The Affordable Care Act is a United States federal act that was enacted by the 111th United States Congress and was signed into law by the former president Barrack Obama on March 23rd, 2010. It represents the United States health care systems most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965. However, the significant provisions came into force in 2014, and by 2016 the uninsured population had gone down from 20 to 24 million. This act has made affordable health insurance available to more people since it provides premium tax credits that lower costs for a household with incomes between 100% and 40%. It has also expanded the Medicaid program to cover all adults with income that is below 138% of the federal poverty level and has also supported innovative medical care delivery methods designed to lower the costs of healthcare generally.




Since being signed into law in 2010, the act has faced strong political opposition, calls for repeal and numerous legal challenges. Its enactment is considered to be a catalyst for the Tea Party Movement. In the National Federation of Independent Business versus Sebelius, the Supreme Court ruled that states could choose not to participate in the ACA’s Medicaid expansion, although it upheld the law as a whole. This act faced major technical problems at the beginning of its rollout in 2013; by 2017 a unified republican government attempted to pass several different partial repeals of the ACA but failed. The law was opposed for several years by a minority of polled Americans even though its provisions were more popular than the law as a whole. The law however, gained a lot of support by 2017.

The ACA ensures supply of provisions which is supposed to take effect from 2010 to 2020, although this act started on January 1st 2014. It amended the public health service act of 1944 and added new provisions on affordable care into title 42 of the United States code. After this amendment just a few areas of the health care system were left untouched, making it the best health care reform since the enactment of Medicare in 1965. However some areas were more affected than others such as the insurance market which was radically overhauled and many more regulations were specifically applied to this market whereas other structures were retained which are Medicare, Medicaid, and the employer market.

So many coverage gains were made through the expansion of Medicaid and the biggest cost savings were made in Medicare. However, despite all this, not all provisions took full effect because some were made discretionary, some were deferred and others were repealed before implementation.


Insurance regulatory laws are rules that have been put in place for the sole purpose of protecting the public as insurance consumers and policy holders. These laws govern and regulate the insurance industry and people involved in the insurance business. Some insurance regulatory laws serve various purposes like:

  1. Prohibits insurers from dropping policy holders when they get sick
  2. Banning annual and lifetime coverage caps on essential benefits
  3. Insurers are to spend at least 80-85% of premium dollars on health costs; rebates were to be issued to policy holders if this regulation was violated
  4. Insurers are required to implement an appeals process for coverage determination and claims on all new plans.




  • This is the requirement to buy insurance or pay a penalty for everyone who is not covered by a health plan that is not sponsored by their employer which is Medicaid, Medicare or Tricare which is a public insurance program. The mandate was designed to avoid the insurance death spiral in which healthy people delay insuring themselves until they fall sick. In such situations, insurers raise their premiums to cover the sicker client’s hence more expensive policies. However, this creates a vicious cycle that gets more people to drop their coverage. This mandate prevents the healthcare system from succumbing to adverse selection, which would result in high premiums for the insured and the uninsured therefore, increasing the size and diversity of the insured population including the younger healthy generation. This mandate did not cover individuals like;
  1. Illegal immigrants
  2. Citizens not enrolled in Medicaid
  3. Citizens who pay the annual penalty instead of purchasing insurance
  4. US citizens who opt out of the Medicaid expansion
  5. As of December 20th 2017 because the individual mandate was repealed starting in January 2019 via the ‘tax cuts and jobs act of 2017’




During the ACA debate, Obama stated that anyone who liked their health care plan would be able to keep it. In the end of 2013 millions of Americans with individual policies were terminated and several other millions risked theirs being cancelled. However, poltifact cited that various estimates of 2% of the total insured population received such notices. In 2010 small business tax credits took place. Then Pre-Existing Condition Insurance took effect to offer insurance to those that had been denied coverage by insurance companies because of a pre-existing condition. By 2011 insurers had stopped child only policies in 17 states because they sought to escape this requirement. In 2013, the internal revenue service ruled that the cost of covering individual employees would be considered in determining whether the cost of coverage exceeded 9.5% of income.  Families would not be considered even if the cost was above the 9.5% income threshold. This implementation was delayed until 2015 whereas the operations stabilized in 2014 although not all planned features were complete. The individual mandate was repealed and was bound to start in 2019 via the Tax Cuts and Jobs Act of 2017. The CBO estimated that the repeal would cause 13 million people to lose their health insurance by 2027.

Senator Lamar Alexander and Senator Patty Murray have reached a compromise to amend the ACA to fund cost-sharing reductions. President trump has stopped paying the cost sharing subsidies and the congressional budget office has estimated that his action will cost 200 billion dollars, causing insurance sold to cost 20% more and cause a million people to lose insurance. This plan will allow interstate insurance compacts and redirect consumer fees to states for outreach.


  • HOLLAND STEVE RAMPTON, ROBERTA (November 6, 2013). “senate democrats frustrated with botched rollout of Obamacare”
  • “A cruel blow to American Families”. The New York times February 2013.
  • “lie of the year if you like your health care plan, you can keep it.” Poltifact. December 12, 2014. Retrieved April 5,2018.

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