The growing role of government in health care finance since 2010
By Tom Daly
Since its enactment in 2010, the Affordable Care Act (ACA) has undergone several significant changes. These alterations reflect efforts to adjust, improve, or challenge various aspects of the law.
Some of the key changes include:
1. Individual Mandate Penalty Removal (2019): One of the most significant changes was the reduction of the individual mandate penalty to $0 in 2019. Originally, the ACA required most Americans to have health insurance or pay a penalty, but the Tax Cuts and Jobs Act of 2017 effectively eliminated this penalty.
2. Expansion of Medicaid (Ongoing): The ACA initially sought to expand Medicaid in all states, but a 2012 Supreme Court decision made this expansion optional for states. Since then, a growing number of states have opted to expand Medicaid coverage, though not all have done so.
3. Changes to Medicare Payments and Services (Ongoing): The ACA included provisions to reduce Medicare spending and improve the efficiency and quality of care. These changes are ongoing and include adjustments to provider payments and the introduction of new delivery models, like Accountable Care Organizations (ACOs).
4. Introduction and Modification of Health Insurance Subsidies (Ongoing): The ACA introduced subsidies to help lower and middle-income individuals afford insurance. These subsidies have been adjusted over time to enhance affordability.
5. Establishment and Evolution of Health Insurance Marketplaces (Ongoing): The ACA created health insurance marketplaces (or exchanges) for individuals and small businesses. These have evolved with changes in policy and technology.
6. Repeal of the Cadillac Tax (2020): The so-called “Cadillac Tax” on high-cost employer health plans was repealed before it ever took effect. This tax was intended to reduce health care costs by taxing expensive health plans.
7. Changes Under the Biden Administration: The Biden administration has made efforts to strengthen the ACA, including increasing subsidies temporarily as part of COVID-19 relief measures and seeking to expand Medicaid in states that have not yet done so.
8. COVID-19 Pandemic Response (2020-2021): The pandemic led to temporary measures to increase access to health care, including special enrollment periods for ACA marketplaces and increased federal support for Medicaid.
9. American Rescue Plan Act (2021): This significant legislation, passed in March 2021, temporarily expanded ACA subsidies, making health insurance more affordable for many Americans. It increased the subsidies for those already eligible and extended subsidy eligibility to those with higher incomes who were previously ineligible.
10. Enhanced Subsidies Extension (2022): The enhanced subsidies introduced in the American Rescue Plan were initially set to expire at the end of 2022. However, subsequent legislation or administrative actions may have sought to extend or modify these subsidies.
Don’t forget the rapid growth of ICHRAs. They are the future of employer sponsored health insurance!
