List of changes made to the Affordable Care Act

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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.

Of the changes that have been made, some of the actions taken directly by the administration have been contentious. Opponents of the ACA and the administration's subsequent actions say that the executive branch overstepped its authority in how it has implemented the law, and contend that some of its actions may be illegal. The administration and its supporters say that the actions are within the bounds of federal law and in line with those taken by previous administrations implementing similarly complex laws.[1]

The list below is a selection of notable and significant changes that have been made to the Affordable Care Act through legislation, administrative action, and Supreme Court rulings. The list was guided in part by a similar document from the Congressional Research Service, listed below, and in part by the amount of debate surrounding each change. The list is not comprehensive and is not organized in any particular order. For more comprehensive information, please see the following documents:

Notable changes

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.[2][3]

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.[4]

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.[5][6]

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.[1]

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.[7]

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.[7]

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.[8][9]

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 Service (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.[1][10]

See also

External links

Footnotes

  1. ↑ 1.0 1.1 1.2 Congressional Research Service, "Implementing the Affordable Care Act: Delays, Extensions, and Other Actions Taken by the Administration," March 3, 2015
  2. ↑ The White House, "FACT SHEET: New Administration Proposal To Help Consumers Facing Cancellations," November 14, 2013
  3. ↑ Roll Call, "Administration Extends Obamacare Grandfathering for 2 More Years," March 5, 2014
  4. ↑ The Washington Post, "White House delays employer mandate requirement until 2015," July 2, 2013
  5. ↑ Federal Register, "Shared Responsibility for Employers Regarding Health Coverage," February 12, 2014
  6. ↑ Society for Human Resource Management, "Health Care Law's Employer Mandate Delayed," July 28, 2014
  7. ↑ 7.0 7.1 The Henry J. Kaiser Family Foundation, "A Guide to the Supreme Court’s Decision on the ACA’s Medicaid Expansion," August 1, 2012
  8. ↑ Politico, "Next big Obamacare battle: 'Cadillac tax,'" April 6, 2015
  9. ↑ Ice Miller, "Cadillac Tax Delayed Until 2020," December 23, 2015
  10. ↑ Internal Revenue Service, "Information Reporting by Applicable Large Employers," accessed May 12, 2016


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