Note: This is the first in a three-part blog series highlighting the upcoming 10th anniversary of the Affordable Care Act (ACA). We invite you to visit ACA Now, the most comprehensive and user-friendly online resource summarizing key developments for every provision of the law over the past decade.
The Affordable Care Act (ACA) – the reigning law of the land for U.S. health care coverage – is suspended within a precarious tension. On the one hand, Republican policymakers continue the case against the law, seeking its dissolvement through the latest major court case against it, Texas v. Azar. On the other, the sweeping health reforms and the foundational programs that ensued – from the ACA Marketplaces to the state-led Medicaid expansions – have become such integral components of our health care system, extending coverage to more than 20 million individuals.
Let’s look first at the courts. After the law survived the battle of NFIB v. Sebelius, which aimed to nullify the ACA’s individual mandate to obtain qualifying health coverage, critics of the law finally succeeded in effectively eliminating its associated penalty in the Tax Cuts and Jobs Act of 2017. Shortly thereafter, 20 Republican state attorneys general and governors filed a lawsuit arguing that the legal integrity of the ACA could no longer be maintained following the elimination of the individual mandate – a concept known as severability. In December 2019, a federal appeals court failed to help clarify the matter, ruling the individual mandate as unconstitutional, but leaving it to the lower courts to decide whether the rest of the law remains valid. The fate of the law is expected to again reach the Supreme Court (though the Court is in no rush to deliberate on the matter).
Which brings us to today. One might wonder what the ACA has to show for itself after a 10-year run. The answer is a good amount. For starters, it is now a political given, and not a faraway hope, that those with pre-existing conditions are better positioned to secure robust health coverage than prior to the ACA individual market reforms. A recent analysis suggests that nearly 54 million people (27 percent of adults under 65) would be rendered uninsurable absent the individual market reforms enacted by the ACA. Moreover, ACA plan premiums are beginning to moderate and the individual market is seeming to stabilize. More insurers are beginning to enter the marketplaces and offer plans to consumers. Racial and ethnic disparities have narrowed. Many (not all, realistically speaking) signs here are pointing north.
To put a finer point on it: With the cards very much stacked against it, the ACA has worked to improve the health care coverage status for millions of Americans. So much of the law has been implemented and has become core to the functioning of the U.S. health care system.
Presenting ACA Now
Ten years in, Wynne Health Group presents our archival snapshot of the ACA’s journey thus far, in what we are calling ACA Now. For those interested in its history, we have for you a free catalogue of each major implementation milestone for every ACA provision. We hope this serves as a helpful resource and guide for the many who continue to study the law and examine its wide-ranging provisions, which include (among many others):
- Implementation of Exchanges under Section 1311 of the ACA (see here);
- ACA-Authorized Medicaid Expansion (see here);
- Research Conducted under the Patient-Centered Outcomes Institute (PCORI) (see here); and
- Implementation, Delay, and Eventual Repeal of Several ACA Taxes (see here).
Each section contains a brief summary of the provision, all implementation steps over the past decade, and the ACA’s original text for reference. And the good news is that the story is not yet over. The ACA has survived its day in court several times now. Many legal experts agree that it is unlikely another encounter with the Supreme Court would be any different. If we’ve gotten this far in 10 years amid a fractured political climate, imagine what we could do in one that is aligned on a solutions-oriented mindset.
Josh LaRosa is a Policy Director at Wynne Health Group, focusing primarily on regulatory affairs with an emphasis on the FDA and CMS. His interests lie in delivery reform and innovations in payment and care delivery models. You can reach Josh via email at email@example.com, and can find him on LinkedIn and Twitter as well.