Patient Protection and Affordable Care Act

In March 2010, the Patient Protection and Affordable Care Act (ACA) was passed and signed into law.  The ACA 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. 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 implemented 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 have affected the implementation of the law.  The United States Supreme Court has upheld the constitutionality of the ACA’s individual mandate and the availability of tax credits to purchase health insurance while also, as a practical matter, made Medicaid expansion optional for states.

Other legal challenges continue. Litigation currently is pending regarding the law’s constitutionality in light of Congress making zero the individual mandate penalty, whether the executive branch may, or is obligated to, make the ACA’s cost-sharing reduction payments to insurers without a separate appropriation for those payments by Congress. 

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 Marketplaces. These challenges include:

  • Ensuring coverage of hospital services for patients;
  • Ensuring adequate health plan networks that provide consumers with meaningful access to providers, including essential community providers;
  • Ensuring the availability of adequate public outreach and enrollment assistance to support consumers in understanding their health insurance options and the process for choosing a health plan;
  • Providing for robust competition in the Marketplaces to provide consumers with a variety of health insurance plan offerings; and,
  • Ensuring that health plans meet the ACA statutory medical loss ratio requirements.

Finally, Medicaid’s section 1115 demonstration authority and the ACA’s section 1332 individual and small-group market authority provide states with the opportunity to make state-specific adjustments to Medicaid and a state’s individual and small group insurance market. FAH advocates that these authorities be used to promote greater coverage and affordability.

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, 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.

FAH continues its efforts to advance health coverage for all.  Since enactment of the ACA, we have strongly advocated for our 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.