In 2010, President Barack Obama signed the Patient Protection and Affordable Care Act into law. This healthcare reform effort, which you may know better as the ACA or Obamacare, sought to lower the cost of healthcare coverage to make it more accessible for average Americans. Since then, it’s given nearly 31 million Americans access to insurance they might not have been able to obtain otherwise. It has also seen numerous changes. This Affordable Care Act history timeline will highlight some of those key changes.
Nearly every year since its inception, the Affordable Care Act has introduced new elements and shifted old ones. From establishing organizations and initiatives to streamlining how care is delivered, to altering rules and regulations around what insurers, employers, and patients can and must do, there’s a lot to track. It may seem daunting, but this brief health insurance history lesson should help out.
Affordable Care Act History in 2010
The Affordable Care Act was signed into law on March 23, 2010. Here were its main provisions:
- Health insurance was made available to those who had previously been denied coverage due to having a “pre-existing condition.” This was thanks to the Pre-Existing Condition Insurance Plan (PCIP).
- Tax credits for small businesses, up to 35% of the cost of coverage for qualifying small employers, took effect.
- An external review process was established for coverage and claim determinations. Consumers were given a path to appeal decisions on their healthcare claims.
- Adult children could remain on their parents’ insurance until age 26.
Affordable Care Act History in 2011
In 2011, the ACA beefed up protections and accessibility for patients, including:
- Further protections for those with pre-existing conditions.
- Removal of lifetime limits for coverage.
- Securing a patient’s choice of physicians – ensuring access to emergency care and prohibiting prior authorizations for things like ob/gyn visits.
- Allocation of funds to expand community health centers.
Affordable Care Act History in 2012
This was a busy year for the ACA. Many provisions, initiatives, and organizations were announced, though most were not enacted or established until later. Here’s what took effect that year:
- Community Living Assistance Services and Supports (CLASS) was established to provide basic long-term care, like home help and nursing home services, to Americans in need.
- Creation of the Hospital Value-Based Purchasing Program, called Hospital VBP, or just VBP. It incentivized high-quality care in inpatient acute care settings by offering additional payments.
Healthcare.gov, the federal health insurance marketplace, was officially brought online – though it had a rocky start. While open enrollment through the Marketplace began on October 1st of that year, the service wasn’t fully stable until December 3rd.
That may have been the most memorable ACA development of the year, but it wasn’t the only one. In 2013, payment bundling – where medical providers and hospitals are paid a flat rate for one procedure, instead of multiple smaller bills – was introduced in an effort to make care more efficient. The Affordable Care Act also imposed a 2.3% sales tax on the sale of certain medical devices to offset the cost of providing healthcare coverage to Americans.
While many of the ACA’s major regulatory provisions were established or introduced earlier, January 1, 2014 marked the official starting point for most of them.
- In many states, Medicaid eligibility was revised and expanded to include those earning up to 138% of the federal poverty level – childless adults included.
- Insurance companies were prohibited from charging higher rates based on pre-existing conditions or gender. Prior to 2014, women regularly paid higher premiums for insurance.
- While originally announced in 2012, new rules regarding the way healthcare payments were received and processed were made effective. In addition to simplifying billing with standardized identifiers and claims attachments, these regulations required health plans to comply with all HIPAA rules and standards.
By 2015, the number of uninsured people in the US had fallen by nearly 13 million, and the ACA wasn’t yet done expanding.
- To assist with implementing state-level marketplaces and ongoing ACA reforms, the Center for Consumer Information and Insurance Oversight (CCIIO) was formed.
- A 40% tax on high-cost, employer-sponsored coverage, which was intended to recoup costs associated with ACA programs, was introduced. However, this “Cadillac Tax” would never see full implementation.
- The Protecting Affordable Coverage for Employees Act (PACE Act), which brought employers with 51 to 100 employees under the umbrella of large employers for the purposes of health insurance, was signed into law in mid-September.
Despite campaign promises from the Trump Administration to repeal the Affordable Care Act immediately, the health care reforms remained in place. Instead, a few of the changes remaining from the Obama Administration were implemented:
- The Center for Medicare and Medicaid Innovation, announced back in 2012, was formally established. Its purpose was to ensure that reforms would continue to happen, improving both Medicare and Medicaid.
- By 2016, qualifying employers were required to offer affordable (9.5% of total compensation) health insurance that covered at least 60% of the cost of covered procedures and services.
The Patient-Centered Outcomes Research Institute (PCORI), an independent and government-sponsored research organization, was established. The PCORI provided patients, providers, and policymakers with relevant information about healthcare issues, with the goal of improving outcomes at both the individual and national levels.
This year also saw a few major changes from the Trump Administration:
- The individual mandate, which required individuals to carry health insurance for at least nine months out of the year, was repealed in December as part of the Tax Cuts and Jobs Act.
- Cost-sharing subsidies to insurance providers, intended to keep premiums lower, were ended.
- States were permitted to add work requirements to Medicaid eligibility at their discretion.
For 2018, the open enrollment period was shortened, from ending in January of the following year to ending in mid-December. This was later changed again, largely in response to the 2020 Pandemic. Tax credits and cost-sharing reductions were also again expanded.
This year saw three significant changes:
- The individual mandate penalty was eliminated. Individuals without coverage no longer received a tax penalty for not being covered.
- Effective January 14th, group health plans – typically offered through an employer – were given the ability to deny coverage for services based on moral or religious beliefs.
- The Cadillac Tax was repealed before being implemented.
Accessibility was expanded this year. We saw:
- New regulations to better ensure that large employers were providing at least Minimum Essential Coverage (MEC) at a rate affordable to their employees.
- New rules were introduced to Medicaid regarding the coverage of drugs and therapies used to treat opioid disorders, ensuring that those on Medicaid suffering from opioid addiction could afford to seek treatment.
- A proposed rule from the Centers for Medicare & Medicaid Services sought to improve access to healthcare information and further streamline prior authorization by requiring modern, electronic processes. While proposed in 2020, it is not yet in place.
The Biden Administration sought to offset the impact of COVID-19 with the American Rescue Plan Act. The ARPA extended eligibility for health insurance subsidies to those on unemployment insurance and those making between 100% and 400% of the national poverty level. This made ACA tax credits available to millions of Americans who did not qualify in 2020.
Wrapping Up Affordable Care Act History
As you can see, the Affordable Care Act has hardly been a static law. This history-changing healthcare reform has adjusted each year since 2010, changed by new administrations, and shifted to account for world-shaking events like the COVID-19 Pandemic. These changes haven’t been for nothing, either. Ensuring coverage for those with pre-existing conditions, providing subsidies and tax credits, adjusting eligibility for insurance, and eliminating discriminatory premium rates, has helped to bring the nation’s uninsured rate to an all-time low of 8%. Call WNC Health Insurance now to see if you qualify for ACA health insurance! Most Americans do!
To learn more about the Affordable Care Act, talk with one of our friendly licensed individual health insurance experts! Call: (828) 681-8223