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Patient Protection and Affordable Care Act

In March 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA), which provides millions of Americans access to affordable health care insurance through federal and state health care Marketplaces, as well as through the expansion of existing Medicaid programs. The FAH strongly supported the ACA due to the new coverage the law would make available to the growing number of uninsured Americans in this country.

The ACA included numerous health insurance reforms, such as:

  • Prohibiting pre-existing condition exclusions
  • Requiring guaranteed issue and renewability
  • Modified community rating

The Marketplaces and insurance market reforms are intended to provide a greater number of Americans with health insurance coverage that allows them to access hospital and other provider services.

There have been ongoing legal challenges to the ACA that could affect implementation of the law and whether consumers can access health insurance coverage for hospital and other provider services.

  • In June 2012, the United States Supreme Court upheld the constitutionality of the ACA’s individual mandate to purchase health insurance; that same decision, as a practical matter, made Medicaid expansion optional for states.
  • In July 2014, the United States Supreme Court struck down the ACA requirement to offer contraceptive coverage.

Other legal challenges continue. Currently pending before the Supreme Court is a challenge to an Internal Revenue Service regulation permitting federal tax credits (subsidies) to assist needy consumers to purchase health care insurance on both federal and state Exchanges. A Supreme Court decision is expected in June 2015.

Implementing ACA

Additionally and apart from legal challenges, the ACA raises a number of issues affecting hospitals and consumers, related to both health insurance reforms and operation of the Exchanges. These challenges include:

  • Ensuring coverage of hospital services for patients under so-called “skinny plans”;
  • Ensuring adequate health plan networks that provide consumers with meaningful access to providers, including essential community providers;
  • Reference pricing strategies that could confuse consumers and significantly and unexpectedly burden them with steep out-of-pocket costs;
  • Permitting flexibility for third parties that may wish to offer financial assistance to needy consumers for payment of their health care premiums to ensure continued access and continuity of care;
  • Ensuring designated ACA navigators and certified application counselors have appropriate incentives (with minimum burden) to assist consumers in understanding their health insurance options and the process for choosing a health plan;
  • Ensuring flexibility in applying quality improvement and patient safety requirements for hospitals that contract with qualified health plans; and,
  • Ensuring that health plans meet the ACA statutory medical loss ratio requirements.

Finally, the ACA raises issues regarding states’ choices surrounding Medicaid coverage and expansion, in addition to ensuring fair and equitable treatment for consumers and safety net hospitals under the alternative Medicaid expansion models. For more information on Medicaid, please refer to our Medicaid section.

It is critical that the ACA is interpreted and implemented by the Administration, Congress and Courts in a manner that reflects the law’s intent -- to promote access to health insurance coverage for millions of Americans to the broadest extent possible.   Leading up to enactment of the ACA, the FAH has been a constant voice for covering the under- and un-insured.  In fact, in March 2008, the FAH developed “Health Coverage Passport,”  a plan to make it possible for all Americans to get the coverage they need.

The FAH continues its efforts to advance health coverage for all.  Since enactment of the ACA, the FAH strongly advocates for its members on ACA implementation issues, and to ensure that health insurance coverage is achieved on a broad scale consistent with the key priorities of investor-owned hospitals.