History of Affordable Care Act in Timeline
The Affordable Care Act (ACA), also known as Obamacare, is a landmark US healthcare law signed by President Obama in 2010. It represents the most significant reform of the US healthcare system since the 1965 establishment of Medicare and Medicaid, aiming to expand health insurance coverage and regulate the industry.
1944: Public Health Service Act
The Public Health Service Act of 1944 was enacted, which the ACA later amended to include provisions on affordable care.
1946: Hill-Burton Act Funds Rural Hospital Construction
The Hill-Burton Act of 1946 provided funding for the construction of many rural hospitals. This historical context is essential to understanding the factors that contributed to the challenges faced by rural hospitals in later decades.
1965: Medicare and Medicaid Enactment
In 1965, Medicare and Medicaid were enacted, marking a pivotal moment in U.S. healthcare history. The Affordable Care Act, signed in 2010, is considered the most significant reform to the system since then.
1974: Congressional Budget Act and Reconciliation
The Congressional Budget Act of 1974 established the process of reconciliation, a legislative maneuver used to pass budgetary measures with a simple majority, bypassing the threat of filibuster.
1986: Emergency Medical Treatment and Active Labor Act
The 1986 enactment of the Emergency Medical Treatment and Active Labor Act (EMTALA) had significant implications for healthcare costs and access. This Act obligated hospitals participating in Medicare to provide emergency care to anyone in need, regardless of their ability to pay. EMTALA inadvertently contributed to the issue of uncompensated care, which later factored into arguments for an individual mandate as a way to share the cost of healthcare more broadly.
1989: The Heritage Foundation Proposes Individual Mandate
The concept of an individual mandate for health insurance, a cornerstone of the ACA, originated in 1989. It was proposed by The Heritage Foundation, a conservative think-tank, as a market-based alternative to a single-payer healthcare system. This idea gained traction among some conservative economists and Republican senators who saw it as a way to promote individual responsibility and address the issue of uncompensated care.
1993: President Clinton's Healthcare Reform Proposal and Its Failure
In 1993, President Bill Clinton put forth a comprehensive healthcare reform bill. His proposal, which included an employer mandate for providing health insurance, faced strong opposition and ultimately failed to pass. This failure highlighted the challenges of enacting sweeping healthcare reform in the United States.
1993: Republican-Proposed HEART Act Includes Individual Mandate
In 1993, the Republican-proposed Health Equity and Access Reform Today (HEART) Act put forward a "universal coverage" requirement that included an individual mandate. This proposal, backed by prominent Republican senators, aimed to achieve broad health insurance coverage through a market-based approach with subsidies provided through state-based "purchasing groups."
1994: Republican Consumer Choice Health Security Act and Removal of Individual Mandate
The 1994 Republican Consumer Choice Health Security Act initially included an individual mandate with penalties for noncompliance. However, the mandate was later removed, reflecting shifting views within the Republican party regarding government's role in mandating health insurance coverage.
1996: Medical Savings Accounts Introduced
In 1996, Medical Savings Accounts (MSAs) were introduced as another innovation in healthcare financing. This development, while predating the ACA, highlighted the ongoing search for market-based solutions to healthcare coverage.
1997: Enactment of the State Children's Health Insurance Program
Following the failure of President Clinton's broader healthcare reform plan, a compromise was reached in 1997 with the enactment of the State Children's Health Insurance Program (SCHIP). SCHIP aimed to expand health insurance coverage to children in low-income families, demonstrating a more incremental approach to healthcare reform.
2000: Start of Period for Comparing Employer-Sponsored Premium Increases
The year 2000 marks the beginning of the timeframe (2000-2005) used to compare the percentage increase in healthcare premiums for individuals with employer-provided insurance.
2000: Start of Period for Comparing Medicare Spending Growth
This year serves as the baseline for comparing the average yearly increase in real per-enrollee Medicare spending, with the period from 2000 to 2005 showing a mean growth of 4.7%.
2003: Health Savings Accounts Introduced
The year 2003 marked a step in healthcare reform with the introduction of Health Savings Accounts (HSAs), offering an alternative way to save for healthcare expenses. While not part of the ACA, this innovation reflected ongoing efforts to address healthcare costs and coverage.
2005: End of First Period, Start of Second Period for Comparing Employer-Sponsored Premium Increases
The year 2005 marks the end of the first period (2000-2005) and the start of the second period (2010-2015) used to analyze the percentage change in healthcare premiums for those with employer-sponsored coverage.
2005: End of First Period, Start of Second Period for Comparing Medicare Spending Growth
This year marks the end of the first period (2000-2005) and the start of the second period (2006-2010) for analyzing the average annual growth in real per-enrollee Medicare spending.
2006: Massachusetts Enacts Healthcare Reform with Individual Mandate
Massachusetts took a significant step in 2006 by enacting a state-level healthcare reform bill that included an individual mandate and an insurance exchange. This legislation, spearheaded by then-Governor Mitt Romney, served as a model for the later Affordable Care Act and reignited the debate about the role of individual mandates in achieving universal healthcare coverage.
2006: Start of Second Period for Comparing Medicare Spending Growth
The year 2006 initiates the second timeframe (2006-2010) used to evaluate the average annual increase in real per-enrollee Medicare spending, which averaged 2.4% during this period.
March 2007: Origin of the Term "Obamacare"
The term "Obamacare", initially used pejoratively by opponents, emerged in early 2007 during discussions about then-candidate Barack Obama's proposal to expand health insurance coverage.
May 2007: Mitt Romney's Use of "Obamacare" in Political Discourse
In May 2007, Mitt Romney, then a presidential candidate, used the term "Obamacare" while criticizing the healthcare proposals of Democrats, including Barack Obama.
2007: Start of National Cancer Database and SEER Program Data Collection
In 2007, two important data collection efforts related to cancer began: the National Cancer Database (NCDB) and the SEER Program. These initiatives aim to track cancer incidence, treatment, and outcomes, providing valuable insights into cancer trends and disparities.
2007: Bipartisan Healthy Americans Act Introduced
The year 2007 saw a notable attempt at bipartisan healthcare reform with the introduction of the Healthy Americans Act by Senator Bob Bennett (R) and Senator Ron Wyden (D). This bill, which included an individual mandate and state-based insurance exchanges, garnered bipartisan support but ultimately failed to pass. It demonstrated the possibility of finding common ground on healthcare reform, even amidst ongoing political divisions.
2007: Early Healthcare Reform Efforts
The year 2007 saw the emergence of a healthcare reform bill that would later influence the Affordable Care Act.
2008: Romney's Healthcare Reform Praised by Republicans
During the 2008 presidential campaign, Republican nominee Mitt Romney's implementation of healthcare reform in Massachusetts, including its individual mandate, was initially praised by members of his own party. This support later waned as the Affordable Care Act, which shared key features with Romney's plan, became a point of political contention.
2008: Healthcare Reform in the 2008 Presidential Election
During the 2008 presidential primaries and general election, healthcare reform emerged as a major campaign issue, with candidates proposing different approaches to expand coverage.
2008: Healthcare Reform Remains a Key Issue
Healthcare reform remained a prominent issue in the 2008 elections, with both major parties recognizing the need for changes to the healthcare system. The debate continued to center around the role of government, affordability, and access to coverage.
2008: National Health Interview Survey
In 2008, The National Health Interview Survey began, a study designed to assess the health status and healthcare access of the U.S. population.
2008: Growing Support for Healthcare Reform
In 2008, many Democrats began to consider a new approach to healthcare reform, laying the groundwork for future legislation.
2008: Start of Period for Analyzing Annual Health Insurance Premium Increases
This year signifies the start of the period (2008-2010), predating the ACA's passage, during which health insurance premiums experienced an average annual increase of 10%.
February 2009: Obama's Push for Healthcare Reform
In February 2009, President Obama addressed Congress, outlining his commitment to healthcare reform and initiating legislative efforts.
April 2009: Shift in Senate Balance and Filibuster Concerns
The Democratic Party gained a supermajority in the Senate in April 2009, securing enough votes to overcome Republican filibusters against the healthcare reform bill.
August 7, 2009: Sarah Palin Coins the Term "Death Panels"
On August 7, 2009, Sarah Palin introduced the term "death panels" into the healthcare debate, alleging that the Affordable Care Act would lead to government-controlled panels deciding who would receive care.
August 2009: Town Hall Meetings and Growing Opposition
During the August 2009 congressional recess, town hall meetings about the proposed healthcare reforms faced protests and opposition, highlighting the contentious nature of the issue.
September 2009: Obama's Continued Advocacy for Healthcare Reform
In September 2009, President Obama addressed Congress once again, reiterating his support for the ongoing healthcare reform negotiations.
October 2009: Saturday Night Live Sketch on ACA Gridlock
In October 2009, the popular comedy show Saturday Night Live (SNL) parodied the political gridlock surrounding the ACA legislation. The sketch featured Dwayne "The Rock" Johnson portraying an exasperated President Obama confronting three senators opposing the healthcare plan.
December 24, 2009: Senate Passage of Healthcare Reform Bill
On December 24, 2009, the Senate passed its version of the healthcare reform bill, marking a significant step toward enacting the Affordable Care Act.
2009: Slowdown in Employer-Sponsored Health Insurance Premium Increases Observed
After 2009, a moderation in the growth rate of health insurance premiums offered through employers was observed.
2009: Public Opinion on Healthcare Reform Shifts During Legislative Debate
As discussions and debates surrounding healthcare reform intensified in 2009, public opinion on the proposed changes began to shift. Differing viewpoints emerged, influenced by factors such as political affiliation, race, and age.
2009: High Number of Uninsured Adults with Diabetes
In 2009, there were approximately 3.5 million uninsured US adults aged 18–64 with diabetes, highlighting the need for affordable healthcare options and the potential impact of the ACA's coverage expansions.
2009: Debunking the "Death Panel" Myth
The "death panel" allegation was widely debunked by fact-checking organizations and healthcare experts in 2009. It was labeled as PolitiFact's "Lie of the Year", highlighting the misinformation surrounding the Affordable Care Act.
2009: Start of CDC Study on Uninsured Rates Among PLWH
The CDC's Medical Monitoring Project started collecting data in 2009 to examine the uninsured rates among people living with HIV who were actively receiving treatment between 2009 and 2012.
2009: Political Momentum for Healthcare Reform
The year 2009 proved pivotal for healthcare reform as it saw a confluence of political will and momentum, culminating in the passage of the Affordable Care Act. This marked a significant shift after years of unsuccessful attempts at major healthcare reform.
2009: Start of Period Analyzed for Changes in Pediatric Emergency Department Visits
This year marked the start of the period analyzed by researchers studying the impact of the ACA on pediatric emergency department visits.
2009: Start of Period for Evaluating National Healthcare Expenditure Growth Before ACA
This year marks the beginning of the period (2009-2013) used to assess the growth of national health care expenditures before the ACA's major provisions came into effect.
2009: Congressional Efforts Towards Healthcare Reform
Throughout 2009, Congress drafted and debated healthcare reform bills, drawing inspiration from previous proposals and state-level reforms.
January 2010: Emergency Room Doctors Report Surge in Patient Visits
Starting in January 2010, many emergency room doctors reported a noticeable increase in patient visits, with some attributing this surge to the ACA's expansion of health insurance coverage. This observation sparked concerns about the capacity of the healthcare system to handle the influx of newly insured patients.
January 19, 2010: Special Election and Political Implications
The outcome of the January 19, 2010, special election in Massachusetts, resulting in a Republican victory, raised concerns among Democrats about the political viability of the healthcare reform bill.
March 2010: Debate Arises Over ACA's Employer Mandate and Part-Time Employment
The implementation of the ACA's employer mandate, requiring businesses with over 50 employees to provide health insurance, sparked debate in March 2010. Critics argued that this mandate would incentivize employers to hire part-time workers to avoid providing insurance.
March 21, 2010: Final Passage and Signing of the Affordable Care Act
On March 21, 2010, the House passed the Senate's version of the healthcare reform bill, followed by President Obama signing it into law, enacting the Affordable Care Act.
March 23, 2010: Affordable Care Act Enacted
On March 23, 2010, President Barack Obama signed the Affordable Care Act (ACA) into law. This marked a significant moment in U.S. healthcare history, representing the biggest overhaul of the system since Medicare and Medicaid in 1965.
September 23, 2010: Expansion of Dependent Coverage
Starting on September 23, 2010, one of the first provisions of the Affordable Care Act went into effect, allowing young adults to stay on their parents' health insurance plans until the age of 26. This change, regardless of their dependent status, marital status, living situation, student status, or employment status, aimed to increase health insurance coverage among young adults.
October 1, 2010: Dependent Coverage Expansion (DCE) under the ACA
On October 1, 2010, the Dependent Coverage Expansion (DCE) under the ACA came into effect, allowing young adults to stay on their parents' insurance plans until age 26. This resulted in a significant increase in health insurance coverage for young adults and had a positive impact on various health metrics.
2010: Nutrition Labeling Requirements Passed
Although officially part of the ACA in 2010, the implementation of nutrition labeling requirements faced delays and didn't come into effect immediately. This delay highlighted the complexities of implementing such regulations.
2010: Analysis of BRFSS Data on Viral Suppression Rates Begins
An analysis of Behavioral Risk Factor Surveillance System (BRFSS) survey data began in 2010 to assess the impact of Medicaid expansion on viral suppression rates among PLWH from 2010 to 2015.
2010: Widespread Awareness and Belief in "Death Panel" Myth
By 2010, the "death panel" claim had gained significant traction, with a Pew Research Center report indicating that a large percentage of Americans were familiar with the allegation and believed it to be true.
2010: David Walker Questions Accuracy of CBO Estimates
In 2010, David Walker expressed doubts about the accuracy of the CBO's estimates regarding the ACA. He argued that the estimates were unreliable because they assumed the law wouldn't be subject to future changes.
2010: Start of Study on Medicaid Expansion's Impact on Cancer Patients
In 2010, a study utilizing data from the National Cancer Institute's SEER program began, aiming to evaluate the impact of Medicaid expansion on cancer patients diagnosed between 2010 and 2014.
2010: Passage of the Affordable Care Act
In 2010, after much debate and negotiation, the Affordable Care Act was passed by Congress and signed into law by President Obama.
2010: High Number of Undiagnosed Diabetes Cases
In 2010, there were approximately 4.6 million people aged 18–64 with undiagnosed diabetes in the U.S., emphasizing the importance of preventive care and early detection through initiatives like the ACA's provision for zero-cost preventive services.
2010: Small Business Tax Credits and Pre-Existing Condition Insurance Plan
Key provisions of the ACA came into effect in 2010. Small businesses began benefiting from new tax credits, and the Pre-Existing Condition Insurance Plan (PCIP) provided coverage to individuals previously denied by private insurers due to pre-existing conditions.
2010: Public Expresses Concerns Over ACA's Potential Costs and Effectiveness
Public opinion polls conducted in 2010 revealed concerns among Americans regarding the potential costs associated with the ACA and its effectiveness in controlling healthcare expenses. A significant portion of respondents believed the law would lead to higher personal healthcare costs and questioned its ability to curb overall healthcare spending.
2010: Affordable Care Act Passed, Marking Beginning of Coverage Expansion Efforts
The Affordable Care Act was passed in 2010, marking a starting point for significant changes in the healthcare landscape, aiming to expand health insurance coverage and improve access to affordable care.
2010: New Tax on Unearned Income
The Health Care and Education Reconciliation Act of 2010, legislation passed alongside the ACA, introduced a 3.8% tax on unearned income. This tax applied to the lesser of an individual's net investment income or the amount their adjusted gross income exceeded specified limits.
2010: Start of Period Marked by Rural Hospital Closures Amidst ACA Implementation
The year 2010 marked the beginning of a period during which a number of rural hospitals faced closure. This coincided with the implementation of the ACA, fueling debate about the law's impact on the financial stability of these hospitals.
2010: Start of Period for Study on ACA's Impact on Preventable Deaths
The year 2010 marks the start of the period examined in a study assessing the impact of the Affordable Care Act on preventing patient deaths (2010-2013).
2010: Start of Third Period for Comparing Employer-Sponsored Premium Increases
The year 2010 marks the start of the third period (2010-2015) for evaluating the percentage increase in healthcare premiums for individuals covered by employer-sponsored insurance plans.
2010: Debate Begins Over CBO Cost Estimates and Medicare Payment Legislation
The year 2010 saw the start of a debate regarding the CBO's cost estimates for the ACA, particularly in relation to potential legislation that could increase Medicare payments. Critics argued that the CBO's estimates were inaccurate because they didn't account for the potential impact of such legislation.
2010: Start of Period Analyzed by Obama for Medicare and Private Insurance Spending
This year marks the start of the period (2010-2014) that Barack Obama analyzed in 2016, revealing a decline in the average annual growth of real per-enrollee spending for both Medicare and private insurance compared to prior years.
2010: Public Opinion on ACA Continues to Evolve as Specific Plans Emerge
Throughout 2010, public opinion on the ACA continued to be shaped by the specific plans and proposals put forth during the legislative process. Certain aspects of the ACA, such as protections for individuals with pre-existing conditions, garnered wider support, while others, like the individual mandate, faced more opposition.
2011: Medicaid Expansion's Impact on Mental Health and Substance Use Disorder Coverage and Treatment
Before the ACA's full implementation, a significant proportion of adults with mental and substance use disorders lacked health insurance. The period between 2011 and 2013 served as a baseline for understanding the potential impact of expanded coverage.
2011: Child-Only Policies and Medicaid Expansion Opt-Out
By 2011, the ACA's impact on the insurance market became evident. Insurers in 17 states stopped offering child-only policies to avoid covering pre-existing conditions. A landmark Supreme Court ruling in National Federation of Independent Business v. Sebelius granted states the right to opt out of the ACA's Medicaid expansion.
2011: Repealing the Job-Killing Health Care Law Act
In 2011, following their House of Representatives win, Republicans, joined by three Democrats, voted 245-189 in favor of H.R. 2, aiming to repeal the ACA. Though the bill passed the House, it was unsuccessful in the Senate. President Obama stated his intent to veto had it reached his desk.
2011: Congressional Budget Office (CBO) Releases ACA Deficit Reduction Projections
In 2011, the CBO projected that the Affordable Care Act (ACA) would reduce the deficit by over $200 billion between 2012 and 2021. The projection was based on the ACA's provisions to reduce Medicare reimbursements, impose taxes on high-premium insurance plans, and implement other changes to the federal tax code, Medicare, and Medicaid.
March 2012: Catholic Church Raises Concerns about ACA's Contraception Mandate
In March 2012, the Roman Catholic Church, through the USCCB, expressed support for the Affordable Care Act's goals but voiced concerns that its contraception and sterilization coverage mandate infringed upon religious freedom, leading to legal challenges like Burwell v. Hobby Lobby.
April 1, 2012: Senate Finance Committee Hearings
On April 1, 2012, the Senate Finance Committee hearings for the 111th Congress regarding the Affordable Care Act were recorded by C-SPAN and made available on Finance.Senate.Gov.
2012: Supreme Court Rules on Medicaid Expansion, Giving States More Autonomy
A landmark Supreme Court ruling in 2012 impacted the trajectory of Medicaid expansion. The court determined that states wouldn't lose existing Medicaid funding if they chose not to expand under the ACA, leading to variations in implementation across the country.
2012: Public Support for ACA Following Supreme Court Ruling
After the Supreme Court upheld the individual mandate of the Affordable Care Act in 2012, a poll revealed that a majority of Americans wanted critics of the law to cease their attempts to block it and instead shift their attention to other pressing national matters.
2012: CDC Study Reveals High Uninsured Rates Among PLWH
By 2012, the CDC's study showed that about 18% of people living with HIV (PLWH) actively receiving HIV treatment were uninsured, highlighting the need for expanded coverage.
2012: Obama's Embrace of the Nickname "Obamacare"
By mid-2012, the term "Obamacare" had become widely used, and Barack Obama himself embraced the nickname, stating, "I have no problem with people saying Obama cares. I do care."
2012: Some Opponents Believe ACA Did Not Go Far Enough
In 2012, a poll revealed that a portion of those who opposed the ACA felt it didn't go far enough in its reforms. This sentiment was particularly prevalent among Republican opponents, suggesting a desire for more fundamental changes to the healthcare system.
2012: Public Opinion on ACA Remains Divided Along Party Lines
In 2012, public opinion on the ACA remained divided, largely along party lines. While a majority of Democrats expressed support for the law, Republicans largely opposed it, and Independents were split. Specific provisions of the ACA, such as protections for pre-existing conditions and allowing young adults to stay on their parents' insurance until age 26, garnered broader support than the individual mandate.
2012: Conclusion of National Cancer Database and SEER Program Data Collection
In 2012, the data collection for both the National Cancer Database (NCDB) and the SEER Program, which started in 2007, concluded. These datasets provided crucial information about cancer trends and outcomes during this period.
2012: Study on Hospitalization Rates of Uninsured PLWH Begins
Researchers began analyzing hospital discharge data in 2012 from four Medicaid expansion states and two non-expansion states, focusing on hospitalization trends among uninsured PLWH between 2012 and 2014.
2012: CBO Deficit Reduction Projections for ACA Begin
The period (2012-2021) over which the CBO projected the ACA would reduce the deficit by over $200 billion began.
June 2013: Public Opinion on ACA Implementation and Repeal Efforts
In June 2013, a majority of the public expressed a preference for Congress to focus on implementing or refining the Affordable Care Act rather than repealing it. This sentiment reflected a desire to see the law given a chance to work and for lawmakers to address any issues that arose.
September 2013: Saturday Night Live Sketch on ACA Rollout
Reflecting the ongoing public debate surrounding the ACA, Saturday Night Live aired another sketch in September 2013. This time, cast member Jay Pharoah impersonated President Obama as he presented the healthcare plan to the public, emphasizing its benefits with the support of ordinary Americans portrayed by Aaron Paul and other SNL cast members.
October 2013: Government Shutdown Over ACA Implementation
In October 2013, a government shutdown lasting until October 17th was triggered by House Republicans' refusal to fund the government unless the ACA's implementation was delayed. This came after Obama controversially delayed the employer mandate, a move critics challenged. The shutdown ended with a clean funding bill passed by the Senate, void of any ACA restrictions.
October 2013: Public Opinion on ACA Divided Along Demographic Lines
In October 2013, public opinion on the Affordable Care Act remained divided. Support for the law varied significantly across racial and age groups, with higher approval among Hispanics and African Americans, as well as those under forty.
2013: Study Attributes Part of Healthcare Inflation Reduction to System Changes
A 2013 study suggested that approximately one-quarter of the recent decline in healthcare inflation could be attributed to modifications made within the healthcare system itself.
2013: Uninsured Rates Drop Significantly in States that Expanded Medicaid
Between 2013 and 2015, states like Arkansas and Kentucky, which embraced Medicaid expansion, witnessed dramatic reductions in uninsured rates. Arkansas went from 42% to 14%, and Kentucky from 40% to 9%, demonstrating the effectiveness of expansion in broadening coverage.
2013: Limited Impact of ACA on Part-Time Employment Trends Observed
By 2013, observations and surveys indicated that only a small percentage of companies had significantly altered their workforce structure to favor part-time employment as a result of the ACA. The prevailing trend during this period was a shift from part-time to full-time work, largely attributed to factors like economic recovery and the benefits of offering health insurance to attract and retain employees.
2013: Uninsured Rate Begins to Decline Across U.S. Congressional Districts
By 2013, the positive effects of the Affordable Care Act on insurance coverage started to become evident as the uninsured rate began to decrease across all congressional districts in the United States, reflecting the law's broad reach.
2013: Union Concerns Over the Affordable Care Act
In 2013, several unions, including the AFL-CIO, Teamsters, and UNITE-HERE, expressed concerns about the Affordable Care Act, arguing that it would disrupt union health care plans and increase costs for their members.
2013: Cancellation of Individual Health Insurance Policies Under ACA
In the fall of 2013, millions of Americans with individual health insurance policies received notices that their plans were being terminated due to not meeting the minimum requirements of the Affordable Care Act, leading to controversy and political debate.
2013: Concerns About "Death Spiral" and Insurer Participation in ACA Marketplaces
Opponents of the Affordable Care Act raised concerns about a potential "death spiral" in which the individual mandate would not be sufficient to incentivize healthy individuals to enroll, leading to higher costs and insurer departures from the marketplaces.
2013: PolitiFact's "Lie of the Year": Obama's Promise on Keeping Health Plans
PolitiFact named President Obama's statement that "If you like your health care plan, you'll be able to keep your health care plan" as the "Lie of the Year" in 2013, following the cancellation of millions of individual health insurance policies under the Affordable Care Act.
2013: HealthCare.gov Rollout Issues
The launch of HealthCare.gov, the federal health insurance exchange, faced significant technical issues in 2013, creating difficulties for people trying to enroll in health insurance plans.
2013: Employer Mandate Delay and Healthcare.gov Launch Issues
The year 2013 saw significant developments related to the ACA. The IRS clarified that only individual employee coverage costs would be considered for the 9.5% income threshold determining employer mandate penalties, excluding family plans. President Obama delayed the employer mandate to 2015. The launch of state and federal health insurance exchanges, including the federal Healthcare.gov, was marred by technical glitches and management problems, highlighting implementation challenges. While operations stabilized in 2014, some planned features remained incomplete.
2013: Unspecified Event
This date is mentioned in the context of cancer diagnosis years in a study evaluating Medicaid expansion's impact, but no specific event is described for 2013.
2013: End of Pre-ACA Period for National Healthcare Expenditure Growth Analysis
This year marks the end of the period (2009-2013) used to analyze the growth of national health care expenditures before the ACA's major provisions were implemented.
2013: End of Study Period on ACA's Impact on Preventable Deaths
This year marks the end of the timeframe (2010-2013) used in a study that evaluated the Affordable Care Act's influence on reducing preventable patient deaths.
January 1, 2014: New Requirements for Health Insurance Policies
On January 1, 2014, new regulations for individual major medical health insurance policies came into effect as part of the Affordable Care Act.
January 2014: Union Leaders Criticize ACA's Impact on Healthcare and Labor
In January 2014, leaders from LIUNA and Unite Here sent a letter to Congress, criticizing the Affordable Care Act's implementation for undermining fair market competition in the healthcare industry and potentially harming workers' benefits and the 40-hour workweek.
November 2014: Rural Hospital Closures Spark Debate About ACA's Impact
By November 2014, the closure of 43 rural hospitals ignited debate about the potential role of the ACA in these closures. While critics attributed the closures to the ACA, it's important to consider the broader context, including the historical funding model of these hospitals under the 1946 Hill-Burton Act and the repurposing of some of these facilities into other healthcare centers.
2014: Government Accountability Office Report and Burwell v. Hobby Lobby
A 2014 Government Accountability Office study criticized the Obama administration's handling of the ACA exchanges, citing inadequate planning and oversight. The Supreme Court, in Burwell v. Hobby Lobby, ruled that closely held corporations with religious objections could be exempt from the contraceptive coverage mandate.
2014: Study Estimates Preventable Deaths Averted by ACA
A 2014 study estimated that the Affordable Care Act (ACA) likely prevented around 50,000 preventable patient deaths between 2010 and 2013.
2014: Study Reveals Medicaid Expansion's Impact on Cancer Diagnoses
A 2014 study using SEER program data from 2010 to 2014 showed that Medicaid expansion was linked to a 6.4% overall rise in early-stage diagnoses of various cancers.
2014: Reinsurance Program Implemented
A temporary reinsurance program, aiming to stabilize health insurance premiums under the Affordable Care Act, was implemented in 2014 and designed to run through 2016.
2014: Analysis of Part-Time vs. Full-Time Employment Trends Following ACA Implementation
Between March 2010 and 2014, data revealed a decrease in part-time jobs and an increase in full-time jobs, contradicting the prediction that the ACA would lead to a shift towards part-time employment. However, it's worth noting that this shift was more pronounced in the public sector than the private sector.
2014: Medicaid Expansion Associated with Increased Mental Health and Substance Use Disorder Treatment Utilization
Following Medicaid expansion in 2014, there was a notable increase in the use of mental health treatment, rising by 2.1 percentage points. This suggests that expanded coverage through Medicaid improved access to crucial mental health services for those who previously faced barriers.
2014: Health Insurance Exchanges Launch
Health insurance exchanges, online marketplaces for purchasing private insurance plans, were launched in 2014 under the Affordable Care Act.
2014: House Republicans Challenge Cost-Sharing Reduction Subsidy Payments
In 2014, House Republicans initiated a legal challenge against the Obama administration's cost-sharing reduction (CSR) subsidy payments to insurers under the Affordable Care Act, arguing that they were unlawful due to lack of congressional appropriations.
2014: ACA's Impact on Income Distribution
In 2014, the ACA's provisions, including subsidies for low- and middle-income individuals and taxes on higher earners, had a notable effect on income distribution. The lowest and second-lowest income quintiles experienced gains, while the top 1% saw an increase in their tax burden.
2014: ACA Medicaid Expansion and Supreme Court Ruling
In 2014, the Affordable Care Act (ACA) expanded Medicaid eligibility to include all U.S. citizens and legal residents with income up to 133% of the poverty line. The federal government committed to funding a significant portion of the increased cost. However, a Supreme Court ruling in NFIB v. Sebelius deemed the provision requiring states to expand Medicaid or lose all existing Medicaid funding as coercive, giving states the option to opt out of the expansion.
2014: Major ACA Provisions Implemented
In 2014, the major provisions of the Affordable Care Act went into effect, leading to significant changes in the U.S. healthcare system.
2014: Number of Insurers Participating in ACA Marketplaces
In 2014, the median number of insurers per state participating in the Affordable Care Act marketplaces was 4.0.
2014: Healthcare.gov Stabilization
In 2014, the operations of Healthcare.gov, the website for health insurance exchanges, stabilized after a rocky launch.
2014: Risk Corridor Program Funding Issues
In 2014, the risk corridor program, intended to support insurers participating in the Affordable Care Act marketplaces, faced funding issues. Despite provisions for payments to insurers experiencing losses, the Consolidated Appropriations Act, 2014, restricted the use of certain funds for these payments, leading to potential breaches of contract with insurers.
2014: Mixed Public Views on the Affordable Care Act's Effectiveness
Public opinion polls conducted throughout 2014 revealed mixed views on the Affordable Care Act. While a portion of Americans expressed support for the law, a significant number held unfavorable views, with many desiring its repeal or improvement.
2014: NBER Study Period Begins for Evaluating Medicaid Expansion's Impact on Mortality
The NBER study began analyzing mortality rate data from 2014 onward to assess the long-term effects of Medicaid expansion.
2014: Study Shows Decrease in Hospitalizations for Uninsured PLWH in Expansion States
The analysis of hospital discharge data, completed in 2014, revealed that hospitalizations of uninsured PLWH decreased significantly in the four states that expanded Medicaid while increasing in the two states that did not.
2014: Study Period Begins for Analyzing Excess Deaths in Non-Expansion States
The study analyzing excess deaths in states that did not expand Medicaid began its observation period in 2014.
2014: ACA Takes Full Effect, Potentially Impacting Emergency Department Visits
The year 2014 marked the full implementation of the Affordable Care Act, leading to an expansion of health insurance coverage and potentially influencing the demand for emergency department services.
2014: Implementation of Key ACA Spending Provisions
The year 2014 marked the start of most spending provisions outlined in the ACA. Despite this, the CBO predicted that revenue would exceed spending in the subsequent years.
2014: End of Period for Obama's Analysis of Medicare and Private Insurance Spending
This year concludes the period (2010-2014) that Barack Obama reviewed in 2016, highlighting a decrease in the average yearly growth of real per-enrollee spending for both Medicare and private insurance compared to preceding years.
2014: Start of Period for Evaluating National Healthcare Expenditure Growth After ACA
This year marks the beginning of the period (2014-2018) used to analyze the growth of national health care expenditures after the ACA's main provisions were enacted.
February 3, 2015: 67th House Repeal Vote
On February 3, 2015, the House of Representatives held its 67th vote on repealing the ACA. This attempt, with a vote of 239 to 186, was also unsuccessful.
June 2015: CBO Forecasts Deficit Increase Upon ACA Repeal
In June 2015, the CBO projected that repealing the ACA would increase the deficit between $137 billion and $353 billion from 2016 to 2025. They also predicted a potential increase in GDP by an average of 0.7% from 2021 to 2025 due to a boost in the labor supply.
June 2015: CBO Releases Estimates of ACA Repeal Impacts
In June 2015, the Congressional Budget Office (CBO) released estimates outlining the potential consequences of repealing the Affordable Care Act (ACA). These estimates covered various aspects, including the impact on the federal deficit.
June 25, 2015: Supreme Court Upholds Federal Subsidies for Health Insurance Premiums
On June 25, 2015, in a significant victory for the Affordable Care Act, the Supreme Court ruled that federal subsidies for health insurance premiums could be used in all states, regardless of whether they established their own insurance exchanges.
October 2015: Cost of Medicaid Expansion and Impact of Non-Expansion Estimated
In October 2015, the Kaiser Family Foundation estimated that 3.1 million people lacked coverage due to states rejecting Medicaid expansion. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) assessed the expansion cost at $6,366 per person for 2015, exceeding previous estimates. Approximately 9 to 10 million people gained Medicaid coverage, mostly low-income adults.
2015: ER Doctors Continue Reporting Increased Patient Visits and Resource Constraints
By 2015, a significant number of emergency room doctors continued to report a surge in patient visits, with many expressing concerns about having sufficient resources to manage the increased demand. This highlighted ongoing challenges in ensuring adequate access to primary care, particularly in light of the ACA's expansion of insurance coverage.
2015: Variations in Medicaid Expansion Implementation and Outcomes Emerge
By 2015, distinct patterns emerged in how states implemented and experienced Medicaid expansion. Kentucky opted for increased managed care, while Arkansas subsidized private insurance. However, both states later considered modifying their programs. In contrast, Texas, which didn't expand, saw a smaller reduction in its uninsured rate (from 39% to 32%).
2015: BRFSS Analysis Shows Increase in Viral Suppression Rates
By 2015, the analysis of BRFSS data indicated a 2.8% yearly increase in viral suppression rates among all PLWH from 2010 to 2015, attributed to the effects of Medicaid expansion.
2015: Risk Corridor Program Funding Shortfalls
By 2015, the risk corridor program, designed to stabilize the Affordable Care Act's insurance marketplaces, faced significant funding shortfalls, raising concerns about the program's long-term viability and its ability to support insurers participating in the ACA exchanges.
2015: ACA Enrollment and Cadillac Tax Delay
Despite initial challenges, 11.7 million people enrolled in ACA exchanges (excluding Medicaid) by the start of 2015, with 8.8 million remaining by year's end. Congress delayed the "Cadillac tax" on high-cost health plans, initially to 2020 and later to 2022.
2015: First Major Poll Showing Majority Approval for ACA
For the first time since its enactment, a major poll in 2015 indicated that more Americans approved of the Affordable Care Act than disapproved. This shift in public sentiment suggested growing acceptance of the law and its impact on healthcare.
2015: Survey Analyzes Non-Group Market (ACA Exchanges) Data
In 2015, a survey was conducted to analyze data from the non-group market, with a particular emphasis on individuals covered by ACA exchanges.
2015: Study Finds No Evidence of Companies Reducing Worker Hours Due to ACA
In 2015, the Center for Economic and Policy Research conducted a study that found no evidence to support claims that companies were reducing worker hours to avoid ACA requirements for employees working over 30 hours per week. This finding challenged a key criticism leveled against the ACA's employer mandate.
2015: Urban Institute Study Shows Millions Gained Coverage Since ACA Enactment
In 2015, the Urban Institute conducted a study that revealed 19.2 million non-elderly Americans had gained health insurance coverage between 2010 and 2015, primarily attributed to the Affordable Care Act's provisions.
2015: Excise Taxes from ACA Generate Billions in Revenue
In fiscal year 2015, excise taxes implemented under the Affordable Care Act generated $16.3 billion in revenue. The majority of this revenue, $11.3 billion, came from an excise tax on health insurers based on their market share.
2015: Employer Mandate Delay
President Obama delayed the employer mandate until 2015, a decision that was met with mixed reactions.
2015: Elimination of Medicare Savings Provision ("Doc Fix")
The "doc fix," a provision intended to reduce Medicare spending growth, became obsolete in 2015. This removed a significant spending restraint and changed the landscape of Medicare financing.
2015: Continued Medicaid Expansion Funding
The ACA continued to provide 100% federal funding for the expanded Medicaid program in 2015, as initially planned.
2015: Increase in Insurer Participation in ACA Marketplaces
The median number of insurers per state participating in the Affordable Care Act marketplaces increased to 5.0 in 2015.
2015: Continued Decline in Uninsured Rate Observed Across U.S. Congressional Districts
The positive trend of declining uninsured rates continued into 2015, further demonstrating the Affordable Care Act's success in expanding health insurance coverage across the nation.
2015: End of Second and Third Periods for Comparing Employer-Sponsored Premium Increases
The year 2015 signifies the end of both the second (2010-2015) and third (2015-2016) periods used to assess the percentage change in healthcare premiums for individuals with employer-provided health insurance.
February 2016: Millions Gain Coverage as ACA Implementation Progresses
By February 2016, the U.S. Department of Health and Human Services (HHS) reported that 20 million adults had gained health insurance coverage due to the Affordable Care Act, highlighting the law's impact in reducing the number of uninsured Americans.
March 2016: Congressional Budget Office Releases Report on ACA's Impact on Insurance Coverage
In March 2016, the Congressional Budget Office (CBO) released a report showing that the Affordable Care Act had resulted in approximately 24 million people gaining health insurance coverage through various provisions, including exchanges and Medicaid expansion.
May 2016: Federal Judge Rules in Favor of House Republicans on CSR Subsidies
In May 2016, a federal judge sided with House Republicans, ruling that the cost-sharing reduction (CSR) subsidy payments to insurers under the Affordable Care Act were unlawful, prompting an appeal from the Obama administration and setting the stage for further legal battles.
June 2016: Significant Reduction in Uninsured Americans Reported
By June 2016, the Affordable Care Act led to a significant decline in the uninsured rate, dropping from 16% in 2010 to 8.9%. The CDC reported this decrease, highlighting the law's positive impact on expanding health insurance coverage.
August 2016: States Establish Health Insurance Marketplaces Under the ACA
By August 2016, 15 states had successfully established their own health insurance marketplaces under the Affordable Care Act, offering residents a platform to compare and purchase health insurance plans.
October 2016: Minnesota Governor's Remarks on ACA Affordability Spark Debate
In October 2016, Minnesota Governor Mark Dayton, while acknowledging positive aspects of the Affordable Care Act, raised concerns about its affordability for an increasing number of people, drawing criticism from fellow Democrats and fueling Republican calls for repeal.
December 2016: Public Opinion on ACA Direction: Expand, Repeal, Implement, or Scale Back
A December 2016 poll highlighted the diversity of public opinion on the future of the Affordable Care Act. Options included expanding its scope, repealing it entirely, continuing its implementation, or scaling back certain provisions.
December 2016: Majority of States Expand Medicaid Under the ACA
By December 2016, 32 states and Washington D.C. had adopted the Medicaid expansion offered under the Affordable Care Act, leading to a significant decrease in the uninsured rate among low-income individuals in those states.
2016: Study Finds Limited Evidence of ACA's Impact on Part-Time Employment
A 2016 study found minimal evidence to support the claim that the ACA had contributed to an increase in part-time employment. This finding challenged earlier criticisms about the potential negative consequences of the ACA's employer mandate.
2016: Medicaid Expansion Leads to Improved Healthcare Access and Affordability in Some States
A 2016 study showcased the positive impact of Medicaid expansion in Kentucky and Arkansas. Residents in these states experienced greater access to healthcare services, reduced emergency room costs, and fewer difficulties paying medical bills. In contrast, Texas, which didn't expand Medicaid, didn't observe similar improvements.
2016: States Choosing Not to Expand Medicaid Have Higher Uninsured Rates
A significant disparity in uninsured rates became apparent in 2016. States that expanded Medicaid had considerably lower uninsured rates compared to those that didn't, highlighting the impact of this specific provision on coverage.
2016: Study Analyzes Pediatric Emergency Department Visits After ACA Implementation
A study analyzing pediatric emergency department visits from 2009 to 2016 found a significant increase in the rate of visits between 2014 and 2016, coinciding with the ACA's full implementation. This suggested a potential link between the ACA's expansion of coverage and the demand for emergency care among children.
2016: Study Published on 2017 Premium Increase Requests
A study published in 2016 analyzed premium increase requests for 2017, revealing an average increase of about 9% for a 40-year-old non-smoker in 17 cities, although some areas saw much higher proposed increases.
2016: Survey Examines Group Market (Employer Insurance) Trends
A survey conducted in 2016 examined trends within the group market, focusing on employer-sponsored insurance plans.
2016: Final Year of Full Federal Funding for Medicaid Expansion
As per the ACA's timeline, 2016 marked the last year of full federal funding (100%) for states that expanded their Medicaid programs under the ACA.
2016: Positive Impact on Health and Mortality Observed a Decade After ACA's Enactment
By 2016, a decade after the Affordable Care Act's enactment, studies showed that it had a positive effect on the health of Americans, leading to a reduction in mortality rates, underscoring the law's far-reaching benefits beyond insurance coverage.
2016: ACA's Impact on Uninsured Rate
By 2016, the Affordable Care Act had a significant impact, roughly halving the uninsured rate in the U.S., with an estimated 20 to 24 million more people gaining coverage.
2016: Barack Obama Reviews Medicare and Private Insurance Spending Trends
In 2016, Barack Obama reviewed healthcare spending trends and highlighted that from 2010 to 2014, the average annual growth in real per-enrollee Medicare spending had decreased compared to previous years.
2016: Study Reveals Lower Premiums on Exchange Policies in Medicaid Expansion States
In 2016, a U.S. Department of Health and Human Services (DHHS) study revealed a correlation between Medicaid expansion and health insurance premiums. States that expanded Medicaid tended to have lower premiums on exchange policies. This was attributed to a lower proportion of low-income enrollees, who generally have higher healthcare needs, in the exchanges of expansion states.
2016: ACA Provisions Contribute to Reduced Income Inequality
In 2016, the Congressional Budget Office (CBO) found that the Affordable Care Act had contributed to a reduction in income inequality after taxes. This reduction was attributed to income tax surcharges and subsidies provided under the law, which helped offset healthcare costs for lower-income individuals.
2016: National Exchange Enrollment
Over 9.6 million people were enrolled on the national exchange in 2016.
2016: First Delay of the "Cadillac Tax"
The "Cadillac tax", a key provision of the ACA, faced its first delay in 2016. Initially slated to begin in 2018, the Consolidated Appropriations Act of 2016 postponed its implementation. This delay signaled growing concerns and political pressures surrounding the tax.
2016: Medicaid Expansion and Insurer Losses
The ACA's impact on Medicaid was significant by 2016, with an estimated 9 to 10 million additional enrollees, mostly low-income adults. However, major national insurers reported financial losses on ACA plans due to a risk pool that included a higher proportion of older, sicker, and lower-income individuals than anticipated.
2016: Decline in Insurer Participation in ACA Marketplaces
The median number of insurers per state participating in the Affordable Care Act marketplaces declined to 4.0 in 2016.
2016: Risk Corridor Program Ends
The risk corridor program, a temporary provision of the Affordable Care Act, concluded in 2016. The program aimed to mitigate risk for insurers participating in the ACA marketplace during its early years.
2016: Reinsurance Program Concludes
The temporary reinsurance program, established under the Affordable Care Act to support the stability of health insurance markets, came to an end in 2016.
2016: Start of CBO's Projected Deficit Increase After Potential ACA Repeal
The year 2016 marked the beginning of the period during which the CBO projected a potential increase in the deficit following a hypothetical ACA repeal.
2016: End of Comparison Period for Employer-Sponsored Premium Increases
The year 2016 represents the conclusion of the timeframe used to compare the percentage changes in healthcare premiums for individuals covered by employer-sponsored health insurance.
January 2017: Himmelstein and Woolhandler Publish Findings on Potential Deaths from ACA Rollback
In January 2017, Himmelstein and Woolhandler released their findings, estimating that rolling back the ACA's Medicaid expansion alone could lead to approximately 43,956 preventable deaths annually.
January 2017: Shifting Public Opinion and Confusion Surrounding ACA Repeal
In January 2017, polls indicated a shift in public opinion with more people viewing the Affordable Care Act favorably. However, there was also confusion surrounding the potential repeal of the law, with many unaware of the implications for Medicaid and subsidized health insurance.
February 2017: Moda Health v. United States Ruling
In February 2017, a significant ruling occurred in the case of Moda Health v. United States. The court ordered the government to fulfill its promise under the Affordable Care Act's risk corridor program, stating that insurers had relied on the government's commitment.
2017: Study Finds ACA Reduced Socioeconomic Disparities in Healthcare Access
A 2017 study highlighted a significant positive consequence of the Affordable Care Act: it helped reduce socioeconomic disparities in access to healthcare services, indicating progress towards more equitable healthcare.
2017: State Innovation Waivers
Beginning in 2017, the ACA introduced a waiver option, allowing states to pursue innovative approaches to healthcare reform. States could apply for a "waiver for state innovation" to create alternative health systems that deviated from some of the ACA's requirements. To qualify, these alternative systems had to meet certain criteria, such as offering coverage that is at least as affordable and comprehensive as the ACA, covering a comparable number of residents, and avoiding an increase in the federal deficit.
2017: Challenges Facing Consumer Operated and Oriented Plans
By 2017, only four out of the initial 23 Consumer Operated and Oriented Plans (CO-OPs), non-profit, member-governed insurance providers established under the ACA, were still operational. This indicated significant challenges faced by these plans in establishing themselves within the healthcare landscape.
2017: Better Care Reconciliation Act
In 2017, Republicans sought to replace the ACA with the "Better Care Reconciliation Act" (BCRA). The drafting process, led by 13 Republicans selected by Leader McConnell, faced criticism for its lack of transparency. Despite lacking full support and facing opposition from Senators Collins and Murkowski, the bill advanced to formal amendment consideration after Vice President Pence cast a tie-breaking vote.
2017: Premium Costs and Tax Credit Offsets Analyzed
In 2017, analyses were conducted on the effectiveness of tax credits in offsetting the rising premium costs, finding that subsidies often balanced out the increases for eligible enrollees.
2017: Cost-Sharing Reduction Subsidies
In 2017, the Affordable Care Act included cost-sharing reduction (CSR) subsidies, amounting to approximately $7 billion, intended to be paid to insurance companies. These subsidies aimed to help reduce out-of-pocket costs for individuals and families with lower incomes.
2017: CBO Estimates Deficit Reduction from Individual Mandate Repeal
In 2017, the CBO estimated that repealing the ACA's individual mandate alone would reduce the deficit by $338 billion over ten years.
2017: Uncertainty over CSR Subsidies Leads to Premium Increases
In 2017, uncertainty surrounding the continuation of cost-sharing reduction (CSR) subsidies under the Affordable Care Act led to insurers proposing significant premium increases, highlighting the potential impact of policy changes on healthcare costs.
2017: Shifting Public Opinion on ACA
Initially met with opposition, the Affordable Care Act saw a shift in public opinion by 2017, achieving majority support.
2017: Individual Market Stabilization Bill Failure
The 2017 Individual Market Stabilization Bill, an attempt to address concerns and provide stability to the ACA's individual health insurance market, ultimately failed. The bill proposed various measures, including funding cost-sharing reductions, greater flexibility for state waivers, the creation of a new catastrophic coverage "Copper Plan," enabling interstate insurance compacts, and redirecting consumer fees to states for outreach purposes.
2017: Study Concludes: Non-Expansion States Suffered Excess Deaths
The 2021 study concluded that states choosing not to expand Medicaid experienced approximately 15,600 excess deaths between 2014 and 2017.
2017: Gradual Decrease in Federal Funding for Medicaid Expansion Begins
The ACA's provision for gradually decreasing federal funding for Medicaid expansion started in 2017, with the federal government covering 95% of the cost. This marked a shift in the financial burden from the federal government to individual states.
2017: NBER Study Concludes, Showing Significant Lives Saved by Medicaid Expansion
The NBER study concluded in 2017, revealing that Medicaid expansion in participating states saved the lives of at least 19,200 adults aged 55 to 64 from 2014 to 2017.
2017: Tax Cuts and Jobs Act Impact on ACA
The Tax Cuts and Jobs Act of 2017 repealed the individual mandate penalty, a key provision of the Affordable Care Act, starting in 2019.
2017: Further Decline in Insurer Participation in ACA Marketplaces
The median number of insurers per state participating in the Affordable Care Act marketplaces continued to decline, reaching 3.0 in 2017. Five states had only one insurer participating.
2017: Tax Cuts and Jobs Act Prompts New Legal Challenge to ACA
The passage of the Tax Cuts and Jobs Act of 2017, which eliminated the individual mandate penalty, sparked a new wave of legal challenges to the Affordable Care Act, with opponents arguing that the entire law was now unconstitutional.
2017: Enrollment Fluctuations, Individual Mandate Weakening, and AHCA Defeat
The year 2017 saw a decline in national exchange enrollment to 9.2 million, a decrease attributed to President Trump's election. Despite this, eleven states managing their exchanges saw increased enrollment, reaching 3 million. The Trump administration's decision to weaken the individual mandate by not requiring health insurance reporting on tax returns further impacted the ACA's reach. Despite the House's vote to repeal the ACA with the American Health Care Act (AHCA), the Senate rejected the proposal.
February 2018: Texas and Other States File Lawsuit Challenging ACA's Constitutionality
In February 2018, Texas and 19 other states filed a lawsuit challenging the constitutionality of the entire Affordable Care Act after the individual mandate penalty was eliminated by the Tax Cuts and Jobs Act of 2017.
March 2018: CBO Report on ACA and Income Inequality
In March 2018, the Congressional Budget Office (CBO) reported that the ACA had contributed to a reduction in income inequality in 2014. The report found that the law provided financial assistance to lower-income households while increasing taxes on higher earners, particularly those in the top 1%.
May 7, 2018: Nutrition Labeling Requirements Take Effect
After an initial delay, the nutrition labeling requirements mandated by the Affordable Care Act finally went into effect on May 7, 2018. This provision aimed to provide consumers with clearer information about the nutritional content of food offered at chain restaurants and similar establishments.
December 14, 2018: Texas Judge Rules Affordable Care Act Unconstitutional
On December 14, 2018, a federal judge in Texas ruled that the Affordable Care Act was unconstitutional, arguing that the individual mandate was no longer valid and that the entire law was inseverable from the mandate, although he did not overturn the law immediately.
2018: Continuing Decline in Federal Medicaid Expansion Funding
As outlined in the ACA, federal funding for expanded Medicaid programs further decreased to 94% in 2018.
2018: Medicaid Expansion Linked to Improved Healthcare Access and Utilization
By 2018, evidence mounted regarding the positive effects of Medicaid expansion on healthcare access. Low-income adults in expansion states experienced improved affordability, increased access to doctors, and greater utilization of usual sources of care, highlighting the tangible benefits of expanding coverage.
2018: Projected Impact of Healthcare Reform Proposals
In 2018, projections estimated the potential impact of different healthcare reform proposals on the number of uninsured Americans.
2018: ACA Mandates and Taxes Yield Billions in Revenue
In the 2018 fiscal year, the Affordable Care Act's individual and employer mandates each generated $4 billion. Additional revenue came from excise taxes on health insurers and drug manufacturers ($18 billion), as well as income tax surcharges ($437 billion).
2018: "Cadillac Tax" Delayed
The Affordable Care Act's 40% excise tax on high-cost employer-sponsored health insurance plans, known as the "Cadillac tax," was initially set to take effect in 2018. However, the Consolidated Appropriations Act of 2016 delayed its implementation.
2018: End of Post-ACA Period for National Healthcare Expenditure Growth Analysis
This year marks the end of the period (2014-2018) used to evaluate the growth of national health care expenditures after the implementation of the ACA's major provisions.
2018: JAMA Studies on Hospital Readmissions Reduction Program (HRRP)
Two JAMA studies in 2018 found that the Hospital Readmissions Reduction Program (HRRP), while aiming to reduce readmissions, was associated with increased post-discharge mortality for heart failure and pneumonia patients. This raised concerns about unintended consequences and potential "gaming the system" to lower readmission rates at the expense of patient well-being.
July 9, 2019: Fifth Circuit Court of Appeals Hears Arguments on ACA's Constitutionality
On July 9, 2019, the Fifth Circuit Court of Appeals heard arguments in the case challenging the constitutionality of the Affordable Care Act, with the Department of Justice siding with Republican states against the law and Democratic states defending it.
July 2019: NBER Study Highlights Mortality Rate Reductions Due to Medicaid Expansion
In July 2019, the National Bureau of Economic Research (NBER) published a study showing states that implemented Medicaid expansion experienced statistically significant decreases in mortality rates.
September 2019: Census Data Highlights Disparities in Uninsured Rates Based on Medicaid Expansion Status
Data released by the Census Bureau in September 2019 underscored the impact of Medicaid expansion on uninsured rates. States that adopted the expansion had significantly lower uninsured rates compared to non-expansion states. This disparity was particularly evident among low-income adults, further emphasizing the role of expansion in increasing coverage access.
December 2019: Medicaid Expansion Progresses Despite Challenges
By December 2019, 37 states, including Washington D.C., had implemented the Medicaid expansion offered under the Affordable Care Act, demonstrating continued progress despite challenges and opposition.
December 2019: Fifth Circuit Rules Individual Mandate Unconstitutional but Sends Case Back to Lower Court
In December 2019, the Fifth Circuit Court of Appeals ruled that the Affordable Care Act's individual mandate was unconstitutional but sent the case back to the lower court to determine whether the rest of the law could stand without it.
2019: JAMA Study on ACA's Impact on Emergency Department and Hospital Use
A 2019 JAMA study indicated that the Affordable Care Act (ACA) led to a decrease in emergency department and hospital use by uninsured individuals, suggesting that increased coverage may have provided better access to primary and preventive care.
2019: Individual Mandate Penalty Set to $0
As part of the Tax Cuts and Jobs Act, the individual mandate penalty was effectively eliminated starting in 2019 by setting it to $0. The CBO projected that this change would result in a decrease of 13 million insured individuals by 2027.
2019: Medicaid Expansion Status
By 2019, a significant majority of states, 35 in total, along with the District of Columbia, had adopted Medicaid expansion or implemented similar programs to broaden coverage under the ACA.
2019: Subsidy Cliff Concerns
Concerns were raised about the "subsidy cliff" in 2019, where subsidies for ACA plans purchased on the exchange stopped at 400% of the federal poverty level, leading to a sharp increase in costs for those just above the threshold.
2019: Cadillac Tax Repeal
Congress repealed the "Cadillac tax" on high-cost health insurance plans in 2019, marking a significant change to the ACA.
2019: Federal Funding for Medicaid Expansion Drops to 93%
Continuing the phased reduction outlined in the ACA, the federal government's contribution to expanded Medicaid programs dropped to 93% in 2019.
2019: Congressional Repeal of ACA Provisions
In 2019, Congress further chipped away at the Affordable Care Act by repealing the "Cadillac" tax on high-cost health insurance plans, a tax on medical devices, and the Health Insurance Tax.
2019: Sliding-Scale Subsidies for Health Insurance
In 2019, a sliding-scale subsidy based on income and federal poverty level was implemented to help individuals and families afford health insurance purchased through the exchange established by the Affordable Care Act.
2019: Individual Mandate Tax Eliminated Under the ACA
The individual mandate tax, a key provision of the Affordable Care Act, was set to $0 beginning in 2019. This change aimed to reduce the financial burden on individuals who chose not to obtain health insurance.
2019: Number of State-Based Health Insurance Marketplaces Increases
The number of states opting to operate their own health insurance exchanges continued to grow. By 2019, 12 states and Washington D.C. had established their own exchanges under the Affordable Care Act.
2019: Repeal of Excise Taxes on Medical Devices and Indoor Tanning
The year 2019 saw the repeal of several excise taxes implemented by the ACA. These included a 2.3% tax on medical devices and a 10% tax on indoor tanning services, signaling a shift in policy and potentially impacting healthcare costs and consumer behavior.
2019: End of Period for Potential Medicare Payment Increases Impacting CBO Estimates
This year marked the end of the period during which potential legislation to increase Medicare payments, as debated in 2010, could have affected the CBO's cost estimates for the ACA.
March 2020: Supreme Court Agrees to Hear Case on ACA's Fate
In March 2020, the Supreme Court agreed to hear the case on the constitutionality of the Affordable Care Act, setting the stage for a major decision with significant implications for healthcare access in the United States.
July 8, 2020: Supreme Court Rules on Contraceptive Coverage in Little Sisters of the Poor Case
On July 8, 2020, the Supreme Court ruled in Little Sisters of the Poor v. Pennsylvania that employers with religious or moral objections could exclude contraceptive coverage from employee health plans, sparking debate about religious freedom and women's healthcare access.
2020: JAMA Study on Medicare Expansion and Breast Cancer
A 2020 JAMA study revealed a link between Medicare expansion under the ACA and a reduced incidence of advanced-stage breast cancer. This suggests that improved access to affordable healthcare through Medicaid facilitated earlier detection and better outcomes for breast cancer patients.
2020: Closing the Medicare Part D "Donut Hole"
A significant milestone in the ACA's phased approach to addressing the Medicare Part D coverage gap, often referred to as the "donut hole," was achieved in 2020. By this year, the coverage gap for brand-name drugs was completely closed, providing substantial financial relief to seniors and individuals with disabilities enrolled in Medicare Part D.
2020: States Grapple with Medicaid Expansion Costs and Coverage Gaps
By 2020, several states faced challenges related to Medicaid expansion. Some argued they couldn't afford the 10% contribution, while studies suggested rejecting expansion could be costlier due to increased uncompensated emergency care. Concerns arose about coverage gaps for individuals with incomes too high for Medicaid but too low for exchange subsidies.
2020: First Cadillac Tax Delay
Congress delayed the implementation of the "Cadillac tax" on high-cost health insurance plans to 2020, pushing back a key provision of the ACA.
2020: Treasury Department Study on ACA and Mortality
In 2020, a study by Treasury Department economists published in the Quarterly Journal of Economics used a randomized controlled trial to assess the ACA's impact on mortality. The study found that obtaining health insurance through the ACA reduced mortality by 12% over two years, highlighting the life-saving potential of expanded coverage.
2020: Democrats Highlight Potential Impact of Invalidating ACA
In 2020, as the Supreme Court prepared to hear a case on the Affordable Care Act's constitutionality, Democrats emphasized the potential negative consequences of invalidating the entire law, particularly the loss of protections for preexisting conditions and the lack of a Republican replacement plan.
2020: Federal Funding for Medicaid Expansion Stabilizes
In 2020, federal funding for states that expanded Medicaid under the ACA reached its long-term level of 90%, as stipulated in the legislation.
2020: "Cadillac Tax" Further Delayed and Repealed
Originally scheduled for 2018, the "Cadillac tax" on high-cost employer health plans was again delayed, this time to 2022, by the Consolidated Appropriations Act. It was later fully repealed as part of the Further Consolidated Appropriations Act of 2020.
2020: Independent Payment Advisory Board (IPAB) and Cost-Saving Measures
The Independent Payment Advisory Board (IPAB), established under the Affordable Care Act, was tasked with recommending cost-saving changes to Medicare. However, it was prohibited from recommending changes that would reduce payments before 2020 or impact premiums, benefits, eligibility, taxes, or lead to rationing.
June 2021: Supreme Court Upholds ACA
In June 2021, the Supreme Court upheld the Affordable Care Act in the case of California v. Texas, marking the third time the law withstood legal challenges.
June 17, 2021: Supreme Court Upholds Affordable Care Act
On June 17, 2021, in a 7-2 decision, the Supreme Court upheld the constitutionality of the Affordable Care Act, rejecting the challenge brought by Texas and other states and preserving access to healthcare for millions of Americans.
2021: Study Finds Lower Mortality Rates in States with Medicaid Expansion
A 2021 study highlighted a significant correlation between states that expanded Medicaid and lower mortality rates compared to those that did not.
2021: Expansion of ACA Subsidies
During the COVID-19 pandemic in 2021, the American Rescue Plan Act expanded subsidies for marketplace health plans created by the Affordable Care Act.
2021: Democrats Propose Cover Now Act for Local Medicaid Expansion Funding
In 2021, due to the lack of Medicaid expansion in many states, numerous Democrats co-sponsored the Cover Now Act, aiming to enable county and municipal governments to financially support Medicaid expansion efforts.
2021: Supreme Court's Decision on ACA Anticipated after 2020 Elections
The Supreme Court's decision on the Affordable Care Act's fate was anticipated to come after the 2020 elections, adding to the political significance of the case and highlighting the deep divisions over healthcare policy in the country.
2021: Start of CBO's Projected GDP Increase After Potential ACA Repeal
The year 2021 marked the beginning of the period in which the CBO projected a potential GDP increase if the ACA were to be repealed.
2021: End of CBO's Projected Period for ACA Deficit Reduction
The year 2021 marked the end of the period for which the CBO projected the ACA would lead to a net deficit reduction.
2022: Second Cadillac Tax Delay and Repeal
Congress further delayed the "Cadillac tax" on expensive health plans until 2022. It was eventually repealed in 2019, signaling a shift in policy regarding the ACA.
2022: Continuation of ACA Subsidy Expansion
In 2022, as part of the Inflation Reduction Act, Congress extended the enhanced subsidies for Affordable Care Act marketplace health plans.
2022: Final Delay of the "Cadillac Tax"
The "Cadillac tax" on expensive employer-sponsored health plans, originally scheduled to start in 2018 and subsequently delayed, was slated for implementation in 2022. However, the tax was ultimately repealed, marking a significant shift in the ACA's trajectory.
March 2023: Federal Judge Rules ACA's Preventative Care Mandate Violates Religious Freedom
In March 2023, a Texas judge ruled that the Affordable Care Act's mandate for contraceptive coverage and certain preventative screenings violated religious freedom, prompting the Biden administration to seek a hold on the decision and continuing the legal battle over the ACA.
2023: Majority Approval for ACA, with Partisan Divide
By the end of 2023, a majority of registered voters expressed approval for the Affordable Care Act, according to a Morning Consult poll. However, there was a significant partisan divide in support, with Democrats overwhelmingly in favor and Republicans largely opposed.
2025: End of CBO's Projected Deficit Increase After Potential ACA Repeal
The year 2025 marked the end of the period during which the CBO projected a potential increase in the deficit if the ACA were to be repealed.
2027: Projected Impact of Individual Mandate Penalty Change
The Congressional Budget Office (CBO) estimated that setting the individual mandate penalty to $0 in 2019 would lead to 13 million fewer people having health insurance by 2027.
