Learn more about the Patient Protection and Affordable Care Act, how it works, its advantages and disadvantages, and more.
Patient Protection and Affordable Care Act Definition and Examples
The Patient Protection and Affordable Care Act is a law that contains comprehensive health insurance reforms designed to help achieve near-universal, affordable health coverage. The law’s provisions create premium and cost-sharing subsidies, lay new rules for the health insurance industry, and create a new market for health insurance purchasing. Consumers are also protected from detrimental insurance industry practices, such as denying coverage due to a preexisting health condition.
Alternate name: Affordable Care Act, ObamacareAcronym: PPACA, ACA
How the Patient Protection and Affordable Care Act Works
On March 23, 2010, President Obama enacted the ACA, putting in place reforms that guarantee access to near-universal, affordable health insurance coverage from birth through retirement. More than 10 years since its enactment, the ACA has reduced the number of uninsured Americans by 20 million and extended vital consumer protections to over 100 million citizens. The U.S. Department of Health & Human Services reported in June 2021 that a record number of Americans—31 million—had health coverage through the Affordable Care Act. Since the law’s coverage expansions took effect, every state in the country has seen a reduction in uninsurance rates. More than 11 million people enrolled in an ACA Marketplace plan as of February 2021, and 14.8 million newly eligible people enrolled in Medicaid through the ACA’s expansion of eligibility to adults as of December 2020. Consisting of nine distinct legislative titles, the Affordable Care Act has four major reforms.
Stronger Consumer Rights and Protections
The ACA’s Patient’s Bill of Rights ended medical underwriting and preexisting-condition exclusions, so insurance companies are unable to deny you or charge you more for coverage based on your health status or medical condition. The law also scraps lifetime dollar caps on essential health benefits and the annual dollar limit on what insurers spend for your coverage.
More Affordable Coverage
The ACA provides more affordable coverage by reducing health care costs and requiring accountability for health care dollars. Its 80/20 rule generally requires that insurance companies spend at least 80% of your premium dollar on health care and quality improvements; otherwise, they must issue a rebate. The ACA has also tightened the review of rate increases by mandating that insurance companies justify their reasons for raising insurance rates by 15% or more before they enforce the rate changes.
Better Access to Health Care
The ACA not only provides better access to care but also offers a range of health insurance choices. For starters, it gives you access to several recommended preventive health services, including diabetes, cancer, and blood screenings, without requiring any additional cost-sharing in the form of deductibles or copays. Second, young adults who fail to secure health coverage through their jobs can remain on their parents’ health plans until they are 26 years old. The ACA law improved access to health care by creating the Health Insurance Marketplace (HIM). HIM is a federal- and state-level one-stop-shop online exchange where you can purchase a private health insurance plan directly from insurers that matches your needs.
Strengthen Medicare
The Affordable Care Act strengthens Medicare for over 61 million Americans who rely on the program by fighting fraud, adding benefits, and improving care for patients. The health care law provides relief for seniors with a coverage gap in their prescription drug costs. Seniors can receive recommended preventive services like diabetes screenings and flu shots for free. The ACA also helps reduce waste—as well as curb fraud and abuse in public programs—through tougher screening procedures, prolonged oversight periods for new suppliers and providers, and stronger penalties. Low-income families, qualified pregnant women, qualified children, and individuals receiving Supplemental Security Income are automatically eligible for the Medicaid program. Still, the ACA enabled states to expand Medicaid to cover nearly all low-income Americans under age 65. Eligibility for children was extended to at least 133% of the federal poverty level in every state, and most state jurisdictions were given the option to extend eligibility to adults who meet that income level, as well.
How To Get ACA Health Coverage
You can apply for or change your 2022 ACA health insurance during the open enrollment period that runs through Jan. 15, 2022. If you don’t enroll in a health plan by that date, you won’t secure coverage unless you have a qualifying special event. You can apply for ACA health coverage in any of these ways:
Apply online. Visit HealthCare.gov to get benefits through the ACA Health Insurance Marketplace. You may be redirected to your state’s Marketplace website.Use a certified enrollment partner’s website. You can use the website of an approved enrollment partner, say an insurance company, to apply and enroll in a Marketplace plan.Contact the Marketplace Call Center. A representative at the Marketplace call center (800-318-2596) can help you fill out an application and enroll.Mail your paper application. You can send in your paper application via mail and wait to receive your eligibility results in two weeks.
Notable Happenings
The Patient Protection and Affordable Care Act altered the health insurance landscape with numerous insurance reforms, but it has since undergone several changes. In 2017, legislation was passed to revoke the mandate that required most people to either have health insurance or pay a tax penalty. The mandate removal went into effect in 2019. Under the Trump administration, short-term plans were re-introduced in 2018, allowing for policies that provided coverage for as little as a few months to up to 364 days. While these policies present lower premiums than ACA-compliant plans, they are not governed by the rules of the ACA; therefore, insurers can be more selective in their coverage offerings. For example, these plans are not subject to the prohibitions on preexisting condition exclusions or lifetime and annual dollar limits. Many such plans also exclude benefits for prescriptions, maternity care, preventive care, mental health services, and substance abuse treatment. The ACA has also placed a limit on the amount of cost-sharing that families and individuals can pay for care annually. It now places maximum annual out-of-pocket spending limits on Marketplace plans, with lower limits for cost-sharing-reduction plans. In 2022, the maximum out-of-pocket limit is $8,700 for individuals and $17,400 for families. In 2022, individuals with an income of up to 150% of the federal poverty level won’t contribute to their premium. Meanwhile, a contribution of up to 8.5% of the household income is required for those with income above 400% of the federal poverty level. Before July 2021, consumers at 150% of the FPL had to contribute more than 4% of their household income for the benchmark plan.
