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The Patient Protection and Affordable Care Act (PPACA), commonly known as Obamacare, is a health reform legislation signed into law by President Barack Obama on March 23, 2010. The primary aim of Obamacare is to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare for individuals and the government. It introduced a number of mechanisms, including mandates, subsidies, and insurance exchanges, designed to increase coverage and affordability. The ACA also aimed to improve healthcare outcomes and streamline the delivery of health services in the United States.
One of the central features of Obamacare is the individual mandate, which requires most Americans to have health insurance or face a penalty. This mandate was designed to expand the pool of insured individuals, thereby spreading the risk and enabling insurers to lower costs for everyone. The ACA also expanded Medicaid eligibility and created health insurance exchanges where individuals and families could purchase insurance plans, often with the help of government subsidies based on income levels. Additionally, the ACA implemented consumer protections, such as prohibiting insurance companies from denying coverage due to pre-existing conditions, charging more based on health status or gender, and setting annual or lifetime coverage limits.
Despite its intentions and achievements, Obamacare has been the subject of significant political controversy and legal challenges. Critics argue that it has led to increased health insurance premiums for some individuals, excessive regulatory burdens on businesses, and undue government intervention in the healthcare market. Supporters contend that the ACA has significantly reduced the number of uninsured Americans, provided essential health benefits, and curbed healthcare spending growth. Legal challenges have reached the Supreme Court, which has upheld most of the law’s provisions, including the individual mandate (later effectively nullified by Congress in 2017 by reducing the penalty to zero). The ongoing debate reflects broader disagreements over the role of government in healthcare and the best ways to achieve universal coverage and cost control in the healthcare system.
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The following documents is publicly available legislation and records released through the Freedom of Information Act (FOIA).
Document Archive
Office of Management and Budget Records
Emails from/to Sylvia Mathews Burwell, Director of the EOP/OMB, containing the keywords “Obamacare” [829 Pages, 50MB] – This request took almost a decade to process and complete.
Full Text of the Patient Protection and Affordable Care Act
Patient Protection and Affordable Care Act, March 23, 2010 [906 Pages, 2.41MB] – Patient Protection and Affordable Care Act as passed by Congress
Compilation of Patient Protection and Affordable Care Act, As Amended Through May 1, 2010 [974 Pages, 2.57MB] – PATIENT PROTECTION AND AFFORDABLE CARE ACT HEALTH-RELATED PORTIONS OF THE HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010.
What exactly is this version? Tom Giffey, of the Leader-Telegram, explains it best: “As you may recall, the Democrats’ loss of a supermajority in the Senate in early 2010 led to parliamentary gymnastics to pass an amended version of the bill in a way that avoided a Republican filibuster; this was done through the so-called “reconciliation” process, which limits debate on spending bills. As far as I can tell, including this reconciliation act makes the document a bit longer.” (Source)
HHS Enrollment Reports
HEALTH INSURANCE MARKETPLACE: NOVEMBER ENROLLMENT REPORT, November 13, 2013 [28 Pages, 0.7MB] – This issue brief highlights national and state-level enrollment-related information for the first month of the Health Insurance Marketplace (Marketplace hereafter) initial open enrollment period that began October 1, 2013 for coverage beginning January 1, 2014 (see Appendix A for state-level data). It also provides an overview of the methodology that was used in compiling these data (see Appendix B), and includes information about strategies to reach consumers.
Other Related Documents
The 2012 Long-Term Budget Outlook [110 Pages, 1.38MB] – Report by the Congressional Budget Office (CBO), June 2012. Multiple references to the Affordable Care Act and its influence on the debt.
DOD Health Care: Cost Impact of Health Care Reform and the Extension of Dependent Coverage, 26 September 2011 [16 Pages, 0.4MB] – The Department of Defense (DOD) offers health care to eligible beneficiaries through TRICARE, its health care program.1 Recently enacted health care reform legislation the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA)2 has implications for much of the nation s health care system, including TRICARE.3 One particular health reform provision directed certain health insurance plans to extend coverage to dependents up to age 26.4 Though this provision does not apply to TRICARE because it is not considered a health insurance plan,5 the subsequent Ike Skelton National Defense Authorization Act for Fiscal Year 2011 (NDAA 2011) included a similar provision that extends TRICARE coverage to certain dependent children of TRICARE beneficiaries.6 In response, in May 2011, DOD began implementing TRICARE Young Adult (TYA), a premium-based health care plan7 that extends TRICARE coverage to dependents of TRICARE beneficiaries up to age 26 who do not have access to employer-sponsored health care coverage and are unmarried.8 The NDAA 2011 directed us to assess the cost to DOD of complying with PPACA and HCERA. You also asked us to examine DOD s costs of implementing, administering, and providing benefits under TYA. In this report, we assess DOD s costs of (1) complying with PPACA and HCERA and (2) implementing and providing benefits under TYA.
National Healthcare Reform: Implications for the Military Healthcare System [36 Pages, 0.7MB] – For decades, economists, forward thinking lawmakers and academicians have issued warnings that continued escalating healthcare costs and an aging population would lead to a day of fiscal reckoning. Today, healthcare spending exceeds $2.1 trillion annually hitting twice that spent on food. Liberal benefits entailing little out of pocket expenses from the consumer lead the list of causes. Hospital and physician expenses experiencing little price discipline are at the heart of an emerging crisis in the American healthcare industry. Paralleling the civilian sector, department of defense medical costs have escalated, now threatening to exceed of the defense budget. Military leaders recognizing the link between open ended access to healthcare and excessive utilization, despite their warnings have met with stiff resistance from a broad coalition of lobbyists and elected representatives to implement reforms. The recent passage of the Patient Protection and Affordable Care Act (PPACA), injects an impetus toward change, however unless addressed comprehensively, the cost of healthcare will continue to rise independently from the stated goals of quality, equity, affordability. Regardless of its previous shortcomings, the Military Healthcare System (MHS) is unique as a large government run healthcare organization which could positively impact national healthcare reform.
TRICARE and VA Health Care: Impact of the Patient Protection and Affordable Care Act, 22 April 2010 [16 Pages, 0.4MB] – The 111th Congress recently passed, and the President signed into law, the Patient Protection and Affordable Care Act (P.L. 111-148; PPACA), as amended by the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152; HCERA). In general, PPACA did not make any significant changes to the Department of Defense (DOD) TRICARE program or to the Department of Veterans Affairs (VA) health care system. However, many have sought clarification as to whether certain provisions in PPACA, such as a mandate for most individuals to have health insurance, or extending dependant coverage up to age 26, would apply to TRICARE and VA health care beneficiaries. To address some of these concerns, Congress has introduced and/or enacted legislation. The TRICARE Affirmation Act (H.R. 4887), passed by both the House and the Senate and received by the President, would affirm that TRICARE satisfies the minimum acceptable coverage requirement in PPACA. Similarly S. 3162 (passed by the Senate on March 26, 2010) and H.R. 5014 (introduced in the House on April 14, 2010) would, if enacted, clarify that the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), Spina Bifida Health Care Program, and the Children of Women Vietnam Veterans Health Care Program meet the “minimum essential coverage” requirement under PPACA. In addition, the TRICARE Dependent Coverage Extension Act (H.R. 4923; S. 3201), if enacted, would extend certain PPACA provisions to TRICARE beneficiaries. This report addresses key questions concerning how PPACA will likely affect TRICARE and VA health care. This report will be updated if events warrant.
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