Key resources
(See full list of resources below)
Frequently asked questions
1. What is the Affordable Care Act?
2. What are the major components of the ACA?
3. Why do we need the ACA?
4. How many people is the ACA expected to cover?
5. When do the different provisions of the ACA go into effect?
6. How can I educate the public about the benefits of the ACA?
7. How much is the ACA expected to cost, and how is it funded?
8. What is the Medicaid expansion, and is it still happening?
9. What are the state-based exchanges?
10. What is the minimum coverage provision (individual mandate) and why is it so important?
1. What is the Affordable Care Act?
The Affordable Care Act is the nation’s health reform law enacted in March 2010. It contains numerous provisions that will expand health coverage to 30 million Americans, increase benefits and lower costs for consumers, provide new funding for public health and prevention, bolster our health care and public health workforce and infrastructure, foster innovation and quality in our system, and more.
The law consists of two pieces of legislation: the Patient Protection and Affordable Care Act (PPACA), enacted on March 23, 2010, and the Health Care and Education Reconciliation Act (HCERA), enacted on March 30, 2010. Jointly they are referred to as the Affordable Care Act or ACA. For more information, see the resources listed below. (FAQ top)
2. What are the major components of the ACA?
The ACA will reform both our private and public health insurance systems, in order to expand coverage to 30 million Americans by 2022. It will also lower costs and increase benefits for consumers, and incentivize quality and innovation in our health care system. In addition, the ACA includes critical funding for public health and prevention.
3. Why do we need the ACA?
There are numerous reasons health reform is critically needed in the U.S., including the following. For more details on each point, see APHA's new one-pager, Why Do We Need the Affordable Care Act?
- High uninsured rate: In July 2012, the CBO estimated that 55 million Americans under the age of 65 are currently uninsured; representing 1 out of 5 Americans in that age group. Without the ACA, the uninsured rate would continue to rise.
- Unsustainable spending: Health care spending represented 17.9 percent of our gross domestic product (GDP) in 2010, and is expected to reach 20 percent by 2020
- Lack of emphasis on prevention: Today, seven in ten deaths in the U.S. are related to preventable diseases such as obesity, diabetes, high blood pressure, heart disease, and cancer, and 75 percent of our health care dollars are spent treating such diseases. However, only three cents of each health care dollar spent in the U.S. go toward prevention.
- Poor health outcomes: The U.S. spends far more on medical care than any other industrialized nation, but ranks 24th among 30 OECD countries in terms of life expectancy.
- Health disparities: While inequities related to income and access to coverage exist across demographic lines, population-based disparities are impossible to deny. As reported by Families USA,“African-American women have the highest death rates from heart disease, breast and lung cancer, stroke, and pregnancy among women of all racial and ethnic backgrounds” and “Hispanics had poorer quality of care than non-Hispanic whites for about 40 percent of quality measures, including not receiving screening for cancer or cardiovascular risk factors.”
The ACA won’t solve all of these problems overnight, but it’s an important step forward. By making health coverage more affordable and accessible and thus increasing the number of Americans with coverage, by funding community-based public health and prevention programs, and by supporting research and tracking on key health measures, the ACA will begin to reduce disparities, improve access to preventive care, and improve health outcomes and reduce the nation’s health spending. For more information, see APHA's new chart, Affordable Care Act Overview: Selected Provisions, or one of the resources listed below. (FAQ top)
4. How many people is the ACA expected to cover?
In July 2012, the Congressional Budget Office (CBO) released updated projections of the ACA’s costs and impacts, accounting for the June 2012 Supreme Court decision upholding the law but limiting the federal government’s ability to enforce the Medicaid expansion. Without the ACA, the CBO estimates that the uninsured rate would rise from 20.4 percent in 2012 to 21.1 percent in 2022, when 60 million people would lack coverage; but under the ACA, the uninsured rate will be cut in half, as 30 million of those individuals will obtain private or public coverage. As a result of the Supreme Court’s ruling on the Medicaid expansion, the CBO estimates that the law will cover 3 million fewer people by 2022 than it estimated in March 2012, as some states are predicted to choose not to expand Medicaid coverage. For more information, see the resources listed below. (FAQ top)
5. When do the different provisions of the ACA go into effect?
Many ACA provisions went into effect immediately or soon after the health reform law was enacted in 2010; others are being phased in over time. Several major reforms, including the Medicaid expansion, insurance exchanges, and minimum coverage provision (“individual mandate”) will go into effect in 2014, and still others will go into effect later. Visit our ACA implementation page for links to implementation timelines, information on federal rulemaking and state progress implementing the ACA, and more. (FAQ top)
6. How can I educate the public about the benefits of the ACA?
There are numerous ways that the ACA will benefit specific populations such as children and parents, childless adults, the elderly, women, low-income individuals and families, LGBT individuals and families, racial and ethnic minorities, and others. The ACA will also benefit small businesses, health care providers, and states; and it contains important public health provisions such as the Prevention and Public Health Fund. Resources you can use to educate the public are listed below. APHA's fact sheets, issue briefs, webinars, our new ACA presentation slide deck, and other resources also provide information you can use to educate the public about the ACA. (FAQ top)
7. How much is the ACA expected to cost, and how is it funded?
The Affordable Care Act includes a number of coverage and other provisions that will require more government spending, but these costs are offset by other ACA provisions that will either bring new revenue into the government, or decrease current spending. In total, the ACA is expected to reduce budget deficits by $210 billion over 2012-2021, according to the Congressional Budget Office’s estimates in February 2011. This includes $1,390 billion in gross costs related to the ACA’s insurance coverage provisions, offset by $349 billion in coverage-related revenues and savings (including minimum coverage provision penalty payments), and $1,252 billion in other revenues and savings.
The Supreme Court decision may impact the cost and coverage impacts of the ACA. As of July 2012, the CBO estimates that the ACA’s coverage provisions will cost $1,168 billion over 2012-22. This is $84 billion lower than CBO estimated in March 2012, and the lower cost is due to the Supreme Court’s June 2012 decision that limited the federal government’s ability to enforce the Medicaid expansion. CBO estimates that due to the Court’s decision, there will be less government spending on Medicaid, and even though there will be more government spending on exchange subsidies for people who would otherwise be eligible for Medicaid, there will be an overall decrease in spending. It’s important to remember that this decrease in spending is because more people will lack coverage; and these numbers don’t account for the costs of uncompensated care.
Although in its July 2012 numbers, the CBO did not update its projection of the ACA’s overall reduction of the budget deficit, it did update a previous estimate of the potential cost of repealing the ACA. CBO now estimates that repealing the ACA would increase federal budget deficits by $109 billion over the 2013–2022 period. Repealing the coverage provisions would save $1,171 billion over that period, but repealing the rest of the act would increase direct spending and reduce revenues by a total of $1,280 billion. For more information, see the resources listed below. (FAQ top)
8. What is the Medicaid expansion, and is it still happening?
Medicaid is the nation's health insurance program for low-income individuals and families. The ACA calls for a nationwide expansion of Medicaid eligibility, set to begin in 2014. As the law was written, nearly all U.S. citizens under 65 with family incomes up to 133 percent of the federal poverty level (FPL) ($30,675 for a family of four in 2012) will now qualify for Medicaid. (About FPL; Is it 133 or 138?) This expansion will particularly benefit childless adults, who in more than 40 states cannot currently qualify for Medicaid regardless of their income level. It will also benefit low income parents, who in more than 30 states don't currently qualify even if their children do.
The Medicaid expansion was one of the major provisions at stake in the ACA cases decided by the Supreme Court in June 2012. The Supreme Court upheld the Medicaid expansion, but limited the federal government’s ability to penalize states that don’t comply. Therefore, where it was originally effectively mandatory for states to expand Medicaid, now it is effectively optional. While some states might not participate in the expansion, given the recent Supreme Court decision, most states are predicted to eventually expand their programs. The CBO predicts that 11 million Americans will gain coverage by 2022 through this provision.
For more information, including background on the Medicaid program and an explanation of the income thresholds, see our Medicaid Expansion and Supreme Court pages, and the links below. (FAQ top)
9. What are the state-based exchanges?
The ACA’s health insurance exchanges are meant to be virtual marketplaces where individuals and families can comparison shop for health coverage. There will also be exchanges for small businesses. The exchanges are to be operable by October 1, 2013, and states have three options regarding their design:
to establish their own,
to establish them in partnership with the federal government, or
to let the federal government establish them.
The exchanges will be most useful for those who don’t have access to employer-based coverage, and who don’t qualify for public programs like Medicaid. Individuals and families with incomes between 100 percent and 400 percent of the federal poverty level ($23,050-$92,200 for a family of four in 2012) will receive income-based subsidies to help them afford coverage, and small businesses will also receive tax credits to help them afford coverage for their employees. By 2022, the Congressional Budget Office estimates that 25 million Americans will have coverage through the exchanges. For more information, see our Exchanges page or the links below. (FAQ top)
10. What is the minimum coverage provision (individual mandate) and why is it so important?
Starting in 2014, the minimum coverage provision will require most U.S. citizens and legal residents to obtain and maintain coverage for themselves and their dependents, or to pay a small penalty. People will be able to opt out if they qualify for one of numerous exemptions. For information about which types of coverage count, who is exempted, and what the penalty will be, see our Minimum Coverage Provision page.
Most people will not directly be affected by the minimum coverage provision, because they already have employer-based coverage, public coverage such as Medicaid, or other coverage that meets the minimum coverage requirement; or because they are exempt. A March 2012 analysis by the Urban Institute found that of the nearly 270 million non-elderly individuals in the U.S., only 7 percent would “face a requirement to newly purchase insurance or pay a fine.” (Read more.)
While the minimum coverage provision would directly affect only a small percentage of the population, it is a very important part of the health reform law. It will make many other ACA provisions possible, by ensuring that insurance markets stay balanced and costs stay low. In June 2012, the Supreme Court upheld the provision as constitutional. For more information, see our Minimum Coverage Provision page, our Supreme Court Decision page, or the links below. (FAQ top)
Additional resources
Including key resources listed above. Note: certain specific resources are listed here. For ACA websites and webpages in general, visit our Useful Links page. For resources on other topics, visit the other pages in this section of APHA's website. (FAQ top)
Text of the law
Overviews and summaries of ACA provisions
ACA FAQs, glossaries, myths and facts
Benefits of the Affordable Care Act (Consumer education)
Coverage and cost data
(Also see FAQ above: Why we need the ACA; ACA coverage estimates; ACA cost estimates)
For more information, visit our Useful Links page.
APHA is continuing to update its health reform website and resources. Please check back as we add new content.
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