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History And Timeline Of The Affordable Care Act (ACA)

The Affordable Care Act (ACA) is one of the most significant developments in health care in the US in recent years. By making health insurance more affordable, millions of Americans were now able to obtain health coverage for themselves and their families. 

It has addressed the issue of access to health insurance for the country’s most vulnerable citizens, in a way that previous initiatives failed to do. But what led to the creation and passing into law of the ACA and what is its future? 

We examine these topics and more in this guide to the history and timeline of the Affordable Care Act. 

Overview Of The Affordable Care Act

Although officially titled The Patient Protection and Affordable Care Act, it soon became more commonly known as Obamacare. The Affordable Care Act earned its moniker because it was signed into law by President Obama on March 23, 2010.

The ACA achieved two very important things. Firstly, it made health insurance mandatory for US citizens. Secondly, it made health insurance, and healthcare in general, more accessible and affordable for low-income households. 

Despite the more affordable health insurance options that the ACA made available, many families still struggled to afford their monthly premiums. Therefore, they introduced subsidies for these low-income households. 

Subsidies Introduced To Reduce Costs Further

These ACA subsidies reduced monthly premiums or offered tax credits.  And, in some cases, these subsidies reduced the upfront and out-of-pocket costs associated with health insurance like copayments, coinsurance, and deductibles. 

The ACA wasn’t an overnight success. But since its inception, it has grown from a place of initial resistance to increasing acceptance. More Americans are insured than ever before, and this is largely thanks to the ACA.

Key Dates In The ACA Timeline

These are key dates and developments that determined the ACA timeline.

The Lead-Up To The Affordable Care Act

In July 2009, the Speaker of the House, Nancy Pelosi, along with several Democrats from the House of Representatives revealed a plan for overhauling the healthcare system. At that stage, it was called the Affordable Health Care for America Act.

When leading healthcare reform supporter Massachusetts Senator Ted Kennedy died the following month, the Senate Democrats’ 60-seat majority required to pass the legislation seemed to be at risk. They temporarily resolved this issue with the appointment of interim senator Paul Kirk in September. 

In November of that same year, in the House of Representatives, 219 Democrats and one Republican voted in favor of the Affordable Health Care for America Act.  However, 39 Democrats and 176 Republicans voted against it.

The Senate’s version of the bill, called America’s Healthy Future Act, was voted on in the Senate the next month. This time, 39 Republicans voted against the bill, and one Republican did not vote.

A New Senator Spelled Near-Disaster For The ACA

In January of 2010, Republican Scott Brown, a Republican, won the special election in Massachusetts to complete the late US Senator Ted Kennedy’s term of office. Although the state of Massachusetts had consistently voted in favor of the Democratic party, Brown’s campaign against the new healthcare was successful. 

Because they now lacked that 60th vote needed to pass the bill, Senate Democrats opted for another route to getting it passed. A procedure known as budget reconciliation only requires 51 Senators to vote in favor of a bill for the President to sign it. They used this process to get the healthcare bill passed.

On March 21, 2010, the Senate’s version of the healthcare plan was finally approved by the House. All Republicans voted against it, as did 34 Democrats vote against the plan. But two days later, on March 23, 2010, President Obama officially signed what was then termed ‘The Affordable Care Act’ into law.

After The ACA Was Signed

After the ACA was signed into law on March 23, 2010, anyone who wanted health insurance had to enroll in a plan that met all of the new standards of the Affordable Care Act. Subsidies were made available to low-income earners.

There was still a big problem, though. Private insurance companies usually denied coverage to individuals with certain pre-existing medical conditions. So, in July 2010, the Pre-Existing Condition Insurance Plan (PCIP) was designed to make health insurance available to them. 

By September 2010, the government created a website to allow citizens to get relevant information about health insurance companies and their available health plans. In 2014, provisions were made to further expand ACA coverage, allowing more people to benefit through ACA subsidies.

The ACA Subsidies Get a Boost

Despite resistance in certain states, the ACA made a big impact on the American people. More people than ever before could now access affordable health insurance. But many low-income households still experienced financial difficulties in complying with this new law, regardless of its subsidies. 

In 2021, the government introduced the American Rescue Plan (ARP). It included provisions to temporarily enhance the ACA’s premium subsidies for low-income earners. Under President Biden, the Inflation Reduction Act extended these temporary measures through to the year 2025.

Eligibility Requirements For ACA Coverage

Although the ACA aims to make health insurance coverage more accessible for Americans, you’ll have to meet certain eligibility criteria.

To qualify for coverage under the ACA, you must:

  • Live in the United States, as a legal U.S. citizen, national, or lawfully present non-citizen
  • Be 18 years of age or above
  • Not be covered by Medicaid 
  • Not qualify for employer-sponsored health insurance
  • Not be incarcerated at the time of application
  • Not be covered by a spouse or parent’s health plan

The Enrollment Process For ACA Coverage

To enroll for health insurance coverage under the ACA, you need to meet the eligibility requirements and follow the correct steps. However, you must sign up for ACA coverage on the marketplace during the official enrolment period. 

This is called Open Enrollment and runs from 1 November to 15 January each year. Extensions are usually only allowed in the case of particular life events. 

You can visit the government’s website at healthcare.gov for further information about the enrollment process. 

Where To Enroll For ACA Coverage

ACA enrollment is generally done on the marketplace website via the government’s website. But there is more than one platform where you can sign up for it. 

ACA coverage sign-up is possible not only on the ACA health insurance marketplace at the federal level but also on state-run exchanges. 

Alternatively, you can enroll for ACA-compliant health insurance coverage through companies like Enhance Health. We have the experience and expertise to assist you with finding the best health plan for your needs. 

Types Of ACA Coverage

ACA-compliant health insurance plans are grouped into four tiers. These are Bronze, Silver, Gold, and Platinum. 

These plans have different costs and offer different benefits, with Bronze and Silver generally offering lower premiums and more limited coverage.  ACA subsidies are typically offered to members on the benchmark Silver ACA health insurance plans.

Despite the small differences in the degree of coverage and the networks of healthcare providers affiliated with each plan, every ACA insurance plan must offer the following basic benefits:

  • Ambulatory and outpatient services
  • Ante-natal care and childbirth services
  • Emergency services
  • Hospitalization
  • Laboratory services
  • Mental health services, including services for substance use disorders
  • Newborn and pediatric services, including oral and vision care
  • Prescription medications
  • Preventive services and chronic disease management
  • Rehabilitative services and devices like mobility aids, hearing aids, and prosthetics

Benefits Of ACA Coverage

There are clear benefits to having ACA coverage.

US citizens who previously had limited access to private health insurance due to financial constraints or pre-existing medical conditions, benefit the most. But everyone benefits from health plans that must offer basic benefits as standard (see above).

With greater access to health insurance, comes greater access to healthcare. This does much to redress the imbalance in the quality of life between high and low-income earners. Even unemployed individuals may sign up for ACA health insurance plans. 

Penalties For Not Having ACA Coverage

When the ACA was first introduced, there was a federal mandate to have health insurance, and a penalty for uninsured individuals. The US Congress later repealed the federal mandate, although certain states implemented individual mandates and penalties for non-compliance.

Five states have retained individual mandates, namely California, Massachusetts, New Jersey, Rhode Island, and Vermont, as well as the district of Washington D.C. The penalties for not having health insurance vary among these states.

In these states, employees report their employees’ ACA information to the state.

Other states may introduce these mandates in the future, meaning that many Americans can still be penalized for not having health insurance, even without a federal mandate. 

Impact Of The ACA On Health Care Costs

The impact of the ACA on health care costs has been phenomenal, thanks to cost reduction subsidies and premium tax credits. 

It has certainly made health insurance more affordable and the subsidies for low-income households made healthcare more affordable for most citizens. It also reduced out-of-pocket costs for healthcare for enrolled individuals. 

However, some more work needs to be done to truly have a nationwide impact. This is because some states chose not to expand the Medicaid program as the Supreme Court’s 2012 ruling made it optional. These states all have different offerings on their health plan exchanges. 

In addition, while the rest of the country has one Financial Poverty level figure to assess their subsidy eligibility, there are two states with much higher criteria – Alaska and Hawaii. That means that where you live can determine what you pay for health care. 

Future Outlook For The ACA

So, what is the future outlook for the ACA?

This depends largely on the political landscape. The ACA has always been, and will likely continue to be, favored by Democrats and not Republicans. Should the political status quo remain, there may be many positive developments that further bolster the ACA.

A public health insurance option, which will be on offer alongside existing ACA-compliant plans from private insurers, is one such development. Increased subsidies, changes to the eligibility criteria for subsidies, and a reduction of prescription medication costs are other possibilities.

Challenges Faced By The ACA

Constant pushback by Republicans and fears over the costs of ACA’s future development to the American taxpayer are challenges that the ACA must face. These obstacles are not easily solved, and they are likely to be influenced by whoever comes to power in the ensuing years. 

That being said, the ACA is a step in the right direction, offering a solution to the problem of the vast number of uninsured Americans. It reduced, at least in part, the healthcare divide between high and low-income earners.

Whether or not this step will lead to long-lasting widespread social change, remains to be seen.


The Affordable Care Act of 2010 introduced sweeping changes throughout the country’s health insurance and healthcare systems. It has allowed millions of Americans, previously unable to obtain coverage, to finally do so. And a lot more may be in store.

If you want to know your eligibility, need help with calculating your affordability, or just need assistance choosing a plan, contact us today.  At Enhance Health, we are trusted advisors in the field of health insurance and have helped countless Americans get the coverage they can afford. 

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