Patient Protection and Affordable Care Act
(ACA): Resources for Frequently Asked
Questions
Angela Napili
Information Research Specialist
April 23, 2014
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. Many of these
provisions take effect in 2014. 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 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 offers an ACA consumer telephone hotline and
online chat assistance. The report also lists sources for congressional staff to contact federal
agencies with ACA questions.
The report provides basic consumer sources, including broad overviews of the ACA law. 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. The report then lists sources on employer-sponsored coverage, including sources on
employer penalties, small businesses, federal workers’ health plans, and union health plans. The
report also provides sources on ACA’s provisions on mental health, public health, workforce,
quality, and taxes. Finally, the report lists sources on ACA costs and appropriations, 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.
Congressional Research Service
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Contents
Contacts for ACA Assistance ........................................................................................................... 1
Basic Consumer Sources ................................................................................................................. 2
The Individual Mandate ................................................................................................................... 3
Private Health Insurance .................................................................................................................. 3
Exchanges and Subsidies ................................................................................................................. 5
Medicaid and the State Children’s Health Insurance Program ........................................................ 7
Medicare .......................................................................................................................................... 7
Indian Health Care ........................................................................................................................... 8
Veterans and Military Health Care ................................................................................................... 8
Employer-Sponsored Coverage ....................................................................................................... 9
Employer Penalties .......................................................................................................................... 9
Small Businesses ........................................................................................................................... 10
Federal Employee Health Benefits Program.................................................................................. 10
Members of Congress and Congressional Staff ............................................................................. 11
Union Health Plans ........................................................................................................................ 11
Mental Health ................................................................................................................................ 12
Public Health, Workforce, Quality, and Related Provisions .......................................................... 12
Tax Provisions................................................................................................................................ 13
ACA Cost Estimates and Spending ............................................................................................... 13
ACA Statute ................................................................................................................................... 14
Contacts
Author Contact Information........................................................................................................... 15
Congressional Research Service
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
his report provides resources to help congressional staff respond to constituents’ frequently
asked questions (FAQs) about the Patient Protection and Affordable Care Act (ACA). The
Treport lists selected resources regarding consumers, employers, and other stakeholders,
with a focus on federal sources. It also lists CRS reports that summarize 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
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). For enrollees in HealthCare.gov’s federally
facilitated exchange plans, see Contacting Your Health Plan’s Customer Service Phone Number at
http://marketplace.cms.gov/getofficialresources/publications-and-articles/contact-health-plan.pdf.
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) and
online chat assistance. 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.
Consumer Assistance Program (The Center for Consumer Information & 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.
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, and state and local government
agencies.
IRS Hotlines and Toll-Free Numbers
http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/IRS-Hotlines-and-Toll-Free-
Numbers
The Internal Revenue Service (IRS) is implementing many of ACA’s tax provisions,
including the individual mandate, premium tax credits, and employer shared responsibility
penalties. IRS has telephone hotlines to answer questions from individuals and employers.
Congressional Research Service
1
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
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.
The U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services
has a dedicated phone number for ACA implementation questions from congressional staff: 202-
690-8004. This number is exclusively for the use of Members of Congress and congressional
staff, not constituents.
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 Internal Revenue Service, 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: Affordable Care Act and Health
Policy.
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 the Congress. 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 Affordable Care Act consumer information. Questions and
answers on health insurance under ACA, including options for obtaining coverage, consumer
rights and protections, and services that must be covered. A Spanish-language version is at
http://www.CuidadoDeSalud.gov.
Affordable Care Act Tax Provisions for Individuals and Families (Internal Revenue Service)
http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-for-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), Health Care Flexible Spending Arrangements, Health Savings Accounts, medical
loss ratio premium rebates, and other tax provisions.
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.
Congressional Research Service
2
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Key Features of the Affordable Care Act By Year (U.S. Department of Health and Human
Services)
http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html
A timeline of selected ACA provisions, with links to federal consumer information sources.
The Individual Mandate
Questions and Answers on the Individual Shared Responsibility Provision (Internal Revenue
Service)
http://www.irs.gov/uac/Questions-and-Answers-on-the-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
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.
What if someone doesn't have health coverage in 2014? (U.S. Department of Health and Human
Services, HealthCare.gov)
https://www.healthcare.gov/what-if-i-dont-have-health-coverage/
Details on the individual mandate penalty. The web page notes that those who enrolled in an
exchange plan by March 31, 2014, will not have to pay the penalty.
How do I qualify for an exemption from the fee for not having health coverage? (U.S. Department
of Health and Human Services, HealthCare.gov)
https://www.healthcare.gov/exemptions/
Lists examples of circumstances that could warrant an individual mandate exemption.
Private Health Insurance
CRS Report R43048, Overview of Private Health Insurance Provisions in the Patient Protection
and Affordable Care Act (ACA)
[ACA] includes provisions that restructure the private health insurance market by (1)
implementing market reforms that impose requirements on private health insurance plans
and sponsors of health insurance (e.g., employers); (2) creating marketplaces, ‘exchanges,’
Congressional Research Service
3
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
where individuals can shop for and purchase health plans that meet or exceed federal
standards; (3) providing financial assistance to qualified individuals who purchase health
plans through an exchange; (4) establishing an individual mandate that requires most
individuals to either maintain health insurance coverage or pay a penalty; and (5) assessing
penalties on certain employers that either do not provide health insurance or provide health
insurance that is ‘unaffordable’ or does not provide ‘minimum value.’
CRS Report R43233, Private Health Plans Under the ACA: In Brief
Briefly describes health plans that may be offered inside and outside of exchanges. Table 2
shows which private health insurance market reforms apply to which plan types, including
multi-state plans, qualified health plans, child-only plans, health cooperatives, catastrophic
and other high-deductible health plans, self-funded plans, union plans, retiree-only plans,
dental plans, vision plans, limited-benefit plans, grandfathered plans, and nongroup, small
group, and large group plans offered outside the exchanges.
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 or new; whether the plans are sold in the
large group market, small group market, or individual market; and whether group plans are
fully insured or self-insured.
Fact Sheets & Frequently Asked Questions (FAQs) (The Center for Consumer Information &
Insurance Oversight)
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/index.html
The federal Center for Consumer Information & Insurance Oversight (CCIIO) is charged
with implementing 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 dependent coverage provision. Under ACA, if a health
plan provides for dependent coverage of children, the plan must make such coverage
available for a child under age 26. This requirement became effective for plan years
beginning on or after September 23, 2010.
Health Insurance Rate Filings by State, 2014 (Congressional Research Service, August 30, 2013,
available to congressional staff upon request)
There is no federal requirement for states to release health insurance rate filings to the public.
As such, there is wide variation in the information available to the general public regarding
health insurance rates (premiums). This document lists summary rate data and access to rate
filings, by state.
Congressional Research Service
4
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Exchanges and Subsidies
Marketplace Overview (U.S. Department of Health and Human Services, Healthcare.gov)
https://www.healthcare.gov/health-insurance-marketplace
Under the ACA, “exchanges” (sometimes called “marketplaces”) have been established to
provide eligible individuals with access to private health insurance plans. This document has
plain language questions and answers about the exchanges. For a briefer overview, see “Get
Covered: A one-page guide to the Health Insurance Marketplace” http://www.healthcare.gov/
get-covered-a-1-page-guide-to-the-health-insurance-marketplace/. For information about the
exchange in your state, choose your state from the pull-down menu at
https://www.healthcare.gov/marketplace/b/welcome/.
Getting coverage outside Open Enrollment (U.S. Department of Health and Human Services,
Healthcare.gov)
https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/
The 2014 open season for exchange plan enrollment ended March 31, 2014. 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 is November 15, 2014-February 15, 2015. Individuals can
apply for Medicaid or State Children’s Health Insurance Program (CHIP) coverage any time.
Special Enrollment Periods for complex cases in the Marketplace (U.S. Department of Health and
Human Services, Healthcare.gov)
https://www.healthcare.gov/sep-list/
Lists examples of circumstances that could qualify individuals for a “special enrollment
period” outside of open season. Examples include natural disasters, medical emergencies, and
exchange enrollment errors. For more detailed guidance for the HealthCare.gov federally-
facilitated exchange, see Guidance for Issuers on Special Enrollment Periods for Complex
Cases in the Federally-facilitated Marketplace after the Initial Open Enrollment Period (The
Center for Consumer Information & Insurance Oversight, March 26, 2014),
http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/complex-
cases-SEP-3-26-2014.pdf.
Using Your New Insurance Coverage (U.S. Department of Health and Human Services,
Healthcare.gov)
https://www.healthcare.gov/using-your-new-marketplace-coverage/
Consumer tips for verifying enrollment, getting prescription drugs, finding a doctor, getting
emergency care, and appealing insurance company decisions.
Using the Marketplace (U.S. Department of Health and Human Services, Healthcare.gov)
https://www.healthcare.gov/using-the-marketplace/
FAQs and tips on exchange coverage, including options for applying, how to report life
changes (such as births, marriage, and changes in income or residence), and how to appeal an
Congressional Research Service
5
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
exchange decision. Open enrollment for 2014 exchange coverage ended March 31, 2014, but
certain individuals may qualify for “special enrollment periods” after that date.
Get Plan Information in Your Area (U.S. Department of Health and Human Services,
Healthcare.gov)
https://www.healthcare.gov/find-premium-estimates/
For federally facilitated exchanges, this website lets consumers view plan information and
premium estimates, without opening a HealthCare.gov account.
CRS Report R41137, Health Insurance Premium Credits in the Patient Protection and Affordable
Care Act (ACA)
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 (FPL), and the individual does not have access to
affordable health coverage through another source such as an employer.
Save Money on Coverage (U.S. Department of Health and Human Services, Healthcare.gov)
https://www.healthcare.gov/getting-lower-costs-on-coverage/
FAQs on available subsidies for health coverage, including premium credits and cost-sharing
subsidies.
The Premium Tax Credit (Internal Revenue Service)
http://www.irs.gov/uac/The-Premium-Tax-Credit
Basic background on premium credits. FAQs are at Questions and Answers on the Premium
Tax Credit http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-the-Premium-Tax-
Credit.
Health Insurance Marketplace (Centers for Medicare & Medicaid Services)
http://marketplace.cms.gov/
For professionals assisting consumers with enrollment, this site has federal brochures,
training materials, and questions & answers about the exchanges. Includes resources in
Spanish: http://marketplace.cms.gov/getofficialresources/spanish-materials/spanish-
materials.html.
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 for ACA health insurance exchanges.
CRS Report R43484, Summary Cost Data for Federally-Facilitated Exchanges, 2014,
CRS is creating a fact sheet for each of the 34 federally-facilitated exchanges, summarizing
the range of costs and options for individual and family plans in each exchange. This
summary document links to completed fact sheets.
Congressional Research Service
6
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
CRS Report R43368, Contractors and HealthCare.gov: Answers to Frequently Asked Questions
FAQs on the selection of vendors for HealthCare.gov and potential reforms in response to
HealthCare.gov’s problematic debut.
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/By-
State.html
• Links to each state’s CHIP website:
http://insurekidsnow.gov/state/index.html
What if I have new Medicaid or CHIP coverage? (U.S. Department of Health and Human
Services, Healthcare.gov)
https://www.healthcare.gov/what-if-i-have-new-medicaid-or-chip-coverage/
FAQs and tips for new Medicaid and CHIP enrollees.
Affordable Care Act (Centers for Medicare & Medicaid Services, Medicaid.gov)
http://www.medicaid.gov/AffordableCareAct/Affordable-Care-Act.html
Summaries and timeline of major ACA provisions related to Medicaid and the State
Children’s Health Insurance Program (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 & 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 and
Medicaid and the State Children’s Health Insurance Program (CHIP).
Medicare
Medicare.gov (Centers for Medicare & Medicaid Services)
https://www.medicare.gov/
Congressional Research Service
7
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Official federal portal for consumer information on Medicare.
CRS Report R41196, Medicare Provisions in the Patient Protection and Affordable Care Act
(PPACA): Summary and Timeline
Detailed section-by-section summary of ACA’s Medicare provisions.
CRS Report R41511, The Independent Payment Advisory Board
The board’s charge is to “reduce the per capita rate of growth in Medicare spending.” As of
this writing, no board members have yet been appointed.
Indian Health Care
CRS Report R41152, Indian Health Care: Impact of the Affordable Care Act (ACA)
ACA reauthorized the Indian Health Care Improvement Act (IHCIA), which authorizes many
Indian Health Service (IHS) 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 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
CRS Report R41198, TRICARE and VA Health Care: Impact of the Patient Protection and
Affordable Care Act (ACA)
Frequently asked questions on how ACA affects the veterans’ and military health care
systems.
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’ frequently asked questions about the ACA. The website notes that “The
health care law does not change VA health benefits or Veterans’ out-of-pocket costs.”
TRICARE and the Affordable Care Act (Defense Health Agency)
http://tricare.mil/aca
Congressional Research Service
8
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Explains that the military’s TRICARE health program is considered minimum essential
coverage for the purpose of ACA’s individual mandate.
Employer-Sponsored Coverage
Affordable Care Act (Employee Benefits Security Administration)
http://www.dol.gov/ebsa/healthreform/
The federal Employee Benefits Security Administration, part of the Department of Labor,
provides information on ACA implementation for employers and employees who receive
health coverage through work. 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 business (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.
Affordable Care Act Tax Provisions for Employers (Internal Revenue Service)
http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-for-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.
Employer Penalties
Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care
Act (Internal Revenue Service)
http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-Employer-Shared-Responsibility-
Provisions-Under-the-Affordable-Care-Act
FAQs on the employer shared responsibility provisions under ACA. Final regulations were
issued by the Internal Revenue Service on February 10, 2014. This document describes which
employers are subject to the penalty, how the penalty amount is calculated, and important
dates.
CRS Report R41159, Potential Employer Penalties Under the Patient Protection and Affordable
Care Act (ACA)
ACA’s “shared responsibility” provision imposes penalties on certain large employers (at
least 50 FTEs) if they do not offer affordable health coverage to employees and at least one of
their full-time employees obtains a premium credit (subsidy) through the exchanges. This
report describes which employers are subject to the provision and describes penalty
calculations.
Congressional Research Service
9
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
CRS Report R43181, The Affordable Care Act and Small Business: Economic Issues
Includes analysis of ACA employer penalties.
Small Businesses
Health Care (U.S. Small Business Administration)
http://www.sba.gov/healthcare
Articles explain ACA provisions for small businesses.
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 Small Business Health Options Program (SHOP) exchange. For further
questions, the federal health insurance call center for small employers is 1-800-706-7893.
CRS Report R41158, Summary of Small Business Health Insurance Tax Credit Under the Patient
Protection and Affordable Care Act (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
wages of less than $50,000. To be eligible for the tax credit, employers must contribute a
uniform percentage of at least 50% toward their employees’ health insurance.
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.
Federal Employee Health Benefits Program
CRS Report R42741, Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
Includes information about 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 (Office of Personnel Management)
http://www.opm.gov/healthcare-insurance/affordable-care-act/
Includes ACA resources and FAQs on FEHBP.
The Affordable Care Act (ACA) and the Federal Employees Health Benefits Program: Questions
and Answers (U.S. Office of Personnel Management)
http://www.chcoc.gov/files/the-affordable-care-act-and-the-federal-employees-health-benefit-
program-questions-answers.pdf
Congressional Research Service
10
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
FAQs for federal employees, retirees, and dependents on how ACA affects FEHBP.
Health Care Reform FEHB Fast Facts: How Does the Affordable Care Act’s Individual Shared
Responsibility Provision and the Requirement to Maintain Minimum Essential Coverage Affect
Me? (U.S. Office of Personnel Management)
http://www.opm.gov/retirement-services/publications-forms/benefits-administration-letters/2013/
13-205attachment1.pdf
FAQs on how the individual mandate affects persons covered by 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 ACA specifically affects Members of Congress and certain congressional staff
and their employer sponsored health benefits. This report explains the implementation of this
provision.
The Affordable Care Act and OPM (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)
http://dchealthlink.force.com/help/articles/FAQ/employee-Congress/
Members of Congress and designated congressional staff could 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-
224-1093) and the House of Representatives Office of Payroll and Benefits (202-225-1435).
The Open Enrollment period for 2014 was from November 11, 2013, to December 9, 2013.
Union Health Plans
Multiemployer Health Plans, the Taft-Hartley Act, and the Patient Protection and Affordable
Care Act (ACA) (Congressional Research Service Memorandum, June 26, 2013, available to
congressional staff upon request)
Unions and multiemployer plan representatives have expressed an interest in allowing union
members and multiemployer plans to participate in the health insurance exchanges
Congressional Research Service
11
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
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
CRS Report R41768, Mental Health Parity and Mandated Coverage of Mental Health and
Substance Use Disorder Services After the ACA
ACA extends applicability of federal mental health parity requirements to three new plan
types: (1) Qualified Health Plans (QHPs, offered through the state Exchanges); (2) plans
offered through the individual market; and (3) Medicaid benchmark and benchmark
equivalent plans that are not managed care plans. The ACA also requires certain plans to
offer coverage of mental health and substance use disorder services, by requiring these plan
types to cover the Essential Health Benefits (EHB), which are defined to include mental
health and substance use disorder services.
CRS Report R42009, Financing and Delivery of Behavioral Health Services and the Patient
Protection and Affordable Care Act
An overview of ACA provisions that are expected to affect the financing and delivery of
behavioral health care services, including mental health and substance abuse services.
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.
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 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.
Congressional Research Service
12
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Tax Provisions
Affordable Care Act (ACA) Tax Provisions (Internal Revenue Service)
http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home
Briefly summarizes ACA’s tax provisions. Sources are tailored for “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 ACA’s revenue (tax) provisions.
ACA 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 ACA. Includes analyses of ACA’s effects on the federal
budget, labor markets, and health insurance coverage.
CRS Report R41390, Discretionary Spending in the Patient Protection and Affordable Care Act
(ACA)
“The Patient Protection and Affordable Care Act (ACA) reauthorized funding for numerous
existing discretionary grant programs and other activities. ACA also created multiple new
discretionary grant programs and provided for each an authorization of appropriations.
Funding for all these discretionary programs is subject to action by congressional
appropriators. This report summarizes all the discretionary spending provisions in ACA.”
CRS Report R41301, Appropriations and Fund Transfers in the Patient Protection and Affordable
Care Act (ACA)
Summarizes ACA’s mandatory appropriations. Appendix B summarizes ACA-related
authorizing legislation in recent congresses. Appendix C summarizes ACA provisions in
recent appropriations bills.
CRS Report R43289, Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act
Includes a section on “How ACA Implementation Affects Federal Spending.”
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
Congressional Research Service
13
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
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 already 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 (Centers for Medicare & Medicaid Services, Office of
the Actuary, 2013)
http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/
NationalHealthExpendData/Downloads/Proj2012.pdf
Projections of national health spending and ACA’s effects on spending growth.
ACA Statute
The following resources can help with constituent requests for the text of the ACA statute.
Compilation of the Patient Protection and Affordable Care Act (U.S. House of Representatives,
Office of the Legislative Counsel)
http://www.house.gov/legcoun/HOLC/Resources/comps_alpha.html
The Patient Protection and Affordable Care Act compilation is listed under “P” on this web
page. The House Office of the Legislative Counsel compiled the text of the ACA (P.L. 111-
148), 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. 112-240, enacted January 2, 2013.
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
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 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)?.”
Congressional Research Service
14
Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions
Author Contact Information
Angela Napili
Information Research Specialist
anapili@crs.loc.gov, 7-0135
Congressional Research Service
15