The Legal Corner
Stay informed on legislative and regulatory changes affecting health insurance
Patient Protection and Affordable Care Act (PPACA) - 2010
Often cited as the ACA: informally known as 'Obamacare'
Signed into law in March 2010, with major provisions being implemented in 2014, the ACA is arguably the largest healthcare reform bill ever passed. Although it has been modified and supplemented by other laws and executive actions over time, as of 2025 it is considered by many to be the most influential piece of legislation impacting the current relationship between health insurance and healthcare services. It remains 'the law of the land' with governing elements reaching into Employer Group Coverage, Marketplace plans for Individuals/Families, as well as Medicare & Medicaid.
A Handful of the Key provisions:
Expanded access to coverage: Expanded Medicaid eligibility in participating states and created health insurance marketplaces for individuals and small businesses to purchase subsidized coverage.
Protections for pre-existing conditions: Prohibits insurers from performing medical underwriting and denying coverage or charging higher premiums based on a person's health status.
Enrollment periods: Limits when people can enroll in coverage to one of two windows: the Annual/Open Enrollment Period or a qualifying Special Enrollment Period. Meant to encourage early participation and eliminate the ability for consumers to take advantage of 'no underwriting' rules and delay coverage until after injury or illness occurs.
Elimination of Policy Benefit Maximums: Eliminated the ability of insurance carriers to terminate a person's coverage if certain annual or lifetime maximum claim totals had been reached (e.g., $500K or $1M).
Advanced Premium Tax Credits (APTC): Federal subsidies paid to the insurance carrier on the consumer's behalf to help make premiums more affordable. It was named the Affordable Care Act after all. Tax credits are determined based on household size and income. Due to the elimination of both medical underwriting as well as policy benefit maximums, legislators and insurance carriers knew premium costs would have to rise significantly. Without subsidies, the program would never get off the ground let alone survive for years to come.
Dependent coverage: Allows young adults to stay on their parents' health insurance plan until age 26.
Essential Health Benefits: A critical element of Minimal Essential Coverage, this provision standardizes the benefits covered by plans on the marketplaces, including preventive services, maternity care, and mental health services.
Interested in the nitty-gritty? Check out some additional resources below.
The formal legislation: https://www.congress.gov/bill/111th-congress/house-bill/3590
An expansive breakdown by the Kaiser Family Foundation: https://www.kff.org/affordable-care-act/health-policy-101-the-affordable-care-act/?entry=table-of-contents-what-did-the-aca-change-about-health-coverage-in-the-u-s
A timeline of implementation dates: https://www.ncbi.nlm.nih.gov/books/NBK241401/
American Rescue Plan Act (ARPA) - 2021
This very targeted COVID-19 economic relief package included temporary healthcare provisions aimed at making coverage more affordable and accessible during the pandemic and its aftermath.
Key provisions:
'Enhanced' ACA subsidies: Adjusted the calculation for determining eligibility for premium tax credits, raising the income threshold so households earning more than 400% of the federal poverty level (which was the previous cut-off) could now qualify for premium tax credits through 2022 (one year). This same provision also provided more tax credit dollars for those who already qualified for tax credits.
Expanded mental health access: Allocated significant funding for mobile crisis intervention services.
Interested in the nitty-gritty? Check out some additional resources below.
The formal legislation: https://www.congress.gov/bill/117th-congress/house-bill/1319
An expansive breakdown by the Kaiser Family Foundation: https://www.kff.org/affordable-care-act/how-the-american-rescue-plan-act-affects-subsidies-for-marketplace-shoppers-and-people-who-are-uninsured/
Inflation Reduction Act (IRA) - 2022
Focused on lowering healthcare and prescription drug costs, particularly for seniors on Medicare. Also extended ACA provisions from the ARPA dealing with 'enhanced premium tax credits' (see ARPA above) through calendar year 2025.
Key provisions:
Drug price negotiation: Empowered Medicare to negotiate prices for certain high-cost prescription drugs directly with drug manufactures, a first in U.S. history.
Medicare cost caps: Capped out-of-pocket prescription drug costs for Medicare beneficiaries at $2,000 annually (beginning in 2025) and set a $35 monthly cap on insulin.
Expanded ACA subsidies: Provided funding to extend the Enhanced premium subsidies from the American Rescue Plan through 2025.
Interested in the nitty-gritty? Check out some additional resources below.
The formal legislation: https://www.congress.gov/bill/117th-congress/house-bill/5376/text
An expansive breakdown by the Kaiser Family Foundation: https://www.kff.org/medicare/faqs-about-the-inflation-reduction-acts-medicare-drug-price-negotiation-program/
This list is not exhaustive and is meant to highlight just some of the most prominent legislation that impacts people shopping for Individual/Family or Medicare insurance. Additionally, the legislation highlighted here may have also included certain provisions that impact areas outside of purchasable insurance, but are not listed for the purpose of brevity.
Resources include government websites, legal publications, and industry articles & newsletters.
H.R. 1, 119th "One Big Beautiful Bill" - 2025
A sweeping and comprehensive legislative package intended to consolidate major economic, healthcare, and regulatory reforms under a single umbrella. Described as a comprehensive “growth and freedom” bill.
Key provisions:
Enhanced Tax Credits Sunset: This resolution did not actively end the enhanced tax credits, but did not include borrowing or other funding mechanisms to continue the 'Enhanced' tax credits causing them to sunset, returning tax credit calculations and income thresholds to what was in place for the first 8.5 years of the ACA, 2014 to mid-2021. This enhanced tax credit package was originally created through the ARPA (see above) and funded for only one year to help consumers rebound from the difficult economy following the COVID-19 pandemic. Congress extended them by way of the IRA in 2022 through the end of 2025.
Expansion of Health Savings Accounts (HSAs): Makes all Bronze level plans HSA-qualified. Doubled the annual contribution limits for HSAs. Allows both spouses to make catch-up contributions (ages 55+) to the same HSA. Permits HSA funds to be used for over-the-counter drugs, menstrual products, and fitness expenses (such as gym memberships and sports equipment). Allows individuals with a Direct Primary Care arrangement to remain HSA-eligible.
Association Health Plan Expansion: Codifies regulatory changes allowing small businesses and self-employed individuals to band together across state lines to purchase Association Health Plans (AHPs).
Short-Term, Limited-Duration Insurance (STLDI) Expansion: Makes it easier for insurers to offer renewable short-term health plans lasting up to 12 months, renewable for up to 36 months.
Price Transparency and Competition Measures: Requires hospitals, insurers, and pharmacy benefit managers (PBMs) to publicly disclose negotiated prices in consumer-accessible formats. Enhances oversight of PBM rebate structures to address drug pricing opacity.
Prescription Drug Pricing Revisions: Replaces the Inflation Reduction Act’s Medicare drug price negotiation provisions with a “transparency and competition” framework focused on generic and biosimilar market entry. Encourages FDA acceleration of generic approvals and limits patent evergreening practices.
Interested in the nitty-gritty? Check out some additional resources below.
The formal legislation: https://www.congress.gov/bill/119th-congress/house-bill/1?q=%7B%22search%22%3A%22one+big+beautiful+bill%22%7D&s=1&r=1
An expansive breakdown by the Kaiser Family Foundation: https://www.kff.org/medicaid/health-provisions-in-the-2025-federal-budget-reconciliation-law/#2ca666ac-5d15-4454-8973-241566e22bb5
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