Affordable Care Act at Ten: Huge Expansion of Welfare and Injury to Individual Insurance Market

March 6, 2020 stgblase

By Brian Blase, Doug Badger, and Grace-Marie Turner

The Patient Protection and Affordable Care Act, signed into law in 2010, represents the most sweeping
federal health reform legislation since the creation of Medicare and Medicaid in 1965. Among many
other changes, the law:
• dramatically expanded eligibility for the Medicaid program
• significantly increased federal regulation of health insurance
• created subsidies for certain people to purchase coverage in the individual health insurance market
• initiated or increased 20 taxes (several since repealed)
• implemented substantial Medicare payment reductions
• imposed a tax penalty on uninsured lawful U.S. residents (the tax has since been reduced to $0)
• imposed a tax penalty on employers with more than 50 full-time workers that failed to offer federally-approved coverage
• imposed an excise tax on health insurance that exceeded a certain cost (since repealed)
• created a new long-term care entitlement program (since repealed)
• empowered the federal bureaucracy, particularly the Department of Health and Human Services,
with sweeping new powers to intervene in health care markets
• invested the HHS Secretary with unprecedented authority to conduct Medicare demonstration projects and to extend those projects nationally without congressional authorization
• created an advisory board and gave it the power to make cuts in Medicare spending, cuts that would
take effect unless Congress enacted an alternative package (since repealed)
Full paper

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