How new provisions, Supreme Court challenges and Congress votes have shaped the healthcare law
President Barack Obama signed the healthcare legislation into law at the White House on March 23, 2010.
PHOTO: J. SCOTT APPLEWHITE/ASSOCIATED PRESS
By June 17, 2021 4:26 pm ET
Since its passage in 2010, the Affordable Care Act has grown to provide health coverage to more than 31 million people when its Medicaid expansion is included, and survived three challenges before the Supreme Court. Here’s a look at notable changes the law has seen over the years.
Implementation of provisions is staggered. The law requires people to have health insurance or pay a penalty.
It establishes minimum benefit standards for health plans and funding for states to expand Medicaid.
The law bars insurers from denying people coverage because of pre-existing health conditions.
The ACA imposes new taxes, requires large employers to provide coverage to workers and sets up a fund to give grants to states.
The statute imposes new employer reporting mandates and creates the first model for paying health providers based on patient outcomes instead of volume of services.
Lifetime limits on coverage for members are eliminated.
Medicare payments for certain preventive services increase.
Health insurers must give consumers rebates if they spend too little on health benefits and quality of care, as opposed to advertising and marketing.
The Supreme Court in June upholds the penalty on people who lack health insurance but lets states decide whether to expand Medicaid.
The law imposes an excise tax of 2.3% on the sale of any taxable medical device after Dec. 21.
State Medicaid agencies that provide preventive services to beneficiaries with no copayments get a 1% increase in federal matching payments.
Open enrollment under new ACA exchanges for the 2014 plan year begins in October. The Obama administration says that more than 100,000 Americans enroll in plans in the first month but the rollout of HealthCare.gov, the federal exchange, is marred by technical problems.
Thirteen states declare they won’t participate in Medicaid expansion.
Nineteen states and Washington, D.C., get approval to set up their own exchanges.
Most of the law takes full effect, with the mandate on individual insurance and employer-provided coverage requirement. Medicaid expansion begins following legislative approvals in 2013.
Bans on annual coverage limits on insurance plans and the penalty for not having health coverage start March 31.
Ohio joins states that expand Medicaid.
The Department of Health and Human Services’ Office of Inspector General puts the cost of building HealthCare.gov at almost $2 billion.
About eight million people select ACA marketplace plans.
Rule finalized that raises premiums on the ACA exchanges.
New rule means employers can forgo offering coverage and instead contribute money to a tax-free account for employees.
Roughly 11.4 million people sign up for ACA plans.
Trump administration narrows scope of ACA provision that provided protection against discrimination in healthcare based on sexual orientation and gender identity.
The Supreme Court in November hears arguments from Texas and other Republican-leaning states seeking to topple the ACA based on technical arguments after the penalty for not having health insurance was reduced to zero.
About 11.4 million people select ACA plans on the marketplaces.
Biden administration reopens a special open enrollment period because of the coronavirus pandemic, and extends it because of changes made to the ACA in the Covid-19 relief package. The changes include temporarily expanding subsidies and ending an income cap that limited eligibility. It also provides financial incentives for states to expand Medicaid.