{
  "id": "R41624",
  "type": "CRS Report",
  "typeId": "REPORTS",
  "number": "R41624",
  "active": true,
  "source": "EveryCRSReport.com, University of North Texas Libraries Government Documents Department",
  "versions": [
    {
      "source": "EveryCRSReport.com",
      "id": 426859,
      "date": "2014-01-08",
      "retrieved": "2016-04-06T20:46:56.278353",
      "title": "Enforcement of Private Health Insurance Market Reforms Under the Affordable Care Act (ACA)",
      "summary": "The Patient Protection and Affordable Care Act (ACA), as amended, greatly expanded the scope of federal regulation over health insurance provided through employment-based group health plans, as well as coverage sold in the individual insurance market. Federal health insurance standards created by ACA require an extension of dependent coverage to age 26 if such coverage is offered; the elimination of preexisting condition exclusions; coverage of certain essential health benefits; a bar on lifetime or annual limits on the dollar value of certain benefits; a prohibition on health insurance rescissions except under limited circumstances; and coverage of preventive health services without cost-sharing, among many other things. While some of these changes took effect in 2010, others begin in 2014. In large part, ACA does not explicitly include any means for enforcing these health insurance requirements. However, these requirements were added to Title XXVII of the Public Health Service Act (PHSA), and incorporated by reference into Part 7 of the Employee Retirement Income Security Act (ERISA) and Chapter 100 of the Internal Revenue Code (IRC). Accordingly, if these ACA provisions are not followed, enforcement may be carried out through mechanisms (such as judicial review and other penalties) that existed prior to ACA in these three federal statutes. \nThe PHSA, ERISA, and the IRC apply to different types of health coverage and contain different types of enforcement mechanisms. In general, the private health insurance requirements of Title XXVII of the PHSA apply to health insurers offering group and individual health coverage, as well as health plans offered to government employees. With respect to health insurers, the PHSA allows states to be the primary enforcers of the federal private health insurance requirements, but the Secretary of Health and Human Services (HHS) assumes this responsibility if it is determined that a state has failed to \u201csubstantially enforce\u201d the federal provisions. Pursuant to this enforcement structure, states are primarily responsible for enforcing federal health insurance requirements both inside and outside of health insurance exchanges. ERISA generally applies to group health coverage provided by private-sector employers. Section 502(a) of ERISA authorizes various civil actions that may be brought by a participant or beneficiary of a plan against both group health plans and health insurers. Chapter 100 of the IRC applies to group health coverage, and the Department of Treasury can enforce the health plan requirements through the imposition of an excise tax. This report examines these provisions in ERISA, the PHSA, and the IRC that may be used to enforce the ACA health insurance market reforms.",
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      ],
      "topics": [
        {
          "source": "IBCList",
          "id": 3746,
          "name": "Health Care Reform"
        }
      ]
    },
    {
      "source": "University of North Texas Libraries Government Documents Department",
      "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc820188/",
      "id": "R41624_2012Jan12",
      "date": "2012-01-12",
      "retrieved": "2016-03-19T13:57:26",
      "title": "Enforcement of Private Health Insurance Market Reforms Under the Affordable Care Act (PPACA)",
      "summary": null,
      "type": "CRS Report",
      "typeId": "REPORT",
      "active": false,
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          "filename": "files/20120112_R41624_2667c8768afd156a0039dd093fdf52d1c824ce1d.pdf"
        }
      ],
      "topics": []
    }
  ],
  "topics": [
    "Domestic Social Policy"
  ]
}