Health Coverage Under the ACA

The U.S. Congress passed the Patient Protection and Affordable Care Act (ACA) on March 23, 2010. The purpose of the ACA was to expand access to insurance, increase consumer protections, emphasize prevention and wellness, improve quality and system performance, expand the health workforce, and curb rising health care costs.

In passage of the ACA, the hospital industry, including the American Hospital Association, agreed to ten years and $155 billion in cuts from the Medicare program to be offset by increased insurance coverage that would result in 94% of the nation’s population having coverage. As a result, Oklahoma hospitals were expected to experience $2.4 billion in cuts from 2013-2023. These reductions occur through Medicare payment rate cuts, quality-based payment changes, and reductions in the disproportionate share hospital (DSH) payments made in the Medicare and Medicaid programs. Until Medicaid expansion was enacted in Oklahoma, hospitals experienced these cuts without revenue effects.

Since the ACA’s inception, numerous court cases have been heard challenging the validity of the ACA, either in its entirety or portions of it. In 2012, the U.S. Supreme Court ruled that the ACA was constitutional. The only change in the ACA, as a result of the ruling, was the Court’s decision that states cannot be required to expand Medicaid coverage beyond existing current Medicaid programs. On June 17, 2021, the U.S. Supreme Court threw out a 2018 challenge to the ACA by 18 Republican state attorneys general and the Trump administration, who sought to declare the ACA unconstitutional. The Court held that because there was no harm or injury traceable to the health insurance mandate, the ACA was constitutional.

The Affordable Care Act requires hospitals to make public the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups. For this reason, the Centers for Medicare & Medicaid Services, as of Jan. 1, 2019, requires all hospitals to post a listing of all detailed charges on the internet.

According to the Kaiser Family Foundation, as of Sept. 2021, 20 million people in the U.S. were enrolled in the ACA Medicaid expansion group and about 17 million of them were newly eligible under the ACA.

As of Jan. 11, 2023, more than 15.9 million Americans had selected ACA health insurance plans on the Health Care Marketplace.