Federal Implementation of the Affordable Care Act

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Federal Implementation of the Affordable Care Act


Signed into law in 2010, the Affordable Care Act (ACA) set out to provide Americans with affordable, high-quality, and comprehensive health insurance. More than five years into its implementation, the legislation has made important changes to the way health insurance coverage works for children and families, while significantly reducing the number of uninsured Americans and improving access to care.

AAP's Priorities: ABCs of Health Reform for Children

Leading up to the law's passage, the AAP championed three fundamental priorities for children and pediatricians, as simple as 'A-B-C': Access to health care services, age-appropriate Benefits in a medical home, and health care Coverage for all children in the United States. The ACA not only addresses these goals, but also provides many additional benefits for children and the pediatricians who care for them. 

As a result of the ACA, the following key health reforms have taken effect:

  • Young adults can stay on their parents' health insurance plan until they turn 26
  • Guaranteed health care coverage for children with pre-existing conditions
  • No more lifetime coverage limits
  • Caps on out of pocket costs
  • Well baby and well child visits (as recommended by Bright Futures) are covered with no cost-sharing for families with new health insurance plans
  • Insurance companies are prevented from dropping coverage when a child or adult gets sick
  • Parents can designate a pediatrician as their child's primary care provider

In addition to protecting and preserving these key reforms, the Academy continues to urge for the extension of the law's expired Medicaid payment equity provision, which raised Medicaid payments for primary care and immunization services to at least those of Medicaid for calendar years 2013 and 2014. To learn more, visit the AAP's Medicaid federal advocacy webpage.

Challenges to the Law

Throughout its implementation, the ACA has faced several obstacles, including more than 50 votes by Congress to repeal the law and numerous legal challenges in court. On June 28, 2012, the U.S. Supreme Court upheld the ACA, supporting its constitutionality, while making Medicaid expansion optional for the states. Following the ruling, many states opted not to expand their Medicaid programs, despite provisions in the ACA that financed the expansion. The AAP weighed in with amicus briefs to the Court in support of the ACA's Medicaid expansion, individual mandate and the mandate's severability from the rest of the statute, and commended the Court's decision.

In the latest legal challenge facing the ACA, King v. Burwell, the Supreme Court decided that those who live in the 34 states with federally-facilitated marketplaces are eligible for subsidies to help buy health insurance. In June 2015, the Court issued a 6-3 decision affirming that federal subsidies can be offered to help individuals purchase health insurance available through the ACA, no matter where they live. As a result, 6.4 million individuals will continue to have access to subsidies to purchase health insurance. Following the Court's decision, the AAP issued a press statement applauding the ruling.

Looking Ahead: Advocacy Efforts Continue

The Academy continues to provide feedback to federal agencies overseeing the law's implementation to ensure that the ACA provides children with access to the services, coverage, and benefits they need to stay healthy. The Academy has been at the forefront of this advocacy, filing numerous public comments to ACA regulations and actively working at the state level with AAP chapters to ensure that state implementation of health care reform meets the needs of children and the profession of pediatrics. The Academy will continue to advocate for access to quality, affordable health care for children and families across the country.

Additional Resources

  • AAP's response to the Supreme Court's King v. Burwell decision, a summary of the Supreme Court's consideration of the ACA in oral arguments, a comprehensive summary of the Court's decision, an amicus brief from the AAP and other health organizations outlining their position
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