NHeLP Analysis of the Affordable Care Act and the Reconciliation Act – Part II: Role of Public Programs

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). On March 30, 2010, the Health Care and Education Reconciliation Act was enacted, the reconciliation law that made changes to the PPACA. After 18 months of legislative activity, preceded by decades of fits and starts, a major step forward was taken in reforming the country?s health care system. Health care reform offers coverage for the majority of uninsured individuals in the United States and eventually will add up to 16 million individuals to the Medicaid program.
The National Health Law Program (NHeLP) analysis includes the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148) as well as the amendments made to PPACA by the Health Care and Education Reconciliation Act (Recon. Act, P.L. 111-152). For those of you who are looking for an integrated version of the PPACA, including the Manager?s Amendment and theReconciliation Act, an unofficial version is available at http://s3.amazonaws.com/thf_media/2010/pdf/ppacaconsolidated.pdf.
NHeLP has undertaken a comprehensive analysis ofthese laws. Given NHeLP?s focus on Medicaid and CHIP, civil rights, reproductive health and justice, and empowering low-income beneficiaries and their advocates, we have concentrated our analysis on areas of the law most related to those areas and populations.
The Table of Contents identifies the sections that have been analyzed. In addition to this broad analysis, NHeLP will release more in-depth analyses on specific topics. We anticipate that these focused stand-alone analyses will covertopics such as Medicaid, children?s health, health care disparities, reproductive health and health care for immigrants.
The analysis primarily focuses on Titles I and II of the law. We have divided the document into three parts:
  • Part Iincludes an analysis of PPACA Title I, covering the private insurance reforms and statebased exchanges;
  • Part IIincludes an analysis of PPACA Title II, covering changes to the Medicaid program; and
  • Part III analyzes selected provisions from Titles III, IV, VI, XIII and IX.


When reading this analysis, ?Secretary? generally refers to the Secretary of the Department of Health and Human Services, unless specifically noted otherwise.
A few other notes and abbreviations are relevant to this analysis:
Abbreviations of Laws:
  • SSA refers to the Social Security Act
  • PHSA refers to the Public Health Service Act, 42 U.S.C. § 300gg etseq.
  • DRA refers to the Deficit Reduction Act
  • CHIPRA refers to the Children?s Health Insurance Program Reauthorization Act
  • IRC refers to the Internal Revenue Code of 1986
Abbreviation of Terms:
  • FMAP refers to the Federal Medical Assistance Percentage
  • FPL refers to the Federal Poverty Level
  • LIS refers to the Low Income Subsidy for Medicare Part D
Abbreviation of Federal Agencies or other Organizations:
  • DHS ? Department of Homeland Security
  • SSA ? Social Security Administration
  • Treasury ? Department of the Treasury
  • NAIC ? National Association of Insurance Commissioners
We have generally included effective dates for each section. However, it is important to recognize that many provisions will not be implemented without appropriations. Thus, the appropriations process is critical to ensuring that many of the Act?s important provisions can be implemented.
If you have any questions about the analysis or need further information, please call NHeLP at (202) 289-7661, or e-mail Mara Youdelman at [email protected].
And finally, much thanks to the NHeLP staff ? in particular Mara Youdelman ? who worked tirelessly to complete this analysis:
Randy Boyle, Senior Attorney
Leonardo Cuello, Staff Attorney
Susan Berke Fogel, Senior Attorney
Lorraine Jones, Senior Attorney
Manju Kulkarni, Senior Attorney
Jane Perkins, Legal Director
Patti Riippa, Communications Director
Deborah Reid, Senior Attorney
Sarah Somers, Senior Attorney
Sarah Lichtman Spector, Staff Attorney
Doreena Wong, Senior Attorney

Mara Youdelman, Senior Attorney

We hope you find this analysis useful.
Emily Spitzer
Executive Director


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