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Health Care Reform

The Affordable Care Act (ACA)

The Patient Protection and Affordable Care Act (or ACA) was enacted by Congress in 2010. The main goal of the act was to increase the number of Americans covered by health insurance by improving access, affordability, and quality in health care.

Individual Mandate

One key requirement of the ACA is the individual mandate, which requires most Americans to have “minimum essential”—or a minimum required amount—of health insurance coverage, or pay a fee or penalty. The way to meet the requirement (if you are not exempt, or do not receive health insurance through an employer or government program) is to buy insurance from a private company.

Shared Responsibility Payment

In 2014, the Federal Government began collecting a “shared responsibility payment” from individuals who do not meet the minimum coverage requirement. This payment is made to the Internal Revenue Service (IRS) with an individual’s taxes, and is assessed and collected like other tax penalties.

Medicaid Expansion

Another key part of the ACA is the expansion of Medicaid. The Medicaid program provides health care coverage for some low-income individuals, families and children, pregnant women, the elderly, and people with disabilities. The ACA was designed to expand Medicaid eligibility to more low–income individuals.

Future of the ACA

Republicans have offered several proposals in the past to replace the Affordable Care Act. 

Common elements of many Republican plans are:

  • Tax Credits. Republican proposals generally replace the ACA's advanced premium tax credit with a new tax credit, though the size and adjustment of that credit varies among the proposals.
  • Mandates. Each proposal repeals the ACA's individual and employer mandates.
  • Benefit and Cost-Sharing Requirements. Most proposals would eliminate the ACA's essential health benefits package and actuarial value requirements.
  • Continuous coverage. The proposals retain ACA-like consumer protections around guaranteed issue, preexisting conditions and community underwriting only for those individuals who maintain continuous coverage.

Useful Links

Massachusetts and Rhode Island Health Care Reform

Useful Links for Massachusetts

Useful Links for Rhode Island

The information in this section is provided for informational purposes only. While we aim to ensure that content is current, accurate, and complete, Tufts Health Plan makes no representations or warranties regarding its accuracy or completeness and the information provided should not be construed as legal or tax advice or as a recommendation of any kind. Please consult your own legal counsel and/or tax and benefit plan advisors with respect to your individual circumstances and needs.

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