More than a decade after its enactment, the future of the Affordable Care Act (ACA) remains uncertain as the U.S. Supreme Court takes up another challenge to the law’s constitutionality in California v. Texas (known as Texas v. U.S. in the lower courts). Oral argument is scheduled for Tuesday, November 10, 2020.
The ACA remains in effect while the litigation is pending. However, if all or most of the law ultimately is struck down, it will have complex and far-reaching consequences for the nation’s health care system, affecting nearly everyone in some way.
For information about ACA Marketplace Open Enrollment, including fact sheets and 300+ FAQs, visit our collection of resources on Understanding Health Insurance.
Featured Affordable Care Act Resources
Explaining California v. Texas: A Guide to the Case Challenging the ACA
This issue brief answers key questions about California v. Texas (known as Texas v. US in the lower courts), the case challenging the Affordable Care Act to be heard by the Supreme Court.
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- Affordability in the ACA Marketplace Under a Proposal Like Joe Biden’s Health Plan
- Eligibility for ACA Health Coverage Following Job Loss
- Protecting People With Pre-Existing Conditions Isn’t As Easy As It Seems
- Is COVID-19 a Pre-Existing Condition? What Could Happen if the ACA is Overturned
- Mental Illnesses May Soon Be the Most Common Pre-Existing Conditions
- Pre-Existing Condition Prevalence for Individuals and Families
- Eliminating the ACA: What Could It Mean for Medicaid Expansion?
- Loss of the Affordable Care Act Would Widen Racial Disparities in Health Coverage
- Loss of the ACA Could Greatly Erode Health Coverage and Benefits for Women
- The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review
- FAQs: Health Insurance Marketplace and the ACA
- Status of State Medicaid Expansion Decisions: Interactive Map
- Preventive Services Tracker
- Tracking Section 1332 State Innovation Waivers
Potential Impact of California v. Texas Decision on Key Provisions of the Affordable Care Act
The Supreme Court will review the constitutionality of the Affordable Care Act (ACA) this November in California v. Texas. This fact sheet summarizes the major provisions of the ACA, illustrating the breadth of its changes to the health care system. If all of most of the ACA is struck down, many of these provisions could be eliminated.
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After Five Years, Public Opinion on Health Law Remains Divided
On the Affordable Care Act’s fifth anniversary, Drew Altman’s column for The Wall Street Journal’s Think Tank discusses two views of public opinion on the law.
Perspective Read MoreEvolving Picture of Nine Safety-Net Hospitals: Implications of the ACA and Other Strategies
Safety-net hospitals are an integral part of the U.S. health care landscape, providing care to some of the nation’s most medically vulnerable populations, including Medicaid enrollees and the uninsured. With the implementation of the Affordable Care Act (ACA), the U.S. health care system is rapidly changing, and safety-net hospitals need to make major adjustments to survive in the post-reform environment. This brief draws on interviews with executives at nine safety-net hospital systems and examines how their hospitals have fared since major coverage provisions of the ACA came into effect in January 2014. The brief also examines new and ongoing strategies that the hospitals are adopting in the face of a quickly changing health care environment. While acknowledging the importance of the ACA, executives at each system in the study noted that other non-ACA related factors have also shaped how their hospitals fared over the last year. The hospitals in the study were: Cook County Health and Hospital System (CCHHS); Denver Health (Denver Health); Harris Health System (Harris Health); New York City Health and Hospitals Corporation (HHC); Parkland Health and Hospital System (Parkland); Santa Clara Valley Health and Hospital System (SCVHHS); San Francisco General Hospital (SFGH); University Medical Center of Southern Nevada (UMC), and Virginia Commonwealth University Health System (VCU). These hospitals participated in two earlier related studies that examined how the systems were preparing for health care reform.
Issue Brief Read MoreAn Overview of Actions Taken by State Lawmakers Regarding the Medicaid Expansion
The ACA Medicaid expansion has garnered different responses from statelawmakers – Democratics and Republicans as well as governors and legislatures. While it does not cover how every state has enacted the ACA Medicaid expansion, this fact sheet highlights some of the different actions state lawmakers have taken in response to the ACA Medicaid expansion.
Fact Sheet Read MoreThe Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States
This brief examines the early state budget effects of the ACA Medicaid expansion in three states: Connecticut, New Mexico, and Washington State. States were asked about savings and costs in Medicaid, behavioral health, corrections, uncompensated care spending, etc. as well as revenues. Findings from a study looking at Kentucky are also included.
Issue Brief Read MoreExplaining the 2015 Open Enrollment Period
The brief provides an overview of what consumers can expect during the second annual Open Enrollment period under the Affordable Care Act (ACA), which runs from November 15, 2014 through February 15, 2015. It is the second opportunity for uninsured individuals to enroll in private insurance coverage, premium tax credits and cost sharing subsidies and the first time that people newly insured in 2014 can renew their health plan coverage and subsidies. It also overlaps with the start of the tax filing season, during which subsidized individuals will undergo tax reconciliation of their 2014 financial assistance and the individual responsibility provisions of the ACA will be enforced.
Issue Brief Read MoreFederal and State Standards for “Essential Community Providers” under the ACA and Implications for Women’s Health
Safety net providers such as community health centers and family planning clinics have served a significant role in the provision of primary care and reproductive health care services to low-income and uninsured people, particularly women. The Affordable Care Act (ACA) has a provision aimed at assuring that newly-insured individuals, as well as those without coverage, can continue seeing their trusted safety net providers, also called Essential Community Providers (ECPs). This brief reviews the definition of ECPs, examines the federal and state rules that govern the extent to which plans must include these providers in their networks, identifies the variation from state to state, and discusses the particular importance of these rules and providers for women’s access to care.
Issue Brief Read MoreSafety-Net Emergency Departments: A Look at Current Experiences and Challenges
Safety-net hospital emergency departments (EDs) are an important part of our health care system, especially, but not only, for the uninsured and others with low income. With multiple major changes unfolding in our system today, including the development of new models of health care delivery, payment reforms, expanded insurance coverage, and increasing demand for primary care access, safety-net EDs are a sort of crucible in which these shifts and transitions can be seen playing out. To understand more about their current experiences and challenges as the Affordable Care Act (ACA) begins to takes hold, we conducted interviews with ED directors in a convenience sample of 15 safety-net hospitals around the country in June and July 2014.
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5 Ways the Graham-Cassidy Proposal Puts Medicaid Coverage At Risk
The Graham-Cassidy proposal to repeal and replace the Affordable Care Act (ACA) is reviving the federal health reform debate and could come up for a vote in the Senate before the budget reconciliation authority expires on September 30. This fact sheet describes five ways in which the proposal revamps and cuts Medicaid, redistributes federal funds across states and eliminates coverage for millions of poor Americans.
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How the Cruz Amendment Might Affect the Marketplace: Applying Different Rules to Competing Health Plans
This analysis examines a draft amendment to the Senate bill to repeal and replace the Affordable Care Act that would exempt some health plans from market rules, leaving 1.5 million people with pre-existing conditions at risk for higher premiums.
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Using Medicaid to Wrap Around Private Insurance: Key Questions to Consider
This issue brief raises three key questions for consideration if using Medicaid to wrap around private coverage is going to be considered as an alternative to the ACA’s Medicaid expansion under the BCRA. We draw on existing information about state Medicaid premium assistance programs to date, the administrative complexity involved, and the financing implications of premium assistance programs.
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