On the 11th anniversary of the ACA’s passage, President Biden announced that CMS is extending the current SEP that was scheduled to end on May 15 to August 15, providing consumers with an additional three months to obtain coverage and utilize the new marketplace subsidies. This week, NAHU reflects on the passage of the ACA and how it transformed the American health insurance industry.

The ACA radically altered health insurance markets in the U.S. The law established some very popular provisions, such as the ban on insurance companies’ ability to discriminate based on pre-existing conditions and a dependent’s ability to stay on their parent or guardian’s health insurance plan until they are 26 years old. Furthermore, the ACA stopped insurance companies’ ability to set limits on the amount of money they would spend on an individual and provided additional coverage of many preventative-care services, two provisions that have also proven to be immensely popular.

However, it goes without saying that the ACA was far from a perfect law and included provisions that needed to be fixed or totally removed. Some of these provisions included the Cadillac Tax, medical device tax and Health Insurance Tax (HIT). The fiscal year 2020 spending bill and companion tax extenders measure that passed at the end of 2019 included a permanent repeal of those taxes, a major victory for the healthcare industry. NAHU and its coalition partners have lobbied intensely against the Cadillac Tax and HIT since they were first mandated. However, there are still provisions that need fixing, such as the ACA’s definition of full-time employment as 30 hours per week, along with the “family glitch,” the ACA rule that establishes eligibility for a family's premium subsidies on whether employer-sponsored insurance is affordable for the employee regardless of whether it is affordable for the family. The ACA’s needlessly burdensome employer-reporting provisions have also been a chief issue for NAHU’s lobbying efforts, and we have continuously sought to ease the reporting requirements under Section 6055 and 6056. Assuming the ACA remains law of the land, we still have a long way to go.

The ACA has been under fire in Congress and in the courts since it passed in 2010. Congressional Republicans were closest to repealing the ACA in 2017, but Senators Susan Collins (R-ME), Lisa Murkowski (R-AK) and John McCain (R-AZ) prevented it. Still, opponents of the ACA did succeed in zeroing out the individual-mandate penalty. This led to the most recent attempt at invalidating the law, California v. Texas. At the crux of this case is the question of whether the ACA should continue to stand as law of the land despite the zeroing out of the individual-mandate penalty. The official position of the Justice Department under the Trump Administration was that the law is unconstitutional, but in February the Biden Administration officially reversed that stance. 

As a reminder, if you work with clients in the individual market who now qualify for subsidies on the exchange, and you haven’t previously been certified to participate in exchange enrollment, you can still complete the HealthCare.gov agent/broker registration and training for plan year 2021 in order to help consumers take advantage of the SEP to enroll in subsidized coverage on the exchange.