Patient Protection and Affordable Care Act
(ACA): Resources for Frequently Asked
Questions
Angela Napili
Information Research Specialist
March 11April 23, 2015
Congressional Research Service
7-5700
www.crs.gov
R43215
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Summary
The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) has numerous
provisions affecting private health insurance and public health coverage programs. This report
provides resources to help congressional staff respond to constituents’ frequently asked questions
(FAQs) about the law. The report lists selected resources regarding consumers, employers, and
other stakeholders, with a focus on federal sources. It also lists CRS reports that summarize the
ACA’s provisions.
The report begins with links to contacts for specific ACA questions, such as consumer assistance
programs, state agencies, and local organizations that can answer constituents’ questions directly.
For example, the federal HealthCare.gov website has a consumer telephone hotline for questions
on exchange (marketplace) coverage, the Internal Revenue Service (IRS) has individual and
employer hotlines for tax-related questions (e.g., about premium tax credits), and the U.S.
Department of Labor has a consumer hotline for questions on employer-based coverage. The
report also lists sources for congressional staff to contact federal agencies with ACA questions.
The report provides basic consumer sources, including a glossary of health coverage terms,
followed by sources on how the ACA affects taxes. The . The
next sections focus on health coverage:
the individual mandate, private health insurance, and
exchanges, as well as public health care
programs, such as Medicaid and the State Children’s
Health Insurance Program (CHIP),
Medicare, Indian health care, and veterans’ and military health
care. It then lists sources on
employer-sponsored coverage, including sources on employer
penalties, small businesses, federal
workers’ health plans, and union health plans. It also provides
sources on the ACA’s provisions on
mental health, public health, workforce, and quality. quality, and taxes.
Finally, the report lists sources on ACA costs
and appropriations, legal issues, the treatment of
noncitizens under the ACA, and sources for
obtaining the law’s full text.
This list is not a comprehensive directory of all resources on the ACA but rather is intended to
address a few questions that may arise frequently.
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Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Contents
Contacts for ACA Assistance ........................................................................................................... 1
Contacts for Constituents .......................................................................................................... 1
Contacts for Congressional Staff ............................................................................................... 2
Basic Consumer Sources ................................................................................................................. 2
TaxesThe Individual Mandate ................................................................................................................... 3
Private Health Insurance ............................. 3
Tax Filing Resources ..................................................................................... 4
Exchanges and Subsidies ............................ 3
Contacts for Tax Filing Assistance ..................................................................................... 5
Exchange Coverage .............. 4
Tax Provisions ............................................................................................................ 5
Subsidies ............... 4
The Individual Mandate ..................................................................................................................... 5
Private Health Insurance 6
Enrollment Reports.................................................................................................................... 6
Exchanges and Subsidies7
Medicaid and the State Children’s Health Insurance Program ........................................................ 7
Medicare ......................................................... 7
Exchange Coverage ................................................................................. 8
Indian Health Care .................................. 7
Subsidies ......................................................................................... 9
Veterans and Military Health Care........................................... 9
Enrollment Reports........................................................ 9
Employer-Sponsored Coverage .......................................................... 10
Medicaid and the State Children’s Health Insurance Program ........................................... 10
Sources for Employees and their Families ...................... 10
Medicare ................................................................... 10
Sources for Employers ..................................................................... 11
Indian Health Care ....................................... 10
Employer Penalties .................................................................................. 12
Veterans and Military Health Care...................................... 11
Small Businesses ........................................................... 12
Employer-Sponsored Coverage ................................................................ 12
Federal Employee Health Benefits Program..................................... 13
Sources for Employees and their Families ............................................. 13
Members of Congress and Congressional Staff ................................. 13
Sources for Employers ............................................ 13
Union Health Plans ................................................................ 13
Employer Penalties ........................................................ 14
Mental Health ................................................................ 14
Small Businesses ................................................................. 14
Public Health, Workforce, Quality, and Related Provisions .......................................................... 15
Federal Employee Health Benefits ProgramTaxes .................................................................................. 16
Members of Congress and Congressional Staff ............................................................. 15
Tax Filing Resources ................ 16
Union Health Plans ............................................................................................... 15
Contacts for Tax Filing Assistance ......................... 17
Mental Health ................................................................. 16
Tax Provisions ............................................................... 17
Public Health, Workforce, Quality, and Related Provisions .......................................................... 1817
Cost Estimates and Spending ......................................................................................................... 1817
Legal Issues ................................................................................................................................... 1918
Noncitizens .................................................................................................................................... 20
ACA Text ....................................................................................................................................... 20
Contacts
Author Contact Information........................................................................................................... 21
Congressional Research Service
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
T
his report provides resources to help congressional staff respond to constituents’ frequently
asked questions (FAQs) about the Patient Protection and Affordable Care Act (ACA; P.L.
111-148, as amended). The report lists selected resources regarding consumers, employers,
and other stakeholders, with a focus on federal sources. It also lists Congressional Research
Service (CRS) reports that summarize the ACA’s provisions. The resources are arranged by topic.
This list is not a comprehensive directory of all resources on the ACA but rather is intended to
address a few questions that may arise frequently.
Contacts for ACA Assistance
Contacts for Constituents
Health plan enrollees may contact insurers directly to verify enrollment or to ask about coverage
of particular drugs, medical services, and health care providers. Enrollees can find their health
plan’s customer service phone number on their insurance card, on the insurer’s website, or by
calling the HealthCare.gov hotline (1-800-318-2596).
Contact Us (U.S. Department of Health and Human Services, HealthCare.gov)
https://www.healthcare.gov/contact-us/
The federal HealthCare.gov website offers a 24/7 consumer hotline (1-800-318-2596). For
translation assistance in other languages, constituents may also call the HealthCare.gov
hotline or visit the website at https://www.healthcare.gov/language-resource.
Find Local Help (U.S. Department of Health and Human Services, HealthCare.gov)
https://localhelp.healthcare.gov
A directory of state and local organizations trained to provide enrollment assistance and help
constituents understand their health coverage options. The directory includes navigators,
application assisters, certified application counselors, state and local government agencies,
and agents and brokers.
Consumer Assistance Program (The Center for Consumer Information and Insurance Oversight)
https://www.cms.gov/CCIIO/Resources/Consumer-Assistance-Grants/
A directory of consumer assistance programs and other state agencies that can answer
constituent questions on ACA and health insurance.
Consumer Assistance (U.S. Department of Labor, Employee Benefits Security Administration)
https://www.dol.gov/ebsa/contactEBSA/consumerassistance.html
Constituents with questions about employer-based health coverage can speak with benefits
advisors at 1-866-444-3272.
Telephone Assistance (Internal Revenue Service)
http://www.irs.gov/uac/Telephone-Assistance
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Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
The IRS is implementing many of the ACA’s tax provisions, including the individual
mandate, premium tax credits, and employer shared responsibility penalties. The Internal
Revenue Service (IRS) has telephone hotlines to answer questions from individuals and
employers.
Contacts for Congressional Staff
Congressional Marketplace Hotline (U.S. Department of Health and Human Services, Centers for
Medicare and Medicaid Services)
A dedicated hotline exclusively for Members of Congress and congressional staff with
questions about ACA implementation and exchanges: 202-690-8004,
MarketplaceHillQuestions@cms.hhs.gov. Hours of operation: 9 a.m.-6 p.m. EST, Monday
through Friday.
CRS Report 98-446, Congressional Liaison Offices of Selected Federal Agencies
This CRS report lists congressional liaison offices at federal agencies, including those that
work on ACA issues, such as the IRS, the Department of Labor, and the Congressional
Budget Office. Congressional liaison offices can answer questions from Members of
Congress and congressional staff; they usually do not assist constituents directly.
CRS reports on ACA are at CRS.gov: Issues Before Congress: Health Care Reform
http://www.crs.gov/pages/subissue.aspx?cliid=3746&parentid=13&preview=False
Each report has author contact information. CRS authors are available to answer questions
from Members of Congress and congressional staff. CRS provides research and analysis
exclusively to Congress, and CRS authors are unable to assist constituents directly.
Basic Consumer Sources
HealthCare.gov (U.S. Department of Health and Human Services)
http://www.healthcare.gov
The official federal portal for ACA consumer information. Questions and answers on health
insurance under ACA, including options for obtaining coverage. Click “Get Answers” for
sources tailored to specific populations, such as young adults, self-employed people,
unemployed people, people with disabilities, veterans, American Indians and Alaska Natives,
pregnant women, same-sex married couples, retirees, and incarcerated people. A Spanishlanguage version is at http://www.CuidadoDeSalud.gov.
Affordable Care Act Tax Provisions for Individuals and Families (Internal Revenue Service)
http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families
Explanations of ACA tax provisions for consumers, including provisions on premium tax
credits, the individual mandate (sometimes called the “individual shared responsibility”
provision), and other tax provisions. FAQs are at http://www.irs.gov/uac/Newsroom/
Affordable-Care-Act-Tax-Provisions-Questions-and-Answers.
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Glossary (U.S. Department of Health and Human Services, HealthCare.gov)
http://www.healthcare.gov/glossary/index.html
Plain-language definitions of health care and health insurance terms.
From Coverage to Care (Centers for Medicare and Medicaid Services)
http://marketplace.cms.gov/technical-assistance-resources/c2c.html
For consumers with new health coverage, the resource “A Roadmap to Better Care and a
Healthier You” and a series of videos explain how to read an insurance card, how to choose a
provider, how to set up and prepare for a health care appointment, and more.
CRS Report RL32237, Health Insurance: A Primer
A basic policy overview of health insurance: key definitions and principles, the regulation of
health insurance, and sources of health insurance.
Taxes
Tax Filing Resources
The Health Care Law and Your Taxes: What the Affordable Care Act (ACA) Means for Your
2014 Federal Tax Return (Internal Revenue Service)
http://www.irs.gov/pub/irs-pdf/p5201.pdf
Infographics on the individual mandate and premium tax credits.
Health coverage and your federal income taxes (U.S. Department of Health and Human Services,
HealthCare.gov)
https://www.healthcare.gov/taxes/
For consumers, links to tips and tools for completing 2014 federal income tax returns.
Fact Sheet: Health Coverage and Federal Income Taxes (U.S. Department of Health and Human
Services)
http://www.hhs.gov/healthcare/facts/factsheets/2015/01/health-coverage-federal-incometaxes.html
Federal income tax information for persons with non-exchange coverage for all of 2014,
persons with exchange coverage in 2014, and persons who did not have health coverage in
2014.
Forms and Publications (Internal Revenue Service)
http://www.irs.gov/Forms-&-Pubs
Federal tax forms and instructions relevant to the ACA. Form 8965 is for reporting a
coverage exemption from the individual mandate granted by an exchange and applying for an
individual mandate exemption. Form 8962 is for reconciling advance premium tax credits
received with the premium tax credits actually due.
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Tax information (Centers for Medicare and Medicaid Services)
https://marketplace.cms.gov/technical-assistance-resources/tax-information.html
Tax fact sheets, infographics, and articles for professionals assisting consumers with
exchange coverage.
Free File: Do Your Federal Taxes for Free (Internal Revenue Service)
http://irs.gov/FreeFile
Fillable electronic forms for persons with income over $60,000, and free file software for
persons with income under $60,000.
Extension of Time To File Your Tax Return (Internal Revenue Service)
http://www.irs.gov/uac/Extension-of-Time-To-File-Your-Tax-Return
Instructions and forms to apply for an extension of time to file. An extension of time to file
does not grant an extension of time to pay the tax liability.
Contacts for Tax Filing Assistance
Telephone Assistance (Internal Revenue Service)
http://www.irs.gov/uac/Telephone-Assistance
The Internal Revenue Service (IRS) is implementing many of the ACA’s tax provisions,
including the individual mandate, premium tax credits, and employer shared responsibility
penalties. The IRS has telephone hotlines to answer questions from individuals and
employers.
Free Tax Return Preparation for Qualifying Taxpayers (Internal Revenue Service)
http://www.irs.gov/Individuals/Free-Tax-Return-Preparation-for-You-by-Volunteers
The Volunteer Income Tax Assistance (VITA) program offers free tax help to people who
generally make $53,000 or less, persons with disabilities, the elderly and limited English
speaking taxpayers who need assistance in preparing their own tax returns. IRS-certified
volunteers provide free basic income tax return preparation with electronic filing to qualified
individuals.
HHS to work with non-profit organizations and tax preparers to help consumers understand the
intersection of taxes and health care (U.S. Department of Health and Human Services, January
28, 2015)
http://www.hhs.gov/news/press/2015pres/01/20150128a.html
Lists tax preparers and nonprofit organizations that provide ACA-specific resources and
assistance.
Tax Provisions
Affordable Care Act (ACA) Tax Provisions (Internal Revenue Service)
http://www.irs.gov/Affordable-Care-Act
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Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Briefly summarizes the ACA’s tax provisions. Sources are tailored for three categories:
individuals and families, employers, and other organizations. For a more comprehensive list,
click “List of Tax Provisions” in the left navigation bar; for many provisions, there are links
to “Questions and Answers.”
Present Law And Background Relating To The Tax-Related Provisions In The Affordable Care Act
(Joint Committee on Taxation, JCX-6-13, March 4, 2013)
https://www.jct.gov/publications.html?func=startdown&id=4511
Summarizes the ACA’s revenue (tax) provisions.
CRS Report R43342, The Medical Device Excise Tax: Economic Analysis
Since January 1, 2013, manufacturers and importers of medical devices have been subject to
an excise tax equal to 2.3% of the manufacturer’s price. This report gives an overview of the
tax: its legislative origins, its revenue effects, arguments for and against the tax, and its
economic effects.
The Individual Mandate
Questions and Answers on the Individual Shared Responsibility Provision (Internal Revenue
Service)
http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/Questions-and-Answers-onthe-Individual-Shared-Responsibility-Provision
Basic background on the individual mandate, the requirement that most individuals have
minimum essential health coverage or else pay a tax penalty. Describes what counts as
minimum essential coverage, who is subject to the mandate, and how the mandate is
enforced.
CRS Report R41331, Individual Mandate Under ACA
An excerpt from the report:
Beginning in 2014, ACA requires most individuals to maintain health insurance coverage or
otherwise pay a penalty. Specifically, most individuals will be required to maintain minimum
essential coverage, which is a term defined in ACA and its implementing regulations and
includes most private and public coverage (e.g., employer-sponsored coverage, individual
coverage, Medicare, and Medicaid, among others). Some individuals will be exempt from
the mandate and the penalty, while others may receive financial assistance to help them pay
for the cost of health insurance coverage and the costs associated with using health care
services.
Fees and Exemptions (U.S. Department of Health and Human Services, HealthCare.gov)
https://www.healthcare.gov/fees-exemptions/
Details on the individual mandate penalty. Lists examples of circumstances that could warrant
an individual mandate exemption. Links to application forms for exemptions based on
coverage being unaffordable; certain hardship, tribal, incarceration, and religious exemptions;
and exemptions based on membership in a health care sharing ministry.
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Health coverage and your federal income taxes: If you didn’t have health coverage in 2014 (U.S.
Department of Health and Human Services, HealthCare.gov)
https://www.healthcare.gov/taxes/no-health-coverage/
In most states, there is a special enrollment period for certain persons who paid the individual
mandate penalty when they filed their 2014 taxes. In states using the HealthCare.gov
federally facilitated exchange, the special enrollment period is March 15 through April 30,
2015. An excerpt appears below:
Do you have to pay the fee for not having coverage in 2014? You may still be able to enroll in
2015 coverage if:
•
You didn't know until after Open Enrollment ended on February 15, 2015 that the
health care law required you and your household to have health coverage, or you
didn’t understand how the requirement would impact you and your household
•
You owe the fee for not having coverage in 2014
•
You aren’t already enrolled in 2015 coverage through the Health Insurance
Marketplace
More details are in Centers for Medicare and Medicaid Services, “CMS Announces Special
Enrollment Period for Tax Season,” press release, February 20, 2015, http://www.cms.gov/
Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-0220.html. Most state-based exchanges (with the exceptions of Colorado, Idaho, and
Massachusetts) have similar special enrollment periods; choose a state from the pull-down
menu at https://www.healthcare.gov/get-coverage/.
Private Health Insurance3
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Private Health Insurance
See also “Exchanges and Subsidies” and “Employer-Sponsored Coverage.”
CRS Report R42069, Private Health Insurance Market Reforms in the Affordable Care Act (ACA)
Table A-1 shows which private health insurance market reforms apply to which health plans,
depending on whether the plans are grandfathered; whether they are sold in the large-group,
small-group, or individual market; and whether group plans are fully insured or self-insured.
CRS Report R43854, Overview of Private Health Insurance Provisions in the Patient Protection
and Affordable Care Act (ACA)
An excerpt from the report:
Private health insurance (PHI) is the predominate form of health insurance coverage in the
United States, covering about two-thirds of Americans in 2013. The Patient Protection and
Affordable Care Act (ACA; P.L. 111-148, as amended) builds on existing sources of private
health insurance coverage—the nongroup (individual), small group, and large group markets.
The ACA private health insurance provisions follow a federalist model in which they
establish federal minimum requirements and give states the authority to enforce and expand
those federal standards.
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Health coverage rights and protections (U.S. Department of Health and Human Services,
HealthCare.gov)
https://www.healthcare.gov/health-care-law-protections/
Summarizes consumer protections under ACA, such as coverage for pre-existing conditions,
the requirement that insurers provide a plain-language Summary of Benefits and Coverage,
and restrictions on lifetime and annual limits.
Fact Sheets and Frequently Asked Questions (FAQs) (The Center for Consumer Information and
Insurance Oversight)
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/index.html
The federal Center for Consumer Information and Insurance Oversight is charged with
implementing the ACA’s private health insurance reforms. This page provides information for
stakeholders, including state officials, health insurance companies, and consumers.
Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on
Businesses and Families (Employee Benefits Security Administration)
http://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html
Questions and answers on the ACA’s dependent coverage provision. Under the ACA, if a
health plan provides for dependent coverage of children, the plan must make such coverage
available for adult children under the age of 26. This requirement became effective for plan
years beginning on or after September 23, 2010.
CRS Report IN10128, From Initial Rate Filings to Final Premiums: Peering into the Black Box
(August 7, 2014)
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Brief overview of the process that insurers and regulators use to develop, review, and finalize
premiums.
ACA Title I Provisions to be Implemented or Terminated in 2015 (CRS Memorandum, November
17, 2014, available to congressional staff upon request)
According to the memorandum,
one of the core objectives of the Patient Protection and Affordable Care Act (ACA, P.L. 111148, as amended) is to expand health insurance coverage. Many of the coverage expansion
provisions emphasize increasing access to private health insurance (Title I of ACA)… This
memorandum provides a broad overview of Title I provisions that either will be
implemented or terminated sometime in 2015.
Exchanges and Subsidies
Exchange Coverage
Get Coverage (U.S. Department of Health and Human Services, HealthCare.gov)
https://www.healthcare.gov/get-coverage-topic/
Under the ACA, exchanges (sometimes called marketplaces) have been established to provide
eligible individuals with access to private health insurance plans. The 2015 open season for
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exchange coverage was November 15, 2014, to February 15, 2015. This website has plainlanguage information about the exchanges. For a briefer overview, see “A one-page guide to
the Health Insurance Marketplace,” https://www.healthcare.gov/quick-guide/. For
information about the exchange in a specific state, choose the state from the pull-down menu
at https://www.healthcare.gov/get-coverage/.
Getting health coverage outside Open Enrollment (U.S. Department of Health and Human
Services, HealthCare.gov)
https://www.healthcare.gov/coverage-outside-open-enrollment/
This document lists examples of “qualifying life events” that could make individuals eligible
for “special enrollment periods” outside of open season. (Examples of qualifying life events
include income changes, marriage, birth, adoption, moving to a new area, and losing other
health coverage.) The 2015 open season was November 15, 2014, to February 15, 2015.
Individuals can apply for Medicaid or State Children’s Health Insurance Program (CHIP)
coverage any time.
Health coverage and your federal income taxes: If you didn’t have health coverage in 2014 (U.S.
Department of Health and Human Services, HealthCare.gov)
https://www.healthcare.gov/taxes/no-health-coverage/
In most states, there is a special enrollment period for certain persons who paid the individual
mandate penalty when they filed their 2014 taxes. In states using the HealthCare.gov
federally facilitated exchange, the special enrollment period is March 15 through April 30,
2015. An excerpt appears below:
Do you have to pay the fee for not having coverage in 2014? You may still be able to enroll in
2015 coverage if:
•
You didn't know until after Open Enrollment ended on February 15, 2015 that the
health care law required you and your household to have health coverage, or you
didn’t understand how the requirement would impact you and your household
•
You owe the fee for not having coverage in 2014
•
You aren’t already enrolled in 2015 coverage through the Health Insurance
Marketplace
More details are in Centers for Medicare and Medicaid Services, “CMS Announces Special
Enrollment Period for Tax Season,” press release, February 20, 2015, http://www.cms.gov/
Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-0220.html. Most state-based exchanges (with the exceptions of Colorado, Idaho, and
Massachusetts) have similar special enrollment periods; choose a state from the pull-down
menu at https://www.healthcare.gov/get-coverage/.
Reporting life & income changes to the Marketplace (U.S. Department of Health and Human
Services, HealthCare.gov)
https://www.healthcare.gov/reporting-changes/
For persons with exchange coverage, instructions for reporting changes in income, health
coverage eligibility (e.g., an offer of job-based coverage), and household members (e.g.,
marriage, birth, adoption). These changes could affect subsidy amounts and eligibility for
coverage.
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marriage, birth, adoption). These changes could affect subsidy amounts and eligibility for
coverage.
Browse coverage options (U.S. Department of Health and Human Services, HealthCare.gov)
https://www.healthcare.gov/see-plans/
For federally facilitated exchanges, this website lets consumers view plan information and
premium estimates without opening a HealthCare.gov account.
What plans cover (U.S. Department of Health and Human Services, HealthCare.gov)
https://www.healthcare.gov/coverage/
Lists the “essential health benefits” that exchange plans are required to cover. Specific benefit
details differ by state and by plan.
Health Insurance Marketplace (Centers for Medicare and Medicaid Services)
http://marketplace.cms.gov/
For professionals assisting consumers with enrollment, this site has technical assistance
resources, applications and forms, and federal education and outreach materials. Some of the
resources are available in Spanish and selected other languages.
Using Your Marketplace Health Coverage (U.S. Department of Health and Human Services,
HealthCare.gov)
https://www.healthcare.gov/using-marketplace-coverage/
Consumer tips for verifying enrollment, getting prescription drugs, finding a doctor, getting
emergency care, and appealing insurance-company decisions.
Subsidies
CRS Report R41137R43945, Health Insurance Premium Credits in the Patient Protection and Affordable
Care Act (ACA) in 2015
To make exchange coverage more affordable, the federal government subsidizes premium
costs for certain individuals through “premium credits,” a type of federal tax credit. An
individual may be eligible for a premium tax credit if his or her household income is between
100% and 400% of the federal poverty level and he or she does not have access to affordable
health coverage through another source, such as an employer.
Getting Lower Costs (U.S. Department of Health and Human Services, HealthCare.gov)
https://www.healthcare.gov/lower-costs/
Information on available subsidies for health coverage, including premium credits and costsharing subsidies.
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The Premium Tax Credit (Internal Revenue Service)
http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/The-Premium-Tax-Credit
Basic background on premium credits. FAQs are at Questions and Answers on the Premium
Tax Credit (http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/Questions-andAnswers-on-the-Premium-Tax-Credit).
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CRS Report R43833, Premium Tax Credits and Federal Health Insurance Exchanges: Questions
and Answers
An excerpt from the report:
Legal challenges that may have a substantial impact on the implementation and operation of
the Patient Protection and Affordable Care Act (ACA) concern whether premium tax credits
are available for millions of individuals participating in federally administered health
insurance exchanges... The Supreme Court has decided to weigh in onis currently reviewing this issue in King v.
Burwell... This report provides The Court heard oral arguments in the King case on March 4, 2015, and a decision
is expected by the end of the Court’s term in June 2015 at the latest. This report provides
background on provisions of ACA relevant to this issue. It
then answers questions
concerning the legal challenges and potential implications of the
Court’s decision in King.
Enrollment Reports
The Affordable Care Act Research Briefs (U.S. Department of Health and Human Services, Office
of the Assistant Secretary for Planning and Evaluation)
http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm
Includes monthly enrollment reports from the 2015 and 2014 open seasons for ACA health
insurance exchanges.
Recent Blogs (U.S. Department of Health and Human Services, HHS.gov/HealthCare)
http://www.hhs.gov/healthcare/facts/blog/index.html
During open season, included weekly enrollment estimates for federally facilitated
exchanges. These estimates were preliminary.
Medicaid and the State Children’s Health Insurance
Program
Individuals can enroll in Medicaid and the State Children’s Health Insurance Program (CHIP) any
time of the year. There is no limited enrollment period for these programs.
Each state operates its own Medicaid and CHIP programs within federal guidelines.
•
Links to each state’s Medicaid website:
http://medicaid.gov/Medicaid-CHIP-Program-Information/By-State/ByState.html
•
Links to each state’s CHIP website:
http://insurekidsnow.gov/state/index.html
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Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Medicaid and CHIP (U.S. Department of Health and Human Services, HealthCare.gov)
https://www.healthcare.gov/medicaid-chip/
FAQs and tips for Medicaid and CHIP potential applicants and new enrollees.
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CRS Report R43564, The ACA Medicaid Expansion
An excerpt from the report:
Historically, Medicaid eligibility has generally been limited to certain low-income children,
pregnant women, parents of dependent children, the elderly, and individuals with disabilities;
however, as of January 1, 2014, states have the option to extend Medicaid coverage to most
nonelderly, low-income individuals.
Affordable Care Act (Centers for Medicare and Medicaid Services, Medicaid.gov)
http://www.medicaid.gov/AffordableCareAct/Affordable-Care-Act.html
Summaries of major ACA provisions related to Medicaid and CHIP.
CRS Report R41210, Medicaid and the State Children’s Health Insurance Program (CHIP)
Provisions in ACA: Summary and Timeline
Detailed section-by-section summary of ACA’s Medicaid and CHIP provisions.
Frequently Asked Questions: Affordable Care Act (Centers for Medicare and Medicaid Services,
Medicaid.gov)
https://questions.medicaid.gov/faq.php?id=5010&rtopic=2040
For state officials and stakeholders, these sources address questions on the ACA, Medicaid,
and CHIP.
Medicare
Medicare.gov (Centers for Medicare and Medicaid Services)
https://www.medicare.gov/
Official federal portal for consumer information on Medicare. See “Find someone to talk to”
for a directory of consumer assistance contacts, including State Health Insurance Assistance
Programs (SHIPs) that offer personalized health insurance counseling for Medicare
beneficiaries.
Medicare and the Health Insurance Marketplace (Centers for Medicare and Medicaid Services)
http://medicare.gov/Pubs/pdf/11694.pdf
Consumer FAQs about the relationship between Medicare and the ACA exchanges
(marketplaces). Questions include “Can I get a Marketplace plan in addition to Medicare?”
and “What if I become eligible for Medicare after I join a Marketplace plan?”
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Medicare and the Marketplace (Centers for Medicare and Medicaid Services)
http://www.cms.gov/Medicare/Eligibility-and-Enrollment/Medicare-and-the-Marketplace/
Overview1.html
FAQs about the relationship between Medicare and the ACA exchanges (marketplaces),
including questions on enrollment, coordination of benefits, and end-stage renal disease.
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Medicare and the Marketplace (U.S. Department of Health and Human Services,
HealthCare.gov)
https://www.healthcare.gov/medicare/medicare-and-the-marketplace/
Information on how the ACA affects Medicare beneficiaries, and how to switch from
exchange coverage to Medicare.
CRS Report R41196, Medicare Provisions in the Patient Protection and Affordable Care Act
(PPACA): Summary and Timeline
Detailed section-by-section summary of the ACA’s Medicare provisions.
Indian Health Care
CRS Report R41152, Indian Health Care: Impact of the Affordable Care Act (ACA)
The ACA reauthorized the Indian Health Care Improvement Act (IHCIA), which authorizes
many Indian Health Service programs and services. This report summarizes major IHCIA
changes and other ACA provisions that may affect American Indian and Alaska Native health
care.
CRS Report R41630, The Indian Health Care Improvement Act Reauthorization and Extension as
Enacted by the ACA: Detailed Summary and Timeline
Detailed section-by-section summary of IHCIA provisions in the ACA.
Affordable Care Act (Indian Health Service)
http://www.ihs.gov/ACA/
Includes FAQs on the ACA for Indian Health Service-eligible persons.
Veterans and Military Health Care
The Affordable Care Act, VA, and You: Frequently Asked Questions (U.S. Department of Veterans
Affairs)
http://www.va.gov/health/aca/FAQ.asp
Answers to veterans’ FAQs about the ACA. The website notes that “the health care law does
not change VA health benefits or Veterans’ out-of-pocket costs.”
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TRICARE and the Affordable Care Act (Defense Health Agency)
http://tricare.mil/aca
Explains that the military’s TRICARE health program is considered minimum essential
coverage for the purpose of ACA’s individual mandate.
Employer-Sponsored Coverage
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Employer-Sponsored Coverage
See also “Employer Penalties,” “Small Businesses,” and “Federal Employee Health Benefits
Program.”
Sources for Employees and their Families
People with coverage through a job (U.S. Department of Health and Human Services,
HealthCare.gov)
https://www.healthcare.gov/have-job-based-coverage/
FAQs for consumers with employer-sponsored coverage and those who are losing their
employer-sponsored coverage.
Consumer Information on the Affordable Care Act (U.S. Department of Labor, Employee Benefits
Security Administration)
http://www.dol.gov/ebsa/healthreform/consumer.html
For employees who receive health coverage through their jobs, this page lists consumer
protections under the ACA, such as coverage of pre-existing conditions and preventive
services; and the requirement that employees receive a plain-language Summary of Benefits
and Coverage.
Consumer Assistance (U.S. Department of Labor, Employee Benefits Security Administration)
https://www.dol.gov/ebsa/contactEBSA/consumerassistance.html
Constituents with questions about employer-based health coverage can speak with benefits
advisors at 1-866-444-3272.
Sources for Employers
Affordable Care Act (U.S. Department of Labor, Employee Benefits Security Administration)
http://www.dol.gov/ebsa/healthreform/
Information on ACA implementation for employers. This page has information on
grandfathered plans, waiting periods, and other topics for employer-sponsored health
coverage.
Health Care Changes (Business.USA.gov)
http://business.usa.gov/healthcare
Employers answer multiple-choice questions about their businesses (e.g., state, number of
employees, whether they offer health insurance to employees). An online “wizard” generates
a list of ACA resources depending on the answers.
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Affordable Care Act: What employers need to know (Internal Revenue Service)
http://www.irs.gov/pub/irs-pdf/p5200.pdf
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One-page overview of ACA information reporting requirements, employer shared
responsibility provisions, SHOP eligibility, and the small business health care tax credit.
Understanding employer reporting requirements of the health care law (Internal Revenue
Service)
http://www.irs.gov/pub/irs-pdf/p5196.pdf
Two-page brochure on ACA information reporting requirements for certain large employers.
Affordable Care Act Tax Provisions for Employers (Internal Revenue Service)
http://www.irs.gov/Affordable-Care-Act/Employers
Explanations of ACA tax provisions for employers, such as W-2 reporting requirements, the
Small Business Health Care Tax Credit, and potential employer penalties for certain large
employersapplicable large
employers.
Are you an applicable large employer? (Internal Revenue Service)
http://www.irs.gov/pub/irs-pdf/p5208.pdf
One-pager explains how to determine whether an organization is an applicable large
employer. Applicable large employers are subject to ACA information reporting and
employer shared responsibility provisions.
Affordable Care Act Tax Provisions for Employers (Internal Revenue Service)
http://www.irs.gov/Affordable-Care-Act/Employers
Explanations of ACA tax provisions for employers, such as W-2 reporting requirements, the
Small Business Health Care Tax Credit, and potential employer penalties for certain large
employers.
Affordable Care Act: Responsibilities for Health Coverage Providers: Understanding reporting
requirements of the health care law (Internal Revenue Service)
http://www.irs.gov/pub/irs-pdf/f5215.pdf
Two-page overview of reporting requirements for entities that provide minimum essential
coverage. The requirement applies to certain plan sponsors of self-insured group health plan
coverage.
Employer Penalties
Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care
Act (Internal Revenue Service)
http://www.irs.gov/Affordable-Care-Act/Employers/Questions-and-Answers-on-EmployerShared-Responsibility-Provisions-Under-the-Affordable-Care-Act
FAQs on the employer shared responsibility provisions under the ACA. This document
describes which employers are subject to the penalty and how the penalty amount is
calculated, and it provides important dates.
CRS Report R41159, Potential Employer Penalties Under the Patient Protection and Affordable
Care Act (ACA)R43981, Affordable Care Act (ACA): Employer Shared Responsibility
Determinations and Potential Penalties
ACA’s “shared responsibility” provision imposes penalties on certain large employers (with
at least 50 full-time equivalent workers) if they do not offer affordable“affordable” health coverage to
employees and at least one of their full-time employees obtains a premium credit (subsidy)
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through the exchanges. This report describes the process for determining which employers
are subject to the provision
and describes penalty calculations. It also describes ACA’s other
employer provisions, such as reporting requirements, the dependent coverage provision, and
provisions on “affordable” and “adequate” health coverage.
CRS Report R43181, The Affordable Care Act and Small Business: Economic Issues
Includes analysis of ACA employer penalties.
CRS Report IF10039, Proposals to Change the ACA’s Definition of “Full Time”
Analysis of proposals to change ACA’s definition of “full-time” from 30 hours to 40 hours a
week.
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Small Businesses
Health Care (U.S. Small Business Administration)
http://www.sba.gov/healthcare
Articles explain ACA provisions for small businesses.
CRS Report R43771, Small Business Health Options Program (SHOP) Exchange
According to the report,
SHOP exchanges are marketplaces where private health insurance issuers sell health
insurance plans to small employers. All health plans available through SHOP exchanges
must meet certain federally required criteria, such as offering a standardized package of
benefits. Certain small employers may be eligible to receive tax credits toward the cost of
coverage if they obtain coverage through a SHOP exchange...
This report describes certain features of SHOP exchanges, such as employer eligibility,
methods for selecting health plans offered through SHOP exchanges, and how health
insurance agents and brokers interact with SHOP exchanges. Each description includes
information about how the feature is implemented in SHOP exchanges administered by
states and those administered in part or in entirety by HHS. Each description also includes
information about the timing of implementation. The report concludes with a discussion
about the current and future place of SHOP exchanges in the broader context of the private
health insurance market.
Small Business: Get health insurance for your employees (U.S. Department of Health and Human
Services, HealthCare.gov)
https://www.healthcare.gov/small-businesses
FAQs about the SHOP exchange. For further questions, the federal health insurance call
center for small employers is 1-800-706-7893.
CRS Report R41158, Summary of the Small Business Health Insurance Tax Credit Under ACA
Under the ACA, the small business tax credit is available to qualifying for-profit and
nonprofit employers with fewer than 25 full-time equivalent employees with average annual
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wages that fall under a statutorily specified cap. To qualify for the credit, employers must
cover at least 50% of the cost of each of their employees’ self-only health insurance coverage.
CRS Report R43181, The Affordable Care Act and Small Business: Economic Issues
Analysis of ACA employer penalties, the small business health insurance tax credit, and
SHOP exchanges.
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Federal Employee Health Benefits Program
CRS Report R42741, Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
Includes information about the ACA in the Appendix, under “Patient Protection and
Affordable Care Act (P.L. 111-148, as amended), March 23, 2010.”
The Affordable Care Act and OPM (U.S. Office of Personnel Management)
http://www.opm.gov/healthcare-insurance/affordable-care-act/
Includes ACA resources and FAQs on FEHBP.
Tribal Employers: Indian Tribes FAQs (U.S. Office of Personnel Management)
http://www.opm.gov/healthcare-insurance/tribal-employers/faqs/
FAQs on how the ACA expands eligibility for tribal employees under FEHBP.
Changes to Federal Benefits Eligibility Due to Health Reform: Frequently Asked Questions
(FAQs) (U.S. Office of Personnel Management)
http://www.opm.gov/healthcare-insurance/special-initiatives/health-care-reform/
FAQs for federal employees on the ACA dependent coverage provision, which became
effective for plan years beginning on or after September 23, 2010.
Members of Congress and Congressional Staff
CRS Report R43194, Health Benefits for Members of Congress and Certain Congressional Staff
A provision in the ACA specifically affects Members of Congress and certain congressional
staff and their employer-sponsored health benefits. This report explains the implementation of
that provision.
The Affordable Care Act and OPM (U.S. Office of Personnel Management)
http://www.opm.gov/healthcare-insurance/affordable-care-act/
Includes ACA resources for Members of Congress and congressional staff.
I am an employee in the official office of a Member of Congress. How do I enroll in DC Health
Link? (DC Health Link)
https://dchealthlink.com/node/1638
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Members of Congress and designated congressional staff can purchase health insurance from
the District of Columbia SHOP exchange, called DC Health Link (855-532-5465). The web
page notes that questions can also be answered by the U.S. Senate Benefits Section (202-2241093) and the House of Representatives Office of Payroll and Benefits (202-225-1435). The
Open Enrollment period for 2015 coverage was November 10, 2014, to December 8, 2014.
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Union Health Plans
Multiemployer Health Plans, the Taft-Hartley Act, and the Patient Protection and Affordable
Care Act (ACA) (CRS Memorandum, June 26, 2013, available to congressional staff upon
request)
According to the memorandum,
Unions and multiemployer plan representatives have expressed an interest in allowing union
members and multiemployer plans to participate in the health insurance exchanges
established by the Patient Protection and Affordable Care Act (ACA, P.L. 111-148), as
amended. In light of this interest, this memorandum provides background information about
multiemployer plans, ACA, and another relevant federal statute, the Taft-Hartley Act. The
analysis considers two related scenarios: (1) an individual who is eligible for a
multiemployer health plan applying for a premium tax credit; and (2) a multiemployer health
plan being offered in a health insurance exchange.
Mental Health
Health Insurance and Mental Health Services (U.S. Department of Health and Human Services,
MentalHealth.gov)
http://www.mentalhealth.gov/get-help/health-insurance/index.html
FAQs about private health insurance, Medicare, and Medicaid coverage of mental health
benefits.
Affordable Care Act Implementation FAQs - Set 17 (The Center for Consumer Information and
Insurance Oversight, November 8, 2013)
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs17.html
FAQs about the implementation of the Mental Health Parity and Addiction Equity Act of
2008 (MHPAEA), as amended by the ACA. An excerpt appears below.
MHPAEA amended the Public Health Service Act (PHS Act), the Employee Retirement
Income Security Act (ERISA) and the Internal Revenue Code (the Code) to provide
increased parity between mental health and substance use disorder benefits and
medical/surgical benefits. In general, MHPAEA requires that the financial requirements
(such as coinsurance) and treatment limitations (such as visit limits) imposed on mental
health and substance use disorder benefits cannot be more restrictive than the predominant
financial requirements and treatment limitations that apply to substantially all
medical/surgical benefits.
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What plans cover: Mental health & substance abuse coverage (U.S. Department of Health and
Human Services, HealthCare.gov)
https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
Brief overview of requirements for behavioral health services coverage in exchange plans.
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Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal
Parity Protections for 62 Million Americans (U.S. Department of Health and Human Services,
Office of the Assistant Secretary for Planning and Evaluation, February 20, 2013)
http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm
Estimates of the impact of the MHPAEA, as amended by ACA.
Public Health, Workforce, Quality, and Related
Provisions
CRS Report R41278, Public Health, Workforce, Quality, and Related Provisions in ACA:
Summary and Timeline
Detailed section-by-section summary of the ACA’s provisions on public health, the health
workforce, quality improvement, health centers, prevention and wellness, maternal and child
health, nursing homes and other long-term care providers, comparative effectiveness
research, health information technology, emergency care, elder justice, biomedical research,
FDA and medical products, 340B drug pricing, and malpractice reform.
Taxes
See also “The Individual Mandate” and “Subsidies.”
Tax Filing Resources
The tax filing deadline was April 15, but the resources below may be helpful for late filers or
others seeking general information.
The Health Care Law and Your Taxes: What the Affordable Care Act (ACA) Means for Your 2014
Federal Tax Return (Internal Revenue Service)
http://www.irs.gov/pub/irs-pdf/p5201.pdf
Infographics on the individual mandate and premium tax credits.
Health coverage and your federal income taxes (U.S. Department of Health and Human Services,
HealthCare.gov)
https://www.healthcare.gov/taxes/
For consumers, links to tips and tools for completing 2014 federal income tax returns.
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Fact Sheet: Health Coverage and Federal Income Taxes (U.S. Department of Health and Human
Services)
http://www.hhs.gov/healthcare/facts/factsheets/2015/01/health-coverage-federal-incometaxes.html
Federal income tax information for persons with non-exchange coverage for all of 2014,
persons with exchange coverage in 2014, and persons who did not have health coverage in
2014.
Forms and Publications (Internal Revenue Service)
http://www.irs.gov/Forms-&-Pubs
Federal tax forms and instructions relevant to the ACA. Form 8965 is for reporting a
coverage exemption from the individual mandate granted by an exchange and applying for an
individual mandate exemption. Form 8962 is for reconciling advance premium tax credits
received with the premium tax credits actually due.
Tax information (Centers for Medicare and Medicaid Services)
https://marketplace.cms.gov/technical-assistance-resources/tax-information.html
Tax fact sheets, infographics, and articles for professionals assisting consumers with
exchange coverage.
Free File: Do Your Federal Taxes for Free (Internal Revenue Service)
http://irs.gov/FreeFile
Fillable electronic forms for persons with income over $60,000, and free file software for
persons with income under $60,000.
Extension of Time To File Your Tax Return (Internal Revenue Service)
http://www.irs.gov/uac/Extension-of-Time-To-File-Your-Tax-Return
Instructions and forms to apply for an extension of time to file. An extension of time to file
does not grant an extension of time to pay the tax liability.
Contacts for Tax Filing Assistance
Telephone Assistance (Internal Revenue Service)
http://www.irs.gov/uac/Telephone-Assistance
The Internal Revenue Service (IRS) is implementing many of the ACA’s tax provisions,
including the individual mandate, premium tax credits, and employer shared responsibility
penalties. The IRS has telephone hotlines to answer questions from individuals and
employers.
Free Tax Return Preparation for Qualifying Taxpayers (Internal Revenue Service)
http://www.irs.gov/Individuals/Free-Tax-Return-Preparation-for-You-by-Volunteers
The Volunteer Income Tax Assistance (VITA) program offers free tax help to people who
generally make $53,000 or less, persons with disabilities, the elderly and limited English
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speaking taxpayers who need assistance in preparing their own tax returns. IRS-certified
volunteers provide free basic income tax return preparation with electronic filing to qualified
individuals.
HHS to work with non-profit organizations and tax preparers to help consumers understand the
intersection of taxes and health care (U.S. Department of Health and Human Services, January
28, 2015)
http://www.hhs.gov/news/press/2015pres/01/20150128a.html
Lists tax preparers and nonprofit organizations that provide ACA-specific resources and
assistance.
Tax Provisions
Affordable Care Act (ACA) Tax Provisions (Internal Revenue Service)
http://www.irs.gov/Affordable-Care-Act
Briefly summarizes the ACA’s tax provisions. Sources are tailored for three categories:
individuals and families, employers, and other organizations. For a more comprehensive list,
click “List of Tax Provisions” in the left navigation bar; for many provisions, there are links
to “Questions and Answers.”
Present Law And Background Relating To The Tax-Related Provisions In The Affordable Care Act
(Joint Committee on Taxation, JCX-6-13, March 4, 2013)
https://www.jct.gov/publications.html?func=startdown&id=4511
Summarizes the ACA’s revenue (tax) provisions.
CRS Report R43342, The Medical Device Excise Tax: Economic Analysis
Since January 1, 2013, manufacturers and importers of medical devices have been subject to
an excise tax equal to 2.3% of the manufacturer’s price. This report gives an overview of the
tax: its legislative origins, its revenue effects, arguments for and against the tax, and its
economic effects.
Cost Estimates and Spending
Affordable Care Act (Congressional Budget Office)
http://www.cbo.gov/topics/health-care/affordable-care-act
A collection of Congressional Budget Office (CBO) analyses and cost estimates on the ACA
and proposals to amend or repeal the ACA. Includes analyses of the ACA’s effects on the
federal budget, labor markets, and health insurance coverage.
CRS Report R41390, Discretionary Spending Under the Affordable Care Act (ACA)
According to the report,
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The Patient Protection and Affordable Care Act (Affordable Care Act, or ACA) reauthorized
funding for numerous existing discretionary grant programs administered by the Department
of Health and Human Services (HHS). The ACA also created many new discretionary grant
programs and provided for each an authorization of appropriations. Generally, the law
authorized (or reauthorized) appropriations through FY2014 or FY2015. This report
summarizes all the discretionary spending provisions in the ACA.
CRS Report R41301, Appropriations and Fund Transfers in the Affordable Care Act (ACA)
Summarizes the ACA’s mandatory appropriations.
CRS Report R43289, Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act
Includes a section on ACA’s impact on federal spending. Appendix C summarizes ACA
provisions in recent appropriations bills.
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CRS Report IN10185, Congress Faces Calls to Address Expiring ACA Funds for Primary Care
Brief overview of selected expiring ACA appropriations, including funds for health centers
and the National Health Service Corps.
Tracking Accountability in Government Grants System: Search Affordable Care Act Awards (U.S.
Department of Health and Human Services)
http://taggs.hhs.gov/SearchACA.cfm
Database of U.S. Department of Health and Human Services ACA grant awards, searchable
by geographic location, grant program name, grantee name, and keyword. The database does
not include existing programs that received ACA funding in addition to their regular funding.
The database includes grants only, not other types of assistance such as contracts. Some
database dollar amounts are negative; these represent downward adjustments to previous
awards due to cost revisions, corrections, or award cancellations.
CRS Report R43066, Federal Funding for Health Insurance Exchanges
Table 1 details ACA exchange funding to states.
National Health Expenditure Projections 2013-2023 (Centers for Medicare and Medicaid
Services, Office of the Actuary, 2014)
http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/
NationalHealthExpendData/Downloads/Proj2013.pdf
Projections of national health spending and the ACA’s effects on spending growth.
Legal Issues
CRS Legal Sidebar: Health and Medicine
http://www.crs.gov/LegalSidebar/Default.aspx?CatId=52
CRS analysis of health-related legal issues. Includes analysis of ACA-related court cases.
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CRS Report R43833, Premium Tax Credits and Federal Health Insurance Exchanges: Questions
and Answers
An excerpt from the report:
Legal challenges that may have a substantial impact on the implementation and operation of
the Patient Protection and Affordable Care Act (ACA) concern whether premium tax credits
are available for millions of individuals participating in federally administered health
insurance exchanges... The Supreme Court has decided to weigh in onis currently reviewing this issue in King v.
Burwell... This report provides The Court heard oral arguments in the King case on March 4, 2015, and a decision
is expected by the end of the Court’s term in June 2015 at the latest. This report provides
background on provisions of ACA relevant to this issue. It
then answers questions
concerning the legal challenges and potential implications of the
Court’s decision in King.
CRS Report IN10239, Many Aspects of the Affordable Care Act Would Not Be Affected by
King v. Burwell
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King v.
Burwell
Describes some of ACA’s key public health and health services-related programs that would
not be affected by King v. Burwell.
CRS Report IF10169, The Affordable Care Act’s Contraceptive Coverage Requirement: History
of Regulations for Religious Objections
An excerpt from the report:
The Affordable Care Act (ACA; P.L. 111-148) requires that group health plans and health
insurance issuers provide coverage for certain preventive health services without imposing
any cost-sharing requirements. 42 U.S.C. §300gg-13(a)(4). The preventive services covered
include Food and Drug Administration (FDA)-approved contraceptive methods, which
generated controversy among employers who oppose the use of contraception based on their
religious beliefs. This requirement has been implemented through a series of administrative
regulations since 2010, when ACA was enacted.
CRS Report R43654, Free Exercise of Religion by Closely Held Corporations: Implications of
Burwell v. Hobby Lobby Stores, Inc.
Discusses the case’s effect on ACA contraceptive coverage requirements. For additional legal
analysis of contraceptive coverage requirements, see CRS Legal Sidebar: Freedom of
Religion, http://www.crs.gov/LegalSidebar/Default.aspx?CatId=Freedom%20of%20Religion.
CRS Report R43474, Implementing the Affordable Care Act: Delays, Extensions, and Other
Actions Taken by the Administration
Summarizes selected administrative actions to address ACA implementation and discusses
the congressional lawsuit authorized by H.Res. 676 in the 113th Congress.U.S. House of Representatives v. Burwell.
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Noncitizens
CRS Report R43561, Treatment of Noncitizens Under the Affordable Care Act
Discusses the treatment of noncitizens with respect to the individual mandate, eligibility for
exchange coverage and subsidies, and Medicaid eligibility. Also discusses the verification of
alien status under the ACA.
Health coverage for immigrants (U.S. Department of Health and Human Services,
HealthCare.gov)
https://www.healthcare.gov/immigrants/
Describes the eligibility of immigrants for exchange coverage and subsidies, Medicaid, and
CHIP.
ACA Text
The following resources can help with constituent requests for the text of the ACA.
Compilation of the Patient Protection and Affordable Care Act (U.S. House of Representatives,
Office of the Legislative Counsel)
http://legcounsel.house.gov/HOLC/Resources/comps_alpha.html
The Patient Protection and Affordable Care Act compilation is listed under “P” on this
website. The House Office of the Legislative Counsel compiled the text of the ACA,
consolidated with amendments made by subsequent laws. This compilation is unofficial. It is
updated periodically. As of this writing, the compilation is current through P.L. 113-188,
enacted November 26, 2014.
P.L. 111-148, Patient Protection and Affordable Care Act (Government Printing Office, March 23,
2010, 124 Stat. 119)
http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf
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Unlike the unofficial compilation above, this is the official publication of the ACA as it
passed on March 23, 2010. However, this does not reflect current law, as the ACA has since
been amended by several subsequent laws, including P.L. 111-152, Health Care and
Education Reconciliation Act of 2010, http://www.gpo.gov/fdsys/pkg/PLAW-111publ152/
pdf/PLAW-111publ152.pdf.
Everything You Should Know About The Health Care Law (Government Printing Office)
http://govbooktalk.gpo.gov/2013/09/24/everything-you-should-know-about-the-health-care-law/
Scroll to “How do I obtain a copy of this Affordable Care Act (ACA)?”
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Author Contact Information
Angela Napili
Information Research Specialist
anapili@crs.loc.gov, 7-0135
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