{ "id": "R42069", "type": "CRS Report", "typeId": "REPORTS", "number": "R42069", "active": true, "source": "EveryCRSReport.com, University of North Texas Libraries Government Documents Department", "versions": [ { "source": "EveryCRSReport.com", "id": 453113, "date": "2016-02-10", "retrieved": "2016-06-21T21:19:13.471819", "title": "Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA)", "summary": "The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) establishes federal requirements that apply to private health insurance. Its market reforms affect insurance offered to groups and individuals and impose requirements on sponsors of coverage (e.g., employers). In general, all of the ACA\u2019s market reforms are currently effective; some became effective shortly after the ACA was passed in 2010, and others became effective for plan years beginning in 2014.\nAlthough some of the market reforms had previously been enacted in some states, many of the reforms are new at the federal level. Collectively, the reforms create federal minimum requirements with respect to access to coverage, premiums, benefits, cost sharing, and consumer protections. For example, the requirement to offer health plans on a guaranteed-issue basis generally means that insurers must accept every applicant for health coverage, as long as the applicant agrees to the terms and conditions of the coverage (e.g., the premium). The ACA\u2019s requirement to offer the essential health benefits means that certain plans must cover a specified package of benefits.\nThe market reforms do not apply uniformly to all types of plans. Some reforms apply to all three segments of the private insurance market\u2014individual, small group, and large group\u2014whereas others may apply only to plans offered in the individual and small-group markets. In the group market, the reforms do not always apply to both fully insured plans (plans offered by state-licensed carriers that are purchased by employers or other sponsors) and self-insured entities (groups that set aside funds to pay for health benefits directly). The reforms\u2019 applicability also depends on whether a plan has grandfathered status. Under the ACA, an existing health plan in which a person was enrolled on the date of ACA enactment was grandfathered; the plan can maintain its grandfathered status as long as it meets certain requirements. Grandfathered health plans are exempt from the majority of ACA market reforms. \nAlthough the market reforms\u2019 applicability is not necessarily uniform across plan types, it is uniform for plans offered inside and outside health insurance exchanges. Every state has an exchange, and individuals and small employers can use the exchanges to shop for and obtain health insurance coverage. The same market reforms apply to an individual plan offered through an exchange and to an individual plan offered in the market outside of an exchange. Some types of plans do not have to comply with any of the market reforms. For example, retiree-only health plans are not required to comply with federal health insurance requirements, including the ACA\u2019s market reforms.\nThis report provides background information about the private health insurance market, including market segments and regulation. It then describes each ACA market reform. The reforms are grouped under the following categories: obtaining coverage, keeping coverage, cost of purchasing coverage, covered services, cost-sharing limits, consumer assistance and other health care protections, and plan requirements related to health care providers. The Appendix provides details about the types of plans that are required to comply with the different reforms.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R42069", "sha1": "24a6e8d8dce6a05edd83ad69145b2eb728fb6478", "filename": "files/20160210_R42069_24a6e8d8dce6a05edd83ad69145b2eb728fb6478.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R42069", "sha1": "326aef16bc543c11df30561b0850327e436d71ab", "filename": "files/20160210_R42069_326aef16bc543c11df30561b0850327e436d71ab.pdf", "images": null } ], "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/metadc462430/", "id": "R42069_2014Jul24", "date": "2014-07-24", "retrieved": "2014-12-05T09:57:41", "title": "Private Health Insurance Market Reforms in the Affordable Care Act (ACA)", "summary": "This report provides background information about the private health insurance market, including market segments and regulation. It then describes each Affordable Care Act (ACA) market reform.", "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20140724_R42069_ca594182d0e9b09002bcb7f58aedac9d6ea5530f.pdf" }, { "format": "HTML", "filename": "files/20140724_R42069_ca594182d0e9b09002bcb7f58aedac9d6ea5530f.html" } ], "topics": [ { "source": "LIV", "id": "Health policy", "name": "Health policy" }, { "source": "LIV", "id": "Health insurance", "name": "Health insurance" }, { "source": "LIV", "id": "Health insurance industry", "name": "Health insurance industry" }, { "source": "LIV", "id": "Public health laws", "name": "Public health laws" } ] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc306460/", "id": "R42069_2014May06", "date": "2014-05-06", "retrieved": "2014-07-08T21:53:44", "title": "Private Health Insurance Market Reforms in the Affordable Care Act (ACA)", "summary": "This report provides background information about the private health insurance market, including market segments and regulation. It then describes each Affordable Care Act (ACA) market reform.", "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20140506_R42069_bba69ea06e041f93900000e5659aa23cd89c1085.pdf" }, { "format": "HTML", "filename": "files/20140506_R42069_bba69ea06e041f93900000e5659aa23cd89c1085.html" } ], "topics": [ { "source": "LIV", "id": "Health policy", "name": "Health policy" }, { "source": "LIV", "id": "Health insurance", "name": "Health insurance" }, { "source": "LIV", "id": "Health insurance industry", "name": "Health insurance industry" }, { "source": "LIV", "id": "Public health laws", "name": "Public health laws" } ] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc462687/", "id": "R42069_2014Mar13", "date": "2014-03-13", "retrieved": "2014-12-05T09:57:41", "title": "Private Health Insurance Market Reforms in the Affordable Care Act (ACA)", "summary": "This report provides background information about the private health insurance market, including market segments and regulation. It then describes each Affordable Care Act (ACA) market reform.", "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20140313_R42069_f8a9f55dbfc40247b2878efc0d0bd89e8ff510b7.pdf" }, { "format": "HTML", "filename": "files/20140313_R42069_f8a9f55dbfc40247b2878efc0d0bd89e8ff510b7.html" } ], "topics": [ { "source": "LIV", "id": "Health policy", "name": "Health policy" }, { "source": "LIV", "id": "Health insurance", "name": "Health insurance" }, { "source": "LIV", "id": "Health insurance industry", "name": "Health insurance industry" }, { "source": "LIV", "id": "Public health laws", "name": "Public health laws" } ] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc805896/", "id": "R42069_2012Apr16", "date": "2012-04-16", "retrieved": "2016-03-19T13:57:26", "title": "Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA)", "summary": null, "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20120416_R42069_29d6bf80e59830cfec576f468bd2719ac2bac400.pdf" }, { "format": "HTML", "filename": "files/20120416_R42069_29d6bf80e59830cfec576f468bd2719ac2bac400.html" } ], "topics": [] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc806243/", "id": "R42069_2011Nov01", "date": "2011-11-01", "retrieved": "2016-03-19T13:57:26", "title": "Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA)", "summary": null, "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20111101_R42069_d8176405b0847b51093cd7764f305968aaf90f89.pdf" }, { "format": "HTML", "filename": "files/20111101_R42069_d8176405b0847b51093cd7764f305968aaf90f89.html" } ], "topics": [] } ], "topics": [ "Domestic Social Policy", "Health Policy" ] }