Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act (PPACA) is a federal statute that was signed into United States law by President Barack Obama on March 23, 2010. This Act and the Health Care and Education Reconciliation Act of 2010 (signed into law on March 30, 2010) made up the health care reform of 2010. The laws focus on reform of the private health insurance market, provide better coverage for those with pre-existing conditions, improve prescription drug coverage in Medicare and extend the life of the Medicare Trust fund by at least 12 years, and to attempt to provide insurance covarge for the 15% of the U.S population that lacks prescription coverage.

The law includes numerous health-related provisions to take effect over a four-year period beginning in 2010. In order of their assessed impact the primary provisions are as follows:
 * Guaranteed issue and community rating will be implemented nationally so that insurers must offer the same premium to all applicants of the same age, sex, and geographical location regardless of pre-existing conditions.
 * Medicaid eligibility is expanded to include all individuals and families with incomes up to 133% of the poverty level.
 * Health insurance exchanges will commence operation in each state, offering a marketplace where individuals and small businesses can compare policies and premiums, and buy insurance (with a government subsidy if eligible).
 * Firms employing 50 or more people but not offering health insurance will pay a "shared responsibility payment" if the government has had to subsidize an employee's health care
 * Non exempt persons not securing minimum essential health insurance coverage are also fined under the shared responsibility rules. This requirement to maintain insurance or pay a fine is often referred to as the individual mandate, though being insured is not actually mandated by law. Not being insured will not be a crime and no criminal penalty can attach to non payment of the fine. The fine serves to encourage most people into an insurance pool and to deter healthy individuals from buying insurance only when they become ill.
 * Improved benefits for Medicare prescription drug coverage are to be implemented.
 * Changes are enacted which allow a restructuring of Medicare reimbursement from "fee-for-service" to "bundled payments".
 * Establishment of a national voluntary insurance program for purchasing community living assistance services and support.
 * Low income persons and families above the Medicaid level and up to 400% of the poverty level will receive subsidies on a sliding scale if they choose to purchase insurance via an exchange (persons at 150% of the poverty level would be subsidized such that their premium cost would be of 2% of income or $50 a month for a family of 4).
 * Very small businesses will be able to get subsidies if they purchase insurance through an exchange.
 * Additional support is provided for medical research and the National Institutes of Health.
 * Enrollment into CHIP and Medicaid is simplified with improvements to both programs.
 * The law will introduce minimum standards for health insurance policies and remove all annual and lifetime coverage caps.
 * The law mandates that some health care insurance benefits will be "essential" coverage for which there will be no co-pays.
 * Policies issued before the law came into effect are "grandfathered" and are mostly not affected by the new rules.

Controversial portions of act
Currently, this act is surrounded in a lot of controversy particularly around the issues of the individual mandate requiring all citizens to acquire health care insurance or be charged a penalty and the contraception provision requiring all health insurances to provide coverage for things such as birth control. The requirement for businesses that employ over 50 employees is also controversial, but has been pushed back till 2015. Opponents to the requirement for businesses above a specific size to provide insurance claim that this will end up being a 'job killer' as employers may reduce the number of employees they have and not add positions in the future.

To add to this, the problems with the rocky roll out of the national heath care exchange, and changing directions with the decision as to whether old health care insurance plans could be continued. The controversy over this act continues.

Controversy over individual mandate
On June 28, 2012, in a 5-4 ruling, the US Supreme Court ruled the individual mandate requiring people to have health insurance is valid as a tax, even though it is impermissible under the Constitution's commerce clause.

"In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance," Chief Justice John Roberts wrote in the majority opinion. "Such legislation is within Congress's power to tax."

Despite the legal ruling this remains controversial as the Republican party works to find a way to repeal this legislation.

Controversy over contraception
As of August 2012 the women's preventative health care amendment officially went into effect. It includes eight preventive health benefits: access to free contraceptives, breast-feeding supplies, screenings for sexually transmitted infections, counseling for domestic violence and routine check-ups for breast and pelvic exams, Pap tests and prenatal care.

Earlier this year, the birth control provision sparked major controversy. Religious organizations protested that they shouldn't have to comply. After weeks of backlash, the White House amended the rule to provide exemptions for religious institutions, but not private companies. Some private companies continue to express concerns over their requirement to provide such services if they have moral objections, along with concerns over the cost associated with providing contraceptives.

On June 30, 2014, in a 5-4 ruling, the US Supreme Court ruled that some corporations also have religious rights to deny coverage of contraceptives. Both corporations involved in this ruling (Conestoga Wood Specialties of Pennsylvania and the Oklahoma based arts-and-crafts retail chain Hobby Lobby) emphasized their conscientious desire to operate in harmony with biblical principles while competing in a secular marketplace. Justice Samuel Alito wrote the majority opinion, "The companies in the cases before us are closely held corporations, each owned and controlled by members of a single family, and no one has disputed the sincerity of their religious beliefs."