Background on the Law

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 the relevant committees in Congress, including a plan submitted by President Obama that became the final piece of legislation.

Learn more about AAHIVM’s Advocacy Efforts during that process: Our Advocacy Efforts

The final health reform bill – The Patient Protection and Affordable Care Act of 2010– was signed into law on March 23, 2010.

In the years since the law’s passage, Republicans in Congress made many attempts at overturning the law. The House of Representatives took over 60 different votes  to repeal or alter the law. In 2015, Republicans passed a budget reconciliation bill containing a repeal of the Affordable Care Act. President Obama vetoed the bill in January of 2016.

In 2017 Republicans gained control of the White House, the House and Senate, with promises to repeal and replace the healthcare law. It remains to be seen what this effort will entail.


The ACA included many provisions that went into effect at the time of the law’s passage, and others that were scheduled to be implemented in various stages over the following decade.

Several of the most significant changes to the health care systems in the US were scheduled to take place in 2014, including the establishment of the new individual and small group state insurance exchanges, and the expansion of state Medicaid programs.

Following the law’s passage, the federal government agencies issued a multitude of rules and regulations pertaining to various provisions of the law, and how they were to be carried out.

Learn more about AAHIVM’s comments on some of those regulations: Our Advocacy Efforts

Legal Challenge

The law has been challenged in several legal cases since its passage. One of those court cases addressed the provisions of the law regarding the expansion of the Medicaid program in the states. In June of 2012 that cases was ruled on by the Supreme Court. That ruling had broad ramifications for Medicaid Expansion going forward.

Learn more: Supreme Court Decision

State Implementation

The federal government regulatory determinations placed many of the law’s aspects in the hands of the states to determine and implement.

The provisions of the law that are being implemented at the state level, give the state lawmakers broad power to determine how the requirements and provisions of the ACA will be fulfilled and organized in each state.

Learn more: State Implementation

Additional Information

Learn more about the background of the health insurance law through the resources below.

Health Reform Implementation Timeline – Kaiser Family Foundation