ABSTRACT
Chapter 3 delivers an overview of the ACA, the process to create and implement the legislation, as well as the obstacles that had to be overcome to successfully pass major health care reform for the first time in American history. Building on the existing structure of the health care system in the U.S., the ACA intended to increase the affordability and accessibility of healthcare. The legislation also reduced barriers to health care by protecting individuals with preexisting conditions, standardizing insurance rates, removing individual lifetime health care spending caps, and allowing adults to stay on their parents’ insurance until they turned 26. Despite an increase in the number of people with access to health insurance, there was very little bipartisan support, and several states sued to protect themselves against what they perceived as an overreach by the federal government. Despite the difficulties and missteps, state marketplaces were available for the first open enrollment period that began on October 1, 2013. This chapter lays the background information for the in-depth state decision-making chapters of this book.
