What were three key items of the Patient Protection and Affordable Care Act?

No, there is no sanction. The Tax Cuts and Jobs Act of December 22, 2017 eliminates the financial penalties as of January 1, 2019 for individuals who do not have health coverage. The 'Individual shared responsiblity payment' disappears.

From 2020, when individuals taxable in the US will file their income tax return, they will automatically be exempted from having to pay a tax to the IRS.

However, some federal states may continue to impose taxes. It is essential to note that if the product you had in 2018 did not comply with the provisions of the 'Patient Protection and Affordable Care Act', you will still be subject to the payment of a federal tax in 2019.

The Patient Protection and Affordable Care Act was signed into law by President Obama on March 23, 2010. It is more commonly known as the Affordable Care Act (ACA) or its nickname, Obamacare. The ACA significantly changed the healthcare system in the U.S. by reducing the amount individuals and families paid in uncompensated care. The act requires every American to have health insurance and provides assistance to those who cannot afford a plan.

Because the law affects so many Americans, it is helpful to understand is the history of Obamacare and how it impacts you and your family. You can also learn more about your options for ACA-compliant health insurance plans with eHealth today. Our specialized brokers will help you find the right plan for you and your family. All eHealth services are available at no cost to you and you can purchase your plan online, by phone, or through our chat.

What is the Affordable Care Act?

The Affordable Care Act is a reformation of the health care law. It was referred to in the news as the Obamacare act, named after the president in office at the time.  The Affordable Care Act history timeline starts with its three goals.  Those are affordability, medical care that is innovative, and the expansion of Medicaid.

The main goal of the ACA was to ensure that every American could afford a health insurance plan. This allowed families whose income put them at poverty level to be able afford their health insurance premium. This is done in the form of issued tax credits.

The use of new health care methods has made coverage more affordable for everyone. Along the same lines, the expansion of Medicaid means that people who weren’t previously eligible for the plan are now.

Obamacare Projections vs. Actuals

2010 Exchange Enrollment Projections vs. ActualsYearCBOCMSActual20148 million116.9 million18 million2201513 million118.6 million111.7 million2201621 million124.8 million112.7 million22017Not forecastedNot forecasted10 million3

1 Mercatus Center: http://mercatus.org/publication/downgrading-affordable-care-act-aca-unattractive-health-insurance-and-lower-enrollment
2 Kaiser Family Foundation: Assessing ACA Marketplace Enrollment http://kff.org/health-reform/issue-brief/assessing-aca-marketplace-enrollment/
3 CBO Forecast: The Budget and Economic Outlook:2017 to 2027 

When did Obamacare start?

The timeline of key events leading up to the passage of the Obamacare law began in 2009. Here is a list of those events, along with key provisions that went into place after the law was enacted.

• July 2009: Speaker of the House Nancy Pelosi and a group of Democrats from the House of Representatives reveal their plan for overhauling the health-care system. It’s called H.R. 3962, the Affordable Health Care for America Act.
• August 25, 2009: Massachusetts Senator Ted Kennedy, a leading supporter of health-care reform, dies and puts the Senate Democrats’ 60-seat supermajority required to pass a piece of legislation at risk.
• September 24, 2009: Democrat Paul Kirk is appointed interim senator from Massachusetts, which temporarily restores the Democrats’ filibuster-proof 60th vote.
• November 7, 2009: In the House of Representatives, 219 Democrats and one Republican vote for the Affordable Health Care for America Act, and 39 Democrats and 176 Republicans vote against it.
• December 24, 2009: In the Senate, 60 Democrats vote for the Senate’s version of the bill, called America’s Healthy Future Act, whose lead author is senator Max Baucus of California. Thirty-nine Republicans vote against the bill, and one Republican senator, Jim Bunning, does not vote.

• January 2010: In the Senate, Scott Brown, a Republican, wins the special election in Massachusetts to finish out the remaining term of US senator Ted Kennedy, a Democrat. Brown campaigned heavily against the health-care law and won an upset victory in a state that consistently votes in favor of the Democratic party. 
• In January 2010, eHealth published research conducted by Opinion Research highlighting public perceptions of health-care reform.

• March 11, 2010:  Now lacking the 60th vote needed to pass the bill, Senate Democrats decide to use budget reconciliation to get one bill approved by the House and the Senate. The use of budget reconciliation only requires 51 Senators to vote in favor of the bill for it to go to the president’s desk for signature.
• March 21, 2010: The Senate’s version of the health-care plan is approved by the House in a 219-212 vote. All Republicans and 34 Democrats vote against the plan.
• March 23, 2010: President Obama signs the Affordable Care Act into law. 

Changes required by the Affordable Care Act immediately 

• March 23, 2010: Anyone who had already purchased a health insurance plan by this date had a plan with “grandfathered status.” The grandfather clause allowed current plans to stay the same as long as their insurer continued to offer that plan.
• March 23, 2010: Anyone who bought a health insurance plan after March 23, 2010 would eventually have to enroll in a new plan that met all of the new standards of the Affordable Care Act. The original deadline for this transition was January 1, 2014, or on a plan’s renewal date within the 2014 plan year.
• On April 7, 2010: eHealth publishes a list of FAQs and tips for consumers and small business owners who buy their own health insurance.

Changes required by the Affordable Care Act after 90 days 

• June 23, 2010:
  • Some small businesses qualified for tax credits of up to 35% of premiums.
  • Five billion dollars were allocated for individuals who could not qualify for insurance. These funds allowed them to buy insurance from the government instead.
  • A temporary reinsurance program was established to reimburse participating employment-based plans for a portion of the cost of providing health insurance coverage to early retirees.  
• July 1, 2010:
• September 14, 2010: eHealth publishes a list of FAQs, which includes a following timeline for the enactment of key changes. Bear in mind that some of these components changed during the ACA’s implementation.  

Changes required by the Affordable Care Act after 180 days 

• September 23, 2010 (Within six months of the ACA’s enactment):
  • Seniors are entitled to a $250 rebate to close the Medicare Part D coverage gap.
  • A government website is created to allow people to search for information about health insurance companies, available plans, and other essential facts.
  • Insurers are not permitted to exclude pre-existing conditions from coverage for children.
• October 19, 2010: eHealth publishes its first in a series of resources to help uninsured children navigate differences in individual states.

Changes required by the Affordable Care Act in 2011

• A provision goes into effect to protect patients’ choice of doctors. Specifics include allowing plan members to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an obstetrician/gynecologist (ob/gyn), and ensuring access to emergency care.
• Young adults can stay on their parents’ insurance until age 26, even if they are not full-time students. This extension applies to all new plans.
• All new health insurance policies must cover preventive care and pay a portion of all preventive care visits.
• A provision goes into effect that eliminates lifetime limits on coverage for members.
• Annual limits or maximum payouts by a health insurance company are now restricted by the ACA.
• The ACA prohibits rescission when a claim is filed, except in the case of fraud or misrepresentation by the consumer.
• Insurance companies must now provide a process for customers to make an appeal if there is a problem with their coverage.  

NOTE: In January, 2011: eHealth publishes 11 guides on the top child-only health insurance coverage that examined differences in implementation in numerous states.

Changes required by the Affordable Care Act in 2014 

• October 1, 2013: Health insurance exchanges scheduled to open for 2014 enrollment begin writing policies that go into effect January 1, 2014.
• January 2014: People buying insurance on their own get subsidies to help them pay their monthly insurance premiums. Premiums are allocated on a sliding scale, as determined by income. Any individual earning over 400% of the poverty level ($43,320 in 2009) does not qualify for subsidies.
• January 2014: When health insurance exchanges are operational, small business tax credits are up to 50% of premiums.
• January 2014: Insurance companies are required to provide health insurance to any adult aged 19 to 64 who applies for coverage.
• January 2014: To prevent people from waiting until they get sick to buy health insurance, the ACA requires all Americans to buy health insurance or pay a fine. The fine starts at $95 for an individual in 2014 and goes up each year until 2016, when the fine is $695 or 2.5% of a person’s annual income, whichever is greater.
• January 2014: Pre-Existing Condition Insurance Plans (PCIPs), established in 2010 are scheduled to expire on January 1, 2014 once all major ACA reforms go into effect.

Actual events that occurred as a result of the Affordable Care Act – 2011 to 2014

• January, 2011: In 2011, insurance companies had to ensure the value for premium payments. If insurance companies did not spend at least 80% to 85% of premiums on care (for individual, small group markets and large group) the difference is sent to customers in a refund.
• January 2011: A Florida judge rules that elements of the Affordable Care Act are unconstitutional.
• November 14, 2011: The US Supreme Court agrees to hear arguments in the Obamacare case brought by 26 states and the National Federation of Independent Business. It argues that elements of the Affordable Care Act are unconstitutional.

• June 28, 2012: The US Supreme Court upholds the major provisions of the Affordable Care Act.
• August 2012: The White House confirms the ACA’s “contraceptive mandate” for women’s preventive services without cost-sharing: HIV screening, contraception counseling, and domestic violence support services.
• November 6, 2012: President Obama is re-elected, effectively ensuring the ACA will survive.
• January 2013: The limit on pre-tax contributions to flex spending accounts is capped at $2,500 annually.
• July 2, 2013: The White House agrees to a one-year delay for large businesses to provide workers with affordable health care.
• October 1, 2013: Healthcare.gov, the federal exchange serving 36 states, experiences technical difficulties and eventually goes offline before reopening on December 2, 2013.
• October 1, 2013: Several state-run exchanges experience enrollment hurdles, including the exchanges in California, Oregon, Washington, and Maryland. Ultimately, some perform better than others.
• November 26, 2013: Eight Senate Democrats tell the Obama administration that they’re “troubled by the ongoing technical difficulties” with healthcare.gov and want an alternative way for insurers and web-based brokers to enroll subsidy-eligible consumers.
• December 2, 2013: Healthcare.gov, the federal exchange serving 36 states, reopens after experiencing technical difficulties and eventually going offline for several weeks.
• January 1, 2014: The bulk of the remaining regulatory changes in the Affordable Care Act go into effect.

• January, 2014: Health Affairs published its most recent analysis of Medical Loss Ratio performance by major insurers.
• March, 2014: The New York Times reports that the U.S. Census Bureau, the authoritative source of health insurance data changed its annual survey so thoroughly that it became difficult to measure the effects of President Obama’s health care law. 

• March 6, 2014: The federal government extends the two-year grace period for individuals enrolled in non-grandfathered health insurance plans.
• May 1, 2014: The US Department of Health and Human Services announces that more than 8 million people enrolled in a health insurance plan during the first Open Enrollment Period (OEP).
• March 4, 2015: The U.S. Supreme Court (SCOTUS) hears oral arguments for King v. Burwell, a lawsuit challenging U.S. Treasury regulation, 26 C.F.R. § 1.36B-2(a)(1), issued under the Patient Protection and Affordable Care Act (ACA). King argues that the ACA only allows subsidies to be distributed through state-run exchanges, and that regulations implemented by the IRS exceed the authority granted to it by Congress. (Read eHealth’s white paper on King vs. Burwell.)
• June 25, 2015:  The Supreme Court ruled 6-3 that subsidies could be distributed through Healthcare.gov, the Federal Exchange, if a state did not set up its own exchange.
• January 1, 2016: The threshold for itemizing medical expenses on taxes increases from 7.5% to 10% for seniors.

• May 12, 2016: U.S. District Judge Rosemary Collyer ruled that the ACA’s cost-sharing reduction (CSRs) subsidies, which pay a portion of an enrollee’s deductibles, do not have permanent funding in the legislation. This makes them subject to appropriations, which means they must be approved by the Congress. The ruling was placed on hold, pending an appeal.
• Tuesday, November 8, 2016: Donald Trump is elected to be the next president of the United States.
• November 20, 2016: Vice President-elect, Mike Pence, says “President-elect Donald Trump will prioritize repealing President Barack Obama’s landmark health care law right “out of the gate” once he takes office.

Subject2010 Projected2016 Actual Exchange Enrollees without subsidies (According to the HHS)25%217%2Spending on Subsidies in 2016 (According to the Motley Fool)
 $59 billion3$56 billion3Medicaid Enrollments 
 16 million11
(CBO by 2016)14.1 million12 
(Kaiser Family Foundation 2016)Census Uninsured
 20.3% in 201211.5% in 2016Old Way:12.5% uninsuredNew Way
 10.6% uninsured
 Prices20132016Individual Premiums
 $1979
(eHealth)$32110
(eHealth Price Index)Individual Deductibles
 $3,3199
(eHealth)$4,35810
(eHealth Price Index)Family Premiums
 $42610$83310Family Deductibles
 $4,23010$7,98310

What the ACA means for you

The Affordable Care Act is perhaps the greatest overhaul of the US health-care system, and it will provide coverage for over 94% of Americans. In addition, one of its key reforms includes health coverage for adults with pre-existing conditions, which generally had not been available up until now.

These great changes in health-care insurance can benefit you and your loved ones. However, it is still essential to find the best plans at the best price to ensure your family is properly covered.

To learn about the specific Obamacare-compliant health insurance plan options available to you—plus see if you are eligible for a government subsidy to help pay for a plan—compare ACA-compliant health insurance plans with eHealth today.

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