below the federal poverty level. When the ACA was passed, it required states to expand eligibility for their Medicaid programs to all individuals with incomes up to 138 percent of the federal poverty level. If the state refused to expand, the law said that the federal government could withhold all of its portion of Medicaid funding from the state.

Shortly after the law's passage, 26 states sued the federal government to challenge the requirement to expand Medicaid. The case made its way to the United States Supreme Court , which ruled on June 28, 2012, that the provision was unconstitutionally coercive. The decision effectively made expanding Medicaid voluntary on the part of the states.

Cadillac tax delay

The ACA establishes a 40 percent excise tax on high-cost health plans known as the "Cadillac tax." The tax applies to health plans valued at over $10,200 for single coverage and $27,500 for family coverage and would only tax the amount that passes the threshold. For example, a family with a plan valued at $30,000 would owe 40 percent of the $2,500 that's above the threshold. The tax was originally slated to go into effect in 2018. In December 2015, President Barack Obama signed legislation that delayed implementation of the tax until 2020, although many have called for a repeal of the tax entirely. The tax was intended to be one of the major sources of revenue that would offset the costs of the ACA.

Reporting requirement delays

The ACA requires large employers to provide their employees each year by January 31 a tax-related form that reports information on health coverage offered by the employer over the previous tax year; this information is intended to be used by employees to determine their eligibility for advanced premium tax credits. While the law set the provision to go into effect in 2014, the Internal Revenue Services (IRS) delayed the mandate until 2016. Additionally, the IRS delayed the January 31 deadline to March 31. The ACA also requires insurers to report coverage information to the IRS beginning in 2014. The IRS delayed the effective date until 2016.

UNDERSTANDING OF AFFORDABLE CARE ACT

The Affordable Care Act was designed to reduce the cost of health insurance coverage for people who qualify. The law includes premium tax credits and cost-sharing reductions to help lower costs for lower-income individuals and families.

Premium tax credits lower your health insurance bill each months. Cost-sharing reduction lower your out -of-pocket cost
for deductibles, copays, and coinsurance. They also lower your out of pocket maximum the total amount you pay in a year for covered health expenses.

All ACA-compliant health insurance plans—including every plan that's sold on the Health Insurance Marketplace—must cover specific "essential health benefits" including:

• Ambulatory patient services
• Breastfeeding
• Emergency services
• Family Planning

• Hospitalization
• Laboratory services
• Mental health and substance use disorder services
• Pregnancy, maternity, and newborn care

• Prescription medications

• Preventive and wellness services and chronic disease management

• Pediatric services

• Rehabilitative and habilitative services

In addition, the Affordable Care Act requires most insurance plans (including those sold on the Marketplace) to cover at no cost to policyholders a list of preventive services. These include checkups, patient counseling, immunizations, and numerous health screenings. It also allowed states that opted in to extend Medicaid coverage to a wider range of people. ( To date, 37 states and the District of Columbia have exercised that option.)

Special Considerations

A notable part of the Affordable Care Act was the individual mandate, a provision requiring all Americans to have healthcare coverage—either from an employer or through the ACA or another source—or face increasingly stiff tax penalties. This mandate served the double purpose of extending healthcare to uninsured Americans and ensuring that there was a sufficiently broad pool of insured individuals to support health-insurance payouts.

On Jan. 20, 2017, in his first executive order after taking office, President Donald Trump signaled his intention to defund the Affordable Care Act, saying executive agency heads should "delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State."

The intention of this order signaled the first phase of Republican efforts to repeal and replace the ACA. Rolling back the law was one of Trump's central campaign promises aimed at reducing the fiscal burden on the government.

Attempts by the government in 2017 to repeal the law altogether were not successful. However, the government substantially scaled back its outreach program to help Americans sign up for the ACA and cut the enrollment period in half.

Changes have been made to the law that have addressed some of the objections raised by opponents, while still keeping the Marketplace open active for users. For example, as part of the Tax Cuts and Jobs Act, Congress in Dec. 2017 removed the penalty for not having health insurance. Starting with 2019 taxes, the individual mandate was reduced to zero dollars, essentially removing the requirement that many Republicans had opposed. By 2018, the number of Americans covered under the ACA had dropped from 17.8 in 2015 to 13.8 in 2015, according to a report from health care research organisation KFF.

In March 2019, the Trump administration revealed it will seek to repeal the entire Affordable Care Act. The Justice Department in a letter to a federal appeals court said it agreed with a federal judge in Texas who declared the healthcare law unconstitutional and added that it will support the judgment on appeal.

The case is expected to go to the Supreme Court with a coalition of 21 attorneys general defending the Affordable Care Act. Meanwhile, also in March 2019, House Democrats unveiled legislation to share up to Act and expand coverage.