The Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act (ACA) or Obamacare, is a law that puts in place comprehensive health insurance reforms that will be implemented in stages over a multi-year period. The purpose of the law is to provide quality, affordable health care for all Americans. It will allow individuals, families, and small businesses to choose insurance coverage in an open, competitive insurance market. The Act also requires insurance companies to provide more coverage, reduce costs, and provide healthcare to those individuals previously disqualified.
In California, Covered California is the marketplace for health insurance as well as the primary source of information about how the ACA is implemented for California residents and businesses. For broader information about the ACA or information for states other than California, the official websites for the Affordable Care Act and the Health Insurance Marketplace are also available now.
- Ends Pre-Existing Condition Exclusions for Children: Health plans can no longer limit or deny benefits to children under 19 due to a pre-existing condition.
- Keeps Young Adults Covered: If you are under 26, you may be eligible to be covered under your parent’s health plan.
- Ends Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage just because you made an honest mistake.
- Guarantees Your Right to Appeal: You now have the right to ask that your plan reconsider its denial of payment.
- Shared Responsibility Provision (sometimes called the Individual Mandate): Everyone, with some exceptions, will be required to have a minimum essential coverage or pay a penalty.
- Ends Lifetime Limits on Coverage: Most benefits are banned from having a lifetime limit on coverage for all new health insurance plans.
- Reviews Premium Increases: Insurance companies must now publicly justify any unreasonable rate hikes.
- Helps You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily on health care – not administrative costs.
- Covers Preventive Care at No Cost to You: You may be eligible for recommended preventive health services without a copayment.
- Protects Your Choice of Doctors: Choose the primary care doctor you want from your plan’s network.
- Removes Insurance Company Barriers to Emergency Services: You can seek emergency care at a hospital outside of your health plan’s network.
2010: A new Patient's Bill of Rights goes into effect. Cost-free preventative services begin for many Americans.
2011: People with Medicare can get key preventive services for free and receive a 50% discount on brand name drugs that fall in the Medicare Part D coverage gap (Donut Hole).
2013: Open enrollment in the Health Insurance Marketplace begins on October 1st.
2014: Insurance plans are prohibited from discriminating due to pre-existing conditions or gender, annual limits on insurance coverage are eliminated , tax credits for middle and lower income people go into effect, Medicaid will be available to a larger population.
2015: Physicians will be paid based on quality of care rather than the number of patients that are treated.
2016: Republicans win U.S. Presidential election and control of U.S. Senate and House of Representatives. Republicans have expressed intention to repeal the Affordable Care Act.
2017: Republicans fail to repeal the Affordable Care Act. The administration ends cost-sharing reduction payments by executive order. Business and policy analyst Avalere projects that premiums for healthcare coverage will increase by an average of 34% as a result of ending cost-sharing reduction payments.
2018: Despite the ruling in Texas about the constitutionality of the ACA, IRS reporting requirements are still in force for filing your 2018 taxes. 2019 IRS reporting will change, as individuals will not receive a tax penalty for failing to have proof of ACA compliant insurance coverage.
The exact language of changes enacted in 2018, for 2019 implementation can be found online in the Federal Register .
The California Health Care Foundation (an independent non-profit organization) provides an evaluation of current issues about the ACA.
The Health Insurance Marketplace is a generic term for the provision of the ACA that requires an open, comptetitive market of insurers to serve each state. Some states will institute their own Marketplace and in other states the Federal Govenment will provide the Marketplace. The Health Insurance Marketplace for California is Covered California. The Health Insurance Marketplace is designed to make buying health coverage easier and more affordable.
Individuals and small business will be able to compare plans, ask questions, find out eligibility for tax credits or health programs, and enroll in a health plan.