When was obamacare enacted

See the section summaries below for a brief description of the information contained in each section. Click on the section titles to be taken to that part of the article. For more information on the impact of the ACA in each state, click here. The House passed the bill on November 7, , with the votes of Democrats and one Republican Rep.

Joseph Cao R-La. Thirty-nine Democrats and Republicans voted against the bill. On December 24, , the Senate passed its version of the bill , with all Democrats voting in favor of the bill and all Republicans but one voting against it Sen. Jim Bunning R-Ky. Ted Kennedy D-Mass. Unless the House agreed to the Senate's version of the bill, a committee of members from the House and Senate would have to resolve differences between the two bills with a new bill that would need to receive another vote in the Senate—with the election of Brown, Senate Democrats would not have 60 votes to overcome a Republican filibuster on the new bill.

A majority of the House Democratic Caucus agreed to pass the Senate bill as long as subsequent budget-related changes to the bill could be made via the reconciliation process—reconciliation bills only need 50 Senate votes to pass and are not subject to filibuster. The House passed the Senate bill on March 21, , with House Republicans opposing the bill's passage along with 34 Democrats, while Democrats voted in favor, leaving the final vote at The House passed the reconciliation package on the same day by a vote of and the Senate approved the bill on March 25, , by a vote of President Obama signed the Senate bill on March 23, , and the reconciliation bill on March 30, 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.

A key goal of the marketplaces was to provide coverage explanations in easy-to-understand, standardized formats, along with uniform definitions of health insurance terminology.

Plans are categorized under metal level classifications based on their actuarial value, and catastrophic plans are also available to eligible enrollees. Included in the exchange options is an enrollment platform called SHOP Small Business Health Options Program — a tool that allows small businesses to compare plans and enroll in coverage for their employees.

In some states, however, there are still thriving SHOP markets. The ACA also created nonprofit health insurance co-ops — private, nonprofit, state-licensed health insurance carriers — that offer ACA-compliant plans in individual and small-business markets.

But only three CO-OPs are still operational in five states. Before the implementation of the ACA, Americans with pre-existing conditions could find it expensive — or impossible — to buy health coverage in the individual market. The law also eliminated waiting periods that employer-sponsored plans would impose before starting coverage of pre-existing conditions, and allows employers to impose waiting periods of no more than three months before full-time employees must be offered health coverage.

Under the ACA, all policies are guaranteed issue — which means that health coverage is guaranteed to be issued to applicants regardless of their health status, age or income. Prior to , coverage on the individual market in most states was not guaranteed issue. The standards also rescued ACA-compliant plan buyers from lifetime benefit limits and annual benefit limits.

Before Obamacare took effect, plan buyers who needed expensive care could exhaust their health insurance benefits , and have nowhere else to turn. These rules apply to student health insurance as well, and those plans commonly had very low lifetime limits pre-ACA. Under the Affordable Care Act, all individual and small-group major medical plans must include coverage of the following EHBs:.

And thanks to Obamacare, health plans offered to college students are just as comprehensive as the ACA-compliant plans offered to everyone else. Health reform advocates hailed Obamacare for its many provisions designed to expand coverage — and to prohibit discrimination. Section prohibits discrimination in health plans — including discrimination based on gender identity or sexual orientation.

That has been a boon to the LGBT community. The Trump administration rolled back those consumer protections with a new rule that was issued in , but the Biden administration announced in May that Section requirements would once again include a prohibition on discrimination by health care entities based on sexual orientation or gender identity.

Another major improvement under the ACA is birth control access — with plans required fully cover ie, with no cost-sharing at least one version of every FDA-approved method of birth control for women. Under the ACA, recission retroactive cancellation of your coverage by a health insurance company is prohibited — unless your application was fraudulent or included intentional misrepresentation.

The law includes numerous provisions designed to reduce Medicare spending, drive down costs, and improve coverage for Medicare beneficiaries. Among them:. The ACA is gradually cutting Medicare costs by restructuring payments to Medicare Advantage , based on the fact that the government was spending more money per enrollee for Medicare Advantage than for Original Medicare.

Medicare Advantage enrollment has continued to increase; the ACA has not dampened that market at all. Our Open Enrollment Guide : Everything you need to know to enroll in an affordable individual-market health plan. The ACA changed the tax code to increase revenue for the Medicare program.

Starting in , the Medicare payroll tax increased by 0. The Medicare Modernization Act of included a provision to pay 10 percent bonuses to Medicare physicians who work in health professional shortage areas HPSAs. 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. 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 A15 L Available online. A2 xb. A2 x. Cumulative updates. Bernstein; Orin S. Kerr; David B. Kopel; Ilya Somin; Jonathan H. Adler; Randy E. Barnett Call Number: KF C66