Original Requirements and Changes Made to the ACA

Policy Analysis for the Patient Protection and Affordable Care Act

Today, more than 23 million Americans are enrolled in the Patient Protection and Affordable Care Act (hereinafter alternatively “the Act”), but this law remains a highly controversial political issue and its future remains uncertain (Stasha, 2022). To help determine its current status and recent trends, the purpose of this paper is to provide a policy analysis of this act, including its full and shortened titles, its origins in the U.S. Congress, as well as its original sponsors and co-sponsors. In addition, an examination concerning what actions have been taken regarding the Act as well as a general overview of the Act is followed by a summary of this landmark piece of federal legislation in the policy analysis’ conclusion.

Description of the Act

The bill number:

HR 3590 (now Public Law 111–148 dated March 23, 2010).

The full title of the Act

The Patient Protection and Affordable Care Act.

The shortened name of the Act

The Patient Protection and Affordable Care Act is commonly referred to as the Affordable Care Act, ACA or “Obamacare.”

Hyperlink to the full text of the Act

http://housedocs.house.gov/energycommerce/ppacacon.pdf

Chamber the Act was first introduced into

U.S. House of Representatives.

When was the Act first introduced in the U.S. House of Representatives?

The Act was originally introduced by the Speaker of the House, Nancy Pelosi, together with a coalition of Democratic Representatives in July 2009 (Davalon, 2022).

Who is the Act’s primary sponsor(s)?

The primary sponsor of the Act was Representative Charles Rangel (D-NY) (Davalon, 2022).

Who is the Act’s co-sponsors?

The Act had the support of 29 original co-sponsors and 10 subsequent Democratic Representative co-sponsors as well as one Republican Representative Todd Platts (R-PA) who joined as a co-sponsor on October 6, 2009 (H.R. 3590 [111th]: Patient Protection and Affordable Care Act, 2022).

What actions have been taken regarding the Act?

Not surprisingly, the sheer complexity of the Act has resulted in a number of actions being taken since it was first signed into law on March 23, 2010, including the major actions that are set forth in Table 1 below:

Table 1

Actions taken on the Act

Change

Description

Extensions of “grandmothered” health plans

Originally, all health plans that were developed during the period from 2010 to 2014 which were not compliant with the requirements of the Act (termed “grandmothered plans”) were required to be complaint by 2014; however, due to problems with implementation, this date was first extended to 2015 and then again to 2017.

Employer mandate delays

The requirement that employers with 50-plus full-time workers to provide them with affordable health insurance by January 1, 2014 was extended to 2015. Likewise, the requirement for larger employers with 100-plus full-time workers was implemented in phases, beginning with the requirement for these employers to provide 70% of their workers with insurance by January 1, 2015 and 90% (a percentage deemed “essentially all” of an enterprise’s workers) by January 1, 2016.

Individual mandate delay

The requirement for all Americans to complete enrollment in a health insurance plan beginning in 2014 was waived for all practical purposes for enrollees who signed up after February 15, 2013 and no penalties are now assessed.

“Cadillac tax” delay

The so-called “Cadillac tax” was a 40% excise tax was originally to be assessed on higher cost health plans which applied to single enrollees with plans over $10,200 and $27,500 or families beginning in 2018. In December 2015, this tax was delayed until 2020.

Delays in reporting requirements

The law requiring larger employers to submit reports concerning the percentage of workers who were offered health coverage during the previous tax year was originally supposed to take effect in 2014, but this requirement was subsequently extended to 2016.

Source: Adapted from List of changes made to the Affordable Care Act (2022)

A general overview summary of the policy

Two federal agencies are responsible for the administration of the private health insurance requirements of the Act (i.e., the Centers for Medicare & Medicaid Services and the Internal Revenue Service) (Redhead & Kinzer, 2015). The Act included multiple provisions that were designed to “expand coverage, control health care costs, and improve health care delivery system” (Summary of the Affordable Care Act, 2013, para. 3). The three main goals of the Act are as follows:

1. 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;

2. Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level; and,

3. Support innovative medical care delivery methods designed to lower the costs of health care generally (About the Affordable Care Act, 2022).

Conclusion

The research showed that the Patient Protection and Affordable Care Act, also known as the Affordable Care Act, the ACA and “Obamacare” was originally introduced in July 2009 with the original sponsor being Democratic Representative Charles Rangel together with 39 Democratic and one Republican co-sponsors. The Act was signed into law on March 23, 2010 and millions of Americans have since enrolled in the health insurance coverage mandated by the Act since that time. Finally, the research also showed that a number of changes have been made to the Act over the years, with most of these being related to some type of delay in the implementation of various requirements.