Research Handbooks in Law and Economics series
Edited by Daniel Schwarcz and Peter Siegelman
Chapter 7: US health care reform
The US Congress passed and President Obama signed the Patient Protection and Affordable Care Act (‘Affordable Care Act’ or ‘ACA’) in March 2010, completing what is arguably the most significant social legislation in the United States since the enactment of Medicare and Medicaid in 1965. Broadly similar in key respects to the Massachusetts health care reform law enacted in 2006, the ACA expands health insurance coverage beginning in 2014 by: (1) mandating that individuals obtain qualified health insurance or pay a financial penalty (the ‘individual mandate’); (2) subsidizing the cost of coverage for low-to-moderate income persons and for some small, low-wage employers; (3) requiring employers with 50 or more employees to offer health coverage or pay fines (later delayed until 2015); and (4) expanding eligibility for publicly funded Medicaid programs in participating states. The US Supreme Court ruled 5-4 in June 2012 that the individual mandate was constitutional under the federal government’s taxing power and upheld the statute, with the important exception that the states could not be compelled to expand Medicaid under threat of the federal government withholding all federal Medicaid funding. The ACA required the establishment of health insurance exchanges (later named ‘Marketplaces’) for individual and small group health insurance markets in each state for coverage effective January 1, 2014, with premium subsidies available only for coverage purchased through an exchange.
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