American Public Health Association
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ACA Implementation

Overview

The 2010 enactment of the Affordable Care Act wasn't the end of our nation's efforts to reform our health system: it was the beginning of a new phase of work. To supplement the overviews and information provided on our ACA Basics page, this page provides information about the implementation process, as well as implementation challenges we face.

APHA and external resources are listed below.

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Public health professionals: Looking for resources to help you educate your community about the Marketplaces and other ACA reforms?

Consumers: Looking for information about how the ACA will affect you?

Go back to the main page of the health reform section of APHA's website for resources and links to the official websites of the ACA and the Health Insurance Marketplaces. 

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Other frequently asked questions

1. When do the different provisions of the ACA go into effect?

2. How is the law being implemented at the federal level?

3. Where can I find information about my state's progress implementing the ACA?

4. What are the implications of the Supreme Court's Affordable Care Act decision on the continued implementation of the law?

5. Where can I find information about Congressional attempts to repeal the ACA?

6. How is APHA involved with the ACA?


1. 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. See below for links to implementation timelines. (FAQ top)

2. How is the law being implemented at the federal level?
After Congress passed and the President signed the ACA in 2010, it became the job of the U.S. Department of Health and Human Services and other federal agencies to implement the law. This is largely done through the rulemaking, or regulatory, process. While the laws that Congress passes are often broadly written, the federal rules that interpret them are detailed outlines of how the laws will work. An important part of the federal rulemaking process is public commenting on early drafts, or "proposed" rules. The federal government must consider those comments as they make revisions to the official, "final" versions of their rules. This Office of the Federal Register guide provides a helpful introduction and overview of the rulemaking process.

Although the departments have been issuing health reform regulations since 2010, a number of important regulations have been released since the November 2012 elections.

In November and December 2012, the following rules were released:

In January and early February 2013, additional rules were released on the following topics:

Released in March 2013:

Released in April 2013:

Additional information, including how you can find other past and current ACA rules, is listed below. (FAQ top)

3. Where can I find information about my state's progress implementing the ACA?
APHA recommends several great resources for tracking state progress on creating health insurance exchanges, funding states have received through various ACA provisions, and states' intentions regarding the Medicaid expansion, and other topics. See below. (FAQ top)

4. What are the implications of the Supreme Court's Affordable Care Act decision on the continued implementation of the law?
On June 28, 2012, the Supreme Court upheld the constitutionality of the Affordable Care Act. This means that the law will continue to move forward as planned, except that the federal government's power to enforce the Medicaid expansion is limited.  See below for links to implementation timelines or visit our Supreme Court Decision page for more information about the ruling. (FAQ top)

5. Where can I find information about Congressional attempts to repeal the ACA?
See our ACA Advocacy page for this information, and for APHA letters to Congress and other actions taken to protect the ACA. (FAQ top)

6. How is APHA involved with the ACA?
Since the early 1900s, APHA has been a strong voice for universal coverage for health care, a health system that emphasizes prevention instead of treatment, and policies and reforms that promote social and economic conditions conducive to individual and community health. In 2009, APHA released its Health Reform Agenda, which summarized and highlighted the most critical changes we must make to improve the public’s health, based on longstanding APHA policies and the best current evidence. During the health reform debate, APHA vigorously advocated for these changes, and was pleased that many of them were addressed in the Affordable Care Act. This 2010 document summarizes provisions in the health reform law relevant to APHA’s agenda for health reform. 

Since the ACA was passed in 2010, APHA has been at the forefront of promoting and protecting the critical public health provisions in the ACA.

  • Through letters, testimony and comments, and direct meetings with Congress and federal agencies, APHA has continued to express strong support for the ACA and has provided important guidance on many of the provisions in the law.
  • Additionally, APHA and our affiliates make up many of the more than 750 organizations that have stated their support for the Prevention and Public Health Fund
  • In 2012, APHA joined two amicus ("friend of the court") briefs (here and here) submitted to the Supreme Court, as the Court prepared to hear arguments on the law's constitutionality. 

APHA is also a trusted source of analysis and information about the law’s prevention and public health provisions, and is committed to helping its members, affiliates, and the public understand and adapt to the law’s reforms. Finally, APHA is one of five public health organizations that have received funding from the Centers for Disease Control and Prevention to provide capacity building assistance (CBA) to state, tribal, local, and territorial health departments as part of the National Public Health Improvement Initiative (NPHII), which is funded through the ACA. (FAQ top)

Resources

APHA Health Reform Updates (e-newsletters)

Implementation timelines

Federal rulemaking

State implementation progress

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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