RESUMO
The Affordable Care Act's legacy extends beyond its provision of health insurance to millions of previously uninsured people and its improved consumer protections. It has also had a significant impact on the US legal system. Litigation over the law began on the day of its enactment and has been a constant in the decade since. Although the law has survived these challenges, its effectiveness has been hobbled. Litigation is now being used as a check on the efforts to undermine the Affordable Care Act by the administration of President Donald Trump. This article reviews the history of litigation over the Affordable Care Act, how the law generally has been shaped by this litigation, and what this experience might mean for the future of health reform efforts.
Assuntos
Reforma dos Serviços de Saúde , Patient Protection and Affordable Care Act , Previsões , Humanos , Seguro Saúde , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Estados UnidosRESUMO
Despite its passage a decade ago, the Affordable Care Act (ACA) remains a politically divisive law. These political divisions have long been on display in Congress, in the White House, and in states. A long-standing stalemate in Congress-where Republicans cannot repeal the law and Democrats cannot improve it-has emboldened efforts by the executive branch to act unilaterally to implement, or undermine, the ACA. In turn, the law's opponents and supporters have turned to the courts to promote their favored policy agendas through both broadside attacks on the law and targeted challenges to its implementation. Litigation has become politics pursued through other means. These challenges have often been brought, or opposed, by state attorneys general and governors, with red-state coalitions facing off against blue-state coalitions. ACA litigation has also been characterized by forum shopping, nationwide injunctions, and questions about the court as a truly adversarial forum. This article briefly reviews the history of ACA litigation, discusses these legal norms in the context of the historic health reform law, and considers the implications of this history and the changing judiciary for future health reform efforts.
Assuntos
Jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , Política , Estados UnidosRESUMO
A spate of health policy litigation featured a challenge to the individual mandate and the entire ACA.
Assuntos
Trocas de Seguro de Saúde/economia , Política de Saúde/legislação & jurisprudência , Humanos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Política , Estados UnidosRESUMO
The Trump administration refused to defend important provisions of the ACA in court and pursued rules that could open the door to less-regulated insurance options.
Assuntos
Política de Saúde , Reforma dos Serviços de Saúde , Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , TexasRESUMO
As federal efforts to stabilize the individual market foundered on abortion coverage, states adopted a variety of approaches. The 2019 payment notice broadened states' options in implementing the ACA.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Seguro Saúde/economia , Patient Protection and Affordable Care Act/organização & administração , Atenção à Saúde/organização & administração , Humanos , Cobertura do Seguro/legislação & jurisprudência , Avaliação de Resultados em Cuidados de Saúde , Governo Estadual , Estados UnidosRESUMO
The Trump administration proposed liberalizing rules governing non-ACA-compliant, short-term coverage; responding to state guidance, Blue Cross of Idaho filed health plans not meeting ACA requirements.
Assuntos
Trocas de Seguro de Saúde/tendências , Cobertura do Seguro/normas , Seguro Saúde/normas , Patient Protection and Affordable Care Act , Humanos , IdahoRESUMO
The Trump administration broke from its predecessors by authorizing Medicaid work requirements. It also proposed to dramatically broaden rights to refuse to provide treatments for religious and moral reasons.
Assuntos
Consciência , Emprego/legislação & jurisprudência , Medicaid , Recusa em Tratar , Política de Saúde , Humanos , Medicaid/legislação & jurisprudência , Recusa em Tratar/ética , Recusa em Tratar/legislação & jurisprudência , Estados UnidosRESUMO
The month brought the repeal of the individual mandate's penalties, but also 2018 enrollment numbers rivaling those of 2017.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Programas Obrigatórios/legislação & jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , Humanos , Seguro Saúde/economia , Estados UnidosRESUMO
Marketplace enrollment for 2018 has been robust in the face of several obstacles, but the ACA faces a new threat after the Senate's vote to repeal the individual mandate.
Assuntos
Patient Protection and Affordable Care Act/economia , Política , Humanos , Seguro Saúde/economia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Estados UnidosRESUMO
The Affordable Care Act continues to be buffeted by administration actions; a bipartisan market stabilization effort emerges in Congress.
Assuntos
Definição da Elegibilidade , Trocas de Seguro de Saúde/legislação & jurisprudência , Cobertura do Seguro/legislação & jurisprudência , Custo Compartilhado de Seguro , Definição da Elegibilidade/economia , Humanos , Cobertura do Seguro/economia , Estados UnidosRESUMO
Bipartisan market stabilization negotiations gave way to a last-gasp attempt at repeal and replace; the ACA emerged intact but buffeted by uncertainty.
Assuntos
Reforma dos Serviços de Saúde , Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Incerteza , Humanos , Cobertura do Seguro/economia , Seguro Saúde/economia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Política , Estados UnidosRESUMO
After GOP efforts to repeal and replace the ACA collapsed in the Senate, attention is focused on whether cost-sharing reduction payments will continue.
Assuntos
Custo Compartilhado de Seguro/economia , Governo Federal , Patient Protection and Affordable Care Act/legislação & jurisprudência , Política , Humanos , Cobertura do Seguro , Seguro Saúde , Estados UnidosRESUMO
Senate GOP hopes to act on health reform before July 4th were dashed. Meanwhile, a leaked rule would offer broad protections for employers objecting to contraceptive coverage.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Política , Reforma dos Serviços de Saúde/economia , Humanos , Patient Protection and Affordable Care Act , Estados UnidosRESUMO
As the Senate struggles to craft its version of legislation replacing Obamacare, the Trump administration puts its stamp on health care regulation.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Legislação como Assunto , Patient Protection and Affordable Care Act , Política , Humanos , Estados UnidosRESUMO
As the GOP worked to pass ACA repeal legislation, HHS finalized a market stabilization rule, and the debate over cost-sharing reduction payments continued.
Assuntos
Custo Compartilhado de Seguro/economia , Regulamentação Governamental , Patient Protection and Affordable Care Act/legislação & jurisprudência , United States Dept. of Health and Human Services , Humanos , Política , Estados UnidosRESUMO
With the GOP's ACA repeal-and-replace plan dead, at least for now, attention shifts to administrative action and other legislation.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/tendências , Política , Humanos , Formulação de Políticas , Estados UnidosRESUMO
The effort to repeal, replace, and repair the ACA faces myriad policy and political challenges.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , Política , Financiamento Governamental , Reforma dos Serviços de Saúde/organização & administração , Humanos , Seguro Saúde/economia , Medicaid/legislação & jurisprudência , Medicaid/organização & administração , Estados UnidosRESUMO
The United States has never experienced a sea change in national health policy like that which occurred in early 2017.
Assuntos
Reforma dos Serviços de Saúde/tendências , Patient Protection and Affordable Care Act , Política , Humanos , Estados UnidosAssuntos
Regulamentação Governamental , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/economia , Seguro Saúde/economia , Patient Protection and Affordable Care Act/organização & administração , Decisões da Suprema Corte , Estados UnidosRESUMO
The Affordable Care Act (ACA) is an essential first step toward making health insurance more affordable for lower and moderate income Americans. It has accomplished historic reductions in the proportion of Americans who are uninsured. The number of Americans reporting delaying medical care for financial reasons has declined by approximately one-third since 2010. Medicaid expansions, in particular, have significantly reduced financial burdens and accompanying anxieties experienced by low-income Americans in states that have embraced this opportunity. 4 Consistent with these finding, one recent analysis of credit report data finds that Medicaid expansion was associated with between a $600 and $1000 decline in collection balances among individuals who gained coverage. Notwithstanding these gains, premiums and cost-sharing are still too high for many Americans. And cost-sharing has continued to edge higher for the majority of Americans who have coverage through employer-based plans. Measures to address these challenges must build on the ACA to provide greater protection to millions of Americans and to address continued dissatisfaction with our health care financing system among middle-income Americans.