By Garrett Hall and Sandra Hernandez
The Historical Journey of the Affordable Care Act
The Patient Protection and Affordable Care Act (ACA) is the comprehensive health care legislation signed into law by President Obama on March 23, 2010. The ACA’s wide-ranging health care system reforms included expanding Medicaid (Medi-Cal), protecting individuals with pre-existing health conditions, prohibiting annual and lifetime caps on insurance coverage, requiring coverage of essential health benefits, and mandating individuals acquire a minimum level of insurance coverage. Provisions of the ACA were implemented in California beginning in 2014. Under the ACA, California cut the number of uninsured in the state by half and embarked on reforms and system transformations touching all aspects of the state’s health care delivery system, including creating the state’s ACA marketplace, Covered California.
Since the ACA was enacted, the landmark legislation has faced challenges in both Congress and the courts, with the latest effort failing to pass the Senate in 2017. Currently, California’s reform progress, and progress around the country, is at risk as the ACA heads to the Supreme Court once again on November 10, 2020, in California v. Texas.
This page provides necessary context into what’s at stake for Californians with the historical and current legal and legislative challenges to the ACA.
Key ITUP Historical References on the Challenges to the ACA
ITUP has written extensively about the ACA and while the legislation has changed since these blogs and publications, the following provide a glimpse into the chaotic battle of maintaining the ACA since 2016.
- Federal Administration’s Refusal to Defend the ACA (March 2019)
- This ITUP blog overviews the decision of the U.S. Department of Justice to change course and support the federal court finding that the entire Affordable Care Act is unconstitutional.
- New CMS Data on ACA Marketplace Enrollment Shows Covered California Stays the Course (April 2018)
- This ITUP Blog overviews the 2018 enrollment data for the Affordable Care Act released by the Centers for Medicare and Medicaid Services (CMS) on April 3, 2018.
- One of these things is not like the others – Affordable Care Act (ACA) open enrollment underway in California (November 2017)
- This ITUP Blog overviews the several administrative actions aimed at undermining the Affordable Care Act and the federal marketplace. The blog also looks at the actions California policymakers and Covered California took to address the potential impacts in California.
- The U.S. Senate is contemplating ACA repeal legislation that could lead to 6.7 million Californians losing coverage (September 2017)
- This ITUP Blog overviews the Graham-Cassidy legislation introduced in 2017 and the potential impact it could have had on California.
- ACA Stands (for Now): Takeaways from the Repeal and Replace Roller Coaster (July 2017)
- This ITUP Blog provides some takeaways from the chaotic “repeal and replace” process to repeal or rollback the Affordable Care Act in 2017.
- ITUP ACA Watch, Issue 4 — The ACA and Medi-Cal: What’s at Stake? (May 2017)
- This issue of ACA Watch highlights program and population changes that re-shaped Medi-Cal under the ACA. In addition to expanding coverage for some of the state’s most disenfranchised residents, the ACA dramatically altered the demographic profile and scope of the Medi-Cal program.
- California Moves to Protect ACA Consumer Cost-sharing Reductions (CSRs) (May 2017)
- The ITUP Blog overviews the motion that California and New York led with 13 other states and the District of Columbia to intervene in the federal lawsuit affecting payments that reduce out-of-pocket costs for low-income individuals enrolled in ACA marketplaces.
- ITUP ACA Watch, Issue 3 — The False Equivalency of High-Risk Pools to Replace the ACA (April 2017)
- This issue of ACA Watch highlights why high-risk pools would also likely not preserve the ACA’s promise to cover everyone regardless of pre-existing conditions. Ultimately, high-risk pools are a false equivalency to the ACA’s comprehensive coverage framework.
- Notes from the Field: California Legislative Hearings Put a Spotlight on the Impact of the ACA (April 2017)
- This ITUP Blog highlights testimonies on the positive impact the ACA has had and the potential damage from ACA rollbacks on consumers and providers around the state.
- ITUP ACA Watch, Issue 2 – Congressional Budget Office Scores the American Health Care Act (March 2017)
- This ACA Watch describes key provisions of the American Health Care Act and highlights the Congressional Budget Office’s (CBO) most significant findings. Notably, CBO projects dramatic increases in the number of uninsured nationwide.
- ITUP ACA Watch, Issue 1 – FAQs on ACA Repeal and Replace (December 2016)
- This ACA watch highlights the legal and administrative context for any repeal or rollback of the ACA. Given Congressional rules and federal administrative procedures, there are limits and specific requirements for pursuing repeal legislatively or through administrative action.
Key Resources on the Future of the ACA
ITUP has compiled the following resources on what’s at stake for Californians and the nation if the ACA is overturned in California v. Texas on November 10, 2020.
- UC Berkeley Labor Center: Affordable Care Act in California: What’s at Stake in California v. Texas? (October 2020)
- UC Berkeley Labor Center: Racial and ethnic health coverage inequities in California would widen if ACA is overturned (October 2020)
- Kaiser Family Foundation: Loss of the Affordable Care Act Would Widen Racial Disparities in Health Coverage (October 2020)
- Kaiser Family Foundation: Pre-existing Conditions: What Are They and How Many People Have Them? (October 2020)
- Kaiser Family Foundation: Eliminating the ACA: What Could It Mean for Medicaid Expansion? (October 2020)
- Kaiser Family Foundation: How Health Insurers Responded to Applicants with Pre-Existing Conditions Before and After the Affordable Care Act (September 2020)
- Kaiser Family Foundation: Is COVID-19 a Pre-Existing Condition? What Could Happen if the ACA is Overturned (September 2020)
- UC Berkeley Labor Center: California’s Health Coverage Gains under the Affordable Care Act: What’s at Stake in California v. Texas? (September 2020)
- California Health Care Foundation: This Legal Attack on the ACA Could Be the Big One (September 2020)
- California Health Care Foundation: How Many in Your Area Are Covered by the Affordable Care Act? (September 2020)
- Health Affairs: After Justice Ginsburg’s Loss, What A New Court Could Mean For The ACA (September 2020)
- Kaiser Family Foundation: Potential Impact of California v. Texas Decision on Key Provisions of the Affordable Care Act (September 2020)
- California Health Care Foundation: Ten Years After: The ACA’s Success in Five Charts (March 2020)