what is the affordable care act aca 
the affordable care act aca is the comprehensive healthcare reform signed into law by then president barack obama in march 2010 formally known as the patient protection and affordable care act and commonly referred to as obamacare the law includes a list of healthcare policies intended to expand access to health insurance to millions of uninsured americans 1the law expanded medicaid eligibility created health insurance exchanges mandated that americans purchase or otherwise obtain health insurance and prohibited insurance companies from denying coverage due to preexisting conditions 1understanding the affordable care act aca the aca was designed to reform the health insurance industry and help reduce the cost of health insurance coverage for individuals who qualify the law includes premium tax credits and cost sharing reductions to help lower expenses for lower income individuals and families the aca requires most insurance plans including those sold on the health insurance marketplace to cover a list of preventive services at no cost to policyholders that include checkups patient counseling immunizations and numerous health screenings 2all aca compliant health insurance plans must cover specific essential health benefits such as emergency services family planning maternity care hospitalization prescription medications mental health services and pediatric care 3the law allows states to extend medicaid coverage to a wider range of people as of september 2022 39 states and the district of columbia had exercised that option 4every year there is an open enrollment period on the health insurance marketplace during which people can buy or switch insurance plans enrollment outside of the open season is allowed only for those whose circumstances change such as marrying divorcing becoming a parent or losing a job that provided health insurance coverage 5the inflation reduction act of 2022 extends the expanded aca for three years through 2025 for people who need financial assistance it also allows medicare to negotiate the cost of prescription drugs and place an annual cap of 2 000 on the cost of drugs the aca extension is expected to cost an estimated 64 billion 67key features of the affordable care actprovisions included in the aca expand access to insurance increase consumer protections emphasize prevention and wellness improve quality and system performance expand the health workforce and curb rising healthcare costs 8the aca requires employers to cover their workers and provides tax credits to certain small businesses that cover specified costs of health insurance for their employees it created state or multistate based insurance exchanges to help individuals and small businesses purchase insurance the law expanded medicaid coverage for low income individuals and allows young adults to remain on parents policies until age 26 part of the aca until 2017 was the individual mandate a provision requiring all americans to have healthcare coverage either from an employer or through the aca or another source or face tax penalties 9the aca prohibits lifetime monetary caps on insurance coverage limits the use of annual caps and establishes state rate reviews for insurance premium increases it prohibits insurance plans from excluding coverage for children with preexisting conditions and canceling or rescinding coverage the prevention and public health fund established under the aca provides grants to states for prevention activities such as disease screenings and immunizations and the national prevention health promotion and public health council addresses tobacco use physical inactivity and poor nutrition the aca requires insurance plans to cover preventive care such as immunizations preventive care for children screening for certain adults for conditions such as high blood pressure high cholesterol diabetes and cancer and a public education campaign for oral health the aca requested investments in health information technology it addressed guidelines to reduce medical errors and create payment mechanisms to improve efficiency and results and improve care coordination among providers the law requires oversight of health insurance premiums and practices reducing healthcare fraud and uncompensated care to foster comparison shopping in insurance exchanges to increase competition and price transparency pros and cons of the affordable care actexpands healthcare availability to more citizensprevents insurers from making unreasonable rate increasesindividuals with preexisting health conditions cannot be deniedcoverage for additional screenings immunizations and preventive carethose already insured saw an increase in premiumstaxes were created to help supplement the aca including taxes on medical equipment and pharmaceutical salesthe enrollment period is limited for new enrolleesmany businesses curtailed employee hours to avoid providing medical insuranceupdates to the affordable care actwith his election in 2016 then president donald trump launched efforts to repeal and replace the aca stating that the united states should delay the implementation of any provision or requirement of the patient protection and affordable care act that would impose a fiscal burden on any state 10in december 2017 the tax cuts and jobs act tcja removed the penalty for individuals not having health insurance and substantially scaled back the outreach program to help americans sign up for the aca cutting the enrollment period in half by 2018 the number of americans covered under the aca had dropped to 13 8 million from 17 4 million in 2015 according to a report from the kaiser family foundation a healthcare research organization 11in 2021 president biden signed an executive order to focus on the rules and other policies that limit americans access to health care prompting federal agencies to examine five areas including preexisting conditions policies undermining the health insurance marketplace enrollment roadblocks and affordability covid 19 relief legislation the american rescue plan act arpa extended eligibility for aca health insurance subsidies to those buying their health coverage on the marketplace with incomes over 400 of poverty 12with the passage of the inflation reduction act signed into law by biden on aug 16 2022 financial assistance was extended for people enrolled in the aca through 2025 instead of 2022 it also expands eligibility allowing more middle class citizens to receive premium assistance the legislation passed in both the house of representatives and the senate 7