Affordable Care Act

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Affordable Care Act

The Affordable Care Act (ACA) expands access to coverage to millions of Americans, a goal health plans have long supported, but major provisions will raise costs and disrupt coverage for individuals, families, employers, and Medicare and Medicaid beneficiaries. 

The broad market reforms outlined in the ACA took effect on January 1, 2014. Individuals and families purchasing insurance in the individual market will be guaranteed coverage for pre-existing conditions, and their premiums cannot vary based on their gender or medical history. There will also be subsidies to help consumers afford the cost of coverage, and new health insurance exchanges will help consumers find the policies that best meet their needs.     

At the same time, other provisions take effect that will significantly increase the cost of coverage, such as the health insurance tax, minimum essential benefits, and restrictions on age rating. The cumulative impact of all of these provisions increases the likelihood that some individuals will choose to purchase insurance only after they become sick or injured, further increasing the cost of coverage for everyone else with insurance.     

The ACA also takes a number of preliminary, but promising, steps toward reforming the delivery system to improve patient safety and quality in Medicare and Medicaid. Many of these initiatives build on successful private-sector programs that health plans have pioneered and implemented. 

Ultimately, the ACA coverage expansion will not be sustainable until policymakers and stakeholders take meaningful steps to reduce the rate of growth in medical costs.  

To learn more about the ACA, please check out the following issues: 

Affordability ACOAge Rating 

Essential BenefitsExchanges  Health Insurance Tax 

The Link Medical Loss Ratio Medicare Advantage 

Rate Review 

Latest Resources

AHIP's Time for Affordability Campaign Highlights Factors Impacting Premiums in 2015

As part of its Time for Affordability campaign, America's Health Insurance Plans (AHIP) today launched a new, redesigned website to raise awareness about the factors impacting health insurance premiums and affordability for consumers. The Time for Affordability website includes updated resources, infographics, and other helpful information about the new health insurance marketplace under the ACA.

Press Releases | Strategic Communications | 06/17/2014

A Roadmap to High Quality Affordable Health Care for All Americans

This document reviews current research outlining the key drivers of health care costs and advances a new policy framework for bending the cost curve and improving the quality of patient care.

Reports/Research/White Papers | Strategic Communications | 12/17/2013

AHIP Statement on New Regulatory Guidance from HHS

America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni released the following statement on the latest regulatory guidance issued today by HHS:

Press Releases | Strategic Communications | 12/12/2013

AHIP Statement on Status of Health Care Reform Implementation

America's Health Insurance Plans' (AHIP) President and CEO Karen Ignagni today released the following statement on the status of health care reform implementation:

Press Releases | Strategic Communications | 11/29/2013

AHIP Statement on Consumers Keeping Their Current Coverage

America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni released the following statement on today’s announcement by the administration related to policy cancellations.

Press Releases | Strategic Communications | 11/14/2013

AHIP Statement on New Bipartisan Legislation to Delay the ACA’s Health Insurance Tax

America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni released the following statement in support of bipartisan legislation, The Small Business and Family Relief Act, introduced today by Representatives Ami Bera (D-CA) and Charles Boustany (R-LA) that would delay the ACA’s health insurance tax for two years.

Press Releases | Strategic Communications | 10/29/2013

AHIP Statement on Open Enrollment

America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni released the following statement on the start of open enrollment in which consumers and small businesses can sign up for coverage that takes effect on January 1.

Press Releases | Strategic Communications | 10/01/2013

What You Need to Know: The Link Between Market Reforms and the Individual Mandate - [PDF]

 

Fact Sheets/Issue Briefs/Talking Points | Strategic Communications | 09/16/2013

Summary of Benefits and Coverage and Uniform Glossary Proposed Rule: Implementation and Annual Ongoing Costs of Compliance - [PDF]

In September 2011, AHIP conducted a survey of health insurance plans on costs of compliance with the new Summary of Benefits and Coverage (SBC) and the Uniform Glossary requirements detailed in a notice of proposed rulemaking (NPRM) issued by the Department of Health and Human Services (HHS), Department of Labor, and Department of Treasury on August 22, 2011.

Reports/Research/White Papers | Center for Policy and Research | 08/20/2013

How Does the ACA Impact Premiums? It Depends. - [PDF]

Infographics | Strategic Communications | 08/09/2013

Majority of U.S. House of Representatives Supports Repeal of Health Insurance Tax

Bipartisan legislation to repeal the Affordable Care Act’s (ACA) health insurance tax has reached 218 co-sponsors, a majority of the U.S. House of Representatives.

Press Releases | Strategic Communications | 06/17/2013

Trends in Medigap Coverage and Enrollment, 2012

This report presents trends in enrollment in Medicare Supplement (Medigap) insurance coverage, using data on the number of policies in force as of December 2012 from the National Association of Insurance Commissioners (NAIC). The NAIC dataset contains information on most Medigap policies in force in the U.S., representing approximately 10.2 million covered lives, with policies from 262 carriers.

Reports/Research/White Papers | Center for Policy and Research | 05/20/2013

Comprehensive Assessment of ACA Factors That Will Affect Individual Market Premiums in 2014

A new report from Milliman, Inc. helps explain how the Affordable Care Act’s (ACA) coverage expansion, new benefits, and market reforms will impact individual market health insurance premiums in 2014. The report highlights how some provisions will increase premiums while others will make health care coverage more affordable for consumers. The focus of this report is to highlight the broad range of changes happening in the marketplace and the wide variation in impact that is likely to occur.

Reports/Research/White Papers | Strategic Communications | 04/25/2013

Fact Check: Subsidies - [PDF]

 

Fact Sheets/Issue Briefs/Talking Points | Strategic Communications | 04/10/2013

Health Insurance Tax Infographic - [PDF]

 

Infographics | Strategic Communications | 04/01/2013

Impact of Market Reforms on Affordability - [PDF]

This presentation from Oliver Wyman examines the impact of ACA market reforms on affordability.

Reports/Research/White Papers | 03/13/2013

Age Band Compression Under Health Care Reform

An article from actuaries at Oliver Wyman published in Contingencies highlights the impact of the Affordable Care Act’s (ACA) age rating restrictions on premiums.

Reports/Research/White Papers | 01/07/2013

Health Plans’ Estimated Costs of Compliance with Expanded Federal Rate Review and with Data Collection for Risk Adjustment and Reinsurance - [PDF]

In December 2012, AHIP conducted two surveys of member health plans regarding new regulatory guidelines released by the Department of Health & Human Services (HHS) for implementation of the Affordable Care Act. Plans were asked to submit responses to surveys concerning: 1) the proposed expansion of the federal rate review and data submission process, and 2) the proposed risk adjustment and reinsurance data collection process.

Research | Center for Policy and Research | 12/21/2012

State-by-State Impact of the Health Insurance Tax

 

Infographics | Strategic Communications | 12/06/2012

Health Insurance Tax to Hit Consumers, Employers in All 50 States

The new health insurance tax included in the Affordable Care Act (ACA) will increase the cost of health care coverage for consumers and employers in every state, according to a new state-by-state analysis conducted by Oliver Wyman for America’s Health Insurance Plans (AHIP).

Press Releases | Strategic Communications | 12/05/2012

AHIP Statement on ACA Implementation

Press Releases | Strategic Communications | 11/20/2012

Annual Tax on Insurers Allocated by State

In this report we have quantified the total premiums by state that will be assessed and estimated per member per year costs of this assessment by line of business.

Reports/Research/White Papers | 11/01/2012

Studies on Hospital Readmissions, Featuring Health Plan Innovations and Comparisons of Medicare Advantage (MA) and Medicare’s Traditional FFS Program

Studies on Hospital Readmissions, Featuring Health Plan Innovations and Comparisons of Medicare Advantage (MA) and Medicare’s Traditional FFS Program.

Reports/Research/White Papers | Center for Policy and Research | 10/03/2012

The Coalition for Medicare Choices: Working Together to Save Medicare Advantage

The Coalition for Medicare Choices is a rapidly growing organization of Medicare Advantage beneficiaries. More than 1.4 million Americans in 50 states have joined the Coalition to protect the benefits they receive through their Medicare Advantage plan. Together, we are working to show Congress that Medicare Advantage plans provide critical benefits and lower out-of-pocket costs to millions of beneficiaries. As Congress debates potential changes to Medicare Advantage, we will make certain that your voices are heard. The Coalition for Medicare Choices is administered by America's Health Insurance Plans, the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans.

Advocacy and Coalition Websites | 10/02/2012

AHIP Statement on Supreme Court Ruling

 

Press Releases | Strategic Communications | 06/28/2012

AHIP Statement on the Status of Current Health Care Benefits

Press Releases | Strategic Communications | 06/12/2012

The Link Infographic - [PDF]

Studies from independent experts--the Congressional Budget Office (CBO), Center for American Progress (CAP), Urban Institute, Lewin Group, and RAND Corporation--have examined the impact of severing the individual mandate but retaining ACA market reforms. While the studies differ on the magnitude of the impact of severing the mandate, they all find that doing so would result in a dramatic rise in the uninsured population and increases in health insurance premiums compared to health reform with a mandate.

Infographics | Strategic Communications | 06/07/2012

The Link

Experience in eight states that enacted various forms of guarantee issue and community rating in the 1990s all showed what happens when these market reforms are not linked to a mandate - higher premiums, no reduction in the uninsured and loss of consumer choice.

Advocacy and Coalition Websites | Strategic Communications | 06/06/2012

Low-Income & Minority Beneficiaries in Medicare Advantage Plans, 2010 - [PDF]

New data from the Medicare Current Beneficiary Survey (MCBS) show that Medicare Advantage plans, Medicare’s private comprehensive health plans, continue to be a vital source of coverage for low-income and minority beneficiaries in 2010.

Reports/Research/White Papers | Center for Policy and Research | 05/03/2012

AHIP Statement on the Medical Loss Ratio Requirement

 

Press Releases | Strategic Communications | 04/26/2012

AHIP Statement on the Two-Year Anniversary of the Passage of the Affordable Care Act

Press Releases | Strategic Communications | 03/23/2012

The Impact of Guaranteed Issue and Community Rating Reforms on Individual Insurance Markets - [PDF]

Milliman examined states that enacted guaranteed issue and community rating reforms in the absence of an individual mandate, and found that they saw their individual insurance markets deteriorate. This report updates Milliman’s August 2007 report on the impact of guaranteed issue and community rating (CR) reforms adopted in eight states in the 1990s. 

Reports/Research/White Papers | 03/15/2012

AHIP Statement on the Final Exchange Rule

 

Press Releases | Strategic Communications | 03/12/2012

AHIP Statement on Summary of Benefits and Coverage

Press Releases | Strategic Communications | 02/09/2012

AHIP-BCBSA Brief Filed in U.S. Supreme Court - [PDF]

On January 6, 2012, AHIP and the Blue Cross Blue Shield Association filed a brief in the U.S. Supreme Court arguing that if the individual mandate is declared unconstitutional, then the market reforms must be struck down as well.  The brief urges reversal of the 11th Circuit Court of Appeals’ judgment on severability, which held that the individual mandate could be removed from the ACA, but that the market reform provisions could remain in force.

Legal Briefs | Federal | 01/06/2012

Oliver Wyman Study: Estimated Premium Impacts of Annual Fees Assessed on Health Insurance Plans - [PDF]

A technical analysis by Oliver Wyman estimates that the new health insurance tax in the Affordable Care Act (ACA) “will increase premiums in the insured market on average by 1.9% to 2.3% in 2014,” and by 2023 “will increase premiums 2.8% to 3.7%.” AHIP commissioned this report as part of its ongoing effort to raise awareness about the impact the tax will have on consumers, employers and public program beneficiaries.

Reports/Research/White Papers | 10/31/2011

Choice & Competition Coalition website

The Choice and Competition Coalition is a partnership of businesses, providers, brokers and insurers working to ensure that Health Insurance Exchanges promote competition and preserve consumer choice.
 

Advocacy and Coalition Websites | 10/01/2011

Board Statements

 

AHIP Health Care Reform Proposals | 09/01/2011

AHIP Letter to HHS Recommending Improvements to ACO Regulation - [PDF]

In its letter to HHS, AHIP recommends that the ACO regulation build on private-sector accountable care models, utilize the programs health plans have implemented to transform the delivery system, transition away from the outdated fee-for-service system, and avoid increasing provider consolidation and cost-shifting that would lead to higher costs for consumers.

Regulatory Comments | 06/06/2011

The Unintended Consequences and Regulatory Burdens of the New Medical Loss Ratio Requirements - [PDF]

AHIP testimony before the House Energy & Commerce Committee’s Subcommittee on Health’s hearing entitled “The Unintended Consequences and Regulatory Burdens of the New Medical Loss Ratio Requirements.”

Congressional Correspondence | 06/02/2011

AHIP Statement on Rate Review

America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni today released the following statement on the rate review rule released by the Department of Health and Human Services.

Press Releases | Strategic Communications | 05/19/2011

Higher Costs and the Affordable Care Act: The Case of the Premium Tax - [PDF]

The Affordable Act imposes a fee on health insurers that amounts to a de facto “health insurance premium tax” that will raise the cost of health insurance for American families and small employers. Specifically, under the law, an annual fee applies to any U.S. health insurance provider, with the intent of raising nearly $90 billion over the budget window.

Reports/Research/White Papers | 03/09/2011

Brief for America’s Health Insurance Plans to US Court of Appeals (4th Circuit) - [PDF]

AHIP filed a policy-oriented amicus brief in the US Court of Appeals for the 4th Circuit that reiterates our longstanding position that the guarantee issue and community rating provisions of the Affordable Care Act (ACA) are inextricably linked to the law’s personal coverage requirement. The decision in the District Court struck down the individual mandate, but left the market reforms in place—a situation which experience in the states has demonstrated would have severe unintended consequences for consumers.

Legal Briefs | 03/07/2011

AHIP Letter to HHS on Rate Review Regulations - [PDF]

AHIP’s letter to HHS on the proposed rate review regulations states that rate review should continue to be done at the state level and should take into account all of the factors driving premium increases, including soaring prices for medical services, new benefit mandates, and changes in the risk pool.

Regulatory Comments | 02/22/2011

Interim Final Rule – Medical Loss Ratio Requirements - [PDF]

AHIP’s letter to HHS raises concerns that the medical loss ratio requirement could disrupt coverage, reduce patients’ access to quality improvement initiatives, and increase administrative costs.

Regulatory Comments | 01/31/2011

Labor Market Incentives, Economic Growth and Budgetary Impacts - [PDF]

Former Director of CBO Doug Holtz-Eakin testified before a House Ways & Means Committee hearing that the tax increase on health insurance premiums will be passed on to consumers with American families paying as much as $135 billion in higher premiums over the next 10 years.

Congressional Correspondence | 01/26/2011

Statement on Essential Health Benefits to the IOM Committee on the Determination of Essential Health Benefits - [PDF]

Testimony from Carmella Bocchino, Executive Vice President of Clinical Affairs and Strategic Planning for AHIP, who participated on a panel discussion at the Institute of Medicine’s (IOM) meeting on the determination of essential health benefits.

Congressional Correspondence | 01/13/2011

AHIP Statement on Rate Review

America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni today released the following statement on the proposed rate review rule released by the Department of Health and Human Services.

Press Releases | Strategic Communications | 12/21/2010

Low-Income & Minority Beneficiaries in Medicare Advantage Plans, 2008 - [PDF]

New data from the Medicare Current Beneficiary Survey (MCBS) show that Medicare Advantage plans, Medicare’s private comprehensive health plans, were a vital source of coverage for low-income and minority beneficiaries in 2008.

Reports/Research/White Papers | Center for Policy and Research | 12/06/2010

Accountable Care Organizations and Market Power Issues - [PDF]

In an effort to assist policymakers, regulators, providers, health plans, and others in considering the rules and regulations that are being formulated for ACOs, AHIP hosted a forum on ACOs on September 23, 2010, in Washington, DC that included a panel of four experts who provided guidance on the implementation of the Shared Savings Program and discussed various aspects of market power and antitrust concerns as they relate to ACOs.  This paper summarizes the key lessons and themes discussed by the presenters as well as the participants.

Reports/Research/White Papers | 10/20/2010

AHIP Comments on the MLR Draft Regulation - [PDF]

AHIP submitted comments to the National Association of Insurance Commissioners (NAIC) raising concerns that the MLR provision could disrupt the coverage families and employers rely on and turn-back-the-clock on quality improvement initiatives.

Regulatory Comments | 10/13/2010

AHIP Letter to HHS on Health Insurance Exchange Regulations - [PDF]

AHIP letter to HHS summarizing our recommendations on how to develop health insurance exchanges that maximize choice and competition for consumers.

Regulatory Comments | 10/04/2010

Reductions in Medicare Advantage Payments: The Impact on Seniors by Region - [PDF]

Heritage Foundation backgrounder on the impact of new Medicare Advantage cuts included in the ACA, which states that these cuts “will restrict senior citizens and the disabled to fewer and worse health care choices, reducing their access to quality health care.”

Reports/Research/White Papers | 09/14/2010

Expanding the ACO Concept to Encourage Innovation, Accountability and High Performance and the Value Health Plans Bring to Delivery System Transformation - [PDF]

Both the public and private sectors are exploring and implementing innovative care and payment models designed to improve delivery of care and encourage Americans to stay healthy. This white paper examines the concept of Accountable Care Organizations (ACOs), often defined as organizations of health care providers that agree to be held accountable for the quality, cost and overall care for a defined population of patients and that seek to receive shared savings if they meet certain quality and costs goals.

Reports/Research/White Papers | 09/13/2010

Setting the Baseline for the Individual Market - [PDF]

This Hay Group presentation provides an overview of how health insurance premiums are calculated and the factors that contribute to premium increases.

Reports/Research/White Papers | 07/20/2010

AHIP Letter to HHS on Health Insurance Rate Review - [PDF]

AHIP’s letter to HHS on the proposed rate review regulations states that rate review should continue to be done at the state level and should take into account all of the factors driving premium increases, including soaring prices for medical services, new benefit mandates, and changes in the risk pool.

Regulatory Comments | 05/14/2010

Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as Amended - [PDF]

The Centers for Medicare and Medicare Services Chief Actuary Rick Foster released an analysis of the Patient Protection and Affordable Care Act, which concluded that cuts to Medicare Advantage would “result in less generous benefit packages” and that MA enrollment would be 50 percent lower than previous projections.

Federal Statutory/Regulatory/ Guidance Docs | 04/22/2010

AHIP Statement on Health Care Reform Legislation(3)

Press Releases | Strategic Communications | 03/30/2010

Comparison of Projected Enrollment in Medicare Advantage Plans - [PDF]

The Congressional Budget Office released its latest projections on the impact new cuts to Medicare Advantage will have on the millions of seniors enrolled in the program. CBO is projecting MA enrollment will decline from 11.7 million enrollees in 2011 to 7.5 million in 2018.

Reports/Research/White Papers | 03/19/2010

AHIP Statement on Health Care Reform Legislation

 

Press Releases | Strategic Communications | 03/18/2010

Impact of Changing Age Rating Bands in “America’s Healthy Future Act of 2009” - [PDF]

Oliver Wyman has developed an actuarial model to study the impact of different reform proposals on the individual and small employer health insurance market.  According to this model, if the age band is compressed to 3:1, premiums for the youngest-healthiest third of individuals would be 35% higher in Year 1 compared to reform with 5:1 rating bands.

Reports/Research/White Papers | 09/28/2009

Now is the Time for Health Care Reform: A Proposal to Achieve Universal Coverage, Affordability, Quality Improvement and Market Reform - [PDF]

AHIP’s proposal offers a new set of proposals aimed at moving the nation toward a restructured health care system in which no one falls through the cracks, all Americans have high quality, affordable coverage, and the efficiency and effectiveness of the system are greatly improved. The comprehensive proposals has four specific objectives: controlling costs, adding value, helping consumers and purchasers, achieving universal coverage.

AHIP Health Care Reform Proposals | 12/01/2008

A Shared Responsibility: Advancing Toward a More Accessible, Safe, and Affordable Health Care System for America - [PDF]

AHIP’s proposal outlines five principles to make health care more affordable: Give patients and their doctors the information and tools they need to make the best health care decisions; create an efficient, interconnected health care delivery system that reduces medical errors; give doctors and nurses the freedom to practice medicine without worrying about frivolous lawsuits; transition to a system that more closely aligns payments with the quality of care patients receive; and move towards a system of care that focuses on keeping people healthy, detecting disease at the earliest possible stage, and rewarding chronic care management.

AHIP Health Care Reform Proposals | 06/01/2008

Guaranteeing Access to Coverage for All Americans - [PDF]

AHIP’s proposal recommends a series of reforms to give individuals peace of mind about their individual market coverage, guaranteeing access to coverage regardless of health status or income.

AHIP Health Care Reform Proposals | 12/03/2007

The Impact of Guaranteed Issue and Community Rating Reforms on Individual Insurance Markets - [PDF]

A report by Milliman, Inc. examined the impact of enacting guarantee issue and community rating without covering everyone. According to the report, these initiatives have the potential to cause individuals to wait until they have health problems to buy insurance. This could cause premiums to increase for all policyholders, increasing the likelihood that lower-risk individuals leave the market, which could lead to further rate increases. If this continues, the pool or market could essentially collapse or shrink to include only the high-risk population.

Reports/Research/White Papers | 08/30/2007

Setting a Higher Bar: We Believe There is More the Nation Can Do to Improve Quality and Safety in Health Care - [PDF]

AHIP’s proposal supports innovation by advancing independent analysis of which procedures and technologies work best; improves clinical quality by improving dissemination and transparency of information on safety, effectiveness, and performance; and better protects patients by resolving disputes faster, fairly, and more effectively.

 

AHIP Health Care Reform Proposals | 04/02/2007

A Vision for Reform: We Believe Every American Should Have Access to Affordable Health Care Coverage - [PDF]

AHIP’s proposal would strengthen the health care safety net, give working families a helping hand to afford coverage, and provide support to states that enable all of their citizens to have coverage.

AHIP Health Care Reform Proposals | 11/01/2006