	Introduction

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act ( P.L. 111-148 , ACA). 111-152 , the Health Care and Education Reconciliation Act of 2010 (HCERA). Throughout this report, this amended version is referred to as ACA. However, in general, ACA did not make any significant changes to the Department of Defense (DOD) TRICARE program or to the Department of Veterans Affairs (VA) health care system. Moreover, many have sought clarification as to whether certain provisions in ACA, such as a mandate for most individuals to have health insurance, or extending dependent coverage up to age 26, would apply to TRICARE and VA health care beneficiaries. To address some of these concerns, Congress has introduced and/or enacted legislation. Questions and Answers

		How Does ACA Affect TRICARE? The TRICARE Affirmation Act ( H.R. 4887 ; P.L. 111-159 ), signed into law on April 26, 2010, amended the Internal Revenue Code to provide that TRICARE coverage satisfies the minimum essential coverage requirements as required by ACA. Likewise, P.L. 111-173 , signed into law on May 27, 2010, clarifies that those enrolled in the VA health care system meet the minimum essential coverage requirement. It was initially unclear whether the Spina Bifida Health Care Program (SBHCP) and the Children of Women Vietnam Veterans Health Care Program (CWVV) met the "minimum essential coverage" requirement under ACA. However, P.L. Subsequent to the passage of the ACA, however, the Ike Skelton National Defense Authorization Act for Fiscal Year 2010 ( P.L. The ACA provision amended the Public Health Service Act to include a Section 2714 that provides: 
A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age. This requirement relating to coverage of adult children took effect for the plan years beginning on or after September 23, 2010. In the 113 th Congress, the CHAMPVA Children's Protection Act of 2013 ( H.R. 288 ) and a similar measure ( S. 325 ) have been introduced. Section 1781(c) to extend eligibility for coverage of children under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) until they reach age 26 so that eligibility for coverage of children under CHAMPVA will be consistent with certain private sector coverage under the Affordable Care Act.
The 111th Congress passed, and the President signed into law, the Patient Protection and Affordable Care Act (P.L. 111-148; ACA), which was later amended by the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152; HCERA), and is hereinafter referred to as ACA. In general, ACA did not make any significant changes to the Department of Defense (DOD) TRICARE program or to the Department of Veterans Affairs (VA) health care system. However, many have sought clarification as to whether certain provisions in ACA, such as a mandate for most individuals to have health insurance, or extending dependent coverage up to age 26, would apply to TRICARE and VA health care beneficiaries.
To address some of these concerns, Congress has introduced and/or enacted legislation. The TRICARE Affirmation Act (P.L. 111-159), signed into law on April 26, 2010, affirms that TRICARE satisfies the minimum essential coverage requirement in ACA. Similarly, P.L. 111-173, signed into law on May 27, 2010, clarifies that the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), Spina Bifida Health Care Program, and the Children of Women Vietnam Veterans Health Care Program meet the "minimum essential coverage" requirement under ACA. TRICARE coverage of children was extended to age 26 by the Ike Skelton National Defense Authorization Act for Fiscal Year 2011 (P.L. 111-383).
ACA requires that if a health insurance plan provides for dependent coverage of children, the plan must continue to make such coverage available for an adult child until age 26. This requirement relating to coverage of adult children took effect for the plan years beginning on or after September 23, 2010. Under ACA, both married and unmarried children qualify for this coverage. The authorizing statute for CHAMPVA currently does not conform to this ACA requirement. Furthermore, although the TRICARE authorizing statute has been amended to provide for coverage of children until age 26, the coverage provided by the new legislation differs from that required by ACA in some important ways. To address CHAMPVA's nonconformance with ACA's requirements, the CHAMPVA Children's Protection Act (H.R. 288) and a similar measure (S. 325) have been introduced in the 113th Congress.
This report addresses key questions concerning how ACA affects TRICARE and VA health care.