The ACA was implemented in stages and encompasses several major areas:
• Measures to encourage more employers to provide coverage, such as the small employer tax credit and health insurance exchanges;
• Insurance reform measures to require insurers and employers to provide better coverage, such as the elimination of lifetime and annual limits and preexisting condition restrictions;
• Measures to reduce costs such as grants for wellness programs and the provision of larger incentives in wellness programs; and
• Measures to greatly reduce the number of uninsured, such as the expansion of Medicaid, the requirement that large employers provide coverage or face financial penalties, the requirement that individuals obtain coverage or face penalties, and mandates on coverage for adult dependent children.
Note: The Supreme Court has ruled the ACA is constitutional, including the individual mandate (National Federation of Independent Business v. Sebelius, 132 S. Ct. 2566 (2012)) and the ACA exchange subsidies (King v. Burwell, 135 S. Ct. 2580 (2015)).
In December 2018, a federal district court in Texas ruled that the ACA is unconstitutional because a 2017 law eliminating the individual mandate penalty effectively undercut the 2012 majority's tax-based rationale for upholding the act. However, the ACA remains in effect as the case is appealed to the 5th U.S. Circuit Court of Appeals.