Although many receive coverage through publicly funded programs (e.g., Medicare and Medicaid), private health insurance is the predominant form of health coverage in the United States. Most individuals and families obtain private insurance through small- or large-group coverage, such as employer-sponsored insurance; some individuals and families purchase private insurance on their own in the non-group market. 111-148 , as amended) includes several provisions that affect the private health insurance market. To help accommodate individuals who have access to private health insurance as a result of these (and other) provisions, individuals and small businesses can shop for and purchase private coverage in health insurance exchanges (marketplaces). The ACA's individual mandate requires most individuals to maintain health insurance coverage or pay a penalty for noncompliance. The ACA created three risk mitigation programs—reinsurance, risk corridors, and risk adjustment—to help health insurance issuers adjust to the reformed private health insurance landscape, particularly the new entrants to the market and the changes to how issuers set premiums. The ACA also includes some provisions that states may choose to implement. This report provides an overview of many of the ACA provisions that affect the private health insurance market. 104-191 ), which requires guaranteed issue in the small-group market in all states. Related CRS Reports

CRS Report RL32237, Health Insurance: A Primer CRS Report R42069, Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA) CRS Report R44163, The Patient Protection and Affordable Care Act's Essential Health Benefits (EHB) CRS Report R42735, Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act (ACA): Issues for Congress CRS Report R44065, Overview of Health Insurance Exchanges CRS Report R44425, Eligibility and Determination of Health Insurance Premium Tax Credits and Cost-Sharing Subsidies: In Brief CRS Report R41331, Individual Mandate Under the ACA CRS Report R43981, The Affordable Care Act's (ACA) Employer Shared Responsibility Determination and the Potential ACA Employer Penalty CRS Report R44414, Consumer Operated and Oriented Plan (CO-OP) Program: Frequently Asked Questions
Private health insurance is the predominant form of health insurance coverage in the United States, covering about two-thirds of Americans in 2014. The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) builds on and modifies existing sources of private health insurance coverage—the non-group (individual), small-group, and large-group markets. The ACA provisions follow a federalist model in which they establish federal minimum requirements and give states the authority to enforce and expand those federal standards.
The ACA includes provisions that restructure the private health insurance market by
implementing market reforms that impose requirements on insurers and sponsors of health insurance (e.g., employers); creating health insurance exchanges (marketplaces) in which individuals and small businesses can shop for and purchase private health plans that meet or exceed federal standards; providing financial assistance to qualified individuals and small employers who purchase health plans through an exchange; establishing an individual mandate, which requires most individuals to either maintain health insurance coverage or pay a penalty; creating three risk mitigation programs to help health insurance issuers adjust to the reformed private health insurance landscape; assessing penalties on certain employers that either do not provide health insurance or provide health insurance that does not meet certain criteria; and including some state-option provisions, which states may choose to implement.
This report provides a broad overview of some of the private health insurance provisions in the ACA and directs readers to more in-depth CRS reports.