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The Coverage Provisions in the Affordable Care Act: An Update

Health Insurance Market Reforms
  1. Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets. 45 CFR Part 147 (2010)

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  2. 45 CFR §§ 147.104, 147.106, 147.108

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  3. Fair health insurance premiums. 45 CFR § 147.102 (2014)

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  4. Preservation of right to maintain existing coverage. 45 CFR § 147.140 (2010)

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  5. Levitt L. September 8, 2011. “Grandfathering Explained.” Kaiser Family Foundation. http://kff.org/health-reform/perspective/grandfathering-explained/

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  6. Kaiser Family Foundation and Health Research & Educational Trust. 2014. 2014 Kaiser/HRET Employer Health Benefits  Survey.   http://kff.org/health-costs/report/2014-employer-health-benefits-survey/

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  7. Jost T. December 23, 2014. Implementing Health Reform: Proposed Changes to the Uniform Summary of Benefits and Coverage, Uniform Glosssary (Updated).Health Affairs Blog. http://healthaffairs.org/blog/2014/12/23/implementing-health-reform-proposed-changes-to-summary-of-benefits-and-coverage-uniform-glossary/

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  8. Coverage of preventive health services. 45 CFR § 147.130 (2013)

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  9. Kaiser Family Foundation. September 2014. “How Does Where You Work Affect Your Contraceptive Coverage?”  http://kff.org/womens-health-policy/fact-sheet/how-does-where-you-work-affect-your-contraceptive-coverage/

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  10. Burwell v. Hobby Lobby, 573 U.S. __ (2014).  Opinion available at http://www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf

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  11. Center for Consumer Information and Insurance Oversight. “Fact Sheet: Women’s Preventive Services Coverage, Non-Profit Religious Organizations, and Closely Held For-Profit Entities.” Available at http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/womens-preven-02012013.html

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  12. Burke A and Simmons A. June 27, 2014. “Increased Coverage of Preventive Services with Zero Cost Sharing under the Affordable Care Act.” Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services. http://aspe.hhs.gov/health/reports/2014/preventiveservices/ib_preventiveservices.pdf

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  13. Hamel L; Firth J and Brodie M. March 2014. “Kaiser Health Tracking Poll: March 2014.” Kaiser Family Foundation. http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-march-2014/

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  14. Department of Health and Human Services, Report to Congress on Preventive Services and Obesity-related Services Available to Medicaid Enrollees, 2014. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/RTC-Preventive-Obesity-Related-Services2014.pdf

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  15. Sommers B. June 2012. “Number of Young Adults Gaining Insurance Due to the Affordable Care Act Now Tops 3 Million.” ASPE, Department of Health and Humans Services.  http://aspe.hhs.gov/aspe/gaininginsurance/rb.cfm

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  16. Kaiser Family Foundation. February 29, 2012. “Explaining Health Care Reform: Medical Loss Ratio (MLR).”  http://kff.org/health-reform/fact-sheet/explaining-health-care-reform-medical-loss-ratio-mlr/

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  17. Cox C, Claxton G and Levitt L. June 6, 2013. “Beyond the Rebates: How Much Are Consumers Saving from the ACA’s Medical Loss Ratio Provisions.” Kaiser Family Foundation.  http://kff.org/health-reform/perspective/beyond-rebates-how-much-are-consumers-saving-from-the-acas-medical-loss-ratio-provision/

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  18. The Kaiser Family Foundation State Health Facts. Data source: State Effective Rate Review Programs, The Center for Consumer Information & Insurance Oversight (CCIIO), CMS; April 16, 2014.http://kff.org/health-reform/state-indicator/rate-review-program-effectiveness/

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  19. Kaiser Family Foundation. October 1, 2012. “Quantifying the Effects of Health Insurance Rate Review.”  http://kff.org/health-costs/report/quantifying-the-effects-of-health-insurance-rate/

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  20. Kaiser Family Foundation. January 2014. “Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors.” http://kff.org/health-reform/issue-brief/explaining-health-care-reform-risk-adjustment-reinsurance-and-risk-corridors/

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  21. 78 FR 12866, February 25, 2013.

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  22. Kaiser Family Foundation. January 2013. “Implementing New Private Health Insurance Market Rules.” http://kff.org/health-reform/issue-brief/implementing-new-private-health-insurance-market-rules-2/

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  23. The Kaiser Family Foundation State Health Facts. Data compiled by KFF staff through a review of state documents and the final EHB rule from the Department of Health and Human Services. http://kff.org/health-reform/state-indicator/ehb-benchmark-plans/

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  24. Salganicoff A, et. al. September 2014.  “Coverage for Abortion Services and the ACA.” Kaiser Family Foundation.  http://kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-and-the-aca/

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  25. Levitt L, Claxton G and Pollitz K. February 28, 2012. “Private Insurance Benefits and Cost-Sharing under the ACA.” Kaiser Family Foundation. http://kff.org/health-reform/perspective/private-insurance-benefits-and-cost-sharing-under-the-aca

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  26. Clemens-Cope L and Anderson N.  March 3, 2014. “How Many Non-Group Policies Were Canceled: Estimates from December 2013.” Health Affairs Blog. http://healthaffairs.org/blog/2014/03/03/how-many-nongroup-policies-were-canceled-estimates-from-december-2013/

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  27. Hamel L, et al. June 19, 2014. “Survey of Non-Group Health Insurance Enrollees.” Kaiser Family Foundation. http://kff.org/health-reform/report/survey-of-non-group-health-insurance-enrollees/

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Individual and Employer Requirements
  1. Individual Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage.   26 CFR §§1.5000A-1 through 1.5000A-5 (2014).

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  2. For individuals and families who owe a penalty based on percentage of income, the penalty is based on income above the tax filing threshold, which is $10,150 for an individual/$20,300 for joint filers in 2014.  This penalty is also capped at the national average premium for a bronze plan.  In 2014, that amount is $2,448 for an individual, $12,240 for a family of five.

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  3. Congressional Budget Office. June 5, 2014. “Payments of Penalties for Being Uninsured under the Affordable Care Act: 2014 Update.” http://www.cbo.gov/publication/45397

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  4. 79 FR 8543. February 12, 2014. Shared Responsibility for Employers Regarding Health Coverage. https://www.federalregister.gov/articles/2014/02/12/2014-03082/shared-responsibility-for-employers-regarding-health-coverage

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  5. Kaiser Family Foundation. December 18, 2014. “Web Briefing for Journalists: How the ACA’s Employer Requirements and Related Provisions Affect Businesses and Workers.” http://kff.org/health-reform/event/december-18-web-briefing-for-journalists-how-acas-employer-requirements-and-related-provisions-affect-businesses-and-workers/

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Expanding Coverage
  1. The Kaiser Family Foundation State Health Facts. Data source: “Creating a New Competitive Health Insurance Marketplace,” CMS.gov.  http://kff.org/health-reform/state-indicator/total-exchange-grants/

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  2. Kaiser Family Foundation State Health Facts. Data Source: Kaiser Family Foundation analysis of health plan information available through healtlhcare.gov and insurance company rate filings to state regulators. http://kff.org/other/state-indicator/number-of-issuers-participating-in-the-individual-health-insurance-marketplace/

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  3. Kaiser Family Foundation State Health Facts. Data Source: Kaiser Family Foundation analysis of premium data from healthcare.gov and insurer rate filings to regulators. http://kff.org/other/state-indicator/monthly-silver-premiums-for-a-40-year-old-non-smoker-making-30000year-2014-2015/

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  4. Kaiser Family Foundation. October 27, 2014. “Explaining Health Reform: Questions about Health Insurance Subsidies.” http://kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/

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  5. Kaiser Family Foundation. April 24, 2011. “Measuring the Affordability of Employer Health Coverage.”  http://kff.org/health-costs/perspective/measuring-the-affordability-of-employer-health-coverage/

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  6. Claxton, G and Panchal, N. February 11, 2015. “Cost-Sharing Subsidies in Federal Marketplace Plans.” Kaiser Family Foundation. http://kff.org/health-costs/issue-brief/cost-sharing-subsidies-in-federal-marketplace-plans/

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  7. Musumeci M. February 2015. “Are Premium Subsidies Available in States with a Federally-run Marketplace? A Guide to the Supreme Court Argument in King v. Burwell.” Kaiser Family Foundation.  http://kff.org/health-reform/issue-brief/are-premium-subsidies-available-in-states-with-a-federally-run-marketplace-a-guide-to-the-supreme-court-argument-in-king-v-burwell/

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  8. Dorn S and Tolbert J. November 2014. “The ACA’s Basic Health Program Option: Federal Requirements and State Trade-offs.” Kaiser Family Foundation. http://kff.org/health-reform/report/the-acas-basic-health-program-option-federal-requirements-and-state-trade-offs/

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  9. Pollitz K, Tolbert J, and Ma, R. July 15, 2014. “Survey of Health Insurance Marketplace Assister Programs.” Kaiser Family Foundation.  http://kff.org/report-section/survey-of-health-insurance-marketplace-assister-programs-section-2/

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  10. Kaiser Family Foundation. September 24, 2013. “Helping Hands: A Look at State Consumer Assistance Programs under the Affordable Care Act.” http://kff.org/health-reform/issue-brief/helping-hands-a-look-at-state-consumer-assistance-programs-under-the-affordable-care-act/

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  11. HHS.gov/HealthCare Blog. February 25, 2015. “Open Enrollment 2015 Re-Enrollment Snapshot.” Department of Health and Human Services.  http://www.hhs.gov/healthcare/facts/blog/2015/02/open-enrollment-2015-re-enrollment.html

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  12. Rudowitz R, Artiga S, and Musumeci M. February 2015. “The ACA and Medicaid Expansion Waivers.” Kaiser Family Foundation.  http://kff.org/medicaid/issue-brief/the-aca-and-medicaid-expansion-waivers/

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  13. Garfield R, et. al. November 2014. “The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid—An Update.” Kaiser Family Foundation.  http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/

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  14. Centers for Medicare and Medicaid Services. February 2015. “Medicaid and CHIP: December 2014 Monthly Applications, Eligibility Determinations and Enrollment Report.”  http://www.medicaid.gov/medicaid-chip-program-information/program-information/downloads/december-2014-enrollment-report.pdf

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  15. Kaiser Family Foundation. December 11, 2012. “Medicaid Eligibility, Enrollment Simplification, and Coordination under the Affordable Care Act: A Summary of CMS’s March 23, 2012 Final Rule.” http://kff.org/medicaid/issue-brief/medicaid-eligibility-enrollment-simplification-and-coordination-under-the-affordable-care-act-a-summary-of-cmss-march-23-2012-final-rule/

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  16. Kaiser Commission on Medicaid and the Uninsured analysis of 2001-2014 National Health Interview Surveys.

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  17. Garfield R and Young K. 2015. “Adults Who Remained Uninsured at the End of 2014.” Kaiser Family Foundation. http://kff.org/health-reform/issue-brief/adults-who-remained-uninsured-at-the-end-of-2014/

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  18. Kaiser Commission on Medicaid and the Uninsured analysis of 2013-2014 National Health Interview Surveys.

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  19. Witters D. August 5, 2014. “Arkansas, Kentucky Report Sharpest Drops in Uninsured Rate.” Gallup. http://www.gallup.com/poll/174290/arkansas-kentucky-report-sharpest-drops-uninsured-rate.aspx#1

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Looking Ahead
  1. DiJulio B, Firth J, and Brodie M. January 28, 2015. “Kaiser Health Tracking Poll: January 2015.” Kaiser Family Foundation. http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-january-2015/

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.