The health reform law, The Patient Protection and Affordable Care Act was signed into law in 2010. More commonly referred to as the “Affordable Care Act” (or ACA), the law represents the broadest reform to the United States’ health care system since the 1960s.
In 2008, Congressional leaders, and President Obama began a roughly two year process of developing legislation to fundamentally reform health care systems in the United States. Many legislative proposals were considered by committees in Congress, including a plan submitted by President Obama. The final health reform bill – The Patient Protection and Affordable Care Act – was signed into law on March 23, 2010.
The implementation of the ACA is rapidly evolving. The Affordable Care Act (ACA) included many provisions that went into effect at the time of the law’s passage, and others that will be implemented in various stages over the next decade.
Several of the most significant provisions are scheduled to take place in 2014. This includes the establishment of the new individual and small group state insurance exchanges, and the expansion of state Medicaid programs.
Since the law's passage, the federal government has issued a multitude of rules and regulations pertaining to various provisions of the law. Many of the provisions of the law are being implemented at the state level, giving the states broad power to determine how the requirements and provisions of the ACA will be fulfilled and organized in each state. State lawmakers are currently determining many important facets of how the law will be implemented.
Learn more about what is happening in The States.
The law was challenged in two separate cases that were ruled on by the Supreme Court in June 2012. The two cases addressed the provisions of the law requiring individuals to purchase insurance (the “individual mandate” and the expansion of the Medicaid program. The Court’s decision had broad ramifications for certain aspects of the law.
Learn more about the Supreme Court’s decision.
The Affordable Care Act (ACA) includes many provisions important to individuals with HIV, and to the practice of HIV care. To learn more about any of the following topics, click on the links provided to the left, or in the topics below:
Private Health Insurance and Employer-based Insurance
Starting in 2010, the law prohibited health insurance discrimination based on health status or gender, lifetime limits on coverage, pre-existing condition exclusions, and charging higher premiums based on gender or health status.
Pre-Existing Condition Insurance Plan (PCIPs)
The ACA required that starting in July 2010 every state create or maintain a state high risk pool to make health insurance available to people who have had a problem getting insurance due to a pre-existing conditions, called a Pre-Existing Condition Insurance Plan (or PCIP).
States were given the option to establish their own state-run PCIP, or to defer to the federal government to establish a PCIP. The PCIPs are temporary, and will provide health coverage to individuals with pre-existing conditions, until 2014.
Learn more about the Pre-Existing Condition Insurance Plan (PCIPs).
The law eliminates the so-called “donut hole” in the Medicare Part D prescription drug benefit by 2020, and provided some rebates for those subject to it in the meantime. Additionally, the law incorporated a provision known as “ADAP as TrOOP,” that allow coverage costs from the Ryan White ADAP program to count towards TrOOP expenditures starting in 2011.
To learn more about these provisions, please visit the Medicare section.
The law also increased Medicaid provider reimbursement rates for 2013-14 for some primary care physicians, including family physicians, general internists, and pediatricians. The raise applies to evaluation and management services as well as immunization administration.
One of the biggest changes in the ACA is the proposed expansion of the Medicaid program. The state Medicaid programs were set to be expanded to include all persons (without other eligibility requirements or categories) under 133% Federal poverty level (an estimated 16 million individuals).
However, the Supreme Court’s decision in a challenge to the law left the implementation for this provision uncertain. Learn more about the Supreme Court’s decision.
Learn more about these provisions in the Medicaid section.
State Insurance Exchanges
Another significant change to the health system under the ACA is the establishment of State Insurance Exchanges in each state.
The Exchanges will be marketplaces for new individual and small group insurance plans in each state. Insurers will develop and offer various plans within the markets, all variable in price and in benefits.
However, all the new plans offered in the Exchanges are required to provide certain Essential Health Benefits (EHBs) outlined by the law. The EHBs include items and services within the following 10 categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services (including oral and vision care).
Learn more about the Essential Health Benefits.
The law also included a requirement for all uninsured individuals to purchase insurance beginning in 2014. All those currently uninsured, and ineligible for public programs, employer-based insurance, or other coverage will be required to attain coverage, and will be able to do so through the Exchanges. This requirement is often referred to as the “individual mandate,” and was recently upheld by the Supreme Court’s decision in a case challenging the provision.
Learn more about the State Insurance Exchanges.
Learn more about the Supreme Court’s decision.
The new law has profound implications for the Ryan White Program. Starting in 2014 many of Ryan White patients who receive care and treatment through the Ryan White program will begin to receive coverage through other programs created under the ACA. A majority will become part of the new Medicaid expansion; another portion are likely to gain coverage through the State Insurance Exchanges. HRSA continues to work toward increased coordination between Medicaid and the Ryan White Program. Visit the Ryan White page to learn more.
HRSA's Webinar: Ryan White and the Affordable Care Act: What You Need to Know
Learn more about the Affordable Care Act, visit our Learn More page, or click on any of the topics above. To learn about AAHIVM’s advocacy efforts on behalf of our members during the law’s development, or since its passage, visit Our Advocacy Efforts page. To get more involved in the decisions being made about the law’s implementation, visit our Take Action on Health Reform page.