Table 1

Selected Components of the Affordable Care Act

Guaranteed issue
  • Requires uniform premium, regardless of sex or pre-existing conditions.

Individual mandate
  • In absence of employer health plan, Medicaid, Medicare: buy insurance or pay penalty.

Health insurance exchanges
  • Offers a marketplace for comparison and purchase of insurance policies.

Subsidies
  • Low income individuals and families (1–4× poverty level) to receive federal subsidies.

Medicaid expansion
  • Eligibility to include all individuals and families up to 1.38× poverty level. (States can opt out.)

Minimum standards
  • Established for all policies, with ban of coverage caps. Children covered to age 26 years.

Employer shared responsibility
  • Firms with ≥50 employees not offering coverage will share subsidy burden.

Subsidy for very small business
  • If they purchase insurance through an exchange.

Copayments, coinsurance, and deductibles
  • Eliminated for benefits considered preventive care.

Fee restructuring
  • Transitions Medicare reimbursement away from fee-for-service toward value-based and bundled payments. Creation of accountable care organizations