Law

The Affordable Care Act, signed into law in March 2010, has made it easier for people to access health coverage by:

Expanding Access

  • Expanded Medicaid eligibility to 138% FPL ($16,105 individual/$32,913 family of four) and allows states to cover parents and childless adults. For more information, visit our Medi-Cal Expansion page.
  • Created regulated health insurance marketplaces, in which consumers can purchase coverage plans. Those earning up to 400% FPL ($46,680 individual/$95,400 family of four) are eligible for tax credits to purchase affordable coverage. For more information, visit our Covered California page.
  • Included $11 billion in additional funds for community clinics.
  • Permanently reauthorized the Indian Health Care Improvement Act.

Promoting Health Equity and Prevention

  • Established Offices of Minority Health (OMH) in federal agencies.
  • Standardized data collection for race, ethnicity and primary language.
  • Established the Prevention and Public Health Trust Fund.
  • Required Medicare & private insurers to provide free preventive services.
  • Increased funding for school-based health centers.
  • Required nutrition labeling for large restaurant chains.

Reforming the Private Insurance Market

  • Prohibited insurers from:
    • instituting lifetime and annual coverage limits in 2014.
    • rescinding coverage based on new diagnoses (known as “rescission“).
    • denying coverage based on pre-existing health conditions.
  • Allowed children up to age 26 allowed to be on parent’s insurance plan.
  • Required insurers to:
    • provide access to free preventive services.
    • use 80 cents out of every dollar of premiums collected to pay claims or improve services (known as “Medical Loss Ratio“).
    • provide standardized summary of benefits and coverage.

Modifying the Employer-Sponsored Insurance Market

Included the following mandates for certain employers, effective in 2015:

  • Large employers: 50 full time employees (FTE) or more
    • Must provide health insurance or pay a fine
      • $2,000 for every FTE beyond first 30
      • $3,000 if coverage offered but not affordable (i.e. employee eligible for tax credit subsidies in the Exchange)
    • No penalty for part-time workers (30 hours or less)
  • Small employers: fewer than 50 FTE
    • 50 FTE or less = exempt from mandate
    • Employers with 25 FTE or less with an average wage less than $50,000 annually are eligible for tax credits to encourage them to offer coverage
      • 50% tax credit 2014 if purchase in the employer exchange
      • Non-profits also qualify for 35% tax credit

Diversifying the Health Care Workforce

  • Included funds for scholarships and student loan repayment to incentivize medical providers to work in areas that do not have enough health professionals.