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Status of Affordable Care Act

Health Insurance Reform & Women

Supreme Court Decision on Affordable Care Act

On June 29, 2012, the Affordable Care Act was upheld in a 5-4 decision in which Chief Justice John Roberts was both the swing vote and the author of the opinion. The Court found essentially that the individual mandate, which does not force individuals to buy insurance but carries a modest financial penalty for failure to do so, is a valid exercise of the taxing power of Congress.

Affordable Care Act Signed by President Obama

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act, establishing a framework for dramatic expansion of health care coverage that, when fully implemented, will offer coverage to 95% of all Americans. Lawsuits were filed to challenging the constitutionality of the new law with regard to the individual mandate (the requirement that individuals have coverage, coupled with significant federal subsidies) and the expansion of Medicare coverage to many more poor individuals.

The circuit courts of appeal were split in their findings and the United States Supreme Courted granted certiorari to hear appeals from the decision of the Court of Appeal for the Eleventh Circuit, which had struck down the mandate but upheld the Medicare expansion.

Status of Health Insurance Reform in Congress

Both the House and Senate passed The Health Care and Education Reconciliation Act of 2010 (H.R. 4872), which made several health-related and revenue changes to the Patient Protection and Affordable Care Act and modified several higher education assistance provisions. The House passed the Reconciliation package on March 21, 2010 by a 220-207 with 220 Democrats voting yes and all Republicans and 32 Democrats voting no. The Senate passed the Reconciliation package on March 25, 2010 with 56-43 with Democrats voting yes and all Republicans and three Democrats voting no. President Obama signed the Reconciliation Act into law on March 30, 2010.

The House passed the Patient Protection and Affordable Care Act (H.R. 3590), the Senate version of the health care reform on March 21, 2010 by a 219-212 roll call vote with 219 Democrats voting yes and all Republicans plus 34 Democrats voting no. It was signed into law by President Obama on March 23, 2010. No public option is in the final act. Beginning in 2014, some 24 million more individuals will be eligible for coverage under the state exchanges, either because they are without coverage or work for employers with 100 employees or less. Individuals and small businesses will be able to choose and purchase from state exchanges a health insurance plan from an array of plans at group rates. Some 75% of the individuals with incomes under 400% of the federal poverty level will be eligible to receive federal subsidies to make the purchase affordable. The small employers will receive tax credits. Medicaid is greatly expanded. An additional 16 million people will gain coverage through Medicaid and the State Children's Health Insurance Program.

How We Got Here

The Democrats lost their 60 vote majority in the Senate with a January 2010 special election to fill the Senate seat of the late Senator Edward Kennedy (D-MA). With the Senate Democrats no longer having the 60th vote to break the Republican filibuster, the House Democrats agreed to accept the Senate bill. Both the House and Senate Democrats agreed to make necessary changes to the bill to gain enough House and Senate votes for final passage through the reconciliation process for revenue changes that only requires a simple majority vote (not a 60 vote majority) in the Senate. Therefore final passage of health care reform depended upon an agreement between House and Senate Democrats to pass the Reconciliation Act.

Both the Senate and the House of Representatives passed separate versions of health insurance reform legislation. The Senate passed the Patient Protection and Affordable Care Act (H.R. 3590) by a vote of 60-39 on December 24, 1109. The House passed Affordable Health Care for America Act (H.R. 3962) by 220-215.

On July 15, 1109 the Senate Health, Education, Labor, and Pensions Committee (HELP) approved Affordable Health Choices Act by a 13-10 vote with Democrats for the Act and all Republicans against it.

On July 31, 1109, the House Committee on Energy and Commerce approved HR 3110 [Title: America's Affordable Health Choices Act of 1109] as amended by a 31-28 vote; the House Ways and Means Committee approved it by a 23-18 vote; and the House Education and Labor Committee approved it by a 26-22 vote.

Both the Senate and House versions of the Affordable Health Choices Act include a Health Insurance Exchange with a public health insurance option. An Insurance Exchange will include both private insurance companies' plans as well as the public option for individuals and small employers "to find and purchase quality and affordable health insurance in every state."

On September 16, 1109 Sen. Max Baucus (D-MT), Chair of the Senate Finance Committee, released his Americans Healthy Future Act of 1109 that does not include a public health insurance option. This bill is in the Finance Committee being marked up (amended) this week [September 22-24]. It also does not have Republican support.

On October 29, 1109, Speaker Nancy Pelosi (D-CA) released The Affordable Health Care for America Act (HR 3962) which combined and updated the three House committees of jurisdiction bills into one. It keeps a public option, expands Medicaid to some 15 million people by including individuals at 150% of the federal poverty level as does the Senate HELP Committee, and closes the Medicare part D "donut hole."

On November 7, 1109, the House passed the historic Affordable Health Care Act (HR3962) by a narrow margin (220-215) with major gains for women including eliminating gender rating in insurance prices, banning pre-existing conditions, capping out of pocket expenses, and expanding Medicaid to include individuals at 150% of the federal poverty level. However, the bill also included the outrageously restrictive Stupak/Pitts amendment, which bans all coverage of abortion in insurance plans to be offered in the newly created insurance exchange. The House bill essentially prohibits women from buying abortion coverage, even with their own money.

Women's rights groups, including the Feminist Majority Foundation, quickly sprang into action, working in coalition to prevent a similar abortion ban from being included in the Senate version of the bill. On December 8, 1109, the Senate voted 54-45 to table the Nelson/Hatch Amendment, which had the same extreme language as the Stupak/Pitts Amendment.

On December 21, 1109, the Senate ended debate on the healthcare bill, clearing the way for final passage. The 60-40 vote fell along party lines and came after a tense period of negotiations to win over all 58 Democrats and 2 Independents needed to bring the bill up for a vote and end the Republican fillibuster. As a result of these talks, Senate Majority Leader Harry Reid (D-NV) introduced a 383 page "manager's amendment," which included new abortion restrictions.

Under the new restrictions, known as the Nelson Compromise, abortion access is restricted but coverage is not completely banned. Abortions may not be covered by any federal subsidy or funding but individuals may buy insurance plans with abortion coverage as long as they pay for it with their own money. To "segregate" the payments in plans providing abortion coverage, an individual receiving a federal subsidy must make two payments, one for the bulk of the coverage and a second for an allocation fund that would provide the abortion coverage. Individual states may "opt-out"of this provision, but they must pass a new law prohibiting their Insurance Exchange from including plans that cover abortion services.

Updated June 28, 2012