Affordable Care Act

Affordable Care Act

Long title	An Act Entitled The Patient Protection and Affordable Care Act
Acronyms (colloquial)	ACA, PPACA
Nicknames	Obamacare, Affordable Care Act, Health Insurance Reform, Healthcare Reform
Enacted by	the 111th United States Congress
Effective	March 23, 2010; 14 years ago (2010-03-23) Most major provisions phased in by January 2014; remaining provisions phased in by 2020; penalty enforcing individual mandate set at $0 starting 2019
Citations
Public law	111–148
Statutes at Large	124 Stat. 119 through 124 Stat. 1025 (906 pages)
Codification
Acts amended	Public Health Service Act
Legislative history
Introduced in the House as the "Service Members Home Ownership Tax Act of 2009" (H.R. 3590) by Charles Rangel (D–NY) on September 17, 2009 Committee consideration by Ways and Means Passed the House on November 7, 2009 (220–215) Passed the Senate as the "Patient Protection and Affordable Care Act" on December 24, 2009 (60–39) with amendment House agreed to Senate amendment on March 21, 2010 (219–212) Signed into law by President Barack Obama on March 23, 2010
Major amendments
Health Care and Education Reconciliation Act of 2010 Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 Tax Cuts and Jobs Act of 2017
United States Supreme Court cases
National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012) Burwell v. Hobby Lobby Stores, Inc., 573 U.S. 682 (2014) King v. Burwell, 576 U.S. 473 (2015) Zubik v. Burwell, No. 14-1418, 578 U.S. ___ (2016) Maine Community Health Options v. United States, No. 18-1023, 590 U.S. ___ (2020) Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, No. 19-431, 591 U.S. ___ (2020) California v. Texas, No. 19-840, 593 U.S. ___ (2021) Cummings v. Premier Rehab Keller, P.L.L.C., No. 20-219, 596 U.S. ___ (2022)

The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965.^[1][2][3][4]

The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered.^[5][6] The law also enacted a host of delivery system reforms intended to constrain healthcare costs and improve quality. After it went into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans.^[7]

The increased coverage was due, roughly equally, to an expansion of Medicaid eligibility and to changes to individual insurance markets. Both received new spending, funded through a combination of new taxes and cuts to Medicare provider rates and Medicare Advantage. Several Congressional Budget Office (CBO) reports said that overall these provisions reduced the budget deficit, that repealing ACA would increase the deficit,^[8][9] and that the law reduced income inequality by taxing primarily the top 1% to fund roughly $600 in benefits on average to families in the bottom 40% of the income distribution.^[10]

The act largely retained the existing structure of Medicare, Medicaid, and the employer market, but individual markets were radically overhauled.^[1][11] Insurers were made to accept all applicants without charging based on preexisting conditions or demographic status (except age). To combat the resultant adverse selection, the act mandated that individuals buy insurance (or pay a monetary penalty) and that insurers cover a list of "essential health benefits".

Before and after enactment the ACA faced strong political opposition, calls for repeal and legal challenges. In National Federation of Independent Business v. Sebelius, the Supreme Court ruled that states could choose not to participate in the law's Medicaid expansion, but upheld the law as a whole.^[12] The federal health insurance exchange, HealthCare.gov, faced major technical problems at the beginning of its rollout in 2013. Polls initially found that a plurality of Americans opposed the act, although its individual provisions were generally more popular.^[13] By 2017, the law had majority support.^[14] The Tax Cuts and Jobs Act of 2017 set the individual mandate penalty at $0 starting in 2019.^[15] This raised questions about whether the ACA was still constitutional.^[16][17][18] In June 2021, the Supreme Court upheld the ACA for the third time in California v. Texas.^[19]