The Affordable Care Act has complicated discussions about U.S. health policy by creating a complicated new language.
Simply deciding whether to call that body of legislation the Affordable Care Act, the Patient Protection and Affordable Care Act, Obamacare or the president’s health law can lead to hours of heated discussion among people who care deeply about the implications, and puzzled looks from others who have no idea what any of those terms mean.
Related: H.R. 3590 and H.R. 4872: A guide to a new health reform world
The ACA has also created, or spurred the creation of or popularization of, different other sets of terms, including terms used to:
Describe the ACA public health insurance exchange system and coverage subsidies.
Distinguish between solid and flimsy major medical coverage.
Explain how members of the public can help shape ACA-related regulations and the federal government’s interpretations of ACA-related laws and regulations.
Refer to health-related insurance products that fall outside the reach of the ACA
Talk about the new cash payments demanded from many people who fail to own enough solid major medical coverage for enough of the year, and from some employers that fail to offer solid coverage.
Warn the public about ACA-related auditing programs and other compliance enforcement programs.
Drafters of the ACA tried to help consumers cope with the jargon by requiring the U.S. Department of Health and Human Services to develop a simple, standardized Summary of Benefits and Coverage flier design for health plans, and to provide a short health insurance glosarry.
When the U.S. Treasury Department’s Treasury Inspector General for Tax Administration, a watchdog agency, put out a report on Internal Revenue Service ACA activities in September, TIGTA included a glossary that listed terms ranging from very simple terms, such as “Affordable Care Act,” to technical terms, such as “collection queue.”
Related: Purple grades for the ACA
But, for the most part, trying to learn how to “speak the ACA” is about as complicated a trying to learn to speak Klingon without a dictionary or a textbook. Taking the jargon too seriously may be a sign that someone has gotten too deeply invested in current Obama administration ACA terminology and has lost any sense of perspective about health benefits basics. Knowing what “CCIIO” is will probably not help any agent resolve a client’s ACA exchange plan billing dispute. But, at the same time, an inability to speak ACA hurts anyone who is trying to understand and shape the ACA health insurance world. People who know what CCIIO and MEC are would seem to have an above-average chance to participate in policy-shaping discussions, not just accept the rules that come down from Washington, state government agencies and public exchange boards as permanent laws of health policy physics.
Here’s the first installment in an effort to create an ACA dictionary of use to insurance agents and brokers. It lists the ACA implementation and administration agencies located in the federal government. We started with listing these agencies because it seems as if readers need this list to understand future dictionary installments.
The first three sections show how the agencies fit together. The last section lists all of the agency names included in alphabetical order.
When the name of an agency is well-known, we put the name of the agency at the beginning of the entry. When an agency is known mainly as an arm of its parent, we start the entry with the name of the parent agency. We list the Centers for Medicare & Medicaid Services simply as the “Centers for Medicare & Medicaid Services,” but we list the Office for Civil Rights at the U.S. Department of Health and Human Services as HHS OCR.
We will list the health benefits data collection and analysis units at the U.S. Census Bureau and the U.S. Commerce Department in a later installment.
For a look at the agencies we included, read on:
Sylvia Mathews Burwell, the current HHS secretary, took over after officials working under her predecessor, Kathleen Sebelius, had already developed much of the ACA implementation framework. (Photo: HHS)
The ‘tri-agencies’: HHS
The tri-agencies: This term may refer to the U.S. Department of Health and Human Services, the U.S. Treasury Department and the U.S. Department of Labor. The term can also refer to HHS, the Treasury Department’s Internal Revenue Service and the Labor Department’s Employee Benefits Security Administration. The agencies in the tri-agency group team up to draft Affordable Care Act regulations, fact sheets and other documents.
U.S. Department of Health and Human Services (HHS): HHS is the cabinet-level department in charge of ACA implementation and many other health care matters, such as running Medicare, running Medicaid, overseeing medical research and fighting the Zika virus.
HHS: Administration for Community Living (ACL): ACL oversees programs that help older people and people with disabilities. It manages little-publicized ACA programs that encourage a shift toward home care, adult daycare and other community-based services, and away from nursing home care.
ACL: Administration on Aging (AoA): The AoA has overseen use of ACA public health grant money to help older adults. The AoA also runs ACA programs that promote use of community-based care for older adults.
HHS: Centers for Medicare and Medicaid Services (CMS): CMS oversees Medicare, Medicaid and the Center for Consumer Information and Oversight, the agency that manages implementation of the ACA provisions that affect the commercial health insurance market.
CMS: Center for Consumer Information and Insurance Oversight (CCIIO):- CCIIO — pronounced “sih-sigh-oh” — is the CMS agency that oversees the ACA programs that most directly affect commercial health insurance agents and brokers, such as the ACA health insurance rate review program and the ACA public health insurance exchange program.
CCIIO: Health Insurance Marketplace (HealthCare.gov): An ACA public health insurance exchange enrollment and exchange account administration system. The system provides some or all ACA exchange services in states that are unwilling or unable to provide the services themselves.
CCIIO: HealthCare.gov: See CCIIO: Health Insurance Marketplace.
CCIIO: Insurance Programs Group: A unit that was responsible for two temporary ACA insurance programs, the Early Retiree Reinsurance Program, which was supposed to stabilize employer-sponsored health insurance programs between the enactment of the ACA and the time when the ACA restrictions on medical underwriting took effect, and the Pre-existing Condition Insurance Program, which was supposed to provide health coverage for people with serious health problems between the enactment of the ACA and the time when the ACA medical underwriting restrictions took effect. The agency also continues to oversee the CO-OP Division, which runs the Consumer Operated and Oriented Program.
CCIIO Insurance Programs Group: CO-OP Division: This unit oversees the ACA Consumer Operated and Oriented Plan program, which provided startup loans for nonprofit, member-owned health plans.
CCIIO Insurance Programs Group: Early Retiree Reinsurance Program: This program was supposed to encourage employers to keep existing retirement plans designed for retirees ages 55 to 64 until Jan. 1, 2014, when the ACA prohibited most forms of medical underwriting and began providing subsidies for moderate-income purchasers of individual health insurance coverage. The program received more applications than it could handle and had to stop accepting new applications in 2011. It paid a total of $5 billion in reinsurance support to about 2,900 early retiree plan sponsors for 2010 through 2013.
CCIIO Insurance Programs Group: Pre-existing Condition Insurance Plan (PCIP): This program — pronounced “p-sip” — was supposed to provide temporary coverage for otherwise “uninsurable’ people from 2010 until Jan. 1, 2014, when an ACA ban on use of personal health status information other than age, location and tobacco use in individual major medical insurance underwriting took effect. Enrollment was much lower than managers had expected but claims were much higher. Because of the funding problems, CCIIO suspended new PCIP enrollment in the states in which it oversaw the program in early 2013.
CCIIO: Oversight Group: This unit runs the ACA rate review and minimum medical loss ratio programs.
CCIIO: State Exchange Group: CCIIO runs ACA exchange programs for some states through HealthCare.gov. Other states manage their own state-based ACA exchange programs. The CCIIO State Exchange Group oversees the state-based exchange programs.
CCIIO: Marketplace Eligibility and Enrollment Group: This unit works on helping consumers sign up for exchange plans through HealthCare.gov.
CCIIO: Marketplace Plan Management Group: This unit helps insurers get their plans into the HealthCare.gov system and is supposed to enforce HealthCare.gov plan standards.
CMS: Office of the Actuary: This unit helps CMS officials collect and analyze health program data. In 2011, the office prevented the birth of one ACA program, the Community Living Assistance Services and Supports Act voluntary long-term care benefits program, by refusing to certify that the program was likely to be sustainable.
CMS: Office of Technology Solutions: This unit helps CMS set up and run information systems, including the systems at the heart of HealthCare.gov.
HHS: Health Care Financing Administration (HCFA): HCFA — pronounced “hick-fuh” — is the agency now known as the Centers for Medicare & Medicaid Services. The agency’s name changed in 2001.
HHS: Health Resources and Services Administration (HRSA): HRSA — pronounced “hersa” — works to expand the supply of health care workers and to provide health resources for underserved groups of people. When HHS was implementing the ACA preventive services coverage mandate provision, HRSA was the agency that recommended that the basic preventive services package should include coverage for birth control products and services.
HHS: Office for Civil Rights (OCR, or HHS OCR): This agency is in charge of interpreting and enforcing compliance with federal health information privacy, data security and breach notification rules.
HHS: Office of the Assistant Secretary for Planning and Evaluation (ASPE): This office helps HHS plan its activities and keep tabs on HHS agencies’ performance. It has been producing the ACA public exchange system’s federal enrollment activity reports.
HHS: Office of Inspector General (HHS OIG): This is a watchdog agency that provides formal audits of the performance of HHS programs, including ACA-related programs.
Related: CCIIO Proposes HSA Plan Valuation Approach
Jack Lew, the U.S. Treasury secretary, oversees the Internal Revenue Service, which is responsible for administering some ACA programs and enforcing compliance with some ACA programs. (Photo: Andrew Harnik/AP Photo)
The other ‘tri-agency’ agencies
U.S. Treasury Department: Top-level department officials usually mention the ACA only in passing, but the Internal Revenue Service, the main ACA compliance enforcement entity, is part of the Treasury Department.
Treasury: Treasury Inspector General for Tax Administration (TIGTA): TIGTA — prounounced “tiggtuh” — keeps tabs on IRS activities, including ACA-related activities, and has released many reports that focus on or touch on the ACA-related activities.
Treasury: Internal Revenue Service (IRS): The IRS plays a role in administering many ACA provisions, including the ACA exchange plan premium tax credit subsidy program and the individual shared responsibility penalty imposed on many people who lack what the federal government classifies as minimum essential coverage, or solid major medical coverage, for at least part of the year.
IRS: Affordable Care Act Office: The IRS Affordable Care Act Office runs ACA-related IRS operations.
IRS: Affordable Care Act Office — Filing and Premium Tax Credit Strategy unit: This unit decides how the ACA premium tax credit program should work.
IRS: Affordable Care Act Office — Program Management Office unit: This unit manages ACA-related programs.
U.S. Department of Labor (DOL): This department weighs in when ACA-related rules and programs affect group health plans, and especially self-insured employer plans.
DOL: U.S. Department of Labor Office of Inspector General (DOL OIG): This watchdog agency has not yet been a major producer of ACA-related audits and reviews but could become more active in that area in the future.
DOL: Employee Benefits Security Administration (EBSA): EBSA — pronounced “eb-suh,” this is the DOL agency that handles DOL’s ACA implementation and administration duties. It has the same relationship to DOL that the IRS has to the Treasury Department.
EBSA: Office of Health Plan Standards and Compliance Assistance (OHPSCA): This unit helps employers and labor organizations understand and apply the ACA and other health reform laws, such as the Health Insurance Portability and Accountability Act of 1996 and the Mental Health Parity and Addiction Equity Act of 2008.
Related: New ACA tax form drafts have a language all their own
Some of the least-visible ACA agencies are inside the Executive Office of the President. (Photo: Pablo Martinez Monsivais/AP Photo)
Other big federal ACA agencies
Executive Office of the President (EOP): These are the people who advise the president of the United States.
EOP: Domestic Policy Council: These are the people who advise the president about issues affecting the United States.
Office of Management and Budget (OMB): OMB helps the president draft federal budget proposals and keep track of federal spending.
OMB: Health Division: This division handles budget work for federal health agencies.
OMB Health Division: Health Insurance, Data and Analysis Unit: This unit handles the budget work associated with the ACA programs that affect the commercial health insurance market.
U.S. Office of Personnel Management (OPM): OPM is an “independent agency,” meaning that, technically, it’s part of the executive branch of the federal government, but is outside the control of the president. It plays a role in some ACA programs partly because, over the years, many advocates of health reform have talked about a need to give ordinary people access to a health coverage program similar to OPM’s highly regarded Federal Employees Health Benefits program.
OPM Healthcare and Insurance Division: This division manages health benefits for federal employees, and it also oversees the ACA Multi-State Plan program.