View source for Patient Protection and Affordable Care Act

The '''Patient Protection and Affordable Care Act''' ('''PPACA'''),<ref>{{USPL|111|148}}, {{USStat|124|119}}, codified as amended at scattered sections of the [[Internal Revenue Code]] and in [[Title 42 of the United States Code|42 U.S.C.]]</ref> commonly called the '''Affordable Care Act''' ('''ACA''') or "'''Obamacare'''"<ref>{{cite web |url=http://www.politifact.com/truth-o-meter/article/2012/mar/20/romneycare-and-obamacare-can-you-tell-difference/ |title=RomneyCare & ObamaCare: Can you tell the difference? |last=Holan |first=Angie D. |authorlink= |date=March 20, 2012 |work=PolitiFact.com |publisher=Tampa Bay Times |location= |archiveurl= |archivedate= |deadurl= |accessdate=August 29, 2012 |quote= |ref= }}</ref> is a [[United States]] [[Law of the United States#Federal law|federal statute]] signed into law by [[President of the United States|President]] [[Barack Obama]] on March 23, 2010. Together with the [[Health Care and Education Reconciliation Act]],<ref>{{USPL|111|152}}, {{USStat|124|1029}}, codified as amended at scattered sections of the Internal Revenue Code and in 42 U.S.C., 19 U.S.C., and 20 U.S.C.</ref> it represents the most significant regulatory overhaul of the [[Health care in the United States|country's healthcare system]] since the passage of [[Medicare (United States)|Medicare]] and [[Medicaid]] in 1965.<ref name=overhaul>{{cite news|url=http://www.reuters.com/article/2012/06/28/usa-healthcare-court-idUSL2E8HS4WG20120628|title=US top court upholds healthcare law in Obama triumph|publisher=Reuters|author1=James Vicini|author2=Jonathan Stempel|date=June 28, 2012}}</ref>

==Overview of provisions==

The ACA includes numerous provisions that take effect between 2010 and 2020. Policies issued before 2010 are exempted by a [[grandfather clause]] from many of the changes to insurance standards, but they are affected by other provisions.<ref>{{cite web|url=https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/|title=What if I have a grandfathered health insurance plan? |publisher=Healthcare.gov }}</ref><ref>{{cite web|author=Bernadette Fernandez |url=http://www.ncsl.org/documents/health/grandfathered.pdf |title=Grandfathered Health Plans Under the Patient Protection and Affordable Care Act (PPACA) |publisher=Congressional Research Service |date=April 27, 2010 }}</ref> Significant reforms, most of which take effect by January 1, 2014, include:
* Forbidden discrimination of clients, called [[guaranteed issue]], which prohibits insurers from denying coverage to individuals due to [[pre-existing condition]]s, and a partial [[community rating]] requires insurers to offer the same premium price to all applicants of the same age and geographical location without regard to gender or most pre-existing conditions (excluding [[tobacco]] use).<ref name="Blue Cross Blue Shield of Michigan">{{cite press release|url=http://www.bcbsm.com/healthreform/pubs/ppaca_insurance_reform_2014.pdf |title=2014 Insurance Reforms under the Patient Protection and Affordable Care Act (PPACA) |publisher=Blue Cross Blue Shield of Michigan |date= |accessdate=April 9, 2012}}{{Dead link |date=September 2013}}</ref><ref name="Pool">{{cite web|last=Pool |first=Gentrie |url=http://www.lifehealthpro.com/2010/10/07/after-ppaca-the-future-of-the-health-insurance-und |title=After PPACA: The Future of the Health Insurance Underwriter &#124; LifeHealthPro |publisher=Asjonline.com |date=October 7, 2010 |accessdate=April 9, 2012}}</ref><ref name="Nursingworld.org">{{cite web|title=Selected Patient Protection and Affordable Care Act  (PPACA) implementation dates of interest to RNs as caregivers, RNs as patients, and RNs as employees |url=http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/HealthSystemReform/Health-Care-Reform-Legislation-Timeline.pdf |publisher=Nursingworld.org |date= |accessdate=April 9, 2012}}</ref>
* Minimum standards for health insurance policies are established.<ref name=CohnInsuranceStandards>{{cite news|author=Jonathan Cohn |url=http://www.newrepublic.com/article/113440/obamacare-rate-shock-higher-prices-can-mean-better-benefits|title=You Call This Insurance? |work=The New Republic |date=June 12, 2013 }}</ref><ref name=essential>{{cite web|url=http://www.healthcare.gov/glossary/e/essential.html |title=Essential Health Benefits – Glossary |publisher=Healthcare.gov |date=September 23, 2010|accessdate=January 9, 2012}}</ref><ref name="Hhs.gov">{{cite press release|url=http://www.hhs.gov/news/press/2011pres/07/20110711a.html |title=HHS and states move to establish Affordable Insurance Exchanges, give Americans the same insurance choices as members of Congress |publisher=Hhs.gov |date=July 11, 2011 |accessdate=April 9, 2012}}</ref><ref name="naic.org">{{cite web|url=http://www.naic.org/documents/committees_b_Exchanges.pdf |title=Patient Protection and Affordable Care Act of 2009: Health Insurance Exchanges |publisher=National Association of Insurance Commissioners |date=April 20, 2010 |accessdate=April 9, 2012}}</ref><ref name="FamiliesUSA">{{cite press release|url=http://www.familiesusa.org/health-reform-central/september-23/Annual-and-Lifetime-Limits.pdf |title=The Patients' Bill of Rights: Ending annual and lifetime limits |publisher=FamiliesUSA |date=2010-09 |accessdate=April 9, 2012}}</ref>
* An individual mandate<ref name=AHPAMandate>{{cite web|title=Minimum Coverage Provision ("individual mandate") |url=http://www.apha.org/advocacy/Health+Reform/ACAbasics/MC_provision.htm |work=American Public Health Association (APHA)}}</ref><ref name="Perkinsaccounting.com">{{cite press release|url=http://www.perkinsaccounting.com/our-story/litigation-support-accounting-firm-newsroom/perkins-news-bulletin/health-insurance-legislation/health-insurance-legislation-mandates.html |title=Perkins Accounting Firm Newsroom Bulletin Health Insurance Legislation Mandates |publisher=Perkinsaccounting.com |date= |accessdate=April 9, 2012}}{{dead link|date=October 2013}}</ref> requires all individuals not covered by an [[Employer-sponsored health insurance|employer sponsored health plan]], [[Medicaid]], [[Medicare (United States)|Medicare]] or other public insurance programs (such as [[Tricare]]) to secure an approved private-insurance policy or [[Provisions of the Patient Protection and Affordable Care Act#Effective January 1, 2014|pay a penalty]], unless the applicable individual has a financial hardship or is a member of a recognized religious sect exempted by the [[Internal Revenue Service]].<ref name="ksr_hlth" >{{cite news|url=http://www.kaiserhealthnews.org/Stories/2010/March/22/consumers-guide-health-reform.aspx|first=Phil |last=Galewitz|title=Consumers Guide To Health Reform|date=March 26, 2010|newspaper=Kaiser Health News}}</ref> The law includes subsidies to help people with low incomes comply with the mandate.<ref name="Tami Luhby">{{cite web|author=Tami Luhby |url=http://money.cnn.com/2013/04/23/news/economy/obamacare-subsidies/index.html |title=Millions eligible for Obamacare subsidies, but most don't know it |work=[[CNNMoney]]|date=April 23, 2013|accessdate=June 22, 2013}}</ref>
* Health insurance exchanges will commence operation in every state. Each exchange will serve as an online marketplace where individuals and small businesses can compare policies and buy insurance (with a government subsidy if eligible).<ref name=HealthCareGov>{{cite web|title=Welcome to the Marketplace|url=https://www.healthcare.gov/marketplace/individual/|publisher=HealthCare.Gov, managed by the [[Centers for Medicare and Medicaid Services]] }}<br />{{cite web|title=What is the Health Insurance Marketplace?|url=https://www.healthcare.gov/what-is-the-health-insurance-marketplace/ |publisher=HealthCare.Gov, managed by the [[Centers for Medicare and Medicaid Services]] }}</ref> In the first year of operation, [[annual enrollment|open enrollment]] on the exchanges runs from October 1, 2013 to March 31, 2014, and insurance plans purchased by December 15, 2013 will begin coverage on January 1, 2014.<ref>{{cite web|url=http://money.cnn.com/2013/04/23/news/economy/obamacare-subsidies/index.html?hpt=hp_t5|title=Millions eligible for Obamacare subsidies, but most don't know it|author=[[CNN]]}}</ref><ref>{{cite web|url=http://www.kff.org/healthreform/upload/8213-2.pdf|title=Establishing Health Insurance Exchanges: An Overview of State Efforts}}</ref><ref>{{cite web|url=http://www.healthcare.gov/marketplace/get-ready/index.html|title=Enrollment in the Marketplace starts in October 2013}}{{dead link|date=October 2013}}</ref><ref>{{cite web|last=Morgan|first=David|title=Obamacare push accelerates as government shutdown nears|url=http://www.reuters.com/article/2013/09/30/us-usa-healthcare-idUSBRE98T14R20130930?irpc=932|publisher=Reuters|accessdate=October 1, 2013|coauthors=Begley, Sharon|date=September 30, 2013|quote=Sebelius said on Monday that "the key date really is the 15th of December," the deadline for buying coverage that starts on January 1.}}</ref> In subsequent years, open enrollment will start on October 15 and end on December 7.<ref name=OpenEnroll1>{{cite news|title=Glossary: Open Enrollment Period |url=https://www.healthcare.gov/glossary/open-enrollment-period/ |publisher=HealthCare.gov|accessdate=October 4, 2013}}</ref><ref name=OpenEnroll2>{{cite news|last=Young|first=Jeffrey|title=Obamacare Benefits Enrollment Will Start Slowly, White House Predicts|url=http://www.huffingtonpost.com/2013/09/25/obamacare-benefits_n_3988946.html|work=The Huffington Post|accessdate=October 2, 2013|date=September 25, 2013}}</ref><ref name=CohnOE>{{cite news|author=Jonathan Cohn |url=http://www.newrepublic.com/article/114163/limited-enrollment-periods-obamacare-means-young-people-cant-wait |title=Burn Your Obamacare Card, Burn Yourself |work=The New Republic |date=August 5, 2013 }}</ref>
* Low-income individuals and families whose incomes are between 100% and 400% of the [[federal poverty level]] will receive [[subsidy|federal subsidies]] on a [[sliding scale]] if they  purchase insurance via an exchange.<ref name="Kaiser Family">{{cite web|url=http://www.kff.org/healthreform/upload/7962-02.pdf |title=Explaining Health Care Reform: Questions About Health Insurance Subsidies |publisher=Kaiser Family Foundation |month=April|year=2010 |accessdate=April 1, 2012}}</ref> Those from 133% to 150% of the poverty level will be subsidized such that their premium costs will be 3% to 4% of income.<ref name="Peter Grier">{{cite web|author=Peter Grier |url=http://www.csmonitor.com/USA/Politics/2010/0320/Health-care-reform-bill-101-Who-gets-subsidized-insurance |title=Health care reform bill 101: Who gets subsidized insurance? |work=[[The Christian Science Monitor]]|date=March 20, 2010|accessdate=January 9, 2012}}</ref> In 2013, the subsidy would apply for incomes up to $45,960 for an individual or $94,200 for a family of four; consumers can choose to receive their tax credits in advance, and the exchange will send the money directly to the insurer every month.<ref>Michelle Andrews, "[http://www.npr.org/blogs/health/2013/08/27/216089762/health-insurance-exchanges-prompt-consumers-questions?ft=1&f=1001 Health Insurance Exchanges Prompt Consumers' Questions]", [[NPR]], August 27, 2013.</ref> Small businesses will also be eligible for subsidies.<ref name="IRSBusinessSubsidy">{{cite web|url=http://www.irs.gov/newsroom/article/0,,id=223666,00.html |title=Small Business Health Care Tax Credit for Small Employers |publisher=Internal Revenue Service|date=December 13, 2011 |accessdate=January 9, 2012}}</ref>
* [[Medicaid]] eligibility is expanded to include individuals and families with incomes up to 133% of the [[federal poverty level]], including adults without disabilities and without dependent children.<ref name=KFF1>{{cite web|url=http://kff.org/medicaid/fact-sheet/where-are-states-today-medicaid-and-chip/ |title=Where are States Today? Medicaid and CHIP Eligibility Levels for Children and Non-Disabled Adults |publisher=Kaiser Family Foundation |date=March 28, 2013 }}</ref> The law also provides for a 5% "income disregard", making the effective income eligibility limit for Medicaid 138% of the poverty level.<ref name="138fpl">{{cite web|title=Medicaid Expansion|url=http://www.apha.org/APHA/CMS_Templates/GeneralArticle.aspx?NRMODE=Published&NRNODEGUID=%7bD5E1C04A-0438-4FD4-A423-CEFDA0D9878D%7d&NRORIGINALURL=%2fadvocacy%2fHealth%2bReform%2fACAbasics%2fmedicaid%2ehtm|work=American Public Health Association (APHA)|accessdate=24 July 2013|location=Is Medicaid eligibility expanding to 133 or 138 percent FPL, and what is MAGI?}}</ref> Furthermore, the [[State Children's Health Insurance Program]] (CHIP) enrollment process is simplified.<ref name=KFF1 /> However, in ''[[National Federation of Independent Business v. Sebelius]]'', the Supreme Court ruled that states may opt out of the Medicaid expansion, and several have done so.
* Reforms to the [[Medicare (United States)|Medicare]] payment system are meant to promote greater efficiency in the healthcare delivery system by restructuring Medicare reimbursements from [[fee-for-service]] to [[bundled payment]]s.<ref>{{cite web|url=http://www.medscape.com/viewarticle/748502 |title=Access |publisher=Medscape |date= |accessdate=January 9, 2012}}</ref><ref>{{cite web|url=http://www.huronconsultinggroup.com/researchdetails.aspx?articleId=2577 |title=Key Healthcare Reform Initiatives: Medicare Bundled Payment Pilots |publisher=Huron Consulting Group |date=November 19, 2010 |accessdate=January 9, 2012}}</ref> Under the new payment system, a single payment is paid to a hospital and a physician group for a defined episode of care (such as a hip replacement) rather than individual payments to individual service providers. In addition, the [[Medicare Part D coverage gap]] (commonly called the "donut hole") will shrink and be completely closed by January 1, 2020.<ref>{{cite web|title=More savings in the drug coverage gap coming through 2020|url=http://www.medicare.gov/part-d/costs/coverage-gap/more-drug-savings-in-2020.html|work=Medicare.gov|publisher=Centers for Medicare & Medicaid Services|accessdate=September 27, 2013}}</ref>
* Businesses who employ 50 or more people but do not offer health insurance to their full-time employees will pay a tax penalty if the government has subsidized a full-time employee's healthcare through tax deductions or other means. This is commonly known as the employer mandate.<ref>{{cite web|url=http://www.kff.org/healthreform/upload/7907.pdf |title=Explaining Health Care Reform: What is Employer "Pay-or-Play" Requirement?|year=2009|month=May|publisher=[[Kaiser Family Foundation]]|accessdate=January 9, 2012}}</ref><ref name=WSJ-mar25>{{cite news |title=What Health Overhaul Means for Small Businesses |author=McNamara, Kristen |url=http://online.wsj.com/article/SB10001424052748703312504575141533342803608.html |newspaper=The Wall Street Journal |date=March 25, 2010}}</ref>

==References==
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