8838 / What is the Affordable Care Act? When did its provisions become effective?

In many ways, the ACA is only a broad outline of the reforms that have taken place, or will take place, over several years, and many of the details either have been, or will be, filled in by regulators. The Department of Labor, the Department of Treasury, the IRS, and the Department of Health & Human Services have all proposed regulations, or will propose regulations, that outline the more detailed requirements of the ACA.

The ACA went into effect between 2010 and 2018. The bulk of the provisions were effective beginning in 2011 through 2014. One provision, the tax on so-called “Cadillac” health care plans was scheduled to go into effect in 2022. The SECURE Act repealed the Cadillac tax entirely late in 2019.

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Planning Point: The ACA continues to be subject to challenges. Early in 2023, a Texas judge declared that the ACA preventive care mandate is unconstitutional under the Appointments Clause of the U.S. constitution. The preventive care mandate requires health care providers to cover certain preventive services without requiring the patient to contribute to the cost (whether through deductibles, co-pays or otherwise). Covered services are those that have an “A” or “B” rating, as determined by an advisory committee called the U.S. Preventive Services Task Force. Examples of covered services include cancer screenings, drugs that can reduce the risk of contracting HIV and drugs that lower the patient’s cholesterol. The Texas court ruling included a nationwide injunction. The Department of Justice has already filed an appeal in this case, which many expect could ultimately reach the U.S. Supreme Court.²

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