Home  ›  Will Senate Vote on Obamacare Again

Will Senate Vote on Obamacare Again

Written By Sunday, 15 May 2022 Add Comment Edit

Healthcare Policy Logo.png

Healthcare policy in the U.S.
Obamacare overview
Obamacare lawsuits
Medicare and Medicaid
Healthcare statistics
Public Policy Logo-one line.png

Obamacare glossary • Issue of Obamacare • Centers for Medicare and Medicaid Services

The Patient Protection and Affordable Care Act, also known as the Affordable Intendance Deed (ACA) or Obamacare, was passed on March 21, 2010, and signed into police force by President Barack Obama on March 23, 2010. The law required near individuals to obtain health insurance and required almost employers to offering information technology. Information technology provided tax credits and cost-sharing subsidies for individuals to buy insurance in the individual market and provided for an expansion of Medicaid to cover childless adults earning incomes up to 138 percent of the poverty level. Insurers were prohibited from denying coverage to individuals with pre-existing conditions, were required to offer a standard set of benefits, and were limited in the means they could vary their premiums.[ane]

HIGHLIGHTS

  • The Affordable Care Deed passed the Senate 60-39 along party lines on December 24, 2009, and passed the Business firm 219-212 on March 21, 2010. Thirty-iv House Democrats voted in opposition.

  • As of Nov 2018, a full of 36 states and Washington, D.C., had expanded or voted to expand Medicaid, while fourteen states had non. The map below provides information on Medicaid expansions by state; for states that expanded, hover over the state to view the political affiliation of the governor at the fourth dimension of expansion.[2]

  • President Donald Trump's main healthcare policy initiative has been working to fulfill his campaign promise to repeal and replace the ACA. He expressed back up for the House and Senate bills that proposed modifying parts of the ACA, but as of November 2018, Congress had not passed a bill.

    • This folio provides a summary of the Affordable Care Human action as it was written and provides data on legislation attempting to alter or repeal the law, as well every bit on lawsuits related to the law. Encounter the section summaries below for a brief description of the information contained in each department. Click on the section titles to be taken to that office of the commodity.

    1. Congressional passage: This department outlines the votes taken on the beak in the U.S. House and U.S. Senate, besides as a list of Democratic senators who voted against the ACA.
    2. Implementation timeline: This department provides a timeline of implementation dates for major provisions of the ACA every bit they were written in the constabulary.
    3. Summary of the police: This section provides a summary of the major components of the ACA, including the requirement to obtain insurance, the ways the law facilitated greater insurance coverage, and the requirements the law placed on health plans and insurers.
    4. Attempts to modify or repeal: This section provides an overview of legislation and lawsuits undertaken in attempts to change or repeal parts of the law.

    For more information on the impact of the ACA in each state, click hither.

    Congressional passage

    Federalism
    Federalism VNT image.png
    Click here for more coverage of federalism on Ballotpedia

    In July 2009, House Democrats introduced the Affordable Wellness Intendance for America Act, the forerunner to the Affordable Care Act. The Business firm passed the bill on Nov seven, 2009, with the votes of 219 Democrats and one Republican (Rep. Joseph Cao (R-La.)). Thirty-nine Democrats and 176 Republicans voted confronting the bill. On Dec 24, 2009, the Senate passed its version of the beak 60-39, with all Democrats voting in favor of the bill and all Republicans but one voting against it (Sen. Jim Bunning (R-Ky.) was non present for the vote).[three]

    In Jan 2010, Republican Scott Brown of Massachusetts won a special election to fill up the seat of Sen. Ted Kennedy (D-Mass.), who had died in Baronial 2009. Unless the House agreed to the Senate's version of the beak, a commission of members from the House and Senate would accept to resolve differences betwixt the two bills with a new pecker that would demand to receive another vote in the Senate—with the ballot of Chocolate-brown, Senate Democrats would non accept lx votes to overcome a Republican filibuster on the new pecker. A majority of the House Autonomous Conclave agreed to pass the Senate neb equally long as subsequent budget-related changes to the bill could be made via the reconciliation process—reconciliation bills only need 50 Senate votes to pass and are not discipline to delay. The Firm passed the Senate bill on March 21, 2010, with 178 Firm Republicans opposing the bill's passage along with 34 Democrats, while 219 Democrats voted in favor, leaving the final vote at 219-212. The Firm passed the reconciliation package on the same 24-hour interval by a vote of 220-211 and the Senate approved the bill on March 25, 2010, by a vote of 56-43.[3] [4]

    President Obama signed the Senate bill on March 23, 2010, and the reconciliation pecker on March xxx, 2010. The two bills together are referred to as the Patient Protection and Affordable Care Act, the Affordable Care Human activity, or Obamacare.[3]

    Democrats in opposition

    The following is a list of U.Southward. Firm Democrats who voted against the ACA's passage during the March 21, 2010 vote:[5]

    • Bobby Bright (D-AL)
    • Artur Davis (D-AL) -Co-Sponsor
    • Robert Berry (D-AR)
    • Mike Ross (D-AR)
    • Jim Marshall (D-GA)
    • John Barrow (D-GA)
    • Walter Minnick (D-ID) -Co-Sponsor
    • Daniel Lipinski (D-IL)
    • Ben Chandler (D-KY)
    • Charlie Melancon (D-LA)
    • Frank Kratovil (D-MD)
    • Stephen Lynch (D-MA)
    • Collin Peterson (D-MN)
    • Travis Childers (D-MS)
    • Factor Taylor (D-MS)
    • Ike Skelton (D-MO) -Co-Sponsor
    • John Adler (D-NJ)
    • Harry Teague (D-NM)
    • Michael East. McMahon (D-NY)
    • Michael Arcuri (D-NY)
    • Mike McIntyre (D-NC)
    • Larry Kissell (D-NC)
    • Heath Shuler (D-NC)
    • Zack Space (D-OH)
    • Dan Boren (D-OK)
    • Jason Altmire (D-PA)
    • Tim Holden (D-PA)
    • Stephanie Herseth Sandlin (D-SD)
    • Lincoln Davis (D-TN)
    • John Tanner (D-TN)
    • Chet Edwards (D-TX)
    • Jim Matheson (D-UT)
    • Glenn Nye (D-VA)
    • Rick Boucher (D-VA)

    Implementation timeline

    Meet likewise: Implementation of the Affordable Care Human action

    President Obama signs the Affordable Care Act.

    The following is a timeline of the implementation dates of key aspects of the Affordable Intendance Act. Some of the dates were later changed or delayed; these changes are not reflected in this timeline.[6]

    2010

    • January 1: The federal government begins providing tax credits for small businesses offering health insurance to employees.
    • July 1: The Temporary Pre-existing Condition Insurance Plan is established, offered by either the federal regime or private state governments. The program provides coverage for individuals with pre-existing conditions until 2014.
    • July one: Deadline for HealthCare.gov to be established equally a minimally functioning website to educate consumers on coverage options.
    • July 1: The federal government begins collecting a ten pct excise tax on indoor tanning services
    • September 23: The requirement for insurers to allow adult children to remain on a parent'due south wellness insurance plan until historic period 26 begins
    • September 23: Insurance plans are prohibited from setting lifetime coverage limitations.
    • September 23: The requirement for insurers to allow appeals with an external review process begins.
    • September 23: New plans established after this appointment are required to embrace a standard set of wellness benefits (the 10 essential wellness benefits).

    2011

    • Jan 1: The requirement for insurers to provide rebate each year if a minimum proportion of premiums was non spent on medical services begins.
    • Jan one: Health savings accounts may no longer be used for certain purposes.
    • March 23: The first circular of grants are provided to states for the institution of health insurance exchanges.

    2012

    • September 23: The requirement for all insurers to provide a uniform summary of care and benefits to consumers begins.

    2013

    • Jan 1: Borderline for states to notify the U.S. Section of Health and Human Services whether they will form their own exchanges or bring together the federal commutation.
    • July one: Deadline for grants and loans to exist awarded to start-up co-ops, nonprofit, member-run health insurance companies designed past the ACA.

    2014

    • January 1: States begin to be allowed to expand Medicaid coverage to childless adults nether 65 earning incomes up to 138 percent of the federal poverty level.
    • January i: Deadline for individuals to obtain health insurance to avoid paying a tax punishment.
    • January 1: Insurance companies no longer immune to place annual limits on the amount they pay out for benefits.
    • March 31: Months spend without health insurance begin to be counted toward the revenue enhancement punishment.

    2015

    • January 1: Employers with more than 100 employees assessed fees, per employee, for non providing health insurance options

    2016

    • January 1: Employers with 50-99 employees assessed fees, per employee, for not providing health insurance options

    Summary of the constabulary

    According to HealthCare.gov, the official website for the Affordable Care Human action, the law had iii main goals:

    "
    • Make affordable health insurance available to more people. The police force provides consumers with subsidies ("premium tax credits") that lower costs for households with incomes between 100% and 400% of the federal poverty level.
    • Expand the Medicaid programme to encompass all adults with income beneath 138% of the federal poverty level. (Non all states take expanded their Medicaid programs.)
    • Support innovative medical care delivery methods designed to lower the costs of wellness care mostly.[vii]
    		"
    —HealthCare.gov[8]

    This section provides a summary of the major components of the ACA:

    • the requirement for individuals to obtain wellness coverage and employers to offer it
    • the constabulary's facilitation of greater wellness insurance coverage through co-ops and health insurance exchanges
    • the requirements the police force placed on wellness plans and insurers
    • the Medicaid expansion
    • changes to Medicare reimbursements and coverage
    • taxes and fees

    Wellness coverage requirements

    Private mandate

    The law required every individual to obtain wellness insurance and established fines for those who did not. The fines were designed to be based on the number of months a person went without health insurance in a given year and to increase each year from 2014 to 2016. The fine schedule was written as follows:[3] [ix]

    • 2014: maximum of $95 or ane pct of income, whichever is greater
    • 2015: maximum of $325 or 2 per centum of income, whichever is greater
    • 2016 and thereafter: maximum of $695 or two.5 per centum of income, whichever is greater

    The Internal Acquirement Service (IRS) was given responsibleness for collecting the fine, assessed annually as a tax penalty during the income tax filing period. The law established a hardship exemption from the fine for individuals who see certain qualifications—such as beingness homeless, beingness a victim of domestic violence, or filing for bankruptcy.[x]

    Employer mandate

    Under the law, medium-sized and big employers could incur fines for not offer affordable health coverage or not offering coverage at all. The law defined affordable as costing employees less than 9.69 percent of their gross household income in premiums. The constabulary established requirements for employers with at least 50 employees to offer affordable coverage that covers at least threescore percent of costs to at least 95 percent of their workforce. If an employer does non encounter these conditions and has at least 1 employee claim a tax credit to buy coverage on the exchange, a fine would be incurred. The fine for non offering coverage at all was set at $2,000 per employee. The fine for non offering affordable coverage was set at $3,000 per employee. These fines were indexed to rise with aggrandizement and in 2017 amounted to $two,260 and $3,390, respectively.[eleven] [12]

    Purchasing health insurance

    Health insurance exchanges

    See also: Healthcare.gov website rollout and wellness insurance exchange issues
    Overview

    The Affordable Care Deed provided for the cosmos of health insurance exchanges, sometimes referred to every bit marketplaces, to deed every bit a hub for consumers to browse and purchase health plans. The exchanges were designed to be accessible via websites, phone call centers, or in person. The law gave states iii options regarding the exchanges:[13] [14]

    1. Establish and manage their ain country substitution (state-based exchange)
    2. Enter into a partnership with the federal regime to jointly manage an exchange (state-federal partnership exchange)
    3. Cede responsibleness for establishing and managing an substitution to the federal authorities (federally facilitated exchange)

    The law also allowed states to set up more 1 commutation to serve residents in different areas within their borders, and multiple states could create a regional exchange. However, equally of August 2017, no state had chosen those options. The majority of states, 28 of them, had federally facilitated marketplaces. Some other 17 had state-based exchanges; 5 of these exchanges were state run while utilizing the federal platform, Healthcare.gov. Half-dozen states partnered with the federal authorities to run their exchanges.[13] [15]

    States were given grants from the federal regime to support the establishment and early administration of their exchanges. A total of $five billion was awarded in grants. The grants ended on January ane, 2015, after which whatever state-based exchanges were expected to exist self-sustaining.[16]

    Plans offered

    The law outlined iv tiers of wellness coverage to exist sold on the exchanges:

    • bronze (lowest premiums, covers 60 percent of costs),
    • silver (covers 70 percent of costs),
    • gold (covers 80 percent of costs), and
    • platinum (highest premiums, covers 90 percent of costs).

    Plans were required to be designed and labeled under one of these four tiers to be sold on the exchanges. But similar other health plans, the portion of costs not covered by the wellness programme would fall to consumers.[17]

    Financial assist

    The police created advanced premium revenue enhancement credits—payments from the federal authorities to assist comprehend the price of premiums for those buying from the exchanges—for individuals earning incomes between 100 pct and 400 percent of the federal poverty level (FPL). In states that expanded Medicaid to adults with incomes up to 138 percent of the poverty level, eligibility for tax credits was set to brainstorm at 139 percent of the poverty level; individuals were not immune to exist eligible for both Medicaid and health insurance subsidies. It limited the percentage of income these individuals could be required to pay towards their premiums and calculated credit amounts based on the difference between this per centum and the full premium cost for a criterion plan. The per centum of income households must pay was indexed to alter each twelvemonth based on premium growth as compared to income growth. Consumers were given the choice to have their tax credits be paid directly to insurance companies on a monthly footing or claim the total credit on an annual basis when filing taxes.

    The ACA also established a reduction in cost-sharing responsibilities for individuals earning incomes between 100 per centum and 250 percentage of the FPL, meaning they could enroll in silvery plans that comprehend up to 94 per centum of their costs. The police restricted eligibility for tax credits and toll-sharing reductions to individuals who buy a wellness plan through an exchange.[18] [19] [20] [21]

    For 2017, the U.S. Section of Wellness and Human Services used 2016 poverty guidelines to decide tax credit and price-sharing eligibility:[xix] [22] [23]

    • The federal poverty level amounted to $11,880 for individuals and $24,300 for families of iv.
    • For individuals, 138 per centum of the FPL amounted to $xvi,394, while 400 percent amounted to $47,520.
    • For a family of four, 138 percent of the FPL amounted to $33,534, while 400 percent amounted to $97,200.
    • Incomes that were 250 percent of the FPL amounted to $29,700 for individuals and $sixty,750 for a family of 4.

    The law did not make tax credits available for individuals below the poverty level. Childless adults who (1) reside in a country that did not aggrandize Medicaid and (2) earn incomes betwixt their land'due south Medicaid eligibility threshold and the poverty level could still purchase insurance on the exchanges, just would not receive revenue enhancement credits. Click 'evidence' on the tables beneath to view consummate data on 2016 incomes and the 2017 maximum monthly premium paid for a criterion plan by poverty level percent, up to a family unit of four.[24]

    Co-ops

    The Affordable Care Human activity designed a plan for the cosmos of nonprofit health insurance companies called Consumer Operated and Oriented Plans, or co-ops for curt. The law provided federal loans for the start-upwardly of co-op insurance companies and outlined a series of regulations for their operation. The controlling board of a co-op was to include members enrolled in health plans through the visitor in order to act as a voice for enrollees. The law also stipulated that no representative from an insurance company or association could serve on the co-op boards.[25]

    Co-ops could sell individual and pocket-sized group insurance plans on or off the wellness insurance exchanges (described below). The co-ops were non allowed to accept investment income and could merely sell ane-third of their plans in the large group employer market. Any profits would exist reinvested back into the company. Out of 23 co-ops that were created nether the law, four remained in performance as of August 2017.[25]

    Requirements for health plans and insurers

    See besides: Wellness insurance policy cancellations since Obamacare

    Coverage

    The Affordable Care Deed prohibited individual market insurers from denying coverage to people with pre-existing conditions. This policy is known equally guaranteed issue. Guaranteed issue regulations had already existed for insurers selling employer-sponsored health plans, and the ACA extended this dominion to the individual market place as well.[26]

    The constabulary also required insurers to allow immature adults to stay on their parents' health insurance plans until historic period 26. Insurers were also required to allow people in the individual market place to renew their health plans each twelvemonth unless they did not pay their premiums.[26]

    Benefits

    The ACA required private and small grouping health plans that were offered both on and off the exchanges to cover services that fall into 10 broad benefits categories, called essential health benefits:[27]

    • Ambulatory patient services
    • Emergency services
    • Hospitalization
    • Maternity and newborn care
    • Rehabilitative and habilitative services and devices
    • Prescription drugs
    • Mental wellness and substance use disorder services, including behavioral wellness handling
    • Laboratory services
    • Preventive and wellness services and chronic illness management
    • Pediatric services, including oral and vision care

    The exact services covered were selected by each land according to the needs of its citizens; the only requirement was that covered benefits fall into each of the 10 broad categories listed above. All health plans were required to cover 100 percentage of the price of preventive services, such as screenings, as long as the medico providing the service was in the insurance plan's network. All health plans were as well required to cover contraception and services related to breastfeeding.[27] [28] [29]

    Premiums

    The ACA placed restrictions on the fashion individual and small-scale group insurers set a plan'due south premium:

    • Premiums were not allowed to vary due to an private's health status or a pre-existing condition.
    • Premiums were non allowed to vary due to characteristics such as gender.
    • Premiums for older individuals were non allowed to be more than than three times college than those for younger individuals.
    • Premiums for tobacco users were not immune to be more i.v times higher than for non-tobacco users.

    The law did not place limits on premium variation due to geographic location or the number of individuals covered by a program. The law prohibited annual and lifetime limits on the amount insurers will pay out for covered benefits. Additionally, if individuals miss premium payments, insurers were required to allow that person to retain coverage for three months, although insurers merely had to pay doctors for one month. If the premium corporeality was not paid during that time, so coverage could be terminated.[26] [28] [30] [31] [32]

    The law established a program for reviewing insurance premium charge per unit increases. If a state decided to administer its own plan, it was required to meet minimum standards outlined by the U.S. Department of Health and Human Services (HHS). HHS was given the authorization to review land programs, and if they did not see the standards, federal regulators could have over the rate review process for that state. States could besides cede rate review responsibility to HHS. Insurers were required to submit proposed rate increases of 10 per centum or more to either state or federal regulators, whichever was applicable, for review, along with data supporting the increase. The secretary of health and man services was not granted the authority to reject premium increases; however, many state laws allow state regulators to reject or amend premium requests.[33]

    Medical loss ratio

    A medical loss ratio (MLR) is the portion of premium revenue that insurers spend on claims, medical care and healthcare quality for their customers. The remaining revenue typically goes toward overhead costs, such as administration, marketing and employee salaries, and so to turn a profit. The Affordable Care Act (ACA) placed new regulations on insurers' medical loss ratios by limiting the portion of revenue that goes toward overhead and profit: private and small grouping insurers were required to maintain a minimum medical loss ratio of 80 percent, while large group insurers were required to maintain a minimum MLR of 85 percent. This ways at to the lowest degree 80 or 85 percent of premium revenue were required be used to pay customer claims and support improvements in health and healthcare quality, such as wellness promotion programs.[34] [35] [36]

    Each yr, insurers were required to publicly report their medical loss ratio and other fiscal information for each state and marketplace segment. If their MLR falls below 80 percent or 85 per centum, they would be required to notify their customers and provide a rebate the following twelvemonth. The police force exempted insurers serving fewer than 1,000 individuals in a country.[34] [36]

    Stabilization programs

    The Affordable Care Act outlined three federal programs that were meant to stabilize the individual market during the offset few years of the law and prevent premiums from ascent too rapidly as insurers adapted to the new regulations:[37]

    • Permanent risk adjustment required all individual and small grouping insurers with relatively lower gamble to make payments to individual and small grouping insurers with relatively college take a chance. The programme was meant to stabilize the market by spreading financial risk. The police force did not give this program an expiration date.
    • Temporary run a risk corridors express the losses and profits of insurers in the reformed private market past requiring insurers with lower-than-expected costs to make payments to the federal authorities. Insurers with college-than-expected costs received payments. The programme was meant to protect insurers that set up inaccurate premiums for the initial years of the exchanges and but practical to insurers selling plans on the exchanges. This program was set to expire in 2017. On June 14, 2018, a federal appellate court ruled that the federal regime did not have to brand payments to insurers under the risk corridor program. The suit was brought by two wellness insurers, Moda Health and Land of Lincoln. The court ruled two to 1 that the federal government did not accept to make risk corridor payments because Congress took activity after the enactment of Obamacare to ensure that the programme remained budget neutral from year to yr.[38]
    • Transitional reinsurance required near wellness insurers (individual, pocket-sized group, and large grouping) to pay a fee to the federal government based on their enrollment figures for a plan year. The fee went toward payments to insurers on the individual market that covered high-cost individuals. The program was meant to keep premiums low by offsetting the cost of care for individuals with complex conditions. This program was ready to elapse in 2016.

    Medicaid

    See also: Medicaid spending past state

    Eligibility expansion

    The Affordable Intendance Act expanded eligibility for Medicaid to more individuals. Medicaid was originally limited to pregnant women and young children with household incomes around the federal poverty level, and to disabled people, older children, and parents with household incomes below the federal poverty level. Each state was allowed to determine whether to too embrace able-bodied adults without children or people with slightly higher incomes, though they were previously required to obtain a federal waiver to do this.[39]

    The ACA provided for the expansion of Medicaid eligibility to encompass childless adults whose income amounted to 138 pct of the federal poverty level (FPL) or below. In 2017, this amounted to $16,643 for individuals and $33,948 for a family unit of iv. Although the constabulary originally required states to expand their Medicaid programs or lose federal Medicaid funding, in 2012, the U.South. Supreme Court ruled that the federal government could not condition Medicaid funding on an expansion of the plan. The ruling essentially made participation in the expansion voluntary on the part of us.[iii] [40]

    The provision for expanding Medicaid went into effect nationwide in 2014. The federal government provided 100 percent of funding to cover newly eligible enrollees through 2016, dropping this funding level to 95 percentage in 2017 and to 90 percent in 2020 and thereafter. The law did non provide for tax credits for adults with household incomes lower than the federal poverty level, because the law had intended to cover these people under Medicaid. In states that didn't expand Medicaid, these adults neither qualified for Medicaid nor for federal tax credits to buy wellness insurance.[41] [42]

    As of Jan 2022, a full of 38 states and Washington, D.C., had expanded or voted to expand Medicaid, while 12 states had non. The map below provides information on Medicaid expansions by land; for states that expanded, hover over the state to view the political affiliation of the governor at the time of expansion.[43]

    Other provisions

    The Affordable Care Act enacted a temporary increase for Medicaid'southward reimbursements to primary intendance physicians, matching Medicare levels during 2013 and 2014. The police force provided states with federal funding for the purpose. States were not required to maintain the higher reimbursement rates after 2014. The law also established the requirement that states accept multiple forms of enrollment applications, including online applications.[3]

    Medicare

    Spending and revenues

    The Affordable Care Human activity (ACA) included changes to Medicare reimbursements and the premiums that beneficiaries pay. The law reduced reimbursements to individual Medicare Advantage plans, which are health plans for Medicare beneficiaries administered by private insurers and financed by the federal authorities. The change was expected to reduce Medicare spending by $132 billion between 2010 and 2020. The law likewise reduced payments to healthcare providers.[44] [45]

    In add-on, prior to the ACA, Medicare required beneficiaries at a certain level of income to pay higher monthly premiums for coverage. The income threshold was indexed to increase annually with inflation. The ACA suspended this indexing through 2019, meaning over time, more beneficiaries would be required to pay the higher premiums. The ACA too required higher-income beneficiaries to begin paying higher premiums for prescription drug coverage.[45]

    Independent Payment Informational Board

    The law established a new regime agency called the Independent Payment Advisory Board (IPAB). IBAP was modeled on a proposal by erstwhile senator Tom Daschle, who in plow modeled it subsequently the Federal Reserve Board. If the projected rate of growth in Medicare spending exceeded a target amount, IPAB would be required to arts and crafts a proposal to reduce Medicare spending. IPAB's decisions would be bounden and would require a iii-fifths super-majority from Congress in club to exist overturned. The Department of Health and Man Services would automatically implement its recommendations unless overridden by Congress. Even so, the law stipulated that IPAB could non ration healthcare, raise premiums or restrict eligibility.[46]

    Writing in the Wall Street Journal, Sarah Palin argued that the Affordable Care Human action "implicitly endorses the use of 'death panel'-like rationing past way of the new Independent Payments Advisory Board—making bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will (and peculiarly volition non) be reimbursed nether Medicare." As of 2017, the IPAB had not been created.[47] [48]

    Medicare prescription drug coverage

    The law closed the doughnut hole of Medicare prescription drug coverage (Part D). Previously, Medicare would embrace prescription drug costs up to $2,250 in a given year, afterwards which beneficiaries were responsible for 100 percent of their prescription drug costs until they hit $5,100 that yr. The ACA established coverage for a portion of the costs for drug spending in this range.[3]

    Payment models

    The ACA outlined a pilot programme to test the effect of bundled payments for Medicare. A bundled payment is the commitment of ane single payment to providers for the unabridged range of services used to care for a condition. By contrast, under traditional fee-for-service reimbursement, doctors are paid separately for each service provided. For the Medicare program, the constabulary immune providers to voluntarily grouping together to enter into the payment organization with Medicares.[26] [49] [fifty]

    Primary care Scrabble letters.jpg

    The ACA too included a shift from volume-based purchasing—paying for the number of services provided—to value-based purchasing—paying for the quality of services provided. Since 2012, hospitals have received a 1 percent reduction in Medicare payments to fund a reward program providing bonuses to hospitals that meet standards of high quality, efficient care.[26] [51]

    Additionally, the police force included iv provisions related to primary care:[26] [52]

    • Extra funding for the National Health Service Corps, which provides scholarships and loan repayment for primary care providers serving in loftier-need communities
    • Extra funding for programs that train primary care providers
    • A 10 per centum increase in Medicare payments to primary intendance providers through 2015
    • An increase in Medicaid payments to main intendance providers to Medicare levels through 2014

    Accountable care organizations

    The Affordable Care Act included provisions outlining a system of accountable care organizations (ACOs) as a model for Medicare providers. An answerable care arrangement (ACO) is a grouping of doctors, hospitals, or other healthcare providers that piece of work together with the stated purpose of delivering high-quality care at a lower cost. The formation of ACOs was made voluntary for providers. Under the model outlined by the ACA, if an ACO generated savings on the cost of treat a Medicare patient, the federal government would requite the providers a portion of the savings. If not, the group would accept to have a loss on the price of care provided. ACOs could be formed by physicians, hospitals or—in the private market place—insurers. Although the ACO provision of the Affordable Care Human activity pertained specifically to Medicare, some providers formed ACOs for patients with private insurance equally well, and xvi state Medicaid programs contract with ACOs. Co-ordinate to the journal Health Affairs, as of September 2015, the majority of the 23.5 meg individuals served by ACOs were enrolled in individual insurance or Medicaid. Medicare patients accounted for seven.8 1000000 of the individuals in ACOs.[26] [53] [54]

    Taxes and fees

    The post-obit is a list of taxes and fees included in the Affordable Care Human action as written. This listing may not be exhaustive and changes to the tax code in subsequent years may accept impacted some of these provisions.[55]

    • additional 0.9 percent Medicare tax on high-income earners
    • 3.eight pct tax on investment income higher up a sure threshold
    • twoscore percentage excise tax on high-cost wellness plans (known as the Cadillac tax)
    • 10 percent excise tax on indoor tanning services
    • annual fee for manufacturers of brand proper noun pharmaceuticals
    • annual fee for health insurers
    • 2.iii per centum excise taxation on medical devices

    Attempts to modify or repeal

    September 14, 2017: Commenting on the apparent alter of position among Republican senators who voted confronting Obamacare repeal, Senator Ben Sasse (R-Pecker.) claimed, "With just one exception, every member of the Republican majority already either voted for repeal or explicitly campaigned on repeal."
    Is Sasse correct?

    Read Ballotpedia'south fact bank check »

    The Affordable Care Act was subject to a number of lawsuits challenging some of its provisions, such every bit the individual mandate and the requirement to embrace contraception. Four of these lawsuits were heard by the United States Supreme Court, resulting in changes to the law and how information technology was enforced. In addition, since the law'southward enactment, lawmakers in Congress accept introduced and considered legislation to modify or repeal parts or all of the Affordable Care Act. Finally, between 2010 and 2012, voters in eight states considered election measures related to the law. This section summarizes the lawsuits, legislation, and state ballot measures that attempted to modify, repeal, or touch enforcement of parts of the constabulary.

    Lawsuits

    See also: Obamacare lawsuits

    Zubik 5. Burwell

    Pursuant to the U.S. Supreme Court's 2014 decision in Burwell v. Hobby Lobby, religious organizations and closely-held for-profit companies became eligible for an exemption from the Affordable Care Act'south contraception mandate. Under the exemption, organizations could notify the government of their religious objections to contraception, which would and then make an organisation with the insurance company to provide contraceptive coverage to the employees. Even so, 43 different Catholic organizations filed 12 lawsuits challenging this accommodation, arguing that they would still be complicit in providing contraception to their employees. Read more than.

    Rex v. Burwell

    The Affordable Care Deed states an individual is eligible for a tax credit if he or she enrolls in an insurance plan through "an Exchange established past the Land." Consequently, the Internal Revenue Service (IRS) issued a rule allowing tax credits for insurance plans purchased in both state and federal exchanges. At issue in King v. Burwell was whether the ACA permitted the IRS to translate the police force in this manner and grant tax credits to individuals who purchased their health insurance from the federal wellness insurance substitution in addition to the state exchanges. If taxation subsidies were non available for insurance plans purchased through federal commutation, an estimated 6.4 million Americans would have been impacted, and the three interconnected reforms of Obamacare would accept been undermined. Read more .

    National Federation of Contained Business organisation five. Sebelius

    This federal lawsuit was filed in Florida, with 26 states, 2 individuals, and an independent organization named as plaintiffs. The lawsuit challenged the Affordable Intendance Act on the grounds that the individual health insurance mandate exceeded Congress' authority to regulate interstate commerce nether the Commerce Clause of Article I and did non fall within its power to tax. The complaint further alleged that the Act violated the Tenth Amendment past compelling states to follow federal regulations—under the ACA, states would have lost federal Medicaid funding had they not expanded their Medicaid programs. Read more .

    Burwell 5. Hobby Entrance hall

    The Affordable Care Act had mandated that insurance plans must cover certain essential benefits—which HHS after interpreted to include contraceptive coverage. Employers that didn't provide this benefit in their health insurance plan would face hefty fines. Two family unit-owned companies—Hobby Lobby and Conestoga Forest Specialty—challenged the contraception mandate in court. They sought exemptions from coverage of four different contraceptives—two emergency morning subsequently pills and two intrauterine devices (IUDs)—on the basis that those contraceptives were forms of abortion according to their religious beliefs. Read more .

    U.S. House of Representatives five. Burwell

    On July 30, 2014, the House voted 225 to 201 in favor of a resolution to file a lawsuit against the Obama administration. The lawsuit challenged the administration's delay of the ACA'southward employer mandate and its payment of subsidies to insurers for providing a reduced price brunt to depression-income consumers under the law. Boehner claimed the executive branch "inverse the healthcare law without a vote of Congress" past delaying the employer mandate and violated Article I of the Constitution by using unappropriated funds to brand payments to insurers. Read more .

    Legislation

    See also: Alternative proposals to the Affordable Care Human activity (Obamacare) and Republican endeavor to repeal the ACA, July 2017

    According to the Congressional Enquiry Service, upward through December 2015, the U.S. House of Representatives voted to alter, defund, delay, or repeal portions of the Affordable Care Act (ACA) in some way 56 times earlier. 16 of these measures were ultimately enacted and signed into law by former President Barack Obama (D); these bills made bipartisan changes such as delaying the 40 percent excise tax on high-cost health plans and amending definitions.[56]

    Four of the bills that passed the House would have repealed the law in its entirety had they been enacted; only one fabricated information technology to President Obama'southward desk, 60 minutes 3762. The passage of HR 3762, the Restoring Americans' Healthcare Freedom Act, marked the first fourth dimension a mensurate to repeal major portions of the law had passed both the House and the U.Southward. Senate. President Obama vetoed the bill.[56] [57]

    In 2017, following the election of President Donald Trump (R), Congress voted on two bills to change the ACA, the American Health Care Act (AHCA) in the House and the Better Care Reconciliation Act (BCRA) in the Senate. Both bills were reconciliation bills that proposed modifying the budgetary and fiscal provisions of the ACA. The House passed the AHCA 217-213 on May 4, 2017. During the calendar week of July 23, 2017, the Senate held a serial of votes on the BCRA. Ultimately, the Senate did non pass the bill.

    American Wellness Intendance Act of 2017

    Run across also: American Health Care Deed of 2017

    On March 6, 2017, Firm Republicans introduced the American Wellness Care Deed of 2017 (AHCA), a reconciliation bill that proposed modifying the budgetary and fiscal provisions of the ACA. Trump offered his full back up for the legislation.[58] [59]

    The bill was a reconciliation neb, meaning it would have impacted the budgetary and fiscal provisions of the ACA, and did not contain a provision to repeal the law in its entirety. It proposed repealing the tax penalties on individuals for not maintaining health coverage and on employers for non offering coverage. The ACA'southward income-based tax credits for purchasing insurance would have ended, as would have the enhanced federal funding for states that expanded Medicaid. The nib contained its own organization of tax credits, based on historic period rather than income, and a punishment in the form of increased premiums for individuals who did not maintain continuous coverage.[58]

    After ii canceled votes in March, the House reintroduced the measure on April 6, 2017. On April xiii, Business firm Republicans added a new amendment to the American Health Care Act in an attempt to unite the political party behind the bill, assuasive states to opt out of some of the bill's provisions. Some other subpoena was added on May iii, 2017, to provide states with an additional $8 billion over v years to fund high-risk pools. These two amendments garnered enough votes from moderate and conservative Republicans to laissez passer the beak on May 4, 2017, by a vote of 217-213.[60] [61] [62]

    Better Care Reconciliation Act of 2017

    Meet also: Better Care Reconciliation Act of 2017

    On June 22, 2017, the U.S. Senate released the Better Care Reconciliation Act of 2017 (BCRA), its version of the Business firm bill, the American Health Intendance Act (AHCA). The bill was a reconciliation nib that proposed modifying the budgetary and financial provisions of the Patient Protection and Affordable Intendance Act (ACA), also known as Obamacare. On July thirteen, 2017, the Senate released a revised version of the bill that included changes, such as $45 billion to accost the opioid epidemic and assuasive the sale of health plans that do not comply with ACA standards. For detailed data on the BCRA, click here.

    On July 17, 2017, after weeks of negotiating the bill, Senate Majority Leader Mitch McConnell (R-Ky.) said that his party was unable to concur on a replacement bill for the ACA, only the bill was revived ii days later. During the last week of July, the Senate voted on 3 major proposals to repeal and supercede the ACA. A procedural vote on the BCRA was rejected by a vote of 43-57. A proposal to repeal the ACA and filibuster the effective date for 2 years to provide time for a replacement pecker failed past a vote of 45-55. The final major amendment—the "skinny bill"—was rejected by a 49-51 vote. Information technology contained the provisions to repeal the requirements for individuals to enroll in wellness insurance and for employers to offer it, among other provisions.[63] [64] [65] [66] [67]

    After the skinny bill failed, McConnell said, "information technology is fourth dimension to move on," and he chosen the final defeat disappointing.[68]

    Restoring Americans' Healthcare Freedom Act of 2015

    See also: Restoring Americans' Healthcare Liberty Reconciliation Act of 2015

    On January vi, 2016, the U.Southward. Business firm of Representatives voted in favor of a nib to repeal parts of the Affordable Intendance Human action, also known as "Obamacare," and to end federal funding for Planned Parenthood over the side by side year. President Barack Obama vetoed the mensurate on January 8, stating that the legislation would have caused damage "to the health and fiscal security of millions of Americans."[57]

    The bill, HR 3762, was widely expected to be vetoed by the president and, co-ordinate to The Colina, was viewed equally more of a symbolic move for the Republican Party to bear witness voters "how they would govern if they win back the White House in November." The measure had been passed earlier in the Senate as a reconciliation bill, which bypasses filibuster attempts and needs only 51 votes to laissez passer, rather than the standard 60 votes. The bill would have concluded the expansion of Medicaid and federal subsidies for people buying wellness insurance on the new exchanges. These changes would take taken identify in 2018, and Republicans say they would have used the two years in between to implement a replacement of the police force. The Congressional Budget Office and the Joint Committee on Taxation estimated that the bill would take reduced the federal deficit past $282 billion between 2016 and 2025.[56] [69]

    This map highlights the various states' responses

    Ballot measure out challenges

    Start early during congressional debate over the Affordable Care Act, ten legislative referrals and denizen initiatives appeared seeking to stop implementation of the human action in eight states. Most of these ballot measures proposed an amendment to the state'due south constitution declaring that citizens of the respective land could not be compelled to buy health insurance or be fined for non doing so. Some measures, all the same, instead chose to focus on prohibiting the state's government from establishing a health insurance commutation. This item tactic was used so as to gain additional legal leverage before the courts past making available the statement that the federal law violated state constitutions. Another aspect of this strategy was to demonstrate public disapproval of the bill by having such constitutional changes exist decided past voters rather than country legislators. This endeavor was not universally successful, however, because voters in some states refused to approve these constitutional amendments.

    The post-obit is a list of states that saw such ramble amendments on their ballots since 2008. Successful measures are indicated with a Approved a.

    • Arizona Health Insurance Reform Amendment, Proposition 106 (2010)Approved a
    • Missouri Health Care Freedom, Proposition C (August 2010)Approved a
    • Oklahoma Health Care Freedom Amendment, State Question 756 (2010)Approved a
    • Alabama Health Care Subpoena, Amendment 6 (2012)Approved a
    • Montana Health Care Measure out, LR-122 (2012)Approved a
    • Wyoming Health Care Amendment, Ramble Amendment A (2012)Approved a
    • Missouri Health Care Exchange Question, Proposition E (2012)Approved a
    • Florida Health Care, Subpoena 1 (2012)Defeated d
    • Arizona Medical Freedom to Choose, Proposition 101 (2008)Defeated d
    • Colorado Health Care, Amendment 63 (2010)Defeated d

    Recent news

    The link below is to the virtually recent stories in a Google news search for the terms Affordable Intendance Act. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.

    Run into also

    Footnotes

    1. ↑ New York Times, "Obama Signs Health Care Overhaul Bill, With a Flourish," March 23, 2010
    2. ↑ National Academy for Country Health Policy, "Where States Stand up on Medicaid Expansion," Nov 7, 2018
    3. ↑ 3.0 three.1 3.2 3.3 3.4 iii.5 3.6 The Staff of The Washington Mail service. (2010). Landmark: The Inside Story of America'southward New Wellness-Intendance Constabulary and What It Means for Us All. New York, NY: PublicAffairs.
    4. ↑ Congress.gov, "H.R.3590 - Patient Protection and Affordable Intendance Act," accessed Baronial 28, 2017
    5. ↑ GovTrack, "H.R. 3590 (111th): Patient Protection and Affordable Care Deed," March 21, 2010
    6. ↑ Kaiser Family unit Foundation, "Health Reform Implementation Timeline," accessed March 12, 2014
    7. ↑ Note: This text is quoted verbatim from the original source. Any inconsistencies are owing to the original source.
    8. ↑ HealthCare.gov, "Affordable Intendance Act (ACA)," accessed August 17, 2017
    9. ↑ HealthCare.gov, "If you don't have wellness insurance: How much y'all'll pay," accessed August 21, 2017
    10. ↑ HealthCare.gov, "Hardship exemptions, forms & how to apply," accessed August 21, 2017
    11. ↑ Henry J. Kaiser Family Foundation, "Employer Responsibility Under the Affordable Care Act," September 30, 2016
    12. ↑ Internal Revenue Service, "Employer Shared Responsibility Provisions," accessed August 28, 2017
    13. ↑ 13.0 13.1 National Briefing of State Legislatures, "Land Actions to Accost Wellness Insurance Exchanges," October thirteen, 2015
    14. ↑ Healthcare.gov, "Health Insurance Marketplace," accessed November 16, 2015
    15. ↑ The Staff of The Washington Mail service. (2010). Landmark: The Inside Story of America's New Health-Intendance Police force and What It Means for U.s.a. All. New York, NY: PublicAffairs.
    16. ↑ The Henry J. Kaiser Family unit Foundation, "Total Health Insurance Commutation Grants," accessed October 20, 2015
    17. ↑ Healthcare.gov, "Health Plan Categories," accessed Nov xvi, 2015
    18. ↑ Healthcare.gov, "Advanced Premium Revenue enhancement Credits (APTC)," accessed Oct nineteen, 2015
    19. ↑ 19.0 19.i Internal Revenue Service, "Questions and Answers on the Premium Tax Credit," accessed October xix, 2015
    20. ↑ The Henry J. Kaiser Family unit Foundation, "Cost-Sharing Subsidies in Federal Marketplace Plans," February 11, 2015
    21. ↑ Healthcare.gov, "Cost Sharing Reduction," accessed October xix, 2015
    22. ↑ Assistant Secretary for Planning and Evaluation, U.South. Department of Wellness and Human being Services, "Computations for the 2016 Poverty Guidelines," accessed Baronial 21, 2017
    23. ↑ Healthcare.gov, "Federal Poverty Level (FPL)," accessed October 19, 2015
    24. ↑ The Henry J. Kaiser Family Foundation, "The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update," Oct 23, 2015
    25. ↑ 25.0 25.ane HealthInsurance.org, "CO-OP health plans: patients' interests beginning," accessed Baronial 23, 2017
    26. ↑ 26.0 26.one 26.2 26.three 26.four 26.five 26.6 Politico, "Understanding Obamacare: Politician's Guide to the Affordable Intendance Deed," accessed Oct 21, 2015
    27. ↑ 27.0 27.1 HealthCare.gov, "What Marketplace health insurance plans cover," accessed August 22, 2017
    28. ↑ 28.0 28.1 Forbes, "Essential Health Benefits Nether The Affordable Care Act," October 11, 2013
    29. ↑ Robert Forest Johnson Foundation, "Essential Wellness Benefits," May 2, 2013
    30. ↑ United State Government Press Office, "Patient Protection and Affordable Care Act; Health Insurance Marketplace Rules; Rate Review," February 27, 2013
    31. ↑ United States Department of Wellness and Human Services, "Lifetime & Annual Limits," accessed October 21, 2015
    32. ↑ Legal Information Institute, "45 CFR 156.270 - Termination of coverage for qualified individuals," accessed October 22, 2015
    33. ↑ The Henry J. Kaiser Family unit Foundation, "Health Insurance Market Reforms: Rate Review," December 2012
    34. ↑ 34.0 34.one Congressional Research Service, "Medical Loss Ratio Requirements Nether the Affordable Care Act," Baronial 26, 2014
    35. ↑ Centers for Medicare and Medicaid Services, "Medical Loss Ratio," accessed Oct 13, 2015
    36. ↑ 36.0 36.one The Henry J. Kaiser Family Foundation, "Explaining Health Care Reform: Medical Loss Ratio (MLR)," Feb 29, 2012
    37. ↑ The Henry J. Kaiser Family Foundation, "Explaining Health Care Reform: Gamble Adjustment, Reinsurance, and Run a risk Corridors," August 17, 2016
    38. ↑ Politico, "Courtroom: Federal regime doesn't owe insurers Obamacare payments," June fourteen, 2018
    39. ↑ Tate, N. (2012) Obamacare Survival Guide. Humanix Books: Boca Raton, FL.
    40. ↑ Oyez, "National Federation of Independent Businesses five. Sebelius," accessed May 20, 2016
    41. ↑ The Henry J. Kaiser Family Foundation, "Medicaid Financing: How Does it Work and What are the Implications?" May 20, 2015
    42. ↑ Kaiser Family Foundation, "The Coverage Gap: Uninsured Poor Adults in States That Practice Not Expand Medicaid Coverage," April 17, 2015
    43. ↑ HealthInsurance.org, "Medicaid," accessed January 10, 2020
    44. ↑ Tate, N. (2012) Obamacare Survival Guide. Humanix Books: Boca Raton, FL.
    45. ↑ 45.0 45.1 Kaiser Family Foundation, "Medicare Spending and Financing: A Primer," February 2011
    46. ↑ Congressional Research Service, "The Independent Payment Advisory Board," April 17, 2013
    47. ↑ Wall Street Journal, "Why I Support the Ryan Roadmap," December 10, 2010
    48. ↑ Health Affairs Blog, "ACA Circular-Up: Medicare Trustees Report Does Not Trigger IPAB, And More," July xiv, 2017
    49. ↑ Health Affairs, "The Payment Reform Landscape: Bundled Payment," July 2, 2014
    50. ↑ Harvard Business concern Review, "Getting Bundled Payments Right in Health Intendance," October 19, 2015
    51. ↑ Robert Wood Johnson Foundation, "How Does Medicare Value-Based Purchasing Work?" June 2012
    52. ↑ United States Section of Wellness and Human Services, "Creating Wellness Care Jobs by Addressing Master Care Workforce Needs," accessed October 22, 2015
    53. ↑ Kaiser Health News, "Accountable Care Organizations, Explained," September 14, 2015
    54. ↑ Wellness Affairs Weblog, "Growth And Dispersion Of Accountable Care Organizations In 2015," March 31, 2015
    55. ↑ Internal Revenue Service, "Affordable Care Act Tax Provisions," accessed August 23, 2017
    56. ↑ 56.0 56.one 56.2 Congressional Research Service, "Legislative Actions to Repeal, Defund, or Filibuster the Affordable Care Act," December 9, 2015
    57. ↑ 57.0 57.1 CNN, "Obama vetoes Obamacare repeal bill," January 8, 2016
    58. ↑ 58.0 58.1 House Free energy and Commerce Committee, "Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of the Patient Protection and Affordable Care Deed," accessed March 7, 2017
    59. ↑ Breitbart, "Donald Trump: 'I'm 100 Percent Behind' Obamacare Replacement Plan," accessed March 22, 2017
    60. ↑ Reuters, "U.S. House passes healthcare nib in large win for Trump," May 4, 2017
    61. ↑ CNBC, "Republicans have a new plan to repeal Obamacare — and here it is," Apr 20, 2017
    62. ↑ The New York Times, "$8 Billion Deal Gives Crucial Momentum to G.O.P. Health Bill," May 3, 2017
    63. ↑ The Colina, "Senate GOP revives negotiation over ObamaCare repeal and supercede," July nineteen, 2017
    64. ↑ Senate.gov, "On the Motion (Motility to Waive All Applicable Monetary Discipline Re: Amdt. No. 270)," July 25, 2017
    65. ↑ Senate.gov, "On the Subpoena (Paul Amdt. No. 271 )," July 26, 2017
    66. ↑ Senate.gov, "On the Amendment (McConnell Amdt. No. 667 )," July 28, 2017
    67. ↑ Axios, "Here's the Senate's "skinny" wellness care nib," July 27, 2017
    68. ↑ The Colina, "McConnell: 'Time to motion on' after healthcare defeat," July 28, 2017
    69. ↑ The Loma, "House passes ObamaCare repeal, sending measure to president," January vi, 2016

    v•e

    Ballotpedia
    Almost

    Overview • What people are saying • Support Ballotpedia • Contact • Contribute • Job opportunities

    Executive: Leslie Graves, President • Gwen Beattie, Principal Operating Officer • Ken Carbullido, Vice President of Ballot Product and Technology Strategy

    Communications: Alison Graves • Megan Dark-brown • Abigail Campbell • Sarah Groat • Lauren Nemerovski
    External Relations: Alison Prange • Sara Primal • Kari Berger • Hannah Nelson
    Operations: Meghann Olshefski • Lauren Dixon • Kelly Rindfleisch
    Policy: Christopher Nelson • Caitlin Styrsky • Molly Byrne • Katharine Frey • Jimmy McAllister
    Research: Josh Altic, Managing Editor
    Tech: Matt Latourelle, Tech Managing director • Nathan Bingham • Ryan Burch • Kirsten Corrao • Margaret Kearney • Joseph Sanchez

    Contributors: Scott Rasmussen
    Editorial

    Geoff Pallay, Editor-in-Master • Daniel Anderson, Managing Editor • Ryan Byrne, Managing Editor • Cory Eucalitto, Managing Editor • Mandy Gillip, Managing Editor • Jerrick Adams • Victoria Antram • Dave Beaudoin • Jaclyn Beran • Marielle Bricker • Kate Carsella • Kelly Coyle • Megan Feeney • Nicole Fisher • Juan García de Paredes • Sara Horton • Tyler King • Doug Kronaizl • Amee LaTour • David Luchs • Brittony Maag • Roneka Matheny • Andrew McNair • Jackie Mitchell • Elisabeth Moore • Ellen Morrissey • Mackenzie Murphy • Samantha Postal service • Paul Rader • Ethan Rice • Myj Saintyl • Maddie Sinclair Johnson • Abbey Smith • Janie Valentine • Caitlin Vanden Boom • Joel Williams • Samuel Wonacott • Mercedes Yanora

    diazpongle.blogspot.com

    Source: https://ballotpedia.org/Obamacare_overview

    0 Response to "Will Senate Vote on Obamacare Again"

    Post a Comment

    Subscribe to: Post Comments (Atom)

    Iklan Atas Artikel

    Iklan Tengah Artikel 1

    Iklan Tengah Artikel 2

    Iklan Bawah Artikel