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Home > Covering Health Issues: A Sourcebook for Journalists Fall 2013 - Table of Contents > Chapter 1 - Patient Protection and Affordable Care Act
 

Chapter 1 - Patient Protection and Affordable Care Act

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CHAPTER 1 - PATIENT PROTECTION AND AFFORDABLE CARE ACT

Content Last Updated: 3/21/2014 2:14:04 PM
Graphics Last Updated: 10/1/2013 8:56:15 AM
Note: Terms in green will show glossary definitions when clicked.

Written by Julie Rovner, NPR. Updated March 2014 by Sabah Bhatnagar, Ivana Castellanos and Amanda Napoles, Alliance for Health Reform

WHAT'S NEXT

  • The small business health options program (SHOP) will open for enrollment on November 1, 2014. Small businesses will be able to enroll in plans, as well as receive tax credits.1
  • After the 2014 open enrollment ends on March 31, 2014, analysts will examine demographic data to see how many young, healthy people purchased insurance through marketplaces. Fewer-than-predicted young enrollees could lead to higher premiums in 2015, they project.2
  • Watch to see how many people whose insurance policies were canceled apply for hardship exemptions so that they will not have to pay a penalty for failing to purchase insurance in 2014. Those with hardship exemptions may buy catastrophic coverage.3

FAST FACTS

BACKGROUND

The Patient Protection and Affordable Care Act (ACA) officially rolled out on October 1, 2013, but it remained as controversial as the day President Obama signed it, according to polls. And the public remained confused about what the sweeping law does – and does not – do, even as the major provisions neared implementation.9

Some of the confusion likely came because lawmakers were forced to write the law in two separate parts. Due to the political situation arising from the loss of the Democrats’ 60-vote, filibuster-proof majority in the Senate in January of 2010, Congress could not finish work on the law in the normal manner: by convening a House-Senate conference committee to work out differences in the versions of the bill passed by the House in November of 2009, and by the Senate that Christmas Eve.10 11

As a result, the health law is actually two separate bills. The Patient Protection and Affordable Care Act is technically the Senate-passed bill as passed without change by the House on March 21. The ACA’s March 23 signing by the president was followed a week later by that of the Health Care and Education Reconciliation Act, which included the changes to the bill negotiated by House and Senate Democrats. Both passed without Republican votes.12 13 

Within hours of the law’s signing, legal challenges were filed, including one that would ultimately be joined by more than half the states. It asserted that the law’s requirement for most people to either obtain health insurance or pay a penalty exceeded Congress’s constitutional authority.14

SUPREME COURT

Although implementation was proceeding as scheduled, it was not until June 28, 2012, that the Supreme Court settled the threshold legal question. In a 5 to 4 ruling, with Chief Justice John Roberts writing the majority opinion, the court held that Congress could, in fact, impose the controversial so-called individual mandate, although not as an exercise of its power to regulate interstate commerce, as asserted in the law and by the Obama administration in court. Rather, wrote Justice Roberts, because the penalty for lacking insurance is paid to the Internal Revenue Service (IRS), it is a tax, and therefore the law is acceptable under Congress’ taxing power.15

But while the court upheld the individual insurance requirement, it did impose a significant — and unexpected — change to the law. The states had also argued that the law’s expansion of Medicaid — the joint federal-state health program for those with low incomes — was unfairly coercive. The states argued that the law essentially blackmailed them by making them either expand Medicaid to everyone with incomes up to 133 percent of the federal poverty level (amounting to $15,282 for an individual in 2013), or give up all their Medicaid funds. The court agreed, and the justices held that the Medicaid expansion is effectively a state option.

WHAT THE ACA DOES 

The coverage provisions of the law have gained by far the most attention. But they are only one of three major pieces of a multi-part measure. There are many comprehensive summaries of the law (including several located at the links at the end of this chapter). What follows is a much more rudimentary summary that can serve as a beginner’s guide to the law:

Insurance Reforms

Most portions of the law that are already in effect attempt to establish new rights and benefits for patients from private insurance companies.

Several of the insurance-related provisions ensure that patients can see certain specialists without having to get permission from a primary care doctor and get preventive care services without having to pay deductibles or copayments. They also bar insurance companies from dropping coverage because a person gets sick.16 Also, parents now may keep adult children on their health insurance plans until age 26.

Another rule highly touted by the Obama administration requires insurance companies to spend 80 to 85 percent of each premium dollar (depending on the policy) on direct medical expenses, rather than on administrative costs or profit. If a plan exceeds the limit, called a medical loss ratio, it must refund the difference.17

And, the law requires that premium increases greater than 10 percent be automatically reviewed, making it easier for states to deny rate hikes.18

Controversy erupted late in 2013 when millions of individuals lost health insurance plans that did not comply with the ACA. The Obama administration responded to consumer complaints by giving health plans an additional two years to meet the law’s standards.19

Quality Improvement, Delivery System Changes and Cost Containment

One of the most frequent complaints about the ACA is that it does not do enough to contain the rising cost of health care. But it does include changes intended to test possible ways to make care more efficient, effective, and, hopefully, less expensive in the future. Here are just a few:

  • Patient-Centered Medical Homes are intended to encourage doctors to work in partnership with nurses and other health professionals to provide primary care services. The idea is to give patients a one-stop shopping experience where they can get multiple medical needs met. But it is also intended to offload minor tasks to junior members of the team and free up physicians for activities that require their level of training.20

  • Accountable Care Organizations, or ACOs, are groups of physicians, hospitals, and other health care providers that band together to manage the health of a population of patients, and take the financial risk for keeping those patients healthy across a wide variety of care settings. ACOs, which are similar to health maintenance organizations and other types of managed care plans, are designed to encourage care quality improvement.21
  • Independent Payment Advisory Board, or IPAB, is one of the most controversial cost-related provisions of the ACA. It calls for a 15-member panel to make recommendations for keeping Medicare spending within certain limits compared to the growth of the economy as a whole. Starting in 2013, Congress is required to act on IPAB’s proposals or pass legislation that would save the same amount of money. If Congress fails to act, the secretary of health and human services is required to implement the cuts as recommended. However, the board has proved so controversial that as of March 2014, the Obama administration had not even tried to appoint anyone. For the moment the matter is moot – since passage of the ACA, the growth of Medicare spending has slowed to the point that no action to launch IPAB appears imminent.22

Health Insurance Coverage Expansion

Most of the major expansions of insurance coverage are set to begin Jan. 1, 2014, and the law has already extended coverage to millions. An estimated three million young adults are covered on their parents’ plans, while insurers are barred from denying coverage to children with pre-existing health conditions. 

Much of the attention, when it comes to expanding coverage, has gone to the health insurance exchanges, which the Obama administration has renamed health insurance marketplaces. These are online portals where, at least at first, individuals and small businesses will go to shop for insurance, find out if they qualify for tax credits or subsidies to help them afford coverage and, if they have very low incomes, get referred for enrollment in Medicaid.23

Originally, Medicaid was expected to account for half of the law’s increase in coverage; about 17 million more people by the year 2022, according to the Congressional Budget Office (CBO). After the Supreme Court’s ruling, though, the Medicaid expansion estimate dropped. (See Medicaid chapter). 24 25

But while many people are expected to obtain insurance coverage under the ACA because they will be able to afford it for the first time, others will be able to get insurance because of the rule taking effect in 2014 that bars insurance companies from refusing to sell people insurance because they have a pre-existing health condition, or charging them more because of that.

It is that provision that prompted Congress — at the urging of the insurance industry — to also include the requirement for nearly every American to maintain insurance coverage, so the costs of people who are sicker can be more evenly spread across the broadest possible population.26 The insurance industry, however, has maintained that the penalties for failure to obtain that insurance — starting at the greater of $95 or one percent of taxable income in 2014 — is lower than the cost of purchasing insurance.27

Public Health and Prevention

The ACA also includes provisions geared toward improving population health. (See Public Health and Prevention chapter.) The law created the Prevention and Public Health Fund (PPHF).28 Money is used for activities ranging from prevention programs to workforce building initiatives. These activities include community and clinical prevention initiatives; research, surveillance and tracking; public health infrastructure; immunizations and screenings; tobacco prevention; and public health workforce and training.29 The ACA originally allocated $15 billion over its first 10 years for the PPHF. On February 22, 2012, President Obama signed legislation cutting the PPHF budget by $5 billion over 10 years to help pay for the continuation of payroll tax breaks and other initiatives.30 Due to these cuts and other budgetary decreases, federal funding for fiscal year 2014 was $1 billion instead of $1.5 billion, removing any money allocated toward ACA implementation.31 32

Long-Term Services and Supports

One thing the law will not include is a program to help people pay for long-term care services provided in the home. (See Long-Term Services and Supports chapter.) As part of the year-end bill to address the “fiscal cliff,” at the end of 2012, Congress repealed the Community Living Assistance Services and Supports (CLASS) Act. It had been the last legislative wish of the late Sen. Edward Kennedy, D-Mass. The Department of Health and Human Services had stopped implementation of the measure in the autumn of 2011, declaring it financially non-viable. But supporters of the measure had maintained hope that a way could be found for the measure to be mended rather than repealed.33

ISSUES AND LIKELY POLICY DEBATES

  • Affordability. The ACA was expressly designed to help spread the cost of insurance more broadly. That will help mostly older and/or sicker people pay lower premiums, thus making insurance more affordable. But to make that happen, others will pay more, mostly those who are younger and/or healthier.

    Insurance companies have referred to these higher premiums for the younger and healthier as “rate shock.” And they say that two things may happen. In the individual market, where people have a choice between purchasing coverage or paying a fine, many younger people will opt to simply pay the fine, since in most cases it will be far less than the cost of coverage, even after penalties are fully phased in. When open enrollment closes for 2014 on March 31, health can policy experts will analyze the demographic composition of enrollees. If the distribution is weighted heavily toward more costly enrollees, they say, premiums in 2015 could rise. 

  • Employer Impact. Because young people will be more directly subsidizing older people (older people can only be charged three times more than younger people, compared to five or even seven times more under many states’ previous limits), their insurance could become unaffordable and they may be forced to drop it and pay the fine.34

Insurance companies and policymakers worry that businesses will stop offering coverage to workers, or cut back their hours, so they won’t be covered by the requirement that employers with more than 50 full-time workers provide a minimum level of insurance. That requirement was originally scheduled to take effect at the beginning of 2014, but the Obama administration delayed its start until 2015 (See Employer-Based Health Coverage chapter.)35

Some companies that have already made such cutbacks, however, have seen a public relations backlash. And, workers who no longer are eligible for workplace coverage will be able to obtain coverage in the new health care exchanges, likely with federal subsidies. That could, however, end up increasing the cost of the law to taxpayers.36

  • Cost Containment. Many critics have complained that the law doesn’t do enough to rein in health care spending, or that what it does do may not work.37

But there remains a huge debate about what would work. Republicans generally want to limit government involvement in health care and let markets work more freely. Democrats want to stay the course with the ACA and have been taking credit for the recent slowdown in health spending, even though it is far from clear that it can be attributed to the law, or that the trend will continue.38 39

  • Contraception. Also, there are questions about who gets to opt out. Some of the fights over details of the law have risen to levels nearly as high-profile as the fate of the law itself.

    For example, in order to ensure that people are able to compare insurance policies more easily, and that policies provide appropriate value for what they cost, the law called for a package of essential benefits. Within one of those categories, preventive care for women, the Department of Health and Human Services (acting on the recommendation of the Institute of Medicine) ordered that all forms of FDA-approved contraception be provided, without deductible or copay, to women of reproductive age.40 41
    The original proposal exempted churches and other houses of worship, but not religious hospitals, universities, and other entities that employ people of multiple religions. Religious entities, particularly the Catholic Church, cried foul. They complained that being required to provide contraception, and particularly the morning-after pill, violated their religious freedom.42

After much negotiation and discussion, the Department of Health and Human Services (HHS) sought a compromise that attempted to guarantee access to contraception to women who work for religious entities, while protecting the religious rights of the employers. But more than two dozen lawsuits continue around the country. In December 2013, the Supreme Court agreed to hear a case from a large arts and crafts company with thousands of employees. Hobby Lobby contends that the ACA violates the Religious Freedom Restoration Act. A June 2014 decision is expected.43

EXPERTS

Analysts/Advocates

Henry Aaron, senior fellow, economic studies, Brookings Institution, 202/797-6128, haaron@brookings.edu

Drew Altman, president and CEO, Kaiser Family Foundation, 650/854-9400

Stuart Altman, professor of national health policy, Brandeis University 781/736-3804 altman@brandeis.edu

Joseph Antos, Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute, 202/862-5800, jantos@aei.org

Deborah H. Bae, senior program officer, Robert Wood Johnson Foundation,
609/627-5812, dbae@rwjf.org

Joe Baker, president, Medicare Rights Center, 212/869-3850, jbaker@medicarerights.org

Georges Benjamin, executive director, American Public Health Association, 202/777-2742

Linda Blumberg, senior fellow, Health Policy Center, Urban Institute, 202/261-5709, LBlumber@ui.urban.org

Stuart Butler, director, Center for Policy Innovation, Heritage Foundation,
202/608-6200, butlers@heritage.org

Michael Cannon, director of health policy studies, Cato Institute, 202/789-5200,
mcannon@cato.org

Nancy Chockley, president and CEO, National Institute for Health Care Management, 202/296-4426, nchockley@nihcm.org

Gary Claxton, vice president and director, Health Care Marketplace Project, Kaiser
Family Foundation, 202/347-5270

David Colby, vice president of public policy, Robert Wood Johnson Foundation,
609/627-5754, dcolby@rwjf.org

Sabrina Corlette, research professor and project director, Health Policy Institute,
Georgetown University, 202/687-3003, sc732@georgetown.edu

Richard Curtis, president, Institute for Health Policy Solutions, 202/789-1491

Judy Feder, professor, Public Policy Institute, Georgetown University, 202/687-8397

Paul Fronstin, director, Health Research Program, Employee Benefit Research Institute, 202/775-6352, fronstin@ebri.org

Jon Gabel, senior fellow, National Opinion Research Center, 301/634-9313,
Gabel-Jon@norc.org

Paul Ginsburg, president, Center for Studying Health System Change, 202/484-5261, pginsburg@hschange.org

Stuart Guterman, vice president, The Commonwealth Fund, 202/292-6735,
SXG@cmwf.org

Dan Hawkins, senior vice president for public policy and research, National Association of Community Health Centers, 202/296-0131, dhawkins@nachc.org

Sinsi Hernández-Cancio, health equity director, Families USA, 202/628-3030,
shernandez-cancio@familiesusa.org

G. William Hoagland, senior vice president, Bipartisan Policy Center, 202/204-2400, gwhoagland@bipartisanpolicy.org

John Holahan, fellow, Health Policy Center, Urban Institute, 202/261-5666

Andrew Hyman, team director and senior program officer, Robert Wood Johnson
Foundation, 609/627-5764, ahyman@rwjf.org

Timothy Jost, Robert L. Willett Family Professor of Law, Washington and Lee University School of Law, 540/421-1529, 540/564-2524, jostt@wlu.edu

Genevieve M. Kenney, co-director and senior fellow, Health Policy Center, Urban
Institute, 202/261-5568, jkenney@urban.org

Robert Laszewski, president, Health Policy Strategy Associates, 703/727-9517,
robert.laszewski@healthpol.com

Risa Lavizzo-Mourey, president and CEO, Robert Wood Johnson Foundation, 888/631-9989

John Lumpkin, senior vice president and director, Health Care Group, Robert Wood Johnson Foundation, 609/627-5724, jlumpkin@rwjf.org

Enrique Martinez-Vidal, vice president for state policy and technical assistance,
Academy Health, 202/292-6729, Enrique.Martinez-Vidal@academyhealth.org

Dan Mendelson, founder and CEO, Avalere Health, 202/207-1310,
dmendelson@avalerehealth.net

Tom Miller, resident fellow, American Enterprise Institute, 202/862-5886

Robert Moffitt, senior fellow, Heritage Foundation, 202/608-6210,
Bob.Moffit@heritage.org

Len Nichols, director, Center for Health Policy Research and Ethics, George Mason
University, 703/993-1978

Edwin Park, vice president for health policy, Center on Budget and Policy Priorities, 510/524-8033, park@cbpp.org

Kip Piper, president, Health Results Group, 202/558-5658,
piper@healthresultsgroup.com

Ron Pollack, executive director, Families USA, 202/628-3030

Karen Pollitz, senior fellow, Kaiser Family Foundation, 202/654-1307

Robert Reischauer, distinguished institute fellow and president emeritus, Urban
Institute, 202/261-5400, Rreischauer@urban.org

Sara Rosenbaum, Harold and Jane Hirsh Professor, George Washington University School of Public Health and Health Services, Department of Health Policy, 202/994-4230, sarar@gwu.edu

John Rother, president and CEO, National Coalition on Health Care, 202/638-7151 x110, jrother@nchc.org

Diane Rowland, executive vice president, Kaiser Family Foundation, 202/347-5270,
drowland@kff.org

James Tallon, president, United Hospital Fund, 212/494-0777, jtallon@uhfnyc.org

Grace-Marie Turner, president, Galen Institute, 703/299-8900

Paul Van de Water, senior fellow, Center on Budget and Policy Priorities, 202/408-1080

Alan Weil, executive director, National Academy for State Health Policy, 202/903-0101

Gail Wilensky, senior fellow, Project HOPE, 301/656-7401, gwilensky@projecthope.org

Cynthia Woodcock, executive director, The Hilltop Institute at UMBC, 410/455-6274, cwoodcock@hilltop.umbc.edu

Steve Zuckerman, co-director and senior fellow, Health Policy Center, Urban Institute, 202/833-7200, SZuckerman@urban.org

Government/Government Related

Jonathan Blum, deputy administrator and director, Center for Medicare, Centers for Medicare and Medicaid Services, Department of Health and Human Services,
202/690-6301, jonathan.blum@cms.hhs.gov

Michael Hash, director, Office of Health Reform, Department of Health and Human
Services, 202/205-1424, michael.hash@hhs.gov

Joy Wilson, health policy director, National Conference of State Legislatures, 202/624-5400

Cindy Mann, deputy administrator and director, Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services, Department of Health and Human Services, 401/786-3871

Mark Miller, executive director, Medicare Payment Advisory Commission, 202/220-3700

Matt Salo, executive director, National Association of Medicaid Directors,
202/403-8620, matt.salo@namd-us.org

Stakeholders

Brenda Craine, director of media and editorial, American Medical Association, 202/789-7447

Elizabeth Fowler, vice president of global health policy, Johnson & Johnson,
202/589-1000, LFowler3@ITS.jnj.com

Alissa Fox, senior vice president, office of policy and representation, Blue Cross and Blue Shield Association, 202/626-8618, alissa.fox@bcbsa.com

Ida Hellander, director of policy and programs, Physicians for a National Health Program, 312/782-6006, Ida@pnhp.org

Karen Ignagni, president and CEO, America’s Health Insurance Plans, 202/778-3203, kignagni@ahip.org

Charles Kahn, president and CEO, Federation of American Hospitals, 202/624-1500

Sister Carol Keehan, president and CEO, Catholic Health Association, 202/296-3993

Gerald Shea, assistant to the president, AFL-CIO, 202/637-5237

Bruce Siegel, CEO, America’s Essential Hospitals, 202/585-0100

Janet Trautwein, CEO, National Association of Health Underwriters, 202/552-5060

Richard Umbdenstock, president and CEO, American Hospital Association, 202/626-4628

WEBSITES

Alliance for Health Reform: www.allhealth.org

American Enterprise Institute: www.aei.org  

Altarum Institute: www.altarum.org  

Avalere Health: www.avalerehealth.net  

Brookings Institution: www.brookings.edu

U.S. Department of Health and Human Services: www.Healthcare.gov

Center for Studying Health System Change: www.hschange.com  

The Commonwealth Fund: www.commonwealthfund.org  

Congressional Budget Office: www.cbo.gov  

Heritage Foundation: www.heritage.org  

Kaiser Family Foundation: www.kff.org  

National Academy for State Health Policy: www.nashp.org  

National Governors Association: www.nga.org

National Institute for Health Care Management: www.nihcm.org  

Robert Wood Johnson Foundation: www.rwjf.org  

Urban Institute: www.urban.org

ENDNOTES

Endnotes

1 A Direct New Path to SHOP Marketplace Coverage(November 27, 2013). U.S. Department of Health and Human Services. HHS.gov/HealthCare blog. Retrieved from http://goo.gl/r0L7H7

2 McArdle, Megan. Obamacare’s Young Healthy Target is Slipping Away(March 19, 2014). Miami Herald. Retrieved from: http://goo.gl/E8f9Mi

3 Options Availalble for Consumers with Cancelled Policies(December 19, 2013). Centers for Medicare & Medicaid Services. Retrieved from: http://goo.gl/COHdxa

4 Insurance Coverage Provisions of the Affordable Care Act – CBO’s February 2014 Baseline(February 2014). Congressional Budget Office. Retrieved from http://goo.gl/sUqwYI

5 Insurance Coverage Provisions of the Affordable Care Act – CBO’s February 2014 Baseline(February 2014). Congressional Budget Office. Retrieved from http://goo.gl/sUqwYI

6 Affordable Care Act extended free preventive care to 71 million Americans with private health insurance(March 18, 2013). HHS Press Office. U.S. Department of Health and Human Services. Retrieved from http://goo.gl/SMD1cJ

7 Slack, M. (November 26, 2013). Seniors Save Nearly $9 Billion on Prescription Drugs Thanks to the Affordable Care Act. Whitehouse.gov. Retrieved from http://goo.gl/BJMedz

8 Health Insurance Marketplace: March Enrollment Report For the Period October 1, 2013 – March 1, 2014(March 11, 2014). Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services. Retrieved from http://goo.gl/28Kahh (Page 5).

9 Public Opinion on Health Care Issues. Kaiser Health Tracking Poll, 5(March, 2013). Kaiser Family Foundation. Retrieved from http://goo.gl/XB8lzm

10 Hulse C. and Pear R. (Nov. 7, 2009) Sweeping Health Care Plan Passes House. The New York Times A1. Retrieved from http://goo.gl/4Z0hXt

11 Pear, R. (Dec. 25, 2009). Senate Passes Health Care Overhaul on Party-Line Vote. The New York Times, A1. Retrieved from http://goo.gl/vhZaKV

12 Patient Protection and Affordable Care Act. Public Law 111-148(March 23, 2010). U.S Government Printing Office. Retrieved from http://goo.gl/gquATY

13 Health Care and Education Reconciliation Act of 2010. Public Law 111-152(March 30, 2010). U.S Government Printing Office. Retrieved from http://goo.gl/jH2TsC

14 14 States Sue to Block Health Care Law(March 23, 2010). CNN Wire Staff. CNN.Com. Retrieved from http://goo.gl/imGGSj

15 National Federation of Independent Business et al v Sebelius. No. 11-393( June 28, 2012). Retrieved from http://goo.gl/rukDRW

16 How does the health care law protect me? HealthCare.Gov. Retrieved from http://goo.gl/8IdGLj

17 New Affordable Care Act Rules Give Consumers Better Value for Insurance Premiums(Nov. 22, 2010). HHS Press Office. U.S. Department of Health and Human Services. Retrieved from http://goo.gl/jNX6jG

18 Affordable Care Act helps fight unreasonable health insurance premium increases(May 19, 2011). HHS Press Office. U.S. Department of Health and Human Services. Retrieved from http://goo.gl/NPzevz

19Radnofsky, L. (March 5, 2014). Obama Gives Health Plans Added Two-Year Reprieve. The Wall Street Journal. Retrieved from http://goo.gl/bl5duC

20 Defining the Patient-Centered Medical Home. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. Retrieved from http://goo.gl/u5ziyy

21 Accountable Care Organizations: Improving Care Coordination for People with Medicare(December 21, 2010). Centers for Medicare and Medicaid Services. HealthCare.Gov. Retrieved from http://goo.gl/PP8Xq5

22 Independent Payment Advisory Board(2011). American Medical Association. Retrieved at http://goo.gl/OXxSx6

23 About the Health Insurance Marketplace. HealthCare.Gov. Retrieved from http://goo.gl/SBnvIt

24 CBO and JCT’s Estimates of the Effects of the Affordable Care Act on the Number of People Obtaining Employer-Based Insurance(March 2012). 13. Congressional Budget Office. Retrieved from http://goo.gl/A22tx3

25 Congressional Budget Office. (July 2012.) Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the Recent Supreme Court Decision. 18. Retrieved from http://goo.gl/tFudMA

26 Abelson, R. (Oct. 26, 2011). Insurers Weigh in on Health Care Law. The New York Times. Retrieved from http://goo.gl/CWhDYF

27 Time for Affordability. America’s Health Insurance Plans. Retrieved from: http://goo.gl/LpzIH4

28 Prevention and Public Health Fund Factsheet. American Public Health Association. Retrieved from http://goo.gl/dbRpE1

29 Prevention and Public Health Fund (2012). U.S. Department of Health and Human Services. Retrieved from http://goo.gl/X6hNfK

30 The Prevention and Public Health Fund (February 23, 2012). HealthAffairs. Retrieved from http://goo.gl/jNEIi

31 Updated Chart of Prevention and Public Health Fund Allocations, FY 2010 enacted through FY 2014. APHA. Retrieved from: http://goo.gl/Cg9AMN

32 Kliff, S. (April 19, 2013) The Incredible Shrinking Prevention Fund. The Washington Post Wonkblog. Retrieved from http://goo.gl/uvBHeU

33 Christy, J. (Jan. 3, 2013). Congress’ Fiscal Cliff Agreement Repeals CLASS Act. LeadingAge California Policy Bulletin. Retrieved from http://goo.gl/VJi7pA

34 Blodgett, H. (July 2, 2102). Here’s How Much the Obamacare Penalty Tax Will Cost You. Business Insider. Retrieved from http://goo.gl/kSlCLK

35 Scherzer, L. (Jan. 9, 2013). Fast-Food Chains Cut Worker Hours, Blame Obamacare. Yahoo!Finance. Retrieved from http://goo.gl/dPJDY4

36 Melloy, J. (Dec. 4, 2012). Red Lobster Fears Diner Backlash From Anti-Obamacare Stance. CNBC.com. Retrieved from http://goo.gl/168MBT

37 Laszewski, R. (April 10, 2011). What will it take to Bring America’s Health Care Costs under Control? Health Care Policy and Marketplace Review. Retrieved from http://goo.gl/DjCpQU

38 Antle, J. (July 3, 2012). Health Care Reform and GOP Alternatives. The American Spectator Spectacle Blog. Retrieved from http://goo.gl/VjAJ48

39 Sebelius, K. (March 7, 2103). Good News on Health Care Spending. HealthCare Blog, HealthCare.Gov. Retrieved from http://goo.gl/VjAJ48

40 Nocera, K. (July 19, 2011.) Institute of Medicine report: Insurers should cover birth control as preventive care. PoliticoPro. Retrieved from http://goo.gl/E0QJDM

41 Affordable Care Act Ensures Women Receive Preventive Services At No Additional Cost (August 1, 2011). HHS Press Office. Department of Health and Human Services. Retrieved from http://goo.gl/EDtCU9

42 USCCB Urges Rescission of HHS Contraceptive Mandate, Criticizes ‘Inexplicably Narrow’ Definition of Religious Freedom(Aug. 31, 2011). United States Conference of Catholic Bishops. Retrieved from http://goo.gl/pr9BDY

43 Rovner, J. (May 21, 2012). Catholic Groups Sue Obama Administration Over Birth Control Rule. NPR Shots health blog. Retrieved from http://goo.gl/IeAGqo

 
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Sister Carol Keehan on Health Law Enrollment Challenges this Year


Related Resources

10.21.2013 - Navigator Answers ACA Questions , Lindsey Ziliac, Kokomo Tribune

Due to the prevalence of confusion about the ACA and health insurance marketplaces, a navigator answers questions about key changes.

10.16.2013 - Health Care Law a Hard Sell Among Native Americans, Christine Vestal, Stateline.org

Though the ACA could provide a number of benefits for Native Americans, they are tentative about stepping into the private insurance market and away from government funded Indian health facilities.

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While Ohio plans to hire more navigators to assist consumers in enrolling in the insurance marketplace, local agencies are confronted by low certification rates, training difficulties and hiring delays.

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Young adults in Mexico, Missouri are weighing the cost of the individual mandate penalty with the price of insurance in the marketplace. National organizations and campaigns are targeting 18- to 34-year olds and encouraging them to enroll.

 

Graphics for This Chapter

Figure 1.1 Major Revenue Sources

Figure 1.2 Paying for Coverage Expansions

Figure 1.3 Health Coverage Under ACA

Figure 1.4 Timeline of Key Elements

Figure 1.5 The Requirement to Buy Coverage

 

This sourcebook for journalists was made possible with the support of the Robert Wood Johnson Foundation.

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