President Donald Trump and Republicans in Congress pursued several major efforts to repeal and replace the Affordable Care Act (ACA) but were unable to get a bill through the U.S. Senate in 2017. In 2018, Congress did pass a tax bill that eliminated the ACA’s tax penalty for not obtaining health coverage beginning in 2019.
In December 2019, a federal appeals court panel ruled that the law’s individual mandate is unconstitutional since Congress has set the mandate tax penalty to zero and sent the case back to a lower court to determine how much of the rest of the ACA should be invalidated. The case was first brought by a number of Republican state attorneys general, and the Trump administration now argues that nearly all of the ACA should be overturned. The U.S. Supreme Court has now agreed to review the case.
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
On December 14, 2018, a federal trial court judge ruled that the Affordable Care Act’s (ACA) individual mandate is unconstitutional and that the entire law should be struck down as a result. This brief considers the complex and far-reaching impact were the entire law ultimately held to be invalid.
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Related Affordable Care Act Resources
- Explaining Texas v. U.S.: A Guide to the Case Challenging the ACA
- Coronavirus Response and the Affordable Care Act
- Republican Voters Have Moved On from Hating the ACA
- FAQs: Health Insurance Marketplace and the ACA
- Status of State Medicaid Expansion Decisions: Interactive Map
- How ACA Marketplace Premiums Are Changing by County in 2020
- Insurer Participation on ACA Marketplaces, 2014-2020
- The Past, Present, And Possible Future Of Public Opinion On The Affordable Care Act
- Pre-Existing Condition Prevalence for Individuals and Families
- Preventive Services Tracker
This month’s KFF Health Tracking poll explores the role of health care in the 2020 election, and public opinion on the Affordable Care Act.
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The Uninsured and the ACA: A Primer – Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act
The Uninsured and the ACA: A Primer provides information on how insurance has changed under the ACA and more recent policy changes, how many people remain uninsured, who they are, and why they lack health coverage. It also summarizes what we know about the impact that a lack of insurance can have on the health outcomes and personal finances and the difference health insurance can make in people’s lives.Report Read More
In this Axios column about the Texas court decision, Drew Altman shows that many provisions of the Affordable Care Act are even more popular than protections for pre-existing conditions, the issue which put Republicans on the defensive and helped Democrats in the midterm elections.Perspective Read More
Universal coverage is a big and important goal. But would absolutely everyone be covered under current proposals? Is it a better rallying cry for Democrats in the primaries or the general election? Drew Altman analyzes these questions in an Axios column.Perspective Read More
In this May 2019 post for The JAMA forum, Larry Levitt examines how the early discussion and positioning among the presidential candidates offers a glimpse into how a debate about Medicare-for-all might play out.Perspective Read More
Medicaid Restructuring Under the American Health Care Act and Implications for Behavioral Health Care in the US
This brief outlines Medicaid’s role for people with behavioral health conditions and the implications of the American Health Care Act for these enrollees. It includes information on the potential impact of ending the enhanced federal financing for newly eligible adults, removing essential health benefits from state plan amendments, and converting federal Medicaid funding into a per capita cap.Issue Brief Read More
Individual market insurers are expecting to return to consumers a record total of about $800 million in medical loss ratio rebates for 2018, a year in which the insurance companies posted their best annual financial performance under the Affordable Care Act to date. Financial results for 2018 suggest that insurers in the individual market are generally returning to or exceeding profitability levels seen before 2014, when ACA insurance market rules took effect, including the requirement to cover people with pre-existing conditions.Issue Brief Read More
Explaining Texas v. U.S.: A Guide to the 5th Circuit Appeal in the Lawsuit Challenging the Affordable Care Act
The outcome of the Texas v. U.S. legal challenge to the Affordable Care Act (ACA) could have far-reaching consequences for the nation’s health system, from rolling back the expansion of Medicaid to removing protections for people with pre-existing conditions and revoking the ability of adult children to stay on their…News Release Read More
The debate among Democratic presidential candidates about how to reform the health care system largely boils down to whether to build on the Affordable Care Act and create an option for people to enroll in Medicare or create a Medicare for all plan that covers everyone. On the other side…Perspective Read More
This analysis provides national estimates of insurance coverage among people with HIV and finds about 1 in 10 are uninsured, similar to the share among the general population following the ACA’s coverage expansions. Medicaid is the single largest source of coverage for people with HIV due to the ACA’s Medicaid expansion. The analysis also looks at access to Ryan White program services, and the impact of coverage and the Ryan White program on people with HIV’s ability to achieve sustained viral suppression.Issue Brief Read More
Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA
This brief reviews medical underwriting practices by private insurers in the individual health insurance market prior to 2014, and estimates how many American adults could face difficulty obtaining private individual market insurance because of a pre-existing condition if the Affordable Care Act (also known as Obamacare) were repealed or amended and such practices resumed.Issue Brief Read More