Obamacare Timeline: Health Coverage and the Insurance Marketplace

How the Patient Protection and Affordable Care Act Has Impacted Americans

Doctor standing in front of a healthcare Clock

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The Patient Protection and Affordable Care Act, also known as Obamacare, still offers health insurance. Your coverage will protect you for the next calendar year if you enroll.

What Are the Enrollment Deadlines You Need to Know?

November 1, 2018, to December 15, 2018 - Open enrollment on the health insurance exchanges for 2019. If you don't have insurance for at least nine months in 2019, you will no longer be assessed an additional tax of 2.5 percent of your income. The exchanges make it fairly easy to get Obamacare in four simple steps.

Businesses with at least 50 workers will no longer be taxed $2,000 per employee (except for the first 30) if they don’t offer health insurance. Those that do will receive a tax credit of 50 percent of the premium cost.

2020 - Businesses who offer so-called "Cadillac" health insurance plans must pay a 40 percent excise tax on this benefit. These plans are defined as those with premiums of at least $10,200 (individuals) or $27,500 (families). They offer exceptional coverage, such as small copayments or unusual circumstances, such as marriage counseling. However, they also cover those with high levels of health needs.

For example, a business may have to offer Cadillac plans if the pooled risk of its employees is greater than usual. This happens if many of them are sick, older, female, or live in an area with expensive health costs. Cadillac plans are also required for those in dangerous jobs. 

The History of Obamacare

March 23, 2010 - President Obama signed the Affordable Care Act, making health care reform the law of the land. 

June 17, 2010 - Federal regulations allowed some health plans that were in existence on March 23, 2010, to be "grandfathered in." That meant they were exempt from the provisions of the Affordable Care Act.

January 2011 - The House voted to repeal the law. That was largely symbolic since the Senate rejected the repeal. But 22 percent of Americans thought the act had already been repealed.

September 2011 - The Justice Department petitioned the Supreme Court to decide whether the Affordable Care Act was constitutional. The 11th Circuit Court of Appeals found that the mandate did not fall within Congress' power to regulate interstate commerce, but that the rest of the Act was fine. Two other federal courts of appeal, the Sixth Circuit, and the Fourth Circuit, ruled that the Act was constitutional.

March 28, 2012 - The Supreme Court held hearings on the constitutionality of the Affordable Care Act. At issue was whether the Act's mandate that people either have insurance or pay a fine violates the Constitution. On Day Three of the hearings, the justices considered whether the entire Act could stand if this statute were struck down. On Day Two, the justices questioned whether the Federal government had the right to compel people to buy health insurance from a private company. On the first day, the justices argued whether they had the authority to review the Act at this time, or needed to wait until someone paid the penalty in 2014.

June 28, 2012 - The Supreme Court upheld the legality of the Affordable Care Act.

January 1, 2013 - Tax changes kicked in. For individuals, medical expenses must be at least 10 percent of income before they are deductible for those under 65. Those who make more than $200,000 ($250,000 for couples) would pay higher taxes. That includes 3.8 percent Medicare taxes on dividends, capital gains, rent, and royalties and 2.35 percent (up from 1.45 percent) Medicare taxes on income. For businesses, those who manufacture or import medical devices were forced to pay a 2.3 percent tax.

States benefited from additional Federal funds to offer free preventive services for Medicaid recipients and extend CHIP for an additional two years. They also received federal funds to pay primary care physicians 100 percent of the Medicare fee. Medicare launched a pilot program to help hospitals bundle services before they submit them for payment. 

October 1, 2013 - The initial open enrollment period began. Medicaid benefits were extended to those with incomes up to 138 percent of the federal poverty level. Those with incomes up to 400 percent of the poverty level receive subsidies. All plans must have covered the 10 essential health benefits to be listed on the exchange. 

March 31, 2014 - The initial period of open enrollment closed. Everyone must be covered, or pay taxes of 1 percent of income in 2014.

June 25, 2015 - The Supreme Court ruled that the federal government has the right to offer subsidies in states that did not set up their exchanges. The ACA specifically mentions subsidies should only go to exchanges "established by the State," even though the writers said that was not their intention. The Supreme Court stuck with the intent, not the wording, of the law.  

June 21, 2018 - Health insurance companies must decide whether they will offer plans on the exchanges for 2019. Companies have dropped out of some areas that are too small. Nine hundred and sixty counties only have one health insurance company. More companies will drop out if the Trump administration does not enforce the individual mandate that requires everyone to buy insurance or pay a tax. 

January 1, 2019 - Coverage for the 2019 calendar year starts, for those who have enrolled and paid their first premium.

A Timeline of How Obamacare Came to Be

Follow the twists and turns back through the different bills proposed by the House and Senate in 2009, ending at the beginning: Obama's original campaign proposals in 2008.

January 2009 - Soon after Obama was elected, he announced the Health Care for America Plan. The most controversial element was known as the "public option." That was a government-run program like Medicare, only it would not be restricted by age.

That was a critical way to reduce health care costs by 1.5 percent per year. That's because the federal government could bargain for lower prices and reduce inefficiencies. But opponents said it was socialized medicine. They worried it would take power away from the states and individuals. 

November 8, 2009 - The House of Representatives passed the 2009 House Health Care Reform Bill. Its programs would cost $894 billion over ten years. However, it proposed a surtax on high-income earners thereby reducing the deficit by $104 billion.

Like Obama's 2009 bill, the House bill proposed a government-run health insurance program, known as the public option. It offered direct subsidies to uninsured people to help them buy insurance through exchanges.

December 24, 2009 - The Senate passed the 2009 Senate Health Care Reform Bill. Its programs would cost $871 billion over 10 years. It would lower the budget deficit by $132 billion during that same period by increasing taxes on health care providers.

It offered subsidies to families and small businesses to shop for insurance on an exchange. It fined companies for not providing insurance but gave them a tax break for small businesses if they couldn't afford to offer health insurance to their employees. 

January 26, 2010 - Republican Scott Brown won the key Democratic seat in Massachusetts, destroying the Democrats’ filibuster-proof 60-vote majority in the Senate. Many thought this ended hopes of passing any health care reform bill at all.

January 27, 2010 - House Democrats protested the excise tax on high-value insurance plans in the Senate plan, which adversely affected union households. Without it, the ACA would create a $300 billion deficit over 10 years.

January 28, 2010 - Obama supported health care reform in the 2010 State of the Union Address.

February 22, 2010 - Obama launched a new health care plan that combined the best elements of the Senate and the 2009 House health care reform bills. Obama's health care reform proposal regulated the health insurance industry under a seven-member Health Insurance Rate Authority that could deny or limit substantial premium increases. That was traditionally a state responsibility.

Like the Senate Bill, it created an exchange that allowed families and small businesses to shop for insurance plans. It kept restrictions on federal funding for abortion, but cut back taxes on the high-end health plans.

March 22, 2010 - The House of Representatives passed the Reconciliation Act, which amended the Senate Health Care Reform Bill by including elements of the health care plan put forth by President Obama on February 22.