“Patient Protection and Affordable Care Act”的意思、由来-开放百科全书

The Patient Protection and Affordable Care Act (PPACA), often shortened to the Affordable Care Act (ACA) or nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965.^[1]^[2]^[3]^[4]

The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered during 2016.^[5]^[6] The increased coverage was due, roughly equally, to an expansion of Medicaid eligibility and to major changes to individual insurance markets. Both involved new spending, funded through a combination of new taxes and cuts to Medicare provider rates and Medicare Advantage. Several Congressional Budget Office reports said that overall these provisions reduced the budget deficit, that repealing the ACA would increase the deficit,^[7]^[8] and that the law reduced income inequality by taxing primarily the top 1% to fund roughly $600 in benefits on average to families in the bottom 40% of the income distribution.^[9] The law also enacted a host of delivery system reforms intended to constrain healthcare costs and improve quality. After the law went into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans.^[10]

The act largely retains the existing structure of Medicare, Medicaid, and the employer market, but individual markets were radically overhauled around a three-legged scheme.^[1]^[1] Insurers in these markets are made to accept all applicants and charge the same rates regardless of pre-existing conditions or sex. To combat resultant adverse selection, the act mandates that individuals buy insurance and insurers cover a list of "essential health benefits". However, a repeal of the individual tax mandate, passed as part of the Tax Cuts and Jobs Act of 2017, became effective on January 1, 2019. To help households between 100–400% of the Federal Poverty Line afford these compulsory policies, the law provides insurance premium subsidies. Other individual market changes include health marketplaces and risk adjustment programs.

Since being signed into law in 2010, the PPACA has faced strong political opposition, calls for repeal (overwhelmingly from Republicans) and numerous legal challenges; its enactment is considered to be a catalyst for the Tea Party movement. In National Federation of Independent Business v. Sebelius, the Supreme Court ruled that states could choose not to participate in the ACA's Medicaid expansion, although it upheld the law as a whole.^[13] The federal health exchange, HealthCare.gov, faced major technical problems at the beginning of its rollout in 2013. In 2017, a unified Republican government attempted but failed to pass several different partial repeals of the ACA. The law spent several years opposed by a slim plurality of Americans polled, although its provisions were generally more popular than the law as a whole,^[2] and the law gained majority support by 2017.^[3]

Provisions

The ACA includes provisions to take effect from 2010 to 2020, although most took effect on January 1, 2014. It amended the Public Health Service Act of 1944 and inserted new provisions on affordable care into Title 42 of the United States Code.{{citation needed|date=December 2017}} Few areas of the US health care system were left untouched, making it the most sweeping health care reform since the enactment of Medicare and Medicaid in 1965.^[4]^[5]^[6]^[7]^[8] However, some areas were more affected than others. The individual insurance market was radically overhauled, and many of the law's regulations applied specifically to this market,^[4] while the structure of Medicare, Medicaid, and the employer market were largely retained.^[5] Most of the coverage gains were made through the expansion of Medicaid,^[9] and the biggest cost savings were made in Medicare.^[5] Some regulations applied to the employer market, and the law also made delivery system changes that affected most of the health care system.^[5] Not all provisions took full effect. Some were made discretionary, some were deferred, and others were repealed before implementation.

Insurance regulations

Individual mandate

The individual mandate^[62] was the requirement to buy insurance or pay a penalty for everyone not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs (such as Tricare). Also exempt were those facing a financial hardship or who were members in a recognized religious sect exempted by the Internal Revenue Service.^[63]

The mandate and the limits on open enrollment^[64]^[65] were designed to avoid the insurance death spiral in which healthy people delay insuring themselves until they get sick. In such a situation, insurers would have to raise their premiums to cover the relatively sicker and thus more expensive policies,^[62]^[67]^[68] which could create a vicious cycle in which more and more people drop their coverage.^[18]

The purpose of the mandate was to prevent the healthcare system from succumbing to adverse selection, which would result in high premiums for the insured and little coverage (and thus more illness and medical bankruptcy) for the uninsured.^[67]^[71]^[72] Studies by the CBO, Gruber and Rand Health concluded that a mandate was required.^[73]^[74]^[75] The mandate increased the size and diversity of the insured population, including more young and healthy participants to broaden the risk pool, spreading costs.^[19] Experience in New Jersey and Massachusetts offered divergent outcomes.^[71]^[74]^[79]

On December 20, 2017, the individual mandate was repealed starting in January 2019 via the "Tax Cuts and Jobs Act of 2017".^[20]

Subsidies

Households with incomes between 100% and 400% of the federal poverty level are eligible to receive federal subsidies for policies purchased via an exchange.^[88]^[89] Households living in the federal poverty level are not eligible to receive federal subsidies. Subsidies are provided as an advanceable, refundable tax credits.^[90]^[91] Additionally, small businesses are eligible for a tax credit provided that they enroll in the SHOP Marketplace.^[92] Under the law, workers whose employers offer affordable coverage will not be eligible for subsidies via the exchanges. To be eligible the cost of employer-based health insurance must exceed 9.5% of the worker's household income.

Exchanges

Established the creation of health insurance exchanges in all fifty states. The exchanges are regulated, largely online marketplaces, administered by either federal or state government, where individuals and small business can purchase private insurance plans.^[102]^[103]^[104]

Setting up an exchange gives a state partial discretion on standards and prices of insurance.^[105]^[106] For example, states approve plans for sale, and influence (through limits on and negotiations with private insurers) the prices on offer. They can impose higher or state-specific coverage requirements—including whether plans offered in the state can cover abortion.^[21] States without an exchange do not have that discretion. The responsibility for operating their exchanges moves to the federal government.^[105]

Risk corridor program

The risk-corridor program was a temporary risk management device defined under the PPACA section 1342^[22]{{rp|1}}

to encourage reluctant insurers into the "new and untested"{{attribution needed|date=July 2017}} ACA insurance market during the first three years that ACA was implemented (2014–2016). For those years the Department of Health and Human Services (HHS) "would cover some of the losses for insurers whose plans performed worse than they expected. Insurers that were especially profitable, for their part, would have to return to HHS some of the money they earned on the exchanges"^[23]^[24]{{attribution needed|date=July 2017}}

According to an article in Forbes, risk corridors "had been a successful part of the Medicare prescription drug benefit, and the ACA's risk corridors were modeled after Medicare's Plan D."^[25] They operated on the principle that "more participation would mean more competition, which would drive down premiums and make health insurance more affordable"{{attribution needed|date=July 2017}} and "[w]hen insurers signed up to sell health plans on the exchanges, they did so with the expectation that the risk-corridor program would limit their downside losses."^[23]{{attribution needed|date=July 2017}} The risk corridors succeeded in attracting ACA insurers. The program did not pay for itself as planned with "accumulated losses"{{attribution needed|date=July 2017}} up to $8.3 billion for 2014 and 2015 alone. Authorization had to be given so that HHS could pay insurers from "general government revenues".{{attribution needed|date=July 2017}} Congressional Republicans "railed against"{{attribution needed|date=July 2017}} the program as a 'bailout' for insurers. Then-Rep. Jack Kingston (R-Ga.), on the Appropriations Committee that funds the Department of Health and Human Services and the Labor Department "[slipped] in a sentence"—Section 227—in the "massive" appropriations Consolidated Appropriations Act, 2014 (H.R. 3547) that said that no funds in the discretionary spending bill "could be used for risk-corridor payments."{{attribution needed|date=July 2017}} This effectively "blocked the administration from obtaining the necessary funds from other programs"^[26]{{attribution needed|date=July 2017}} and placed Congress in a potential breach of contract with insurers who offered qualified health plans, under the Tucker Act^[22] as it did not pay the insurers.^[27]^[27]

On February 10, 2017, in the Moda Health v the US Government, Moda, one of the insurers that struggled financially because of the elimination of the risk corridor program, won a "$214-million judgment against the federal government".{{attribution needed|date=July 2017}} On appeal, judge Thomas C. Wheeler stated, "the Government made a promise in the risk corridors program that it has yet to fulfill. Today, the court directs the Government to fulfill that promise. After all, to say to [Moda], 'The joke is on you. You shouldn't have trusted us,' is hardly worthy of our great government."^[28]

Temporary reinsurance

Temporary reinsurance for insurance for insurers against unexpectedly high claims was a program that ran from 2014 through 2016. It was intended to limit insurer losses.{{citation needed|date=August 2016}}

Risk adjustment

Of the three risk management programs, only risk adjustment was permanent. Risk adjustment attempts to spread risk among insurers to prevent purchasers with good knowledge of their medical needs from using insurance to cover their costs (adverse selection). Plans with low actuarial risk compensate plans with high actuarial risk.{{citation needed|date=August 2016}}

Medicaid expansion

ACA revised and expanded Medicaid eligibility starting in 2014. Under the law as written, all U.S. citizens and legal residents with income up to 133% of the poverty line, including adults without dependent children, would qualify for coverage in any state that participated in the Medicaid program. The federal government paid 100% of the cost of Medicaid eligibility expansion in participating states in 2014, 2015, and 2016; and will pay 95% in 2017, 94% in 2018, 93% in 2019, and 90% in 2020 and all subsequent years.^[29]^[30]^[31] The law provides a 5% "income disregard", making the effective income eligibility limit for Medicaid 138% of the poverty level.^[122]

However, the Supreme Court ruled in NFIB v. Sebelius that this provision of the ACA was coercive, and that the federal government must allow states to continue at pre-ACA levels of funding and eligibility if they chose.

Medicare savings

Spending reductions included a reduction in Medicare reimbursements to insurers and drug companies for private Medicare Advantage policies that the Government Accountability Office and Medicare Payment Advisory Commission found to be excessively costly relative to government Medicare;^[123]^[32] and reductions in Medicare reimbursements to hospitals that failed standards of efficiency and care.^[123]

Taxes

Medicare taxes

Income from self-employment and wages of single individuals in excess of $200,000 annually are subject to an additional tax of 0.9%. The threshold amount is $250,000 for a married couple filing jointly (threshold applies to joint compensation of the two spouses), or $125,000 for a married person filing separately.^[33]

In the ACA's companion legislation, the Health Care and Education Reconciliation Act of 2010, an additional Medicare tax of 3.8% was applied to unearned income, specifically the lesser of net investment income or the amount by which adjusted gross income exceeds $200,000 ($250,000 for a married couple filing jointly; $125,000 for a married person filing separately.)^[34]

Excise taxes

SCHIP

The State Children's Health Insurance Program (CHIP) enrollment process was simplified.^[130]

Dependents' health insurance{{anchor|Dependent's Health Insurance}}

Dependents were permitted to remain on their parents' insurance plan until their 26th birthday, including dependents who no longer live with their parents, are not a dependent on a parent's tax return, are no longer a student, or are married.^[131]^[37]

Employer mandate

Businesses that employ 50 or more people but do not offer health insurance to their full-time employees pay a tax penalty if the government has subsidized a full-time employee's healthcare through tax deductions or other means. This is commonly known as the employer mandate.^[133]^[134] This provision was included to encourage employers to continue providing insurance once the exchanges began operating.^[135] Approximately 44% of the population was covered directly or indirectly through an employer.^[136]^[137]

Delivery system reforms

The act includes a host of delivery system reforms intended to constrain healthcare costs and improve quality. These include Medicare payment changes to discourage hospital-acquired conditions and readmissions, bundled payment initiatives, the Center for Medicare and Medicaid Innovation, the Independent Payment Advisory Board, and the creation of Accountable care organizations.

Hospital quality

Health care cost/quality initiatives including incentives to reduce hospital infections, to adopt electronic medical records, and to coordinate care and prioritize quality over quantity.^[138]

The [https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html Hospital Readmissions Reduction Program] (HRPP) was established as an addition to the Social Security Act, in an effort to reduce hospital readmissions. This program penalizes hospitals with higher than expected readmission rates by decreasing their Medicare reimbursement rate.

Bundled Payments

The Medicare payment system switched from fee-for-service to bundled payments.^[38]^[39] A single payment was to be paid to a hospital and a physician group for a defined episode of care (such as a hip replacement) rather than individual payments to individual service providers. In addition, the Medicare Part D coverage gap (commonly called the "donut hole") was to shrink incrementally, closing completely by January 1, 2020.^[40]

Accountable Care Organizations

The Act allowed the creation of Accountable Care Organizations (ACOs), which are groups of doctors, hospitals and other providers that commit to give coordinated, high quality care to Medicare patients. ACOs were allowed to continue using a fee for service billing approach. They receive bonus payments from the government for minimizing costs while achieving quality benchmarks that emphasize prevention and mitigation of chronic disease. If they fail to do so, they are subject to penalties.^[41]

Unlike Health Maintenance Organizations, ACO patients are not required to obtain all care from the ACO. Also, unlike HMOs, ACOs must achieve quality of care goals.^[41]

Medicare donut hole

Medicare Part D participants received a 50% discount on brand name drugs purchased after exhausting their initial coverage and before reaching the catastrophic-coverage threshold.^[42] The United States Department of Health and Human Services began mailing rebate checks in 2010.^[43] By the year 2020, the donut hole will be completely phased out.^[44]

State waivers

From 2017 onwards, states can apply for a "waiver for state innovation" that allows them to conduct experiments that meet certain criteria.^[147] To obtain a waiver, a state must pass legislation setting up an alternative health system that provides insurance at least as comprehensive and as affordable as ACA, covers at least as many residents and does not increase the federal deficit.^[148] These states can be exempt from some of ACA's central requirements, including the individual and employer mandates and the provision of an insurance exchange.^[149] The state would receive compensation equal to the aggregate amount of any federal subsidies and tax credits for which its residents and employers would have been eligible under ACA plan, if they cannot be paid under the state plan.^[147]

In May 2011, Vermont enacted Green Mountain Care, a state-based single-payer system for which they intended to pursue a waiver to implement.^[151]^[152]^[153] In December 2014, Vermont decided not to continue due to high expected costs.^[45]

Other insurance provisions

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Legislative history

Background

An individual mandate coupled with subsidies for private insurance as a means for universal healthcare was considered the best way to win the support of the Senate because it had been included in prior bipartisan reform proposals. The concept goes back to at least 1989, when the conservative The Heritage Foundation proposed an individual mandate as an alternative to single-payer health care.^[160]^[50] It was championed for a time by conservative economists and Republican senators as a market-based approach to healthcare reform on the basis of individual responsibility and avoidance of free rider problems. Specifically, because the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) requires any hospital participating in Medicare (nearly all do) to provide emergency care to anyone who needs it, the government often indirectly bore the cost of those without the ability to pay.^[162]^[163]^[164]

President Bill Clinton proposed a healthcare reform bill in 1993 that included a mandate for employers to provide health insurance to all employees through a regulated marketplace of health maintenance organizations. Republican Senators proposed an alternative that would have required individuals, but not employers, to buy insurance.^[163] Ultimately the Clinton plan failed amid an unprecedented barrage of negative advertising funded by politically conservative groups and the health insurance industry and due to concerns that it was overly complex.^[166] Clinton negotiated a compromise with the 105th Congress to instead enact the State Children's Health Insurance Program (SCHIP) in 1997.^[51]

The 1993 Republican alternative, introduced by Senator John Chafee as the Health Equity and Access Reform Today Act, contained a "universal coverage" requirement with a penalty for noncompliance—an individual mandate—as well as subsidies to be used in state-based 'purchasing groups'.^[168] Advocates for the 1993 bill included prominent Republicans such as Senators Orrin Hatch, Chuck Grassley, Bob Bennett and Kit Bond.^[52]^[53] Of 1993's 43 Republican Senators, 20 supported the HEART Act.^[160]^[172] Another Republican proposal, introduced in 1994 by Senator Don Nickles (R-OK), the Consumer Choice Health Security Act, contained an individual mandate with a penalty provision;^[54] however, Nickles subsequently removed the mandate from the bill, stating he had decided "that government should not compel people to buy health insurance".^[55] At the time of these proposals, Republicans did not raise constitutional issues with the mandate; Mark Pauly, who helped develop a proposal that included an individual mandate for George H. W. Bush, remarked, "I don't remember that being raised at all. The way it was viewed by the Congressional Budget Office in 1994 was, effectively, as a tax."^[160]

In 2006, an insurance expansion bill was enacted at the state level in Massachusetts. The bill contained both an individual mandate and an insurance exchange. Republican Governor Mitt Romney vetoed the mandate, but after Democrats overrode his veto, he signed it into law.^[177] Romney's implementation of the 'Health Connector' exchange and individual mandate in Massachusetts was at first lauded by Republicans. During Romney's 2008 presidential campaign, Senator Jim DeMint praised Romney's ability to "take some good conservative ideas, like private health insurance, and apply them to the need to have everyone insured". Romney said of the individual mandate: "I'm proud of what we've done. If Massachusetts succeeds in implementing it, then that will be the model for the nation."^[178]

In 2007, a year after the Massachusetts reform, Republican Senator Bob Bennett and Democratic Senator Ron Wyden introduced the Healthy Americans Act, which featured an individual mandate and state-based, regulated insurance markets called "State Health Help Agencies".^[164]^[178] The bill initially attracted bipartisan support, but died in committee. Many of the sponsors and co-sponsors remained in Congress during the 2008 healthcare debate.^[181]

By 2008 many Democrats were considering this approach as the basis for healthcare reform. Experts said that the legislation that eventually emerged from Congress in 2009 and 2010 bore similarities to the 2007 bill^[168] and that it was deliberately patterned after Romney's state healthcare plan.^[57]

Healthcare debate, 2008–10

Healthcare reform was a major topic during the 2008 Democratic presidential primaries. As the race narrowed, attention focused on the plans presented by the two leading candidates, Hillary Clinton and the eventual nominee, Barack Obama. Each candidate proposed a plan to cover the approximately 45 million Americans estimated to not have health insurance at some point each year. Clinton's proposal would have required all Americans to obtain coverage (in effect, an individual mandate), while Obama's proposal provided a subsidy but rejected the use of an individual mandate.^[184]^[58]

During the general election, Obama said that fixing healthcare would be one of his top four priorities as president.^[186] Obama and his opponent, Sen. John McCain, proposed health insurance reforms though they differed greatly. Senator John McCain proposed tax credits for health insurance purchased in the individual market, which was estimated to reduce the number of uninsured people by about 2 million by 2018. Obama proposed private and public group insurance, income-based subsidies, consumer protections, and expansions of Medicaid and SCHIP, which was estimated at the time to reduce the number of uninsured people by 33.9 million by 2018.^[59]

After his inauguration, Obama announced to a joint session of Congress in February 2009 his intent to work with Congress to construct a plan for healthcare reform.^[188]^[189] By July, a series of bills were approved by committees within the House of Representatives.^[190] On the Senate side, from June to September, the Senate Finance Committee held a series of 31 meetings to develop a healthcare reform bill. This group—in particular, Democrats Max Baucus, Jeff Bingaman and Kent Conrad, along with Republicans Mike Enzi, Chuck Grassley and Olympia Snowe—met for more than 60 hours, and the principles that they discussed, in conjunction with the other committees, became the foundation of the Senate healthcare reform bill.^[60]^[61]^[62]

Congressional Democrats and health policy experts like MIT economics professor Jonathan Gruber^[194] and David Cutler argued that guaranteed issue would require both community rating and an individual mandate to ensure that adverse selection and/or "free riding" would not result in an insurance "death spiral".^[195] This approach was taken because the president and congressional leaders had concluded that more progressive plans, such as the (single-payer) Medicare for All act, could not obtain filibuster-proof support in the Senate. By deliberately drawing on bipartisan ideas—the same basic outline was supported by former Senate majority leaders Howard Baker, Bob Dole, Tom Daschle and George J. Mitchell—the bill's drafters hoped to garner the votes necessary for passage.^[63]^[64]

However, following the adoption of an individual mandate, Republicans came to oppose the mandate and threatened to filibuster any bills that contained it.^[160] Senate minority leader Mitch McConnell, who led the Republican congressional strategy in responding to the bill, calculated that Republicans should not support the bill, and worked to prevent defections:^[199]

Republican Senators, including those who had supported previous bills with a similar mandate, began to describe the mandate as "unconstitutional". Journalist Ezra Klein wrote in The New Yorker that "a policy that once enjoyed broad support within the Republican Party suddenly faced unified opposition."^[164] Reporter Michael Cooper of The New York Times wrote that: "the provision ... requiring all Americans to buy health insurance has its roots in conservative thinking."^[163]^[172]

The reform negotiations also attracted attention from lobbyists,^[66] including deals between certain lobby groups and the advocates of the law to win the support of groups that had opposed past reforms, as in 1993.^[67]^[68] The Sunlight Foundation documented many of the reported ties between "the healthcare lobbyist complex" and politicians in both parties.^[69]

During the August 2009 summer congressional recess, many members went back to their districts and held town hall meetings on the proposals. The nascent Tea Party movement organized protests and many conservative groups and individuals attended the meetings to oppose the proposed reforms.^[189] Many threats were made against members of Congress over the course of the debate.^[209]^[70]

When Congress returned from recess, in September 2009 President Obama delivered a speech to a joint session of Congress supporting the ongoing Congressional negotiations.^[211] He acknowledged the polarization of the debate, and quoted a letter from the late Senator Edward "Ted" Kennedy urging on reform: "what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."^[71] On November 7, the House of Representatives passed the Affordable Health Care for America Act on a 220–215 vote and forwarded it to the Senate for passage.^[189]

Senate

The Senate began work on its own proposals while the House was still working. The United States Constitution requires all revenue-related bills to originate in the House.^[214] To formally comply with this requirement, the Senate used H.R. 3590, a bill regarding housing tax changes for service members.^[215] It had been passed by the House as a revenue-related modification to the Internal Revenue Code. The bill became the Senate's vehicle for its healthcare reform proposal, discarding the bill's original content.^[72] The bill ultimately incorporated elements of proposals that were reported favorably by the Senate Health and Finance committees. With the Republican Senate minority vowing to filibuster, 60 votes would be necessary to pass the Senate.^[73] At the start of the 111th Congress, Democrats had only 58 votes; the Senate seat in Minnesota ultimately won by Al Franken was still undergoing a recount, while Arlen Specter was still a Republican (he became a Democrat in April, 2009).

Negotiations were undertaken attempting to satisfy moderate Democrats and to bring Republican senators aboard; particular attention was given to Republicans Bennett, Enzi, Grassley and Snowe. On July 7 Franken was sworn into office, providing a potential 60th vote. On August 25 Ted Kennedy—a longtime healthcare reform advocate—died. Paul Kirk was appointed as Senator Kennedy's temporary replacement on September 24.

After the Finance Committee vote on October 15, negotiations turned to moderate Democrats. Majority leader Harry Reid focused on satisfying centrists. The holdouts came down to Joe Lieberman of Connecticut, an independent who caucused with Democrats, and conservative Nebraska Democrat Ben Nelson. Lieberman's demand that the bill not include a public option^[195]^[219] was met,^[220] although supporters won various concessions, including allowing state-based public options such as Vermont's Green Mountain Care.^[220]^[74]

The White House and Reid addressed Nelson's concerns^[75] during a 13-hour negotiation with two concessions: a compromise on abortion, modifying the language of the bill "to give states the right to prohibit coverage of abortion within their own insurance exchanges", which would require consumers to pay for the procedure out of pocket if the state so decided; and an amendment to offer a higher rate of Medicaid reimbursement for Nebraska.^[189]^[76] The latter half of the compromise was derisively termed the "Cornhusker Kickback"^[77] and was repealed in the subsequent reconciliation amendment bill.

On December 23, the Senate voted 60–39 to end debate on the bill: a cloture vote to end the filibuster.^[78] The bill then passed, also 60–39, on December 24, 2009, with all Democrats and two independents voting for it, and all Republicans against (except Jim Bunning, who did not vote).^[228] The bill was endorsed by the AMA and AARP.^[79]

On January 19, 2010, Massachusetts Republican Scott Brown was elected to the Senate in a special election to replace Kennedy, having campaigned on giving the Republican minority the 41st vote needed to sustain Republican filibusters.^[189]^[80]^[81] His victory had become significant because of its effects on the legislative process. The first was psychological: the symbolic importance of losing Kennedy's traditionally Democratic Massachusetts seat made many Congressional Democrats concerned about the political cost of passing a bill.^[82]^[234]

House

Brown's election meant Democrats could no longer break a filibuster in the Senate. In response, White House Chief of Staff Rahm Emanuel argued that Democrats should scale back to a less ambitious bill; House Speaker Nancy Pelosi pushed back, dismissing Emanuel's scaled-down approach as "Kiddie Care".^[235]^[236]

Obama remained insistent on comprehensive reform. The news that Anthem Blue Cross in California intended to raise premium rates for its patients by as much as 39% gave him new evidence of the need for reform.^[235]^[236] On February 22, he laid out a "Senate-leaning" proposal to consolidate the bills.^[83] He held a meeting with both parties' leaders on February 25. The Democrats decided that the House would pass the Senate's bill, to avoid another Senate vote.

House Democrats had expected to be able to negotiate changes in a House–Senate conference before passing a final bill. Since any bill that emerged from conference that differed from the Senate bill would have to pass the Senate over another Republican filibuster, most House Democrats agreed to pass the Senate bill on condition that it be amended by a subsequent bill.^[234] They drafted the Health Care and Education Reconciliation Act, which could be passed by the reconciliation process.^[235]^[242]^[243]

Per the Congressional Budget Act of 1974, reconciliation cannot be subject to a filibuster. But reconciliation is limited to budget changes, which is why the procedure was not used to pass ACA in the first place; the bill had inherently non-budgetary regulations.^[84]^[85] Although the already-passed Senate bill could not have been passed by reconciliation, most of House Democrats' demands were budgetary: "these changes—higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal—mainly involve taxes and spending. In other words, they're exactly the kinds of policies that are well-suited for reconciliation."^[242]

The remaining obstacle was a pivotal group of pro-life Democrats led by Bart Stupak who were initially reluctant to support the bill. The group found the possibility of federal funding for abortion significant enough to warrant opposition. The Senate bill had not included language that satisfied their concerns, but they could not address abortion in the reconciliation bill as it would be non-budgetary. Instead, Obama issued Executive Order 13535, reaffirming the principles in the Hyde Amendment.^[247] This won the support of Stupak and members of his group and assured the bill's passage.^[243]^[86] The House passed the Senate bill with a 219–212 vote on March 21, 2010, with 34 Democrats and all 178 Republicans voting against it.^[250] The next day, Republicans introduced legislation to repeal the bill.^[251] Obama signed ACA into law on March 23, 2010.^[87] Since passage, Republicans have voted to repeal all or parts of the Affordable Care Act over sixty times; no such attempt by Republicans has been successful.^[88] The amendment bill, The Health Care and Education Reconciliation Act, cleared the House on March 21; the Senate passed it by reconciliation on March 25, and Obama signed it on March 30.

Impact

Coverage

The law has caused a significant reduction in the number and percentage of people without health insurance. The CDC reported that the percentage of people without health insurance fell from 16.0% in 2010 to 8.9% from January to June 2016.^[89] The uninsured rate dropped in every congressional district in the U.S. from 2013 to 2015.^[90] The Congressional Budget Office reported in March 2016 that there were approximately 12 million people covered by the exchanges (10 million of whom received subsidies to help pay for insurance) and 11 million made eligible for Medicaid by the law, a subtotal of 23 million people. An additional 1 million were covered by the ACA's "Basic Health Program," for a total of 24 million.^[91] CBO also estimated that the ACA would reduce the net number of uninsured by 22 million in 2016, using a slightly different computation for the above figures totaling ACA coverage of 26 million, less 4 million for reductions in "employment-based coverage" and "non-group and other coverage."^[91]

The U.S. Department of Health and Human Services (HHS) estimated that 20.0 million adults (aged 18–64) gained healthcare coverage via ACA as of February 2016, a 2.4 million increase over September 2015. HHS estimated that this 20.0 million included: a) 17.7 million from the start of open enrollment in 2013–2016; and b) 2.3 million young adults aged 19–25 who initially gained insurance from 2010 to 2013, as they were allowed to remain on their parent's plans until age 26. Of the 20.0 million, an estimated 6.1 million were aged 19–25.^[92] Similarly, the Urban Institute issued a report in December 2016 that said that about 19.2 million non-elderly Americans had gained health insurance coverage from 2010 to 2015.^[93] In March 2016, the CBO reported that there were approximately 27 million people without insurance in 2016, a figure they expected would range from 26 to 28 million through 2026. CBO also estimated the percentage of insured among all U.S. residents would remain at 90% during that period, 92–93% excluding unauthorized immigrants.^[91]

States that expanded Medicaid had a 7.3% uninsured rate on average in the first quarter of 2016, while those that did not expand it had a 14.1% uninsured rate, among adults aged 18–64.^[94] As of December 2016 there were 32 states (including Washington DC) that had adopted the Medicaid extension, while 19 states had not.^[95]

By 2017, nearly 70% of those on the exchanges could purchase insurance for less than $75 per month after subsidies, which rose to offset significant pre-subsidy price increases in the exchange markets.^[96] Healthcare premium cost increases in the employer market continued to lessen. For example, healthcare premiums for those covered by employers rose by 69% from 2000 to 2005, but only 27% from 2010 to 2015,^[97] with only a 3% increase from 2015 to 2016.^[98]

The ACA also helps reduce income inequality measured after taxes, due to higher taxes on the top 5% of income earners and both subsidies and Medicaid expansion for lower-income persons.^[99] The CBO estimated that subsidies paid under the law in 2016 averaged $4,240 per person for 10 million individuals receiving them, roughly $42 billion. For scale, the subsidy for the employer market, in the form of exempting from taxation those health insurance premiums paid on behalf of employees by employers, was approximately $1,700 per person in 2016, or $266 billion total in the employer market. The employer market subsidy was not changed by the law.^[91]

Taxes

Insurance exchanges

As of August 2016, 15 states operated their own exchanges. Other states either used the federal exchange, or operated in partnership with or supported by the federal government.

Medicaid expansion

As of December 2016 there were 32 states (including Washington DC) that had adopted the Medicaid extension, while 19 states had not.^[95] Those states that expanded Medicaid had a 7.3% uninsured rate on average in the first quarter of 2016, while those that did not expand Medicaid had a 14.1% uninsured rate, among adults aged 18 to 64.^[94] Following the Supreme Court ruling in 2012, which held that states would not lose Medicaid funding if they didn't expand Medicaid under the ACA, several states rejected expanded Medicaid coverage. Over half of the national uninsured population lived in those states.^[277] In a report to Congress, the Centers for Medicare and Medicaid Services (CMS) estimated that the cost of expansion was $6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 million to 10 million people had gained Medicaid coverage, mostly low-income adults.^[278] The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered because of states that rejected the Medicaid expansion.^[103]

States that rejected the Medicaid expansion could maintain their Medicaid eligibility thresholds, which in many states were significantly below 133% of the poverty line.^[280] Many states did not make Medicaid available to childless adults at any income level.^[281] Because subsidies on exchange insurance plans were not available to those below the poverty line, such individuals had no new options.^[104]^[283] For example, in Kansas, where only able-bodied adults with children and with an income below 32% of the poverty line were eligible for Medicaid, those with incomes from 32% to 100% of the poverty level ($6,250 to $19,530 for a family of three) were ineligible for both Medicaid and federal subsidies to buy insurance. Absent children, able-bodied adults were not eligible for Medicaid in Kansas.^[277]

Studies of the impact of state decisions to reject the Medicaid expansion calculated that up to 6.4 million people could fall into this status.^[105] The federal government initially paid for 100% of the expansion (through 2016). The subsidy tapered to 90% by 2020 and continued to shrink thereafter.^[286] Several states argued that they could not afford their 10% contribution.^[286]^[288] Studies suggested that rejecting the expansion would cost more than expanding Medicaid due to increased spending on uncompensated emergency care that otherwise would have been partially paid for by Medicaid coverage,^[106]

A 2016 study led by Harvard University health economics professor Benjamin Sommers found that residents of Kentucky and Arkansas, which both accepted the Medicaid expansion, were more likely to receive health care services and less likely to incur emergency room costs or have trouble paying their medical bills than before the expansion. Residents of Texas, which did not accept the Medicaid expansion, did not see a similar improvement during the same period.^[107] Kentucky opted for increased managed care, while Arkansas subsidized private insurance. The new Arkansas and Kentucky governors have proposed reducing or modifying their programs. From 2013 to 2015, the uninsured rate dropped from 42% to 14% in Arkansas and from 40% to 9% in Kentucky, compared with 39% to 32% in Texas. Specific improvements included additional primary and preventive care, fewer emergency departments visits, reported higher quality care, improved health, improved drug affordability, reduced out-of-pocket spending and increased outpatient visits, increased diabetes screening, glucose testing among diabetes patients and regular care for chronic conditions.^[108]

A 2016 DHHS study found that states that expanded Medicaid had lower premiums on exchange policies, because they had fewer low-income enrollees, whose health on average is worse than that of those with higher income.^[109]

Healthcare insurance costs

The law is designed to pay subsidies in the form of tax credits to the individuals or families purchasing the insurance, based on income levels. Higher income consumers receive lower subsidies. While pre-subsidy prices rose considerably from 2016 to 2017, so did the subsidies, to reduce the after-subsidy cost to the consumer. For example, a study published in 2016 found that the average requested 2017 premium increase among 40-year-old non-smokers was about 9 percent, according to an analysis of 17 cities, although Blue Cross Blue Shield proposed increases of 40 percent in Alabama and 60 percent in Texas.^[111] However, some or all of these costs are offset by subsidies, paid as tax credits. For example, the Kaiser Foundation reported that for the second-lowest cost "Silver plan" (a plan often selected and used as the benchmark for determining financial assistance), a 40-year old non-smoker making $30,000 per year would pay effectively the same amount in 2017 as they did in 2016 (about $208/month) after the subsidy/tax credit, despite large increases in the pre-subsidy price. This was consistent nationally. In other words, the subsidies increased along with the pre-subsidy price, fully offsetting the price increases.^[112]

Healthcare premium cost increases in the employer market continued to moderate after the implementation of the law. For example, healthcare premiums for those covered by employers rose by 69% from 2000 to 2005, but only 27% from 2010 to 2015,^[97] with only a 3% increase from 2015 to 2016.^[98] From 2008 to 2010 (before passage of the ACA) health insurance premiums rose by an average of 10% per year.^[113]

Several studies found that the financial crisis and accompanying recession could not account for the entirety of the slowdown and that structural changes likely share at least partial credit.^[299]^[300]^[114]^[115] A 2013 study estimated that changes to the health system had been responsible for about a quarter of the recent reduction in inflation.^[116] Paul Krawzak claimed that even if cost controls succeed in reducing the amount spent on healthcare, such efforts on their own may be insufficient to outweigh the long-term burden placed by demographic changes, particularly the growth of the population on Medicare.^[117]

In a 2016 review of the ACA published in JAMA, Barack Obama himself wrote that from 2010 through 2014 mean annual growth in real per-enrollee Medicare spending was negative, down from a mean of 4.7% per year from 2000 through 2005 and 2.4% per year from 2006 to 2010; similarly, mean real per-enrollee growth in private insurance spending was 1.1% per year over the period, compared with a mean of 6.5% from 2000 through 2005 and 3.4% from 2005 to 2010.^[118]

Effect on deductibles and co-payments

While health insurance premium costs have moderated, some of this is because of insurance policies that have a higher deductible, co-payments and out-of-pocket maximums that shift costs from insurers to patients. In addition, many employees are choosing to combine a health savings account with higher deductible plans, making the impact of the ACA difficult to determine precisely.

For those who obtain their insurance through their employer ("group market"), a 2016 survey found that:

For the "non-group" market, of which two-thirds are covered by the ACA exchanges, a survey of 2015 data found that:

Health outcomes

Insurance coverage helps save lives, by encouraging early detection and prevention of dangerous medical conditions. According to a 2014 study, the ACA likely prevented an estimated 50,000 preventable patient deaths from 2010 to 2013.^[121] City University public health professors David Himmelstein and Steffie Woolhandler wrote in January 2017 that a rollback of the ACA's Medicaid expansion alone would cause an estimated 43,956 deaths annually.^[122]

The Federal Reserve publishes data on premature death rates by county, defined as those dying below age 74.^[123] According to the Kaiser Foundation, expanding Medicaid in the remaining 19 states would cover up to 4.5 million persons.^[124] Since expanding Medicaid expands coverage^[124] and expanding coverage reduces mortality,^[121] therefore expanding Medicaid reduces mortality by syllogism. Texas, Oklahoma, Mississippi, Alabama, Georgia, Tennessee, Missouri and South Carolina, indicated on the map at right as having many counties with high premature mortality rates^[123] could therefore reduce mortality by expanding Medicaid, other things equal.

Distributional impact

In March 2018, the CBO reported that the ACA had reduced income inequality in 2014, saying that the law led the lowest and second quintiles (the bottom 40%) to receive an average of an additional $690 and $560 respectively while causing households in the top 1% to pay an additional $21,000 due mostly to the net investment income tax and the additional Medicare tax. The law placed relatively little burden on households in the top quintile (top 20%) outside of the top 1%.^[125]

Federal deficit

CBO estimates of revenue and impact on deficit

The CBO reported in several studies that the ACA would reduce the deficit, and that repealing it would increase the deficit.^[7]^[8]^[126]^[127] The 2011 comprehensive CBO estimate projected a net deficit reduction of more than $200 billion during the 2012–2021 period:^[8]^[322] it calculated the law would result in $604 billion in total outlays offset by $813 billion in total receipts, resulting in a $210 billion net deficit reduction.^[8] The CBO separately predicted that while most of the spending provisions do not begin until 2014,^[324]^[325] revenue would exceed spending in those subsequent years.^[326] The CBO claimed that the bill would "substantially reduce the growth of Medicare's payment rates for most services; impose an excise tax on insurance plans with relatively high premiums; and make various other changes to the federal tax code, Medicare, Medicaid, and other programs"^[327]—ultimately extending the solvency of the Medicare trust fund by 8 years.^[128]

This estimate was made prior to the Supreme Court's ruling that enabled states to opt out of the Medicaid expansion, thereby forgoing the related federal funding. The CBO and JCT subsequently updated the budget projection, estimating the impact of the ruling would reduce the cost estimate of the insurance coverage provisions by $84 billion.^[329]^[330]^[129]

The CBO in June 2015 forecast that repeal of ACA would increase the deficit between $137 billion and $353 billion over the 2016–2025 period, depending on the impact of macroeconomic feedback effects. The CBO also forecasted that repeal of ACA would likely cause an increase in GDP by an average of 0.7% in the period from 2021 to 2025, mainly by boosting the supply of labor.^[7]

Although the CBO generally does not provide cost estimates beyond the 10-year budget projection period because of the degree of uncertainty involved in the projection, it decided to do so in this case at the request of lawmakers, and estimated a second decade deficit reduction of $1.2 trillion.^[327]^[334] CBO predicted deficit reduction around a broad range of one-half percent of GDP over the 2020s while cautioning that "a wide range of changes could occur".^[130]

Opinions on CBO projections

The CBO cost estimates were criticized because they excluded the effects of potential legislation that would increase Medicare payments by more than $200 billion from 2010 to 2019.^[131]^[132]^[133] However, the so-called "doc fix" is a separate issue that would have existed whether or not ACA became law – omitting its cost from ACA was no different from omitting the cost of other tax cuts.^[134]^[135]^[136]

Scheiber and Cohn rejected critical assessments of the law's deficit impact, arguing that predictions were biased towards underestimating deficit reduction. They noted that for example, it is easier to account for the cost of definite levels of subsidies to specified numbers of people than account for savings from preventive healthcare, and that the CBO had a track record of overestimating costs and underestimating savings of health legislation;^[344]^[345] stating, "innovations in the delivery of medical care, like greater use of electronic medical records^[139] and financial incentives for more coordination of care among doctors, would produce substantial savings while also slowing the relentless climb of medical expenses ... But the CBO would not consider such savings in its calculations, because the innovations hadn't really been tried on such large scale or in concert with one another—and that meant there wasn't much hard data to prove the savings would materialize."^[344]

In 2010, David Walker, former U.S. Comptroller General then working for The Peter G. Peterson Foundation, stated that the CBO estimates are not likely to be accurate, because they were based on the assumption that the law would not change.^[348] The Center on Budget and Policy Priorities objected that Congress had a good record of implementing Medicare savings. According to their study, Congress followed through on the implementation of the vast majority of provisions enacted in the past 20 years to produce Medicare savings, although not the payment reductions addressed by the annual "doc fix".^[140]^[141]

Economic consequences

In 2015 the Center for Economic and Policy Research found no evidence that companies were reducing worker hours to avoid ACA requirements^[142] for employees working over 30 hours per week.^[143]

The CBO estimated that the ACA would slightly reduce the size of the labor force and number of hours worked, as some would no longer be tethered to employers for their insurance. Cohn, citing CBO's projections, claimed that ACA's primary employment effect was to alleviate job lock: "People who are only working because they desperately need employer-sponsored health insurance will no longer do so."^[354] He concluded that the "reform's only significant employment impact was a reduction in the labor force, primarily because people holding onto jobs just to keep insurance could finally retire", because they have health insurance outside of their jobs.^[355]

Employer mandate and part-time work

The employer mandate requires employers meeting certain criteria to provide health insurance to their workers. The mandate applies to employers with more than 50 employees that do not offer health insurance to their full-time workers.^[356] Critics claimed that the mandate created a perverse incentive for business to keep their full-time headcount below 50 and to hire part-time workers instead.^[357]^[358] Between March 2010 and 2014 the number of part-time jobs declined by 230,000, while the number of full-time jobs increased by 2 million.^[359]^[360] In the public sector full-time jobs turned into part-time jobs much more than in the private sector.^[359]^[144] A 2016 study found only limited evidence that ACA had increased part-time employment.^[145]

Several businesses and the state of Virginia added a 29-hour-a-week cap for their part-time employees,^[146]{{Unreliable source?|date=October 2013}}^[147]{{Unreliable source?|date=October 2013}} to reflect the 30-hour-or-more definition for full-time worker.^[356] As of yet, however, only a small percent of companies have shifted their workforce towards more part-time hours (4% in a survey from the Federal Reserve Bank of Minneapolis).^[358] Trends in working hours^[368] and the effects of the Great Recession correlate with part-time working hour patterns.^[148]^[149] The impact of this provision may have been offset by other factors, including that health insurance helps attract and retain employees, increases productivity and reduces absenteeism; and the lower training and administration costs of a smaller full-time workforce over a larger part-time work force.^[358]^[368]^[150] Relatively few firms employ over 50 employees^[358] and more than 90% of them offered insurance.^[375] Workers without employer insurance could purchase insurance on the exchanges.^[151]

Most policy analysts (on both right and left) were critical of the employer mandate provision.^[357]^[375] They argued that the perverse incentives regarding part-time hours, even if they did not change existing plans, were real and harmful;^[379]^[380] that the raised marginal cost of the 50th worker for businesses could limit companies' growth;^[152] that the costs of reporting and administration were not worth the costs of maintaining employer plans;^[379]^[380] and noted that the employer mandate was not essential to maintain adequate risk pools.^[153]^[385] The effects of the provision generated vocal opposition from business interests and some unions not granted exemptions.^[380]^[154]

A 2013/4 survey by the National Association for Business Economics found that about 75 percent of those surveyed said ACA hadn't influenced their planning or expectations for 2014, and 85 percent said the law wouldn't prompt a change in their hiring practices. Some 21 percent of 64 businesses surveyed said that the act would have a harmful effect and 5 percent said it would be beneficial.^[155]

Hospitals

From the start of 2010 to November 2014, 43 hospitals in rural areas closed. Critics claimed that the new law caused these hospitals to close. Many of these rural hospitals were built using funds from the 1946 Hill–Burton Act, to increase access to medical care in rural areas. Some of these hospitals reopened as other medical facilities, but only a small number operated emergency rooms (ER) or urgent care centers.^[156]

Between January 2010 and 2015, a quarter of emergency room doctors said they had seen a major surge in patients, while nearly half had seen a smaller increase. Seven in ten ER doctors claimed that they lacked the resources to deal with large increases in the number of patients. The biggest factor in the increased number of ER patients was insufficient primary care providers to handle the larger number of insured patients.^[157]

Insurers claimed that because they have access to and collect patient data that allow evaluations of interventions, they are essential to ACO success. Large insurers formed their own ACOs. Many hospitals merged and purchased physician practices. The increased market share gave them more leverage in negotiations with insurers over costs and reduced patient care options.^[41]

Public opinion

Prior to the law's passage, polling indicated the public's views became increasingly negative in reaction to specific plans discussed during the legislative debate over 2009 and 2010. Polling statistics showed a general negative opinion of the law; with those in favor at approximately 40% and those against at 51%, as of October 2013.^[392]^[393] About 29% of whites approved of the law, compared with 61% of Hispanics and 91% of African Americans.^[158] Opinions were divided by age of the person at the law's inception, with a solid majority of seniors opposing the bill and a solid majority of those younger than forty years old in favor.^[159]

Specific elements were popular across the political spectrum, while others, such as the mandate to purchase insurance, were widely disliked. In a 2012 poll 44% supported the law, with 56% against. By party affiliation, 75% of Democrats, 27% of Independents and 14% of Republicans favored the law overall. 82% favored banning insurance companies from denying coverage to people with pre-existing conditions, 61% favored allowing children to stay on their parents' insurance until age 26, 72% supported requiring companies with more than 50 employees to provide insurance for their employees, and 39% supported the individual mandate to own insurance or pay a penalty. By party affiliation, 19% of Republicans, 27% of Independents, and 59% of Democrats favored the mandate.^[396] Other polls showed additional provisions receiving majority support, including the creation of insurance exchanges, pooling small businesses and the uninsured with other consumers so that more people can take advantage of large group pricing benefits and providing subsidies to individuals and families to make health insurance more affordable.^[160]^[161]

In a 2010 poll, 62% of respondents said they thought ACA would "increase the amount of money they personally spend on health care", 56% said the bill "gives the government too much involvement in health care", and 19% said they thought they and their families would be better off with the legislation.^[162] Other polls found that people were concerned that the law would cost more than projected and would not do enough to control costs.^[163]

Some opponents believed that the reform did not go far enough: a 2012 poll indicated that 71% of Republican opponents rejected it overall, while 29% believed it did not go far enough; independent opponents were divided 67% to 33%; and among the much smaller group of Democratic opponents, 49% rejected it overall and 51% wanted more.^[396]

In June 2013, a majority of the public (52–34%) indicated a desire for "Congress to implement or tinker with the law rather than repeal it".^[164] After the Supreme Court upheld the individual mandate, a 2012 poll held that "most Americans (56%) want to see critics of President Obama's health care law drop efforts to block it and move on to other national issues".^[165]A 2014 poll reported that 48.9% of respondents had an unfavorable view of ACA vs. 38.3% who had a favorable view (of more than 5,500 individuals).^[167]

A 2014 poll reported that 26% of Americans support ACA.^[168] Another held that 8% of respondents say that the Affordable Care Act "is working well the way it is".^[169] In late 2014, a Rasmussen poll reported Repeal: 30%, Leave as is: 13%, Improve: 52%.^[170]

In 2015, a CBS News / New York Times poll reported that 47% of Americans approved the health care law. This was the first time that a major poll indicated that more respondents approved ACA than disapproved of it.^[171] The recurring Kaiser Health Tracking Poll from December 2016 reported that: a) 30% wanted to expand what the law does; b) 26% wanted to repeal the entire law; c) 19% wanted to move forward with implementing the law as it is; and d) 17% wanted to scale back what the law does, with the remainder undecided.^[172]

Separate polls from Fox News and NBC/WSJ both taken during January 2017 indicated more people viewed the law favorably than did not for the first time. One of the reasons for the improving popularity of the law is that Democrats who opposed it in the past (many prefer a "Medicare for All" approach) have shifted their positions since the ACA is under threat of repeal.^[173]

A January 2017 Morning Consult poll showed that 35% of respondents either believed that "Obamacare" and the "Affordable Care Act" were different or did not know.^[174] Approximately 45% were unsure whether the "repeal of Obamacare" also meant the "repeal of the Affordable Care Act."^[174] 39% did not know that "many people would lose coverage through Medicaid or subsidies for private health insurance if the A.C.A. were repealed and no replacement enacted," with Democrats far more likely (79%) to know that fact than Republicans (47%).^[174]

A 2017 study found that personal experience with public health insurance programs leads to greater support for the Affordable Care Act, and the effects appear to be most pronounced among Republicans and low-information voters.^[175]

Political aspects

"Obamacare"

The term "Obamacare" was originally coined by opponents as a pejorative. The term emerged in March 2007 when healthcare lobbyist Jeanne Schulte Scott used it in a health industry journal, writing "We will soon see a 'Giuliani-care' and 'Obama-care' to go along with 'McCain-care', 'Edwards-care', and a totally revamped and remodeled 'Hillary-care' from the 1990s".^[418]^[419] According to research by Elspeth Reeve, the expression was used in early 2007, generally by writers describing the candidate's proposal for expanding coverage for the uninsured.^[420] It first appeared in a political campaign by Mitt Romney in May 2007 in Des Moines, Iowa. Romney said, "In my state, I worked on healthcare for some time. We had half a million people without insurance, and I said, 'How can we get those people insured without raising taxes and without having government take over healthcare?' And let me tell you, if we don't do it, the Democrats will. If the Democrats do it, it will be socialized medicine; it'll be government-managed care. It'll be what's known as Hillarycare or Barack Obamacare, or whatever you want to call it."^[418]

By mid-2012, Obamacare had become the colloquial term used by both supporters and opponents. In contrast, the use of "Patient Protection and Affordable Care Act" or "Affordable Care Act" became limited to more formal and official use.^[420] Use of the term in a positive sense was suggested by Democrat John Conyers.^[176] Obama endorsed the nickname, saying, "I have no problem with people saying Obama cares. I do care."^[177]

In March 2012, the Obama reelection campaign embraced the term "Obamacare", urging Obama's supporters to post Twitter messages that begin, "I like #Obamacare because ...".^[425]

In October 2013, the Associated Press and NPR began cutting back on use of the term.^[178] Stuart Seidel, NPR's managing editor, said that the term "seems to be straddling somewhere between being a politically-charged term and an accepted part of the vernacular".^[179]

Common misconceptions

"Death panels"

On August 7, 2009, Sarah Palin pioneered the term "death panels" to describe groups that would decide whether sick patients were "worthy" of medical care.^[428]

One was that under the law, seniors could be denied care due to their age^[180] and the other that the government would advise seniors to end their lives instead of receiving care. The ostensible basis of these claims was the provision for an Independent Payment Advisory Board (IPAB).^[430] IPAB was given the authority to recommend cost-saving changes to Medicare by facilitating the adoption of cost-effective treatments and cost-recovering measures when the statutory levels set for Medicare were exceeded within any given 3-year period. In fact, the Board was prohibited from recommending changes that would reduce payments to certain providers before 2020, and was prohibited from recommending changes in premiums, benefits, eligibility and taxes, or other changes that would result in rationing.^[181]^[182]

The other related issue concerned advance-care planning consultation: a section of the House reform proposal would have reimbursed physicians for providing patient-requested consultations for Medicare recipients on end-of-life health planning (which is covered by many private plans), enabling patients to specify, on request, the kind of care they wished to receive.^[183] The provision was not included in ACA.^[184]

In 2010, the Pew Research Center reported that 85% of Americans were familiar with the claim, and 30% believed it was true, backed by three contemporaneous polls.^[185] A poll in August 2012 found that 39% of Americans believed the claim.^[186]

The allegation was named PolitiFact's "Lie of the Year",^[428]^[187] one of FactCheck.org's "whoppers"^[188]^[189] and the most outrageous term by the American Dialect Society.^[190] AARP described such rumors as "rife with gross—and even cruel—distortions".^[442]

Members of Congress

ACA requires members of Congress and their staffs to obtain health insurance either through an exchange or some other program approved by the law (such as Medicare), instead of using the insurance offered to federal employees (the Federal Employees Health Benefits Program).^[191]^[192]^[193]^[194]^[195]

Illegal immigrants

ACA does not provide benefits to illegal immigrants.^[196] It explicitly denies insurance subsidies to "unauthorized (illegal) aliens".^[80]^[81]^[197]

Exchange "death spiral"

One argument against the ACA is that the insurers are leaving the marketplaces, as they cannot profitably cover the available pool of customers, which contains too many unhealthy participants relative to healthy participants. A scenario where prices rise, due to an unfavorable mix of customers from the insurer's perspective, resulting in fewer customers and fewer insurers in the marketplace, further raising prices, has been called a "death spiral."^[198] During 2017, the median number of insurers offering plans on the ACA exchanges in each state was 3.0, meaning half the states had more and half had fewer insurers. There were five states with one insurer in 2017; 13 states with two; 11 states with three; and the remainder had four insurers or more. Wisconsin had the most, with 15 insurers in the marketplace. The median number of insurers was 4.0 in 2016, 5.0 in 2015, and 4.0 in 2014.^[199]

Further, the CBO reported in January 2017 that it expected enrollment in the exchanges to rise from 10 million during 2017 to 13 million by 2027, assuming laws in place at the end of the Obama administration were continued.^[200] Following a 2015 CBO report that reached a similar conclusion, Paul Krugman wrote: "But the truth is that this report is much, much closer to what supporters of reform have said than it is to the scare stories of the critics—no death spirals, no job-killing, major gains in coverage at relatively low cost."^[201]

Opposition

Opposition and efforts to repeal the legislation have drawn support from sources that include labor unions,^[456]^[457] conservative advocacy groups,^[458]^[459] Republicans, small business organizations and the Tea Party movement.^[202] These groups claimed that the law would disrupt existing health plans, increase costs from new insurance standards, and increase the deficit.^[203] Some opposed the idea of universal healthcare, viewing insurance as similar to other unsubsidized goods.^[204]^[205] President Donald Trump has repeatedly promised to "repeal and replace" it.^[206]^[207]

In October 2016, Mark Dayton, the governor of Minnesota and a member of the Minnesota Democratic–Farmer–Labor Party, said that the ACA had "many good features" but that it was "no longer affordable for increasing numbers of people" and called on the Minnesota legislature to provide emergency relief to policyholders.^[208] Dayton later said he regretted his remarks after they were seized on by Republicans seeking to repeal the law.^[209]

Legal challenges

National Federation of Independent Business v. Sebelius

Opponents challenged ACA's constitutionality in multiple lawsuits on multiple grounds.^[210]^[211]{{failed verification|reason=Probably want one of the subsidiary pages to this page|date=May 2016}} In National Federation of Independent Business v. Sebelius, the Supreme Court ruled on a 5–4 vote that the individual mandate was constitutional when viewed as a tax, although not under the Commerce Clause.

The Court further determined that states could not be forced to participate in the Medicaid expansion. ACA withheld all Medicaid funding from states declining to participate in the expansion. The Court ruled that this withdrawal of funding was unconstitutionally coercive and that individual states had the right to opt out without losing preexisting Medicaid funding.^[212]

Contraception mandate

In March 2012, the Roman Catholic Church, while supportive of ACA's objectives, voiced concern through the United States Conference of Catholic Bishops that aspects of the mandate covering contraception and sterilization and HHS's narrow definition of a religious organization violated the First Amendment right to free exercise of religion and conscience. Various lawsuits addressed these concerns.^[213]^[214]

On June 25, 2015, the U.S. Supreme Court ruled 6–3 that federal subsidies for health insurance premiums could be used in the 34 states that did not set up their own insurance exchanges.^[215]

House v. Price

In United States House of Representatives v. Price (previously United States House of Representatives v. Burwell) the House sued the administration alleging that the money for premium subsidy payments to insurers had not been appropriated, as required for any federal government spending. The ACA subsidy that helps customers pay premiums was not part of the suit.

Without the cost-sharing subsidies, the government estimated that premiums would increase by 20 percent to 30 percent for silver plans.^[216] In 2017, the uncertainty about whether the payments would continue caused Blue Cross Blue Shield of North Carolina to try to raise premiums by 22.9 percent the next year, as opposed to an increase of only 8.8 percent that it would have sought if the payments were assured.^[217]

Texas et al v. United States of America et al

Texas and nineteen other states filed a civil suit in the United States District Court for the Northern District of Texas in February 2018, arguing that with the passage of the Tax Cuts and Jobs Act of 2017, which eliminate the tax penalty for not having health insurance starting January 1, 2019, the constitutionality of the individual mandate that formed the basis of the ACA, as determined in National Federation of Independent Business, was no longer valid, and thus the entire ACA was no longer constitutional.^[218] During the prosecution of the case, the Justice Department said it would no longer defend the ACA in court, but seventeen states led by California stepped in to defend it.^[480]

District judge Reed O'Connor of Texas ruled in favor of the plaintiffs on December 14, 2018, stating [that the] "Individual Mandate can no longer be fairly read as an exercise of Congress's Tax Power and is still impermissible under the Interstate Commerce Clause—meaning the Individual Mandate is unconstitutional." He then further reasoned that the individual mandate is an essential part of the entire law, and thus inseverable, leading to declaring the entire law unconstitutional.^[219]^[220] While O'Connor ruled the law unconstitutional, he did not declare the law overturned with this decision.^[221] Through Twitter messages following the decision, President Trump urged Congress, particularly Mitch McConnell and Nancy Pelosi, to enact a replacement for the ACA with stronger protections for pre-existing conditions.^[222]^[223]

Several states with Democratic leadership state they plan to appeal the decision to the United States Court of Appeals for the Fifth Circuit, and observers believe this case will ultimately be seen by the Supreme Court.^[224] O'Connor wrote in a December 30, 2018 order that his decision is to be held back while such appeals are in progress, allowing the ACA to continue to be used after January 1, 2019.^[225]

Non-cooperation

Officials in Texas, Florida, Alabama, Wyoming, Arizona, Oklahoma and Missouri opposed those elements of ACA over which they had discretion.^[226]^[489] For example, Missouri declined to expand Medicaid or establish a health insurance marketplace engaging in active non-cooperation, enacting a statute forbidding any state or local official to render any aid not specifically required by federal law.^[490] Other Republican politicians discouraged efforts to advertise the benefits of the law. Some conservative political groups launched ad campaigns to discourage enrollment.^[227]^[228]

Repeal efforts

ACA was the subject of unsuccessful repeal efforts by Republicans in the 111th, 112th, and 113th Congresses: Representatives Steve King (R-IA) and Michele Bachmann (R-MN) introduced bills in the House to repeal ACA the day after it was signed, as did Senator Jim DeMint (R-SC) in the Senate.^[229] In 2011, after Republicans gained control of the House of Representatives, one of the first votes held was on a bill titled "Repealing the Job-Killing Health Care Law Act" (H.R. 2), which the House passed 245–189.^[230] All Republicans and 3 Democrats voted for repeal.^[231] House Democrats proposed an amendment that repeal not take effect until a majority of the Senators and Representatives had opted out of the Federal Employees Health Benefits Program; Republicans voted down the measure.^[232] In the Senate, the bill was offered as an amendment to an unrelated bill, but was voted down.^[233] President Obama had stated that he would have vetoed the bill even if it had passed both chambers of Congress.^[234]

Following the 2012 Supreme Court ruling upholding ACA as constitutional, Republicans held another vote to repeal the law on July 11;^[235] the House of Representatives voted with all 244 Republicans and 5 Democrats in favor of repeal, which marked the 33rd, partial or whole, repeal attempt.^[500]^[501] On February 3, 2015, the House of Representatives added its 67th repeal vote to the record (239 to 186). This attempt also failed.^[236]

2013 federal government shutdown

Strong partisan disagreement in Congress prevented adjustments to the Act's provisions.^[503] However, at least one change, a proposed repeal of a tax on medical devices, has received bipartisan support.^[237] Some Congressional Republicans argued against improvements to the law on the grounds they would weaken the arguments for repeal.^[380]^[506]

Republicans attempted to defund its implementation,^[489]^[238] and in October 2013, House Republicans refused to fund the federal government unless accompanied with a delay in ACA implementation, after the President unilaterally deferred the employer mandate by one year, which critics claimed he had no power to do. The House passed three versions of a bill funding the government while submitting various versions that would repeal or delay ACA, with the last version delaying enforcement of the individual mandate. The Democratic Senate leadership stated the Senate would only pass a "clean" funding bill without any restrictions on ACA. The government shutdown began on October 1.^[239]^[510]^[240] Senate Republicans threatened to block appointments to relevant agencies, such as the Independent Payment Advisory Board^[241] and Centers for Medicare and Medicaid Services.^[242]^[243]

2017 repeal effort

During a midnight congressional session starting January 11, 2017, the Senate of the 115th Congress of the United States voted to approve a "budget blueprint" which would allow Republicans to repeal parts of the law "without threat of a Democratic filibuster."^[244]^[245] The plan, which passed 51–48, is a budget blueprint named by Senate Republicans the "Obamacare 'repeal resolution.{{' "}}^[246] Democrats opposing the resolution staged a protest during the vote.^[247]

May 4, 2017, the United States House of Representatives voted to pass the American Health Care Act (and thereby repeal most of the Affordable Care Act) by a narrow margin of 217 to 213, sending the bill to the Senate for deliberation.^[250] The Senate Republican leadership announced that Senate Republicans would write their own version of the bill, instead of voting on the House version.^[251]

The Senate process began with an unprecedented level of secrecy; Senate Majority Leader Mitch McConnell named a group of 13 Republican Senators to draft the Senate's substitute version in private, raising bipartisan concerns about a lack of transparency.^[252]^[253]^[254] On June 22, 2017, Republicans released the first discussion draft for an amendment to the bill, which would rename it to the "Better Care Reconciliation Act of 2017" (BCRA).^[255] On July 25, 2017, although no amendment proposal had yet garnered majority support, Senate Republicans voted to advance the bill to the floor and begin formal consideration of amendments. Senators Susan Collins and Lisa Murkowski were the only two dissenting Republicans making the vote a 50–50 tie. Vice President Mike Pence then cast the tiebreaking vote in the affirmative.^[256]

All specific bills were defeated, however. The revised BCRA failed on a vote of 43–57. A subsequent "Obamacare Repeal and Reconciliation Act" abandoned the "repeal and replace" approach in favor of a straight repeal, but failed on a vote of 45–55. Finally, the "Health Care Freedom Act", nicknamed "skinny repeal" because it would have made the least change to the ACA, failed by 49–51, with Collins, Murkowski, and Senator John McCain joining all the Democrats and independents in voting against it.^[257]

Actions to hinder implementation

Under both the ACA (current law) and the AHCA, CBO reported that the health exchange marketplaces would remain stable (i.e., no "death spiral").^[530] However, Republican politicians have taken a variety of steps to undermine it, creating uncertainty that has adversely impacted enrollment and insurer participation while increasing premiums.^[259] Insisting the exchanges are in difficulty was also used as an argument for passing reforms such as AHCA or BCRA. Past and ongoing Republican attempts to weaken the law have included, among others:

Ending cost-sharing reduction (CSR) payments

President Trump announced on October 12, 2017,^[271] he would end the smaller of the two types of subsidies under the ACA, the cost sharing reduction (CSR) subsidies. This controversial decision significantly raised premiums on the ACA exchanges along with the premium tax credit subsidies that rise with them, with the CBO estimating a $200 billion increase in the budget deficit over a decade. The reasons for this are complex and require discussion of how the two major subsidies work.^[272]

The CSR subsidies are paid to insurance companies to reduce copayments and deductibles for a smaller group of ACA enrollees, those earning less than 250% of the federal poverty line (FPL). The second and larger type of subsidy, the premium tax credits designed to reduce the post-subsidy cost of monthly premiums, apply to all enrollees earning less than 400% of the FPL. For scale, during 2017, approximately $7 billion in CSR subsidies will be paid, versus $34 billion for the premium tax credits.^[273] A court decision meant that CSR subsidies were treated as discretionary spending, meaning Congress must decide to appropriate funds for them each year. This effectively gave the President the power to end them, as Democrats with a minority in Congress could not appropriate the funds, let alone override his veto of an appropriations bill.^[272]

However, the premium tax credits are mandatory spending, meaning all those eligible under the ACA receive them without Congressional appropriation. These adjust with premium increases to limit after-subsidy premium payments by ACA enrollees to a fixed percentage of income. Based on President Trump's threats to end the CSR payments during early 2017, several insurers and actuarial groups estimated this resulted in a 20 percentage point or more increase in premiums for the 2018 plan year. In other words, premium increases expected to be 10% or less in 2018 became 28–40% instead.^[269]^[272]

The CBO reported in August 2017 (prior to President Trump's decision) that ending the CSR payments might increase ACA premiums by 20 percentage points or more, with a resulting increase of nearly $200 billion in the budget deficit over a decade, as the premium tax credit subsidies would rise along with premium prices. CBO also estimated that initially up to one million fewer would have health insurance coverage, although more might have it in the long-run as the subsidies expand. CBO expected the exchanges to remain stable (i.e., no "death spiral" before or after Trump's action) as the premiums would increase and prices would stabilize at the higher (non-CSR) level.^[274]

CBO estimated that of the 12 million with private insurance via the ACA exchanges in 2017, about 10 million receive premium tax credit subsidies and will be shielded from premium increases, as their after-subsidy premiums are limited as a percentage of income under the ACA. However, those 2 million who do not receive subsidies face the brunt of the 20%+ premium increases, without subsidy assistance. This may adversely impact enrollment in 2018 and beyond. Another 13 million who are covered under the ACA's Medicaid expansion (in the 31 states that chose to expand coverage) should not be directly affected by Trump's action.^[274]^[273]

President Trump's argument that the CSR payments were a "bailout" for insurance companies and therefore should be stopped, actually results in the government paying more to insurance companies ($200B over a decade) due to increases in the premium tax credit subsidies.^[272]

Implementation

At various times during and after the ACA debate, Obama stated that "if you like your health care plan, you'll be able to keep your health care plan".^[275]^[555] However, in fall 2013 millions of Americans with individual policies received notices that their insurance plans were terminated,^[276] and several million more risked seeing their current plans cancelled.^[277]^[278]^[279] However, Poltifact cited various estimates that only about 2% of the total insured population (4 million out of 262 million) received such notices.^[280] Obama's previous unambiguous assurance that consumers' could keep their own plans became a focal point for critics, who challenged his truthfulness.^[281]^[282] On November 7, 2013, President Obama stated: "I am sorry that [people losing their plans] are finding themselves in this situation based on assurances they got from me."^[283] Various bills were introduced in Congress to allow people to keep their plans.^[284]

In 2010 small business tax credits took effect.^[285] Then Pre-Existing Condition Insurance Plan (PCIP) took effect to offer insurance to those that had been denied coverage by private insurance companies because of a pre-existing condition.^[285] By 2011, insurers had stopped marketing child-only policies in 17 states, as they sought to escape this requirement.^[286] In National Federation of Independent Business v. Sebelius decided on June 28, 2012, the Supreme Court ruled that the individual mandate was constitutional when the associated penalties were construed as a tax. The decision allowed states to opt out of the Medicaid expansion.^[287]^[288]^[289]

In 2013, the Internal Revenue Service ruled that the cost of covering only the individual employee would be considered in determining whether the cost of coverage exceeded 9.5% of income. Family plans would not be considered even if the cost was above the 9.5% income threshold.^[290]^[291] In July 2 it was announced the implementation of the employer mandate would be delayed until 2015.^[375]^[574]^[575] The launch for both the state and federal exchanges was troubled due to management and technical failings. HealthCare.gov, the website that offers insurance through the exchanges operated by the federal government, crashed on opening and suffered endless problems.^[292] Operations stabilized in 2014, although not all planned features were complete.^[293]^[294]

The Government Accountability Office released a non-partisan study in 2014 that concluded that the administration did not provide "effective planning or oversight practices" in developing the ACA website.^[579] In Burwell v. Hobby Lobby the Supreme Court exempted closely held corporations with religious convictions from the contraception rule.^[580] At the beginning of the 2015, 11.7 million had signed up (ex-Medicaid).^[295] By the end of the year about 8.8 million consumers had stayed in the program.^[296] The December spending bill delayed the onset of the "Cadillac tax" on expensive insurance plans by two years, until 2020.^[297] In January 2018, the implementation of the "Cadillac Tax" was postponed until 2022.

An estimated 9 million to 10 million people had gained Medicaid coverage in 2016, mostly low-income adults.^[278] A survey of New York businesses found an increase of 8.5 percent in health care costs, less than the prior year's survey had expected.^[298] The five major national insurers expected to lose money on ACA policies in 2016.^[299] One of the causes of insurer losses is the lower income, older and sicker enrollee population.^[300]

More than 9.2 million people signed up for care on the national exchange (healthcare.gov) for 2017, down some 400,000 from 2016. This decline was due primarily to the election of President Trump.^[588] Of the 9.2 million, 3.0 million were new customers and 6.2 million were returning. The 9.2 million excludes the 11 states that run their own exchanges, which have signed up around 3 million additional people.^[301] The IRS announced that it would not require that tax returns indicate that a person has health insurance, reducing the effectiveness of the individual mandate, in response to an executive order from President Donald Trump.^[302] The CBO reported in March that the healthcare exchanges were expected to be stable.^[303] In May the United States House of Representatives voted to repeal the ACA using the American Health Care Act of 2017.^[304]^[305] The individual mandate was repealed starting in 2019 via the "Tax Cuts and Jobs Act of 2017".^[20] The CBO estimated that the repeal would cause 13 million people to lose their health insurance by 2027.^[306]

By 2019, 35 states and the District of Columbia had either expanded coverage via traditional Medicare or via an alternative program.^[307]

Murray—Alexander Individual Market Stabilization Bill

Senator Lamar Alexander and Senator Patty Murray reached a compromise to amend the Affordable Care Act to fund cost cost-sharing reductions.^[308] President Trump had stopped paying the cost sharing subsidies and the Congressional Budget Office estimated his action would cost $200 billion, cause insurance sold on the exchange to cost 20% more and cause one million people to lose insurance.^[309] The proposed legislation will also provide more flexibility for state waivers, allow a new "Copper Plan" or catastrophic coverage for all, allow interstate insurance compacts, and redirect consumer fees to states for outreach.

See also

References

1. ^{{cite journal |last1=Gruber |first1=Jonathan |title=The Impacts of the Affordable Care Act: How Reasonable Are the Projections? |journal=National Tax Journal |date=2011 |volume=64 |issue=3 |pages=893–908 |url=https://economics.mit.edu/files/11416 |accessdate=23 July 2017 |doi=10.17310/ntj.2011.3.06}}
2. ^{{cite web |last1=Kirzinger |first1=Ashley |last2=Sugarman |first2=Elise |last3=Brodie |first3=Mollyann |title=Kaiser Health Tracking Poll: November 2016 |url=http://www.kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-november-2016/ |publisher=Kaiser Family Foundation |accessdate=23 July 2017 |date=1 December 2016}}
3. ^{{cite news |title=Gallup: ObamaCare has majority support for first time |url=http://thehill.com/policy/healthcare/327267-poll-obamacare-has-majority-support-for-first-time |accessdate=18 November 2017 |work=The Hill |language=en}}
4. ^¹²³{{cite journal |last1=Oberlander |first1=Jonathan |title=Long Time Coming: Why Health Reform Finally Passed |journal=Health Affairs |date=1 June 2010 |volume=29 |issue=6 |pages=1112–1116 |doi=10.1377/hlthaff.2010.0447 |pmid=20530339 |url=http://content.healthaffairs.org/content/29/6/1112.full |language=en |issn=0278-2715 |deadurl=yes |archiveurl=https://web.archive.org/web/20161205105530/http://content.healthaffairs.org/content/29/6/1112.full |archivedate=December 5, 2016 |df=mdy-all }}
5. ^¹²³⁴{{cite journal |last1=Blumenthal |first1=David |last2=Abrams |first2=Melinda |last3=Nuzum |first3=Rachel |title=The Affordable Care Act at 5 Years |journal=New England Journal of Medicine |date=18 June 2015 |volume=372 |issue=25 |pages=2451–2458 |doi=10.1056/NEJMhpr1503614 |pmid=25946142 |issn=0028-4793}}
6. ^¹{{cite book |last1=Cohen |first1=Alan B. |last2=Colby |first2=David C. |last3=Wailoo |first3=Keith A. |last4=Zelizer |first4=Julian E. |title=Medicare and Medicaid at 50: America's Entitlement Programs in the Age of Affordable Care |date=1 June 2015 |publisher=Oxford University Press |isbn=9780190231569 |url=https://books.google.com/books?id=H9DGBwAAQBAJ |language=en}}
7. ^{{cite news |last1=Stolberg |first1=Sheryl Gay |last2=Pear |first2=Robert |title=Obama Signs Health Care Overhaul Into Law |url=https://www.nytimes.com/2010/03/24/health/policy/24health.html |work=The New York Times |date=23 March 2010}}
8. ^¹{{cite news |last1=Vicini |first1=James |last2=Stempel |first2=Jonathan |last3=Biskupic |first3=Joan |title=Top court upholds healthcare law in Obama triumph |url=https://www.reuters.com/article/us-usa-healthcare-court-idUSBRE85R06420120628 |work=Reuters |date=28 June 2017}}
9. ^{{cite news |last1=Greenberg |first1=Jon |title=Rand Paul goes too far on Obamacare Medicaid growth |url=http://www.politifact.com/truth-o-meter/statements/2017/jan/15/rand-paul/medicaid-expansion-drove-health-insurance-coverage/ |work=politifact |date=15 January 2017 |language=en}}
10. ^{{cite web |last1=Amadeo |first1=Kimberly |title=How Much Will Obamacare Cost Me |url=https://www.thebalance.com/how-much-will-obamacare-cost-me-3306054 |website=The Balance |accessdate=November 11, 2016}}
11. ^{{cite web |url=http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html |title=Preventive Services Covered Under the Affordable Care Act}}
12. ^{{cite web |url=http://kff.org/health-reform/fact-sheet/quick-take-essential-health-benefits-what-have-states-decided-for-their-benchmark |title=Quick Take: Essential Health Benefits: What Have States Decided for Their Benchmark? |date=December 7, 2012 |publisher=Kaiser Family}}
13. ^[https://www.govtrack.us/congress/bills/111/hr3590/text PPACA], 2713,(a)(4)
14. ^Women's Preventive Services Guidelines HRSA, US Department of Health and Human Services
15. ^{{cite web |title=How do out-of-pocket maximums work? |publisher=Blue Cross Blue Shield of Michigan |url=http://www.bcbsm.com/index/health-insurance-help/faqs/topics/how-health-insurance-works/out-of-pocket-maximums.html}}
16. ^{{cite web |title=Age Band Rating (ACA) |publisher=National Association of Personal Financial Advisors |url=http://www.naifa.org/practice-resources/prp/age-band-rating-(aca)}}
17. ^{{cite web |url=https://www.healthcare.gov/glossary/health-plan-categories/ |title=Health Plan Categories |publisher=HealthCare.Gov, managed by the Centers for Medicare and Medicaid Services}}
18. ^{{cite news |url=https://newrepublic.com/article/113851/obamacare-individual-mandate-republicans-push-delay |title=Obamacare's Individual Mandate Can't Wait |last=Cohn |first=Jonathan |date=July 15, 2013 |work=The New Republic}}
{{cite news |url=https://newrepublic.com/blog/jonathan-cohn/102285/supreme-court-obamacare-mandate-severability-cbo |title=What If the Mandate Goes? |last=Cohn |first=Jonathan |date=April 2, 2012 |work=The New Republic}}
19. ^{{cite news |url=https://newrepublic.com/article/health-care/why-americans-should-support-individual-mandate |title=Common Sense |last=Cohn |first=Jonathan |date=April 9, 2010 |work=The New Republic}}
{{cite news |url=https://newrepublic.com/blog/jonathan-cohn/102285/supreme-court-obamacare-mandate-severability-cbo |title=What If the Mandate Goes? |last=Cohn |first=Jonathan |date=April 2, 2012 |work=The New Republic}}
{{cite news |url=https://newrepublic.com/blog/jonathan-cohn/98928/individual-mandate-mistake-health-reform-starr-cbo-ppaca |title=Was the Mandate a Mistake? |last=Cohn |first=Jonathan |date=December 26, 2011 |work=The New Republic}}
20. ^¹²{{Cite news|url=http://www.foxnews.com/opinion/2017/12/20/sen-orrin-hatch-repealing-individual-mandate-tax-is-beginning-end-obamacare-era.html|title=Sen. Orrin Hatch: Repealing the individual mandate tax is the beginning of the end of the ObamaCare era|first=Orrin|last=Hatch|date=December 20, 2017|accessdate=December 21, 2017|publisher=Fox News}}
21. ^{{Cite news |url=http://www.rollcall.com/news/the_question_of_abortion_coverage_in_health_exchanges-226547-1.html |title=The Question of Abortion Coverage in Health Exchanges |last=Adams |first=Rebecca |date=July 22, 2013 |work=Roll Call}}
22. ^¹{{citation |url=http://www.rubio.senate.gov/public/_cache/files/1dc92ef8-c340-4cfd-95c0-67369a557f1e/2AA5EF8F125279800BFABC8B8BA37072.05.24.2016-crs-rubio-memo-risk-corridors-1-5-16-1-redacted.pdf |title=Lawsuits to Recover Payments under the Risk Corridors Program of the Affordable Care Act |date=January 5, 2016 |accessdate=February 11, 2017 |author=Legislative Attorneys, American Law Division |publisher=Congressional Research Service |page=6}}
23. ^¹{{citation |title=Trouble on the Exchanges – Does the United States Owe Billions to Health Insurers? |author=Nicholas Bagley |journal=New England Journal of Medicine |date=November 24, 2016 |doi=10.1056/NEJMp1612486 |pmid=27959725 |volume=375 |issue = 21|pages=2017–2019}}
24. ^{{citation |url=https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/faq-risk-corridors-04-11-2014.pdf |date=April 11, 2014 |title=Risk Corridors and Budget Neutrality |publisher=Centers for Medicare & Medicaid Services (CMS) |location=Washington, DC}} Department of Health and Human Services
25. ^{{citation |title=Yes, Marco Rubio Led The Effort To End Obamacare's Health |publisher=Forbes |url=https://www.forbes.com/.../yes-marco-rubio-led-the-effort-to-end-obamacares-health-insuran... |date=December 15, 2015 |accessdate=February 10, 2017}}
26. ^{{cite news |url=https://www.washingtonpost.com/news/fact-checker/wp/2015/12/23/rubios-inaccurate-claim-that-he-inserted-a-provision-restricting-obamacare-bailout-funds/ |title=Rubio's inaccurate claim that he 'inserted' a provision restricting Obamacare 'bailout' funds |newspaper=The Washington Post |date=December 23, 2015 |first=Glenn |last=Kessler}}
27. ^¹{{citation |url=http://www.latimes.com/business/hiltzik/la-fi-hiltzik-risk-corridor-moda-20170210-story.html |title=With billions at stake, a federal judge just nullified the GOP's most cynical attack on Obamacare |publisher=LA Times |date=February 10, 2017 |accessdate=February 10, 2017 |author=Michael Hiltzik}}
28. ^{{citation |url=https://ecf.cofc.uscourts.gov/cgi-bin/show_public_doc?2016cv0649-23-0 |title=Moda Health Plan, Inc. v. The United States |publisher=US Courts |date=February 10, 2017 |accessdate=February 10, 2017 |pages=40}}
29. ^{{cite news |author=HHS Press Office |date=March 29, 2013 |title=HHS finalizes rule guaranteeing 100 percent funding for new Medicaid beneficiaries |location=Washington, D.C. |publisher=U.S. Department of Health & Human Services |url=https://www.hhs.gov/news/press/2013pres/03/20130329a.html |accessdate=April 23, 2013 |quote=effective January 1, 2014, the federal government will pay 100 percent of defined cost of certain newly eligible adult Medicaid beneficiaries. These payments will be in effect through 2016, phasing down to a permanent 90 percent matching rate by 2020.}}
{{cite journal |author=Centers for Medicare & Medicaid Services |date=April 2, 2013 |title=Medicaid program: Increased federal medical assistance percentage changes under the Affordable Care Act of 2010: Final rule |journal=Federal Register |volume=78 |issue=63 |pages=19917–19947 |quote=(A) 100 percent, for calendar quarters in calendar years (CYs) 2014 through 2016; (B) 95 percent, for calendar quarters in CY 2017; (C) 94 percent, for calendar quarters in CY 2018; (D) 93 percent, for calendar quarters in CY 2019; (E) 90 percent, for calendar quarters in CY 2020 and all subsequent calendar years.}}
30. ^https://www.hhs.gov/news/press/2013pres/03/20130329a.html
31. ^http://www.cbpp.org/cms/?fa=view&id=3801
32. ^{{cite web |title=Higher Spending Relative to Medicare Fee-for-Service May Not Ensure Lower Out-of-Pocket Costs for Beneficiaries |url=http://www.gao.gov/products/GAO-08-522T |publisher=Government Accountability Office |date=February 8, 2008 |accessdate=October 7, 2013}}
33. ^{{cite web |url=http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf |title=PPACA, section 9015 as modified by section 10906}}
34. ^{{cite web |url=http://www.gpo.gov/fdsys/pkg/BILLS-111hr4872enr/pdf/BILLS-111hr4872enr.pdf |title=HCERA section 1402}}
35. ^{{cite web |url=http://www.commonwealthfund.org/publications/issue-briefs/2015/dec/aca-cadillac-tax |title=Rethinking the Affordable Care Act's "Cadillac Tax": A More Equitable Way to Encourage "Chevy" Consumption |publisher=Commonwealth Fund|date=December 18, 2015|first1=Sarah|last1=Nowak|first2=Christine|last2=Eibner}}
36. ^{{cite web |url=http://www.taxpolicycenter.org/briefing-book/what-are-major-federal-excise-taxes-and-how-much-money-do-they-raise |title=Briefing Book|publisher=Tax Policy Center}}
37. ^{{cite web |url=https://www.whitehouse.gov/sites/default/files/rss_viewer/fact_sheet_young_adults_may10.pdf |title=Young Adults and the Affordable Care Act |deadurl=yes |archiveurl=https://web.archive.org/web/20161111074656/https://www.whitehouse.gov/sites/default/files/rss_viewer/fact_sheet_young_adults_may10.pdf |archivedate=November 11, 2016 |df=mdy-all }}
38. ^{{cite web |url=http://www.medscape.com/viewarticle/748502 |title=Access |publisher=Medscape |accessdate=January 9, 2012}}{{Registration required}}
39. ^{{cite web |url=http://www.huronconsultinggroup.com/researchdetails.aspx?articleId=2577 |title=Key Healthcare Reform Initiatives: Medicare Bundled Payment Pilots |date=November 19, 2010 |publisher=Huron Consulting Group |accessdate=January 9, 2012}}
40. ^{{cite web |url=http://www.medicare.gov/part-d/costs/coverage-gap/more-drug-savings-in-2020.html |title=More savings in the drug coverage gap coming through 2020 |publisher=Centers for Medicare & Medicaid Services |accessdate=September 27, 2013 |archive-url=https://web.archive.org/web/20130923130511/https://www.medicare.gov/part-d/costs/coverage-gap/more-drug-savings-in-2020.html |archive-date=September 23, 2013 |dead-url=yes |df=mdy-all }}
41. ^¹²{{Cite web |url=http://khn.org/news/aco-accountable-care-organization-faq/ |title=Accountable Care Organizations, Explained |last= |first= |date=September 14, 2015 |website= |publisher=Kaiser Health News |language=en-US |accessdate=August 18, 2016}}
42. ^{{Cite web |url=https://www.washingtonpost.com/sf/brand-connect/wp/2014/03/17/what-the-affordable-care-act-means-for-prescription-coverage/ |title=What the Affordable Care Act means for prescription coverage |website=Washington Post |accessdate=August 7, 2016}}
43. ^Claffey, Jason (August 14, 2010). "Medicare 'Doughnut Hole' Checks in the Mail". Foster's Daily Democrat. Retrieved December 26, 2012.
44. ^{{cite web |url=http://www.medicare.gov/Publications/Pubs/pdf/11493.pdf |title=Closing the Coverage Gap – Medicare Prescription Drugs Are Becoming More Affordable |date=January 2015 |publisher=CMS |deadurl=yes |archiveurl=https://web.archive.org/web/20130523191556/http://www.medicare.gov/Publications/Pubs/pdf/11493.pdf |archivedate=May 23, 2013 |df=mdy-all }}
45. ^{{cite web |url=https://www.bostonglobe.com/business/2015/01/25/costs-derail-vermont-single-payer-health-plan/VTAEZFGpWvTen0QFahW0pO/story.html |title=Costs derail Vermont's single-payer health plan |publisher=The Boston Globe}}
46. ^{{cite news|url=https://www.nytimes.com/2010/03/30/health/30care.html|title=Options Expand for Affordable Long-Term Care|last=Span|first=Paula|date=March 29, 2010|newspaper=The New York Times|accessdate=March 29, 2010}}
47. ^Carney, Timothy (February 28, 2011) So, yeah, the health-care bill was really an awful piece of legislation that sent the revolving door spinning faster{{dead link|date=November 2017 |bot=InternetArchiveBot |fix-attempted=yes }}, Washington Examiner
48. ^{{cite web |url=http://www.healthcare.gov/law/features/choices/co-op/index.html |title=Consumer Operated and Oriented Plans (CO-OPs)}}
49. ^[https://wreg.com/2018/05/07/affordable-care-acts-calorie-count-rules-go-into-effect/ Affordable Care Act's calorie count rules go into effect]
50. ^{{cite web |url=http://healthcarereform.procon.org/sourcefiles/1989_assuring_affordable_health_care_for_all_americans.pdf |first=Stuart M. |last=Butler |publisher=The Heritage Foundation |title=Assuring Affordable Healthcare for All Americans|year=1989}}
51. ^{{cite news |url=http://www.newsmax.com/insidecover/hillary_health_care/2007/10/05/38601.html |title=Hillary Claims Credit for Child Program |agency=Associated Press for NewsMax |first=Beth |last=Fouhy |date=October 5, 2007 |archiveurl=https://web.archive.org/web/20080123174618/http://www.newsmax.com/insidecover/hillary_health_care/2007/10/05/38601.html |archivedate=January 23, 2008}}
52. ^{{cite web |url=https://www.npr.org/2012/03/31/149767150/in-1993-republicans-proposed-a-mandate-first |title=In 1993, Republicans Proposed A Mandate First |publisher=NPR |date=March 31, 2012}}
53. ^{{cite web |url=http://healthcarereform.procon.org/view.resource.php?resourceID=004182 |title=History of the Individual Health Insurance Mandate, 1989–2010 Republican Origins of Democratic Health Care Provision |publisher=ProCon.org |date=February 9, 2012}}
54. ^{{cite web |url=http://www.coloradostatesman.com/content/991732-ag-suthers-couldn%3Ft-be-more-wrong-his-decision-file-lawsuit |title=AG Suthers couldn't be more wrong in his decision to file lawsuit |newspaper=Colorado Statesman |accessdate=July 29, 2012}}
55. ^{{cite news |url=https://www.nytimes.com/2012/02/27/opinion/gop-and-health-mandate.html?_r=2&adxnnl=1&adxnnlx=1333652503-360xnkv/rpzNURZGZh5Vdw |work=The New York Times |title=G.O.P. and Health Mandate |date=February 26, 2012}}
56. ^{{cite news |url=https://www.bloomberg.com/news/2012-03-26/romneycare-s-98-success-rate-defies-gripes-on-obama-law.html |publisher=Bloomberg |title=Romneycare's 98% Success Rate Defies Gripes on Obama Law |date=March 26, 2012}}
57. ^{{cite news |url=http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2011/06/28/romneycare_vs_obamacare |title=RomneyCare vs. ObamaCare |work=The Boston Globe |date=June 28, 2011 |first=Robert |last=Kuttner |accessdate=September 23, 2013}}
58. ^{{cite news |title=CNN Democratic presidential debate |url=http://www.cnn.com/2008/POLITICS/01/21/debate.transcript2/ |publisher=CNN |date=January 21, 2008 |accessdate=September 26, 2013}}
59. ^{{Cite journal |last=Rustgi |first=Sheila |last2=Collins |first2=Sara R. |last3=Davis |first3=Karen |last4=Nicholson |first4=Jennifer L. |title=The 2008 Presidential Candidates' Health Reform Proposals: Choices for America |url=http://www.commonwealthfund.org/publications/fund-reports/2008/oct/the-2008-presidential-candidates-health-reform-proposals--choices-for-america |language=en}}
60. ^{{cite web |title=Health Care Reform from Conception to Final Passage |url=http://finance.senate.gov/issue/?id=32be19bd-491e-4192-812f-f65215c1ba65 |accessdate=November 23, 2010}}
61. ^{{cite web |url=http://www.c-spanvideo.org/videoLibrary/search-results.php?organization=%22Finance%22&organization=%22Senate+Committee%22&date-from=01%2F06%2F2009&date-to=01%2F02%2F2011 |archive-url=https://archive.today/20120802043711/http://www.c-spanvideo.org/videoLibrary/search-results.php?organization=%22Finance%22&organization=%22Senate+Committee%22&date-from=01/06/2009&date-to=01/02/2011 |dead-url=yes |archive-date=2012-08-02 |title=Senate Finance Committee Hearings for the 111th Congress recorded by C-SPAN |publisher=C-SPAN }}
62. ^{{cite web |url=http://finance.senate.gov/hearings/index.cfm?PageNum_rs=1&maxrows=100 |title=Senate Finance Committee hearings for 111th Congress |publisher=Finance.Senate.Gov |accessdate=April 1, 2012 |deadurl=yes |archiveurl=https://web.archive.org/web/20130111185729/http://www.finance.senate.gov/hearings/index.cfm?PageNum_rs=1&maxrows=100 |archivedate=January 11, 2013 |df=}}
63. ^{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/article/health-care/party-is-such-sweet-sorrow |title=Party Is Such Sweet Sorrow |work=The New Republic |date=September 4, 2009}}
64. ^{{cite news |first=Jonathan |last=Chait |url=https://newrepublic.com/blog/jonathan-chait/obamas-moderate-health-care-plan |title=Obama's Moderate Health Care Plan |work=The New Republic |date=April 22, 2010}}
{{cite news |first=Jonathan |last=Chait |url=https://newrepublic.com/blog/the-plank/the-republican-health-care-blunder |title=The Republican Health Care Blunder |work=The New Republic |date=December 19, 2009}}
65. ^{{cite news |first=Carl |last=Hulse |first2=Adam |last2=Nagourney |url=https://www.nytimes.com/2010/03/17/us/politics/17mcconnell.html?pagewanted=1&hp |title=Senate G.O.P. Leader Finds Weapon in Unity |work=The New York Times |date=March 16, 2010}}
66. ^{{cite news |first=Joe |last=Eaton |first2=M. B. |last2=Pell |first3=Aaron |last3=Mehta |url=https://www.npr.org/templates/story/story.php?storyId=125170643 |title=Lobbying Giants Cash In On Health Overhaul |publisher=NPR |date=March 26, 2010 |accessdate=April 9, 2012}}
67. ^{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/article/politics/drug-deal |title=Drug Deal |work=The New Republic |date=August 25, 2009}}
68. ^{{cite news |url=http://www.huffingtonpost.com/2009/08/13/internal-memo-confirms-bi_n_258285.html |publisher=The Huffington Post |first=Ryan |last=Grim |title=Internal Memo Confirms Big Giveaways In White House Deal With Big Pharma |date=August 13, 2009}}
69. ^{{cite web |url=http://sunlightfoundation.com/projects/2009/healthcare_lobbyist_complex |title=Visualizing The Health Care Lobbyist Complex |publisher=Sunlight Foundation |date=July 22, 2009 |accessdate=April 1, 2012 |archive-url=https://web.archive.org/web/20120405053508/http://sunlightfoundation.com/projects/2009/healthcare_lobbyist_complex/ |archive-date=April 5, 2012 |dead-url=yes |df=mdy-all }}
70. ^{{cite news |first1=Laurie |last1=Kellman |first2=Jim |last2=Abrams |url=http://www.boston.com/business/healthcare/articles/2010/03/26/threats_against_lawmakers_spread_after_health_vote/?page=full |title=Threats against lawmakers spread after health vote |date=March 26, 2010 |publisher=Associated Press}}
71. ^{{cite web |last=Kennedy |first=Edward M. |authorlink=Ted Kennedy |title=Text of letter to the President from Senator Edward M. Kennedy |url=http://www.whitehouse.gov/the_press_office/Text-of-letter-to-the-President-from-Senator-Edward-M-Kennedy |date=May 12, 2009 |publisher=White House Press Secretary |accessdate=September 10, 2009 |archiveurl=https://web.archive.org/web/20090910065606/http://www.whitehouse.gov/the_press_office/Text-of-letter-to-the-President-from-Senator-Edward-M-Kennedy |archivedate=September 10, 2009 |deadurl=yes |df=mdy-all }}
72. ^{{USBill|111|S.AMDT.|2786}}
73. ^{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/blog/the-treatment/why-reform-survived-august |title=Why Reform Survived August |work=The New Republic |date=September 7, 2009}}
74. ^{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/blog/the-treatment/what-public-option-supporters-won |title=What Public Option Supporters Won |work=The New Republic |date=December 15, 2009}}
75. ^{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/blog/the-treatment/ben-nelson-still-big-problem |title=Ben Nelson, Still a Big Problem (Updated) |work=The New Republic |date=December 17, 2009}}
76. ^{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/blog/the-treatment/breaking-nelson-says-yes-makes-60 |title=Nelson Says Yes; That Makes 60 |work=The New Republic |date=December 19, 2009}}
77. ^{{cite news |title={{-'}}Cornhusker' Out, More Deals In: Health Care Bill Gives Special Treatment|url=http://www.foxnews.com/politics/2010/03/18/cornhusker-kickback-gets-boot-health|date=March 19, 2010|publisher=Fox News|accessdate=April 26, 2010}}
78. ^{{cite web |url=https://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=111&session=1&vote=00395 |title=Roll Call vote No. 395 – On the Cloture Motion (Motion to Invoke Cloture on H.R. 3590) |publisher=U.S. Senate |accessdate=July 20, 2017}}
79. ^"AARP, AMA Announce Support For Health Care Bill: Largest Doctors And Retiree Groups Backing Legislation". The Huffington Post, March 19, 2010.
80. ^{{cite news |first=J. Scott |last=Applewhite |agency=Associated Press |url=http://www.cleveland.com/nation/index.ssf/2010/01/senator-elect_scott_brown_welc.html |title=Senator-elect Scott Brown welcomed as Republican hero after upset victory in Massachusetts |publisher=McClatchy-Tribune News Service |accessdate=April 19, 2012}}
81. ^{{cite press release |url=http://www.votesmart.org/public-statement/477580/scott-brown-responds-to-martha-coakleys-misleading-health-care-distortions |title=Public Statements – Project Vote Smart |publisher=Votesmart.org |date=January 13, 2010 |accessdate=April 9, 2012}}
82. ^{{cite web |first=Nate |last=Silver |url=http://www.fivethirtyeight.com/2010/01/will-base-abandon-hope.html |title=Will the Base Abandon Hope? |publisher=FiveThirtyEight |date=January 21, 2010}}
83. ^{{cite web |url=http://www.kaiserhealthnews.org/Daily-Reports/2010/February/22/President-Obama-Health-Care-Reform-Plan.aspx |title=White House Unveils Revamped Reform Plan, GOP And Industry React |publisher=Kaiser Health News |date=February 22, 2010 |accessdate=June 29, 2012}}
84. ^{{cite web |first=Nate |last=Silver |url=http://www.fivethirtyeight.com/2010/01/1-reconciliation-2-3-profit.html |title=1. Reconciliation! 2. ??? 3. Profit! |publisher=FiveThirtyEight |date=January 21, 2010}}
85. ^{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/blog/the-treatment/reconciliation-why-most-dems-dont-want-go-there |title=Reconciliation: Why Most Dems Don't Want to Go There |work=The New Republic |date=September 21, 2009}}
86. ^{{cite news |first=Jonathan |last=Chait |url=https://newrepublic.com/blog/jonathan-chait/stupak-makes-deal-reform-pass |title=Stupak Makes A Deal, Reform To Pass |work=The New Republic |date=March 21, 2010}}
87. ^{{Cite news |title=Obama Signs Health Care Overhaul Bill, With a Flourish |first=Sheryl |last=Stolberg |first2=Robert |last2=Pear |url=https://www.nytimes.com/2010/03/24/health/policy/24health.html |newspaper=The New York Times |date=March 23, 2010 |accessdate=March 24, 2010}}
88. ^{{cite web |title=On Groundhog Day, Republicans vote to repeal Obamacare |publisher=MSNBC |date=February 2, 2016 |author=Benen, Steve |url=http://www.msnbc.com/rachel-maddow-show/groundhog-day-republicans-vote-repeal-obamacare}}
89. ^{{Cite web |url=https://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201611_01.pdf |title=National Health Interview Survey, January to June 2016 |website=CDC.gov |accessdate=November 23, 2016}}
90. ^{{cite news |last1=Barry-Jester |first1=Anna Maria |last2=Ben |first2=Casselman |title=Obamacare Has Increased Insurance Coverage Everywhere |url=http://fivethirtyeight.com/features/obamacare-has-increased-insurance-coverage-everywhere/ |accessdate=October 12, 2016 |publisher=FiveThirtyEight |date=September 22, 2016}}
91. ^¹²³⁴⁵{{Cite web |url=https://www.cbo.gov/publication/51385 |title=Federal Subsidies for Health Insurance Coverage for People Under Age 65:2016 to 2026 |website=CBO |accessdate=November 23, 2016}}
92. ^¹{{Cite web |url=https://aspe.hhs.gov/pdf-report/health-insurance-coverage-and-affordable-care-act-2010-2016 |title=Health Insurance Coverage and the Affordable Care Act, 2010–2016 |accessdate=December 7, 2016}}
93. ^{{cite web |url=http://www.urban.org/sites/default/files/publication/86761/2001041-who-gained-health-insurance-coverage-under-the-aca-and-where-do-they-live.pdf |title=Who Gained Health Insurance Coverage Under the ACA, and Where Do They Live? |work=Urban Institute |date=December 2016 |accessdate=22 April 2017 |author=Garrett, Bowen |pages=2}}
94. ^¹{{Cite web |url=http://hrms.urban.org/briefs/health-insurance-coverage-ACA-March-2016.html |title=Health Reform Monitoring Survey |accessdate=December 5, 2016}}
95. ^¹{{Cite web |url=http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/ |title=Current Status of State Medicaid Expansion Decisions |accessdate=December 5, 2016}}
96. ^{{Cite web |url=https://www.npr.org/sections/health-shots/2016/10/24/499190020/rates-rise-again-for-obamacare-health-plans-but-so-do-subsidies |title=Rates Up 22 Percent For Obamacare Plans, But Subsidies Rise, Too |accessdate=November 19, 2016}}
97. ^¹²{{Cite web |url=http://files.kff.org/attachment/summary-of-findings-2015-employer-health-benefits-survey |title=Employer Health Benefits 2015 |website=Kaiser Family Foundation |accessdate=November 19, 2016}}
98. ^¹{{Cite web |url=http://kff.org/health-costs/press-release/average-annual-workplace-family-health-premiums-rise-modest-3-to-18142-in-2016-more-workers-enroll-in-high-deductible-plans-with-savings-option-over-past-two-years/ |title=Average Annual Workplace Family Health Premiums Rise Modest 3% |website=Kaiser Family Foundation |accessdate=November 23, 2016}}
99. ^{{Cite web |url=https://www.whitehouse.gov/sites/default/files/page/files/20160923_record_inequality_cea.pdf |title=The Economic Record of the Obama Administration: Progress Reducing Inequality |website=Whitehouse.gov |accessdate=December 6, 2016 |deadurl=yes |archiveurl=https://web.archive.org/web/20161126124328/https://www.whitehouse.gov/sites/default/files/page/files/20160923_record_inequality_cea.pdf |archivedate=November 26, 2016 |df=mdy-all }}
100. ^¹https://www.fool.com/taxes/2018/01/07/what-the-individual-mandate-repeal-means-for-the-a.aspx
101. ^https://www.taxpolicycenter.org/briefing-book/what-tax-changes-did-affordable-care-act-make
102. ^https://money.cnn.com/2018/03/03/news/economy/obamacare-tax-penalty/index.html
103. ^{{Cite web |url=http://kff.org/disparities-policy/issue-brief/the-impact-of-the-coverage-gap-in-states-not-expanding-medicaid-by-race-and-ethnicity/ |title=The Impact of the Coverage Gap for Adultsin States not Expanding Medicaid |date=October 26, 2015}}
104. ^{{cite web |title=Analyzing the Impact of State Medicaid Expansion Decisions |url=http://kff.org/medicaid/issue-brief/analyzing-the-impact-of-state-medicaid-expansion-decisions/ |publisher=Kaiser Family Foundation |date=July 17, 2013}}
105. ^{{cite news |title=We Don't Know Everything About Obamacare. But We Know Who's Trying to Sabotage It |first=Jonathan |last=Cohn |work=The New Republic |date=July 19, 2013 |url=https://newrepublic.com/article/113947/obamacare-implementation-and-role-state-officials}}
106. ^{{cite news |title=Wonkbook: The terrible deal for states rejecting Medicaid |url=https://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/04/wonkbook-the-terrible-deal-for-states-rejecting-medicaid |date=June 4, 2013 |newspaper=The Washington Post |author1=Evan Soltas}}
107. ^{{Cite web |url=https://www.newscientist.com/article/2100311-obamacare-has-already-improved-health-of-low-income-americans |title=Obamacare has already improved health of low-income Americans |last=Rutkin |first=Aviva |date= |website= |publisher= |language=en-US |accessdate=August 15, 2016}}
108. ^{{Cite web |url=https://www.hsph.harvard.edu/news/press-releases/medicaid-expansion-aca-lbetter-health-care-improved-health-low-income-adults/ |title=Medicaid expansion under ACA linked with better health care, improved health for low-income adults {{!}} News {{!}} Harvard T.H. Chan School of Public Health|website=www.hsph.harvard.edu|accessdate=August 30, 2016}}
109. ^{{Cite news |url=https://www.nytimes.com/2016/08/26/upshot/how-expanding-medicaid-may-lower-insurance-premiums.html |title=How Expanding Medicaid Can Lower Insurance Premiums for All |last=Sanger-katz |first=Margot |date=August 25, 2016 |newspaper=The New York Times |issn=0362-4331 |accessdate=September 4, 2016}}
110. ^{{cite web |url=https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html |title=NationalHealthAccountsProjected |date=February 15, 2017 |publisher=}}
111. ^{{Cite web |url=http://thehill.com/policy/healthcare/291056-next-president-faces-possible-obamacare-meltdown |title=Next president faces possible ObamaCare meltdown |last=Mali |first=Meghashyam |date=August 11, 2016 |accessdate=August 15, 2016}}
112. ^{{Cite web |url=http://kff.org/health-reform/issue-brief/2017-premium-changes-and-insurer-participation-in-the-affordable-care-acts-health-insurance-marketplaces/ |title=2017 Premium Changes and Insurer Participation in the Affordable Care Act's Health Insurance Marketplaces |website=Kaiser Family Foundation |accessdate=November 23, 2016}}
113. ^{{Cite web |url=http://www.commonwealthfund.org/publications/press-releases/2014/jun/new-analysis-of-health-insurance-premium-trends |title=New Analysis of Health Insurance Premium Trends in the Individual Market Finds Average Yearly Increases of 10 Percent or More Prior to the Affordable Care Act |website=Commonwealth Fund |date=June 5, 2014}}
114. ^{{cite web |first=Jonathan |last=Chait |title=Someone Tell Ted Cruz the Obamacare War Is Over |url=http://nymag.com/daily/intelligencer/2013/09/someone-tell-ted-cruz-the-obamacare-war-is-over.html |date=September 26, 2013 |work=New York}}
115. ^{{cite news |title=Health Cost Growth Slows Further Even as Economy Rebounds |publisher=Bloomberg L.P. |first=Alex |last=Wayne |date=June 18, 2013 |url=https://www.bloomberg.com/news/print/2013-06-18/health-cost-growth-slows-further-even-as-economy-rebounds.html}}
116. ^{{cite web |title=Assessing the Effects of the Economy on the Recent Slowdown in Health Spending |publisher=Kaiser Family Foundation |date=April 22, 2013 |url=http://kff.org/health-costs/issue-brief/assessing-the-effects-of-the-economy-on-the-recent-slowdown-in-health-spending-2}}
117. ^{{cite web |title=In Spending Debate, Baby Boomer Issue Remains a Headache for Legislators |work=Roll Call |first=Paul |last=Krawzak |date=June 14, 2013 |url=http://www.rollcall.com/news/in_spending_debate_baby_boomer_issue_remains_a_headache_for_legislators-225650-1.html}}
118. ^Obama, B, JD. United States Health Care Reform – Progress to Date and Next Steps. JAMA. Published online July 11, 2016. {{DOI|10.1001/jama.2016.9797}}
119. ^{{Cite web |url=https://www.washingtonpost.com/news/wonk/wp/2016/09/14/the-quiet-change-to-insurance-plans-thats-making-health-care-more-expensive-for-patients/ |title=How companies are quietly changing your health plan to make you pay more |last=Johnson |first=Carolyn Y. |date=September 14, 2016 |website=Washington Post |publisher= |accessdate=September 14, 2016}}
120. ^{{Cite web |url=http://kff.org/health-reform/poll-finding/survey-of-non-group-health-insurance-enrollees-wave-3/ |title=Survey of Non-Group Health Insurance Enrollees, Wave 3 |date=May 20, 2016 |website=kff.org |publisher=Kaiser Family Foundation |accessdate=September 14, 2016}}
121. ^¹{{Cite web |url=https://www.washingtonpost.com/news/fact-checker/wp/2015/04/01/obamas-claim-the-affordable-care-act-was-a-major-reason-in-preventing-50000-patient-deaths/ |title=Obama's claim the Affordable Care Act was a 'major reason' in preventing 50,000 patient deaths |website=Washington Post |accessdate=November 10, 2016}}
122. ^{{Cite web |url=https://www.washingtonpost.com/posteverything/wp/2017/01/23/repealing-the-affordable-care-act-will-kill-more-than-43000-people-annually/ |title=Repealing the Affordable Care Act will kill more than 43,000 people annually |website=Washington Post|access-date=2017-01-23}}
123. ^¹²[https://fredblog.stlouisfed.org/2017/11/theres-death-and-then-theres-death/ The FRED Blog-There's Death and then there's Death-Nov 2, 2017]
124. ^¹[https://www.kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/ Kaiser Family Foundation-The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid-November 1, 2017]
125. ^¹[https://www.cbo.gov/publication/53597 CBO-The Distribution of Household Income, 2014-March 19, 2018]
126. ^{{cite web |url=http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/121xx/doc12119/03-30-healthcarelegislation.pdf |title=CBO's Analysis of the Major Health Care Legislation Enacted in March 2010 |first=Douglas W. |last=Elmendorf |date=March 30, 2011 |publisher=Congressional Budget Office |accessdate=July 15, 2012}}
127. ^{{cite web |url=http://cbo.gov/sites/default/files/cbofiles/attachments/06-21-Long-Term_Budget_Outlook.pdf |title=CBO's 2011 Long-Term Budget Outlook |first=Douglas W. |last=Elmendorf |date=June 21, 2011 |page=44 |publisher=Congressional Budget Office |quote=Through those changes and numerous others, the 2010 legislation significantly decreased Medicare outlays relative to what they would have been under prior law.}}
128. ^{{cite news |author1=Judith Solomon |author2=Paul N. Van de Water |url=http://www.cbpp.org/cms/?fa=view&id=3746 |title=Letter: Improving the Strength and Solvency of Medicare |publisher=The Center on Budget and Policy Priorities |date=April 18, 2012}}
129. ^{{cite news |last=Sahadi |first=Jeanne |url=http://money.cnn.com/2012/03/13/news/economy/health-reform-costs |title=Health reform coverage cost falls slightly |publisher=CNN |date=March 13, 2012 |accessdate=June 29, 2012}}
130. ^{{cite news |url=http://www.politifact.com/truth-o-meter/statements/2010/mar/18/nancy-pelosi/pelosi-cbo-says-health-reform-bill-would-cut-defic |title=Pelosi: CBO says health reform bill would cut deficits by $1.2 trillion in second decade |last=Farley |first=Robert |date=March 18, 2010 |publisher=PolitiFact.com |accessdate=April 7, 2010}}
131. ^{{cite web |url=http://washingtonexaminer.com/opinion/op-eds/2010/06/sen-tom-coburn-obamacare-pr-campaign-anchored-spin-not-reality/32134 |title=Sen. Tom Coburn: Obamacare PR campaign anchored in spin, not reality |work=The Washington Examiner |date=July 8, 2006 |accessdate=April 1, 2012 |deadurl=yes |archiveurl=https://archive.is/20120717095633/http://washingtonexaminer.com/opinion/op-eds/2010/06/sen-tom-coburn-obamacare-pr-campaign-anchored-spin-not-reality/32134 |archivedate=July 17, 2012 |df=mdy-all }}
132. ^{{cite news |url=http://www.nationalreview.com/critical-condition/55996/obamacare-s-cooked-books-and-doc-fix/james-c-capretta |title=Obamacare's Cooked Books and the 'Doc Fix{{'-}}|work=National Review|author=James Capretta}}
133. ^{{cite web |last=Hogberg |first=David |url=http://www.investors.com/NewsAndAnalysis/Article/554579/201011221909/GOP-Might-Target-ObamaCare-As-Part-Of-A-Medicare-Doc-Fix.aspx |title=GOP Might Target ObamaCare As Part Of A Medicare 'Doc Fix' |work=Investor's Business Daily |date=November 22, 2010 |accessdate=April 1, 2012 |archive-url=https://web.archive.org/web/20110126045757/http://www.investors.com/NewsAndAnalysis/Article/554579/201011221909/GOP-Might-Target-ObamaCare-As-Part-Of-A-Medicare-Doc-Fix.aspx |archive-date=January 26, 2011 |dead-url=yes |df=mdy-all }}
134. ^{{cite web |url=http://www.cbo.gov/ftpdocs/113xx/doc11376/RyanLtrhr4872.pdf |title=Responses to Questions About CBO's Preliminary Estimate of the Direct Spending and Revenue Effects of H.R. 4872, the Reconciliation Act of 2010 |publisher=Congressional Budget Office |date=March 19, 2010 |accessdate=April 1, 2012}}
135. ^{{cite news |first=Jonathan |last=Chait |url=https://newrepublic.com/blog/jonathan-chait/the-doc-fix-myth |title=The Doc Fix Myth And The Right's Misinformation Feedback Loop |work=The New Republic |date=March 24, 2010}}
136. ^{{cite web |last=Van de Water |first=Peter |title=Debunking False Claims About Health Reform, Jobs, and the Deficit |url=http://www.cbpp.org/cms/index.cfm?fa=view&id=3366 |publisher=Center for Budget and Policy Priorities}}
137. ^{{cite news |title=Wrapping Your Head Around the Health Bill |author=Uwe Reinhardt |newspaper=The New York Times |date=March 24, 2010 |url=https://economix.blogs.nytimes.com/2010/03/24/wrapping-your-head-around-the-health-bill |accessdate=October 9, 2010}}
138. ^{{cite news |url=https://www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html |work=The New York Times |title=The Real Arithmetic of Health Care Reform |first=Douglas |last=Holtz-Eakin |date=March 21, 2010}}
139. ^{{cite web |url=http://www.medicalrecords.com/physicians/electronic-medical-records-deadline |title=Electronic Medical Records (Health Information Technology)}}
140. ^{{cite web |url=http://www.cbpp.org/cms/index.cfm?fa=view&id=3021 |title=Congress Has Good Record of Implementing Medicare Savings |publisher=CBPP |accessdate=March 28, 2010}}
141. ^{{cite news |url=http://voices.washingtonpost.com/ezra-klein/2009/12/can_congress_cut_medicare_cost.html |title=Can Congress cut Medicare costs? |work=The Washington Post |accessdate=March 28, 2010}}
142. ^{{Cite web |url=https://www.randstadusa.com/workforce360/workforce-insights/the-affordable-care-act-and-employers/91/ |title=The Affordable Care Act and Employers |accessdate=August 11, 2016}}
143. ^{{cite web |title=Is the Affordable Care Act a Hidden Jobs Killer? |url=http://www.cepr.net/blogs/cepr-blog/is-the-affordable-care-act-a-hidden-jobs-killer |website=Center for Economic and Policy Research |publisher=CEPR |accessdate=August 26, 2015}}
144. ^{{cite news |last=Conover |first=Chris |title=Who Can Deny It? Obamacare Is Accelerating U.S. Towards A Part-Time Nation |url=https://www.forbes.com/sites/theapothecary/2013/07/31/who-can-deny-it-obamacare-is-accelerating-u-s-towards-a-part-time-nation/ |work=Forbes |accessdate=November 11, 2014}}
145. ^{{cite journal |last1=Moriya |first1=A. S. |last2=Selden |first2=T. M. |last3=Simon |first3=K. I. |title=Little Change Seen In Part-Time Employment As A Result Of The Affordable Care Act |journal=Health Affairs |date=January 5, 2016 |volume=35 |issue=1 |pages=119–123 |doi=10.1377/hlthaff.2015.0949}}
146. ^{{cite news |url=http://hamptonroads.com/2013/02/state-workers-parttime-hours-capped-due-health-law |title=Va. workers' part-time hours capped due to health law |author=Bill Sizemore |work=The Virginian-Pilot |date=February 8, 2013}}
{{cite web |url=http://thinkprogress.org/health/2013/02/11/1568291/virginia-employees-obamacare |title=Virginia Cuts State Employees' Hours To Avoid Providing Obamacare Coverage |author=Annie-Rose Strasser |publisher=ThinkProgress |date=February 11, 2013}}
147. ^{{cite web |url=http://tv.msnbc.com/2013/01/14/colleges-roll-back-faculty-hours-in-response-to-obamacare |title=Colleges roll back faculty hours in response to Obamacare |author=Ned Resnikoff |publisher=MSNBC |date=January 14, 2013}}
{{cite web |url=http://thinkprogress.org/health/2013/01/14/1445301/four-public-colleges-obamacare |title=Four Public Colleges Will Cut Adjunct Faculty Hours To Avoid Providing Health Coverage Under Obamacare |author=Sy Mukherjee |publisher=ThinkProgress |date=January 14, 2013}}
148. ^{{cite news |author=Jared Bernstein |title=Stop Blaming Obamacare for Part-Time Workers |url=http://wonkwire.rollcall.com/2013/09/04/stop-blaming-obamacare-part-time-workers |publisher=Teagan Goddard's Wonkwire |date=September 4, 2013 |deadurl=yes |archiveurl=https://web.archive.org/web/20140715044934/http://wonkwire.rollcall.com/2013/09/04/stop-blaming-obamacare-part-time-workers/ |archivedate=July 15, 2014}}
149. ^{{cite news |author=Matthew Yglesias |title=Obamacare's Not To Blame For Increasing Part-time Work |url=http://www.slate.com/blogs/moneybox/2013/07/15/obamacare_part_time_work.html |publisher=Slate |date=July 15, 2013}}
150. ^{{cite news |author=Timothy Jost |title=Implementing Health Reform: A One-Year Employer Mandate Delay |url=http://healthaffairs.org/blog/2013/07/02/implementing-health-reform-a-one-year-employer-mandate-delay |publisher=Health Affairs |date=July 2, 2013}}
151. ^{{cite web |title=Am I eligible for coverage in the Marketplace? |url=https://www.healthcare.gov/am-i-eligible-for-coverage-in-the-marketplace |publisher=HealthCare.Gov, managed by the Centers for Medicare and Medicaid Services}}
152. ^{{cite news |author=Matthew Yglesias |title=Delaying Employer Responsibility Fines Is a Good Idea—the Real Problem Comes Later |url=http://www.slate.com/blogs/moneybox/2013/07/03/obamacare_delayed_a_good_idea_covering_up_a_big_problem.html |publisher=Slate |date=July 3, 2013}}
153. ^{{cite web |first=Jonathan |last=Chait |title=Obamacare Haters Struggling to Understand What 'Nonessential' Means |url=http://nymag.com/daily/intelligencer/2013/07/obamacare-haters-struggle-to-get-nonessential.html |work=New York |date=July 3, 2013}}
{{cite web |first=Jonathan |last=Chait |title=Obamacare Still Not Collapsing |url=http://nymag.com/daily/intelligencer/2013/07/obamacare-still-not-collapsing.html |work=New York |date=July 3, 2013}}
154. ^[https://blogs.wsj.com/corporate-intelligence/2013/07/12/union-letter-obamacare-will-destroy-the-very-health-and-wellbeing-of-workers/ "Union Letter: Obamacare Will 'Destroy The Very Health and Wellbeing' of Workers"], The Wall Street Journal, July 12, 2013.
155. ^{{cite web |url=http://www.businessweek.com/news/2014-01-27/economists-see-little-effect-on-hiring-from-u-dot-s-dot-health-care-law |title=Economists See Little Effect on Hiring From U.S. Health-Care Law |last1=Torres |first1=Carlos |date=January 27, 2014 |website=www.businessweek.com |publisher=Bloomberg L.P. |accessdate=January 27, 2014}}
156. ^{{cite news |last=O'Donnell |first=Jayne |last2=Ungar |first2=Laura |last3=Hoyer |first3=Meghan |date=November 12, 2014 |title=Rural hospitals in critical condition |url=https://www.usatoday.com/longform/news/nation/2014/11/12/rural-hospital-closings-federal-reimbursement-medicaid-aca/18532471/ |newspaper=USA Today |accessdate=January 28, 2015}}
{{cite news |last=Hamada |first=Omar L. |date=November 18, 2014 |title=Obamacare has detrimental effect on rural hospitals |url=http://www.tennessean.com/story/opinion/contributors/2014/11/19/obamacare-detrimental-effect-rural-hospitals/19087985/ |newspaper=The Tennessean |accessdate=January 28, 2015}}
157. ^{{cite news |url=http://www.washingtontimes.com/news/2015/may/4/er-visits-under-obamacare-doctors-say/#ixzz3ZH4xpm5H |title=ER visits up under Obamacare despite promises, doctors' poll finds |first=Tom Jr. |last=Howell |work=The Washington Times |date=May 4, 2015 |accessdate=May 6, 2015}}
158. ^{{cite web |url=http://www.people-press.org/files/legacy-pdf/9-16-13%20Health%20Care%20Release.pdf |title=As Health Care Law Proceeds, Opposition and Uncertainty Persist |publisher=Pew Research Center |date=September 16, 2013}}
159. ^{{cite news |url=https://www.usatoday.com/news/washington/2010-03-23-health-poll-favorable_N.htm |title=Poll: Health care plan gains favor |last=Page |first=Susan |date=March 24, 2010 |work=USA Today |accessdate=March 24, 2010}}
160. ^{{cite news |url=https://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/26/poll-republicans-hate-obamacare-but-like-most-of-what-it-does |title=Republicans hate 'Obamacare', but like most of what it does |work=The Washington Post |author=Ezra Klein |date=June 26, 2012 |accessdate=June 28, 2012}}
161. ^{{cite news |author=Greg Sargent |url=https://www.washingtonpost.com/blogs/plum-line/post/republicans-support-obamas-health-reforms--as-long-as-his-name-isnt-on-them/2012/06/25/gJQAq7E51V_blog.html |title=Republicans Support Obama's Health Reforms – As Long As His Name Isn't On Them |work=The Washington Post |date=June 25, 2012 |accessdate=June 28, 2012}}
162. ^{{cite news |url=http://i2.cdn.turner.com/cnn/2010/images/03/22/rel5a.pdf |title=CNN Opinion Research Poll |publisher=CNN |date=March 22, 2010}}
163. ^{{cite news |url=https://www.wsj.com/articles/SB10001424052748704784904575111993559174212 |work=The Wall Street Journal |first1=Scott |last1=Rasmussen |first2=Doug |last2=Schoen |title=Why Obama Can't Move the Health-Care Numbers |date=March 9, 2010}}
164. ^{{cite news |first=Jonathan |last=Chait |url=http://nymag.com/daily/intelligencer/2013/06/obamacare-and-conservative-self-delusion.html |title=Obamacare, Public Opinion, and Conservative Self-Delusion |date=June 13, 2013 |work=New York Magazine}}
165. ^Jackson, David. "Poll: Most oppose blocking Obama health care law". USA Today. Retrieved July 8, 2012.
166. ^{{cite news |url=http://www.foxnews.com/on-air/on-the-record/2014/02/28/krauthammer-buyers-remorse-obama-comes-obamacare-having-wide-broad-effect-bleeding-happen |title=Krauthammer: Buyer's remorse on Obama comes from ObamaCare having 'this wide, broad effect ... the bleeding is happening among Independents and Democrats' |publisher=Fox News |date=February 27, 2014}}
167. ^{{cite web |url=https://www.rand.org/health/projects/health-reform-opinion.html |title=RAND Health Reform Opinion Study |publisher=RAND Health |date=May 1, 2014 |accessdate=May 10, 2014}}
168. ^{{cite news |url=http://bigstory.ap.org/article/poll-obama-health-law-fails-gain-support |title=AP-GfK Poll: Obama's health care fails to gain support |publisher=Associated Press |date=March 28, 2014 |accessdate=March 30, 2014}}
169. ^{{cite web |url=https://online.wsj.com/news/articles/SB10001424052702303678404579533362696579096 |title=The ObamaCare 8% |newspaper=The Wall Street Journal |date=April 30, 2014 |accessdate=May 1, 2014}}
170. ^Alan Colmes, "Poll: Voters No Longer Want To Repeal Obamacare", Liberaland, December 1, 2014.
171. ^{{cite web |url=http://www.cbsnews.com/news/poll-obamacare-and-the-supreme-court/ |title=Poll: Obamacare and the Supreme Court |publisher=CBS News |accessdate=June 23, 2015}}
172. ^{{cite web |url=http://kff.org/health-reform/press-release/after-the-election-the-public-remains-sharply-divided-on-future-of-the-affordable-care-act/ |title=After the Election, the Public Remains Sharply Divided on Future of the Affordable Care Act |publisher=Kaiser Family Foundation |date=December 3, 2016}}
173. ^{{cite web |url=https://www.nytimes.com/interactive/2017/02/01/us/politics/100000004904286.mobile.html? |title=Obamacare More Popular Than Ever, Now That It May Be Repealed |publisher=NYT |date=February 1, 2017}}
174. ^¹²{{Cite news |url=https://www.nytimes.com/2017/02/07/upshot/one-third-dont-know-obamacare-and-affordable-care-act-are-the-same.html |title=One-Third Don't Know Obamacare and Affordable Care Act Are the Same |last=Dropp |first=Kyle |date=2017-02-07 |newspaper=The New York Times|access-date=2017-02-08 |last2=Nyhan |first2=Brendan |issn=0362-4331}}
175. ^{{Cite journal |last=Lerman |first=Amy E. |last2=McCabe |first2=Katherine T. |date=2017-01-24 |title=Personal Experience and Public Opinion: A Theory and Test of Conditional Policy Feedback |journal=The Journal of Politics |volume=79 |issue=2 |pages=624–641 |doi=10.1086/689286 |issn=0022-3816}}
176. ^{{cite web |last=Nelson |first=Steven |url=http://dailycaller.com/2011/06/08/democratic-leader-wants-to-reclaim-obamacare-make-it-a-compliment |title=Democratic Rep. John Conyers wants to reclaim 'ObamaCare', make it a compliment |publisher=The Daily Caller |date=June 8, 2011 |accessdate=April 1, 2012}}
177. ^{{cite news |first=Lucy |last=Madison |url=http://www.cbsnews.com/news/on-bus-tour-obama-embraces-obamacare-says-i-do-care/ |title=On bus tour, Obama embraces 'Obamacare', says 'I do care{{'-}} |publisher=CBS News |date=August 15, 2011 |accessdate=April 28, 2012}}
178. ^{{cite web |last=Prince |first=Richard |url=http://mije.org/richardprince/ap-npr-curb-use-obamacare-term |title=AP, NPR Curb Use of "Obamacare" Term |publisher=Robert C. Maynard Institute for Journalism Education |date=October 2, 2013 |accessdate=October 5, 2013 |deadurl=yes |archiveurl=https://web.archive.org/web/20131005231540/http://mije.org/richardprince/ap-npr-curb-use-obamacare-term |archivedate=October 5, 2013 |df=mdy-all }}
179. ^{{cite web |last=Gold |first=Hadas |authorlink=Hadas Gold|title=AP, NPR to cut back on 'Obamacare' |url=http://www.politico.com/blogs/media/2013/10/ap-npr-to-cut-back-on-obamacare-174305.html |work=Politico |date=October 4, 2013 |accessdate=October 19, 2013}}
180. ^{{cite web |url=http://snopes.com/politics/medical/over75.asp |title=Seniors Beware |publisher=Snopes |date=August 23, 2012}}
181. ^{{cite web |first=Jack |last=Ebeler |first2=Tricia |last2=Neuman |first3=Juliette |last3=Cubanski |title=The Independent Payment Advisory Board: A New Approach to Controlling Medicare Spending |url=http://kff.org/health-reform/issue-brief/the-independent-payment-advisory-board-a-new/ |publisher=Kaiser Family Foundation |date=April 13, 2011 |page=3 |accessdate=November 27, 2013}}
182. ^{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/blog/jonathan-cohn/87102/ipab-medicare-commission-repeal-ryan-schwartz |title=Here We Go Again, With the Death Panels |work=The New Republic |date=April 20, 2011}}
183. ^{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/blog/the-treatment/mandatory-death-counseling-exposed |title=Mandatory Death Counseling – exposed! |work=The New Republic |date=August 13, 2009}}
184. ^{{cite news |title=Senate committee scraps healthcare provision that gave rise to 'death panel' claims; Though the claims are widely discredited, the Senate Finance Committee is withdrawing from its bill the inclusion of advance-care planning consultations, calling them too confusing |first=Christi |last=Parsons |first2=Andrew |last2=Zajac |newspaper=Los Angeles Times |date=August 14, 2009 |url=http://articles.latimes.com/2009/aug/14/nation/na-health-end-of-life14}}
185. ^{{Cite journal |first=Brendan |last=Nyhan |title=Why the "Death Panel" Myth Wouldn't Die: Misinformation in the Health Care Reform Debate |journal=The Forum |volume=8 |issue=1 |year=2010 |doi=10.2202/1540-8884.1354 |url=http://www.dartmouth.edu/~nyhan/health-care-misinformation.pdf |citeseerx=10.1.1.692.9614 }}
186. ^{{cite news |url=http://thehill.com/blogs/healthwatch/health-reform-implementation/258753-poll-four-in-10-believe-in-health-law-death-panels |title=Poll: Four in 10 believe in Obama healthcare law 'death panels{{'-}}|work=The Hill|date=September 26, 2012|first=Elise|last=Viebeck}}
187. ^{{Cite news |title=PolitiFact's Lie of the Year: 'Death panels' |publisher=PolitiFact |date=December 19, 2009 |url=http://politifact.com/truth-o-meter/article/2009/dec/18/politifact-lie-year-death-panels |first=Angie |last=Drobnic Holan |accessdate=November 19, 2010}}
188. ^{{Cite news |title=False Euthanasia Claims |first=Jess |last=Henig |first2=Lori |last2=Robertson |publisher=FactCheck.org |date=July 29, 2010 |url=http://www.factcheck.org/2009/07/false-euthanasia-claims}}
189. ^{{cite web |title=Whoppers of 2009—We review the choicest falsehoods from a year that kept us busy |date=December 24, 2009 |author=Lori Robertson |url=http://www.factcheck.org/2009/12/whoppers-of-2009 |publisher=FactCheck.org |accessdate=April 28, 2011}}
190. ^{{cite web |url=http://www.americandialect.org/2009-Word-of-the-Year-PRESS-RELEASE.pdf |title={{-'}}Tweet' 2009 Word of the Year, 'Google' Word of the Decade, as voted by American Dialect Society|date=January 8, 2010|publisher=American Dialect Society|accessdate=October 8, 2010}}
191. ^Public Law 111 – 148, section 1312: "... the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are (I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act (or an amendment made by this Act)."
192. ^{{cite web |first=Jonathan |last=Chait |url=http://nymag.com/daily/intelligencer/2013/08/congress-exempt-from-obamacare-or-something.html |title=Congress Exempts Itself From Obamacare! Or Something! |work=New York |date=August 6, 2013}}
193. ^{{cite web |first=Jonathan |last=Cohn |url=https://newrepublic.com/article/114284/congress-exempt-obamacare-latest-lie-wont-die |title=The Latest Obamacare Lie That Just Won't Die |work=The New Republic |date=August 13, 2013}}
194. ^{{Cite news |title=Sen. Ted Cruz says Obama 'just granted all of Congress an exception' to Obamacare |publisher=PolitiFact |date=August 14, 2013 |url=http://www.politifact.com/truth-o-meter/statements/2013/aug/14/ted-cruz/sen-ted-cruz-says-obama-just-granted-all-congress- |first=Becky |last=Bowers |accessdate=August 19, 2013}}
195. ^{{Cite news |title=Congress Exempt from Health Bill? |first=Lori |last=Robertson |publisher=FactCheck.org |date=January 20, 2010 |url=http://www.factcheck.org/2010/01/congress-exempt-from-health-bill}}
196. ^{{cite news |last=Viebeck |first=Elise |title=Poll: Four in 10 think illegals are covered by Obama healthcare law |url=http://thehill.com/blogs/healthwatch/health-reform-implementation/285089-poll-four-in-10-think-illegals-are-covered-by-obamacare |publisher=The Hill |date=February 27, 2013 |accessdate=December 7, 2013}}
197. ^{{Cite news |title=The Democrats' health care bills would provide 'free health care for illegal immigrants' |publisher=PolitiFact |date=January 21, 2010 |url=http://www.politifact.com/truth-o-meter/statements/2010/jan/21/chain-email/chain-e-mail-claims-health-care-bills-congress-wou |first=Robert |last=Farley |accessdate=August 19, 2013}}
198. ^{{cite web |url=https://www.bloomberg.com/view/articles/2017-01-18/the-once-and-future-obamacare-death-spiral |title=The Once and Future Obamacare Death Spiral |publisher=Bloomberg |date=January 18, 2017}}
199. ^{{cite web |url=http://kff.org/other/state-indicator/number-of-issuers-participating-in-the-individual-health-insurance-marketplace/?currentTimeframe=0 |title=Number of Insurers Participating in the Individual Health Insurance Marketplaces |publisher=Kaiser Family Foundation |date=January 30, 2017}}
200. ^{{Cite web |url=https://www.cbo.gov/publication/52370 |title=CBO The Budget and Economic Outlook 2017–2027 |publisher=CBO |date=24 January 2017}}
201. ^{{cite web |url=https://krugman.blogs.nytimes.com/2015/06/20/obamacare-and-labor-supply/ |title=Obamacare and Labor Supply |publisher=New York Times |date=June 20, 2015}}
202. ^{{cite news |last=Peters |first=Jeremy |title=Conservatives' Aggressive Ad Campaign Seeks to Cast Doubt on Health Law |url=https://www.nytimes.com/2013/07/07/us/politics/conservatives-aggressive-ad-campaign-seeks-to-cast-doubt-on-health-law.html |work=The New York Times |date=January 20, 2011}}
203. ^{{cite news |first=Jonathan |last=Chait |url=https://newrepublic.com/article/113994/obamacare-implementation-conservatives-brace-it-working |title=Conservatives Brace for the Possibility Obamacare Won't Totally Suck |work=The New Republic |date=July 23, 2013}}
204. ^{{cite web |author=Michael Cannon |url=http://www.cato.org/blog/anti-universal-coverage-club-manifesto |title=The Anti-Universal Coverage Club Manifesto |publisher=Cato Institute |date=July 6, 2007}}
205. ^{{cite news |first=Jonathan |last=Chait |url=http://nymag.com/daily/intelligencer/2012/06/health-care-as-privilege-what-gop-wont-admit.html |title=Health Care As a Privilege: What the GOP Won't Admit |work=New York |date=June 25, 2012}}
206. ^{{Cite web |url=https://www.cnbc.com/2016/11/09/trumps-first-100-day-agenda-may-be-stymied-by-his-own-party.html |title=Here's what's coming from the Trump administration |last=Schoen |first=John W. |date=November 9, 2016 |website=CNBC |accessdate=November 16, 2016}}
207. ^{{cite news |last1=Haberman |first1=Maggie |last2=Pear |first2=Robert |title=Trump Tells Congress to Repeal and Replace Health Care Law 'Very Quickly' |url=https://www.nytimes.com/2017/01/10/us/repeal-affordable-care-act-donald-trump.html |accessdate=25 January 2017 |work=The New York Times |date=10 January 2017}}
208. ^{{cite news |url=http://www.politico.com/story/2016/10/minnesota-mark-dayton-obamacare-not-affordable-229690 |title=Democratic governor: Obamacare 'no longer affordable' for many |publisher=Politico |date=October 12, 2016 |first=Rachana |last=Pradhan}}
209. ^{{cite news |url=http://www.politico.com/story/2016/10/mark-dayton-obamacare-comments-affordable-230156 |title=Democratic governor expresses regret over Obamacare comments, requests emergency relief for rate hikes |publisher=Politico |date=October 21, 2016 |first=Paul |last=Demko}}
210. ^{{cite web |last=Cauchi |first=Richard |title=State Legislation and Actions Challenging Certain Health Reforms |url=http://www.ncsl.org/research/health/state-laws-and-actions-challenging-ppaca.aspx |publisher=National Conference of State Legislatures |date=November 15, 2013 |accessdate=November 28, 2013}}
211. ^{{cite web |title=Health Care Lawsuit Case Challenges |url=http://www.healthcarelawsuits.org/cases.php |publisher=Independent Women's Forum |date=November 26, 2013 |accessdate=November 28, 2013}}
212. ^¹{{cite web |title=Analysis: U.S. Supreme Court Upholds the Affordable Care Act: Roberts Rules? |url=http://www.natlawreview.com/article/analysis-us-supreme-court-upholds-affordable-care-act-roberts-rules |publisher=von Briesen & Roper, S.C. |work=The National Law Review |date=June 29, 2012 |accessdate=July 2, 2012}}
213. ^{{cite web |url=http://www.usccb.org/issues-and-action/religious-liberty/march-14-statement-on-religious-freedom-and-hhs-mandate.cfm |title=March 14, 2012 Statement on Religious Freedom and HHS Mandate |date=March 14, 2012 |publisher=United States Conference of Catholic Bishops |accessdate=April 28, 2012}}
214. ^{{cite news |last=Goodstein |first=Laurie |title=Catholics File Suits on Contraceptive Coverage |url=https://www.nytimes.com/2012/05/22/us/catholic-groups-file-suits-on-contraceptive-coverage.html?_r=0 |newspaper=The New York Times |date=May 21, 2012}}
215. ^{{cite news |url=http://abcnews.go.com/Politics/supreme-court-upholds-obama-health-care-subsidies/story?id=31931412 |title=Supreme Court Upholds Obamacare Subsidies, President Says ACA 'Is Here to Stay' |last1=Taylor |first1=Audrey |last2=Seanz |first2=Arlette |last3=Levine |first3=Mike |publisher=ABC News |date=June 25, 2015 |accessdate=June 25, 2015}}
216. ^{{Cite web |url=http://www.politico.com/story/2016/05/house-gop-wins-obamacare-lawsuit-223121 |title=House GOP wins Obamacare lawsuit |last=Haberkorn |first=Jennifer |date=May 12, 2016 |website= |publisher=Politico |accessdate=August 21, 2016}}
217. ^{{Citation |last=Sargent |first=Greg| author-link = Greg Sargent |title=Trump's latest tantrum will hurt hundreds of thousands of people. Here's how. |newspaper=The Washington Post |date=May 26, 2017 |url=https://www.washingtonpost.com/blogs/plum-line/wp/2017/05/26/trumps-latest-tantrum-will-hurt-hundreds-of-thousands-of-people-heres-how/?tid=hybrid_collaborative_1_na | access-date = 2017-05-29}}
218. ^[https://www.courtlistener.com/recap/gov.uscourts.txnd.299449/gov.uscourts.txnd.299449.1.0.pdf]
219. ^{{Cite web|url=https://thehill.com/policy/healthcare/421511-federal-judge-in-texas-strikes-down-obamacare|title=Federal judge in Texas strikes down ObamaCare|last=Sullivan|first=Peter|date=2018-12-14|website=TheHill|language=en|access-date=2018-12-15}}
220. ^{{Cite web|url=https://www.wsj.com/articles/federal-judge-rules-affordable-care-act-is-unconstitutional-11544838743|title=Federal Judge Rules Affordable Care Act Is Unconstitutional Without Insurance-Coverage Penalty|last=Armour|first=Stephanie|date=December 14, 2018|website=The Wall Street Journal|access-date=}}
221. ^¹{{cite web | url = https://www.cnn.com/2018/12/14/politics/texas-aca-lawsuit/index.html | title = Federal judge in Texas strikes down Affordable Care Act | first1 = Ariane | last1 = de Vogue | first2= Tami | last2= Luhby | date = December 14, 2018 | accessdate = December 14, 2018 | work = CNN }}
222. ^{{Cite web|url=https://twitter.com/realDonaldTrump/status/1073761497866747904|title=As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!|last=Trump|first=Donald J.|date=2018-12-14|website=@realDonaldTrump|language=en|access-date=2018-12-15}}
223. ^{{Cite web|url=https://thehill.com/homenews/administration/421517-trump-calls-on-mitch-and-nancy-to-pass-healthcare-law-after-obamacare|title=Trump touts ruling against ObamaCare: 'Mitch and Nancy' should pass new health-care law|last=Axelrod|first=Tal|date=2018-12-14|website=TheHill|language=en|access-date=2018-12-15}}
224. ^{{cite web | url = https://www.washingtonpost.com/national/health-science/federal-judge-in-texas-rules-obama-health-care-law-unconstitutional/2018/12/14/9e8bb5a2-fd63-11e8-862a-b6a6f3ce8199_story.html | title = Federal judge in Texas rules entire Obama health-care law is unconstitutional | first= Amy | last= Goldstein | date = December 14, 2018 | accessdate = December 14, 2018 | work = The Washington Post }}
225. ^{{cite web | url = https://www.cnn.com/2018/12/30/politics/judge-affordable-care-act-remain-in-effect-appeal/index.html | title = Judge says Affordable Care Act will remain in effect during appeal | first1= Kate |last1= Sullivan | first2= Tami | last2= Luhby | date= December 30, 2018 | accessdate = December 31, 2018 | work = CNN }}
226. ^{{cite news |first=Sandhya |last=Somashekhar |title=States find new ways to resist health law |url=https://www.washingtonpost.com/national/health-science/states-find-new-ways-to-resist-health-law/2013/08/28/c63f8498-0a93-11e3-8974-f97ab3b3c677_story.html |work=The Washington Post |date=August 29, 2013}}
227. ^{{cite news |title=The Right's Latest Scheme to Sabotage Obamacare |first=Jonathan |last=Cohn |work=The New Republic |date=July 25, 2013 |url=https://newrepublic.com/article/114028/obamacare-sabotage-watch-conservative-campaign-gets-real}}
228. ^{{cite news |title=Inside the Obamacare Resistance |first=Sarah |last=Kliff |work=The Washington Post |date=August 1, 2013 |url=https://www.washingtonpost.com/blogs/wonkblog/wp/2013/08/01/inside-the-obamacare-resistance}}
229. ^{{cite web |last=O'Brien |first=Michael |url=http://thehill.com/blogs/blog-briefing-room/news/88323-house-and-senate-republicans-quick-to-release-repeal-bills |title=GOP quick to release 'repeal' bills |work=The Hill |date=March 22, 2010 |accessdate=April 1, 2012}}
230. ^{{cite web |url=http://thomas.loc.gov/cgi-bin/bdquery/z?d112:HR00002: |title=Bill Summary & Status – 112th Congress (2011–2012) – H.R. 2 |publisher=THOMAS |date=January 19, 2011}}
231. ^{{cite web |url=http://clerk.house.gov/evs/2011/roll014.xml |title=Final Vote Results for passage of Repealing the Job-Killing Health Care Law Act (H.R. 2) |publisher=THOMAS |date=January 19, 2011}}
232. ^{{cite web |last=Beutler |first=Brian |title=Dems Press GOPers To Repeal Their Own Benefits Along With Health Care Law |publisher=Talking Points Memo |date=January 19, 2011 |url=http://tpmdc.talkingpointsmemo.com/2011/01/dems-press-gopers-to-repeal-their-own-benefits-along-with-health-care-law.php?ref=dcblt |accessdate=January 21, 2011}}
233. ^{{cite web |url=https://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=112&session=1&vote=00009 |title=Motion to Waive All Applicable Budgetary Discipline Re: McConnell Amdt. No. 13 |publisher=U.S. Senate |date=February 2, 2011 |accessdate=April 1, 2012}}
234. ^{{cite web |url=http://c-span.com/Events/House-Passes-Health-Care-Repeal-245-189/10737418994 |title=House Passes Health Care Repeal 245–189 |publisher=C-SPAN |date=January 19, 2011 |access-date=January 21, 2011 |archive-url=https://web.archive.org/web/20110708110210/http://c-span.com/Events/House-Passes-Health-Care-Repeal-245-189/10737418994/ |archive-date=July 8, 2011 |dead-url=yes |df=mdy-all }}
235. ^{{cite news |url=https://www.wsj.com/articles/SB10001424052702303561504577494682627914026 |title=Romney, GOP Pledge to Repeal Health Law |last=Boles |first=Corey |newspaper=The Wall Street Journal |date=June 28, 2012 |accessdate=June 29, 2012}}
236. ^{{cite news |title=House votes -again-to repeal Obamacare |url=http://www.cnn.com/2015/02/03/politics/obamacare-repeal-vote-house/index.html |publisher=Reuters |date=February 3, 2015 |author=Deirdre Walsh |accessdate=February 4, 2015}}
237. ^{{cite news |last=Lipton |first=Eric |title=In Shift, Lobbyists Look for Bipartisan Support to Repeal a Tax |url=https://www.nytimes.com/2013/03/20/us/politics/lobbyists-look-for-bipartisan-support-to-repeal-a-tax.html?pagewanted=all&_r=0 |newspaper=The New York Times |date=March 19, 2013}}
238. ^{{cite news |first=Jonathan |last=Cohn |title=What Defunding Health Reform Would Do |url=https://newrepublic.com/blog/jonathan-cohn/80411/what-defunding-health-reform-would-do |work=The New Republic |date=December 23, 2010}}
239. ^{{cite news |url=https://www.washingtonpost.com/politics/washington-braces-for-the-first-shutdown-of-the-national-government-in-17-years/2013/09/30/977ebca2-29bd-11e3-97a3-ff2758228523_story.html |title=Shutdown begins: Stalemate forces first U.S. government closure in 17 years |work=The Washington Post |date=October 1, 2013 |author1=Lori Montgomery |author2=Paul Kane}}
{{cite news |url=https://www.washingtonpost.com/blogs/post-politics/wp/2013/09/19/mccain-efforts-to-repeal-and-defund-obamacare-not-rational |title=McCain: Efforts to repeal and defund Obamacare 'not rational{{'-}}|work=The Washington Post|date=September 19, 2013 |author=Blake, Aaron |accessdate=September 24, 2013}}
240. ^{{cite news |first=Jonathan |last=Cohn |title=Tea Party to Republicans: Shut Down the Government, or You're a Sellout |url=https://newrepublic.com/article/114229/tea-party-wants-government-shutdown-over-obamacare |work=The New Republic |date=August 7, 2013}}
241. ^{{cite web |last=Goddard |first=Teagan |title=Blocking the Medicare Reform Board Won't Stop Reform |url=http://wonkwire.rollcall.com/2013/05/17/blocking-the-medicare-reform-board-wont-stop-reform/ |publisher=WonkWire.RollCall.com |date=May 17, 2013 |deadurl=yes |archiveurl=https://web.archive.org/web/20130921055215/http://wonkwire.rollcall.com/2013/05/17/blocking-the-medicare-reform-board-wont-stop-reform/ |archivedate=September 21, 2013 |df=mdy-all }}
242. ^{{cite news |last=Cohn |first=Jonathan |title=Save Donald |url=https://newrepublic.com/article/politics/75324/save-donald |work=The New Republic |date=May 24, 2010}}
{{cite news |last=Cohn |first=Jonathan |title=Meet The Don |url=https://newrepublic.com/blog/jonathan-cohn/76076/meet-the-don |work=The New Republic |date=July 6, 2010}}
243. ^{{cite news |last=Cohn |first=Jonathan |title=The New Nullification: GOP v. Obama Nominees |url=https://newrepublic.com/blog/jonathan-cohn/92167/cordray-warren-cfpb-obama-republicans-nomination |work=The New Republic |date=July 19, 2011}}
244. ^{{Cite news |url=https://www.nytimes.com/2017/01/12/us/politics/health-care-congress-vote-a-rama.html?_r=0 |title=Senate Takes Major Step Toward Repealing Health Care Law |last=Kaplan |first=Thomas |date=12 January 2017 |work=The New York Times |last2=Pear |first2=Robert|access-date=12 January 2017 |via=}}
245. ^{{Cite news |url=http://www.foxnews.com/politics/2017/01/11/gop-senate-to-move-forward-on-obamacare-repeal.html |title=GOP Senate to Move Forward on ObamaCare Repeal |last= |first= |date=11 January 2017 |work=Fox News Politics|access-date=12 January 2017 |via=}}
246. ^{{Cite news |url=http://www.cnn.com/2017/01/11/politics/senate-obamacare-repeal/ |title=Senate Opens Obamacare Repeal Drive with Overnight Marathon |last=Lee |first=MJ |date=12 January 2017 |work=CNN |last2=Barrett |first2=Ted |last3=LoBianco |first3=Tom|access-date=12 January 2017 |via=}}
247. ^{{Cite news |url=http://www.nbcnews.com/politics/congress/senate-vote-obamacare-repeal-measure-late-night-session-n705816 |title=Senate Approves First Step Toward Repealing Obamacare in Late-Night Session |last=Caldwell |first=Leigh Ann |date=12 January 2017 |work=NBC News|access-date=12 January 2017 |via=}}
248. ^{{cite news |last1=Golstein |first1=Amy |last2=DeBonis |first2=Mike |last3=Snell |first3=Kelsey |title=House Republicans release long-awaited plan to repeal and replace Obamacare |url=https://www.washingtonpost.com/powerpost/new-details-emerge-on-gop-plans-to-repeal-and-replace-obamacare/2017/03/06/04751e3e-028f-11e7-ad5b-d22680e18d10_story.html |accessdate=March 7, 2017 |work=Washington Post}}
249. ^{{cite news |last1=Pear |first1=Robert |title=Push to Repeal Health Law Fails |url=https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html|accessdate=24 March 2017 |publisher=New York Times |date=24 March 2017}}
250. ^{{cite news |url=http://edition.cnn.com/2017/05/04/politics/health-care-vote/ |title=House Republicans pass bill to repeal and replace Obamacare |publisher=CNN |date=May 4, 2017 |accessdate=May 4, 2017}}
251. ^{{cite news |url=http://www.businessinsider.com/senate-plan-for-healthcare-bill-ahca-2017-5 |title=Senate Republicans signal they plan to scrap bill the House just passed and write their own}}
252. ^{{cite news |work=New York Times |title=Secrecy Surrounding Senate Health Bill Raises Alarms in Both Parties |url=https://www.nytimes.com/2017/06/15/us/politics/secrecy-surrounding-senate-health-bill-raises-alarms-in-both-parties.html |first1=Thomas |last1=Kaplan |first2=Robert |last2=Pear |date=June 15, 2017 |deadurl=no |archiveurl=https://web.archive.org/web/20170618182849/https://www.nytimes.com/2017/06/15/us/politics/secrecy-surrounding-senate-health-bill-raises-alarms-in-both-parties.html |archivedate=June 18, 2017 |df=mdy-all}}
253. ^{{cite news |work=Washington Post |title=The remarkable steps Republicans are taking to obscure what's in their health-care bill |first=Philip |last=Bump |url=https://www.washingtonpost.com/news/politics/wp/2017/06/13/the-remarkable-steps-republicans-are-taking-to-obscure-whats-in-their-health-care-bill/ |date=June 13, 2017 |deadurl=no |archiveurl=https://web.archive.org/web/20170620082523/https://www.washingtonpost.com/news/politics/wp/2017/06/13/the-remarkable-steps-republicans-are-taking-to-obscure-whats-in-their-health-care-bill/ |archivedate=June 20, 2017 |df=mdy-all}}
254. ^{{cite news |publisher=NBC News |title=The Senate's Health Care Bill Remains Shrouded in Secrecy |first1=Benjy |last1=Sarlin |first2=Leigh Ann |last2=Caldwell |url=http://www.nbcnews.com/politics/congress/senate-s-health-care-bill-remains-shrouded-secrecy-n772456 |date=June 15, 2017 |deadurl=no |archiveurl=https://web.archive.org/web/20170619162148/http://www.nbcnews.com/politics/congress/senate-s-health-care-bill-remains-shrouded-secrecy-n772456 |archivedate=June 19, 2017 |df=mdy-all}}
255. ^{{cite web |url=https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf |title=H.R. 1628, Better Care Reconciliation Act of 2017, discussion draft ERN17282 |publisher=Senate Budget Committee |date=June 22, 2017}}
256. ^{{cite web |url=http://www.cnn.com/2017/07/25/politics/senate-health-care-vote/index.html |title=McCain returns as Senate advances health bill |first=Lauren Fox, MJ Lee, Phil Mattingly and Ted Barrett |last=CNN |website=CNN |deadurl=no |archiveurl=https://web.archive.org/web/20170725204952/http://www.cnn.com/2017/07/25/politics/senate-health-care-vote/index.html |archivedate=July 25, 2017 |df=mdy-all}}
257. ^{{Citation |last=Klein |first=Ezra | author-link = Ezra Klein |title=The GOP's massive health care failures, explained |publisher=Vox |date=July 28, 2017 |url=https://www.vox.com/health-care/2017/7/28/16055284/gop-massive-health-care-failures-explained | access-date = 2017-08-03}}
258. ^[https://www.nytimes.com/interactive/2017/12/29/opinion/2017-the-year-in-charts.html? NYT-Steven Rattner-2017: The Year in Charts-December 29, 2017]
259. ^[https://www.nytimes.com/2017/07/27/opinion/health-care-obamacare.html? NYT-Edsall-Killing Obamacare Softly-July 27, 2017]
260. ^The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid-October 19, 2016
261. ^¹[https://www.vox.com/policy-and-politics/2017/9/14/16308502/cbo-trump-obamacare-premiums Vox-Sarah Kliff-CBO: Trump is making Obamacare premiums more expensive-September 14, 2017]
262. ^[https://www.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-affordable-care-act.html NYT-Robert Pear-Marco Rubio Quietly Undermines Affordable Care Act-December 9, 2015]
263. ^Politico-Trump Still Enforcing Obamacare Mandate-May 2017
264. ^[https://www.vox.com/2017/8/31/16236280/trump-obamacare-outreach-ads VOX-Sarah Kliff-Trump is slashing Obamacare's advertising budget by 90%-August 31, 2017]
265. ^[https://www.nytimes.com/2017/11/04/opinion/obamacare-vs-the-saboteurs.html? NYT-Editorial-Obamacare vs. the Saboteurs-November 4, 2017]
266. ^[https://www.healthinsurance.org/blog/2017/05/17/10-ways-the-gop-sabotaged-obamacare/ Healthinsurance.org Ten Ways the GOP sabotaged Obamacare-May 17, 2017]
267. ^{{cite news |url=https://www.npr.org/sections/health-shots/2017/10/13/557541856/halt-in-subsidies-for-health-insurers-expected-to-drive-up-costs-for-middle-clas |title=Halt In Subsidies For Health Insurers Expected To Drive Up Costs For Middle Class |last=Kodjak |first=Alison |agency=NPR |date=October 13, 2017 |accessdate=October 18, 2017}}
268. ^{{cite news |url=http://www.journalnow.com/news/state_region_ap/many-states-consumers-alarmed-by-trump-s-health-care-order/article_ae739354-22f7-5998-9ac7-53f0fe029442.html |title=Many states, consumers alarmed by Trump's health care order |last1=Mulvihill |first1=Geoff |last2=Kennedy |first2=Kelli |work=Winston-Salem Journal |agency=Associated Press |date=October 13, 2017 |accessdate=October 18, 2017 }}{{dead link|date=March 2018 |bot=InternetArchiveBot |fix-attempted=yes }}
269. ^¹Scott, Dylan (October 18, 2017). [https://www.vox.com/policy-and-politics/2017/10/18/16458316/obamacare-premiums-trump "Obamacare premiums were stabilizing. Then Trump happened"]. Vox.
270. ^[https://www.cbpp.org/sabotage-watch-tracking-efforts-to-undermine-the-aca "Sabotage Watch: Tracking Efforts to Undermine the ACA"]. Center on Budget and Policy Priorities. Updated October 12, 2017. Retrieved October 19, 2017.
271. ^Pear, Robert; Haberman, Maggie; Abelsonoct, Reed (October 12, 2017). [https://www.nytimes.com/2017/10/12/us/politics/trump-obamacare-executive-order-health-insurance.html?_r=0 "Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again"]. The New York Times.
272. ^¹²³Kliff, Sarah (October 18, 2017). [https://www.vox.com/health-care/2017/10/18/16499806/trump-insurance-bailouts-completely-incoherent "Sarah Kliff-Trump's stance on insurance 'bailouts' is completely incoherent"] Vox..
273. ^¹[https://www.cbo.gov/publication/53091 "Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2017 to 2027"]. Center on Budget and Policy Priorities. September 14, 2017.
274. ^¹[https://www.cbo.gov/publication/53009 "The Effects of Terminating Payments for Cost-Sharing Reductions"]. Center on Budget and Policy Priorities. August 15, 2017.
275. ^{{cite web |title=A Town Hall, and a Health Care Model, in Green Bay |url=http://www.whitehouse.gov/blog/A-Town-Hall-and-a-Health-Care-Model-in-Green-Bay |publisher=The White House Blog |accessdate=November 9, 2013 |archive-url=https://web.archive.org/web/20131109162556/http://www.whitehouse.gov/blog/A-Town-Hall-and-a-Health-Care-Model-in-Green-Bay/ |archive-date=November 9, 2013 |dead-url=yes |df=mdy-all }}
276. ^{{cite news |title=After the big Obamacare apology: where things stand |url=http://www.cnn.com/2013/11/08/politics/obama-obamacare-apology |publisher=CNN |date=November 8, 2013 |accessdate=November 9, 2013}}
277. ^{{cite web |url=http://www.cnn.com/2013/11/07/politics/obama-obamacare-apology |title=Obama apologizes for insurance cancellations due to Obamacare |publisher=CNN |date= |accessdate=July 29, 2014}}
278. ^[https://www.reuters.com/article/2013/10/30/us-usa-healthcare-sebelius-idUSBRE99T0PN20131030 Obama blames 'bad apple' insurers for canceled coverage], Reuters.com, October 30, 2013.
279. ^{{cite news |first=Ed |last=Sealover |title=Health insurers say they're canceling plans because of federal law |url=http://www.bizjournals.com/denver/news/2013/11/08/health-insurers-canceling-plans-say.html |work=Denver Business Journal |date=November 8, 2013 |accessdate=November 9, 2013}}
280. ^{{cite news |title=Lie of the Year: "If you like your health care plan, you can keep it|url=http://www.politifact.com/truth-o-meter/article/2013/dec/12/lie-year-if-you-like-your-health-care-plan-keep-it/|publisher=Politifact |date=December 12, 2014|accessdate=April 5, 2018}}
281. ^{{cite web |first=David |last=Weigel |url=http://www.slate.com/blogs/weigel/2013/11/08/the_white_house_s_web_site_still_says_if_you_like_your_plan_you_can_keep.html |title=The White House's Website Still Says If You Like Your Plan You Can Keep It |publisher=Slate |date=November 8, 2013 |accessdate=November 9, 2013}}
282. ^{{cite news |title=Obamacare: The debacle |url=https://www.economist.com/news/united-states/21588951-congress-hears-tales-baffling-ineptitude-debacle |work=The Economist |date=November 2, 2013 |accessdate=November 8, 2013}}
283. ^{{cite news |title=Obama apologizes to Americans who lost health plans |url=http://www.foxnews.com/politics/2013/11/08/bipartisan-bill-to-delay-individual-mandate-introduced-as-obama-apologizes-over |publisher=Fox News |date=November 8, 2013 |accessdate=November 9, 2013}}
284. ^{{cite news |last=Schoof |first=Renee |title=Congress weighing laws to let people keep health insurance |url=http://www.mcclatchydc.com/2013/11/08/207999/congress-weighing-laws-to-let.html |publisher=McClatchyDC |date=November 8, 2013 |accessdate=November 14, 2013}}
285. ^¹{{cite web |url=https://resources.ehealthinsurance.com/affordable-care-act/history-timeline-affordable-care-act-aca |title=History of the Affordable Care Act (ACA) |date=October 22, 2014 |publisher=}}
286. ^{{Cite web |url=http://www.help.senate.gov/imo/media/doc/Child-Only%20Health%20Insurance%20Report%20Aug%202,%202011.pdf |title=Health Care Reforrm Law's Impact on Child-Only Health Insurance Policies |last=Enzi |first=Michael B. |date=August 2, 2011 |website=United States Senate |publisher= |accessdate=August 10, 2016}}
287. ^{{cite web |url=http://www.post-gazette.com/stories/news/us/supreme-court-justices-face-important-rulings-in-upcoming-term-655566/ |title=Supreme Court justices face important rulings in upcoming term September |last=Liptak |first=Adam |date=September 30, 2012 |publisher=Pittsburgh Post-Gazette |work=The New York Times |accessdate=September 30, 2012}}
288. ^{{Cite web |url=http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ |title=Status of State Action on the Medicaid Expansion Decision |last= |first= |date= |website= |publisher=Kaiser Family Foundation |language=en-US |accessdate=August 12, 2016}}
289. ^{{cite web |last1=Walton |first1=Alice G. |title=How To Explain The Obamacare Ruling To A Five-Year-Old |url=https://www.forbes.com/sites/alicegwalton/2012/07/02/how-to-explain-the-obamacare-ruling-to-a-five-year-old/#23e103e723e1 |website=Forbes |accessdate=5 May 2017}}
290. ^{{cite news |url=https://www.nytimes.com/2013/02/03/opinion/sunday/a-cruel-blow-to-american-families.html |title=A Cruel Blow to American Families |date=February 2, 2013 |work=The New York Times}}
291. ^{{cite news |url=https://newrepublic.com/article/112327/obamacare-not-universal-you-thought |title=Not-So-Universal Health Care |last=Cohn |first=Jonathan |date=February 5, 2013 |work=The New Republic}}
292. ^{{cite news |url=https://www.usatoday.com/story/news/politics/2013/12/01/federalexchangmeetsgoal/3795523/ |title=White House claims success on HealthCare.gov repairs |last=Kennedy |first=Kelly |date=December 1, 2013 |newspaper=USA Today |accessdate=December 1, 2013}}
293. ^{{cite news |url=http://www.cnn.com/2013/10/22/politics/obamacare-website-four-reasons |title=Rough Obamacare rollout: 4 reasons why |last=Cohen |first=Tom |date=October 23, 2013 |publisher=CNN |accessdate=November 5, 2013}}
294. ^{{cite news |url=http://www.csmonitor.com/USA/Latest-News-Wires/2013/1106/Senate-Democrats-frustrated-with-botched-rollout-of-Obamacare |title=Senate Democrats frustrated with botched rollout of Obamacare |last=Holland |first=Steve |date=November 6, 2013 |publisher=The Christian Science Monitor |last2=Rampton |first2=Roberta |agency=Reuters |accessdate=November 19, 2013}}
295. ^{{Cite web |url=https://www.bloomberg.com/news/articles/2015-06-02/obamacare-dropouts-lead-to-enrollment-decline-of-1-5-million |title=Obamacare Sign-Ups Decline to 10.2 Million as Some Don't Pay |last=Tracer |first=Zachary |website=Bloomberg.com |accessdate=August 21, 2016}}
296. ^{{Cite web |url=https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-03-11.html |title=December 31, 2015 Effectuated Enrollment Snapshot |last= |first= |date=March 11, 2016 |website=cms.gov |publisher= |accessdate=}}
297. ^{{Cite web |url=http://www.politico.com/story/2015/12/white-house-obamacare-cadillac-tax-216881 |title=How the White House lost on the Cadillac Tax |last=COOK |first=NANCY |date=December 16, 2015 |website= |publisher=Politico |accessdate=August 21, 2016}}
298. ^{{Cite web |url=https://www.newyorkfed.org/medialibrary/media/survey/business_leaders/2016/2016_08supplemental.pdf?la=en |title=Supplemental Survey Report: Empire State Manufacturing Survey/Business Leaders Survey Firms Assess Effects of Affordable Care Act |last= |first= |date=August 2016 |website= |publisher=Federal Reserve Bank of New York |accessdate=}}
299. ^{{Cite news |url=https://www.wsj.com/articles/aetna-to-drop-some-affordable-care-act-markets-1471311737 |title=Aetna to Drop Some Affordable Care Act Markets |last=Mathews |first=Anna Wilde |date=August 16, 2016 |newspaper=Wall Street Journal |issn=0099-9660 |accessdate=August 16, 2016}}
300. ^{{Cite news |url=https://www.wsj.com/articles/the-unstable-economics-in-obamas-health-law-1471452938 |title=The Unstable Economics in Obama's Health Law |last=Ip |first=Greg |date=August 17, 2016 |newspaper=Wall Street Journal |issn=0099-9660 |accessdate=August 23, 2016}}
301. ^¹{{Cite web |url=https://www.nytimes.com/2017/02/03/us/politics/affordable-care-act-obama-care-sign-up.html? |title=Affordable Care Act signups dip amid uncertainty and Trump attacks |website=NYT |date=February 3, 2017}}
302. ^{{Cite news |url=http://www.washingtontimes.com/news/2017/feb/14/irs-weakens-enforcement-obamacare-individual-manda/ |title=IRS weakens enforcement of Obamacare individual mandate: Report |last=Morton |first=Victor |date=February 14, 2017 |newspaper=The Washington Times|access-date=2017-02-16 |work= |language=en-US |via=}}
303. ^¹{{Cite web |url=https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact_0.pdf |title=American Healthcare Act Cost Estimate |publisher=Congressional Budget Office |date=March 13, 2017}}
304. ^{{cite news |title=House Passes Bill to Repeal Obamacare: Live Updates |url=https://www.wsj.com/livecoverage/house-gop-obamacare-repeal-bill-vote |accessdate=5 May 2017 |work=WSJ}}
305. ^{{cite news |last1=Epstein |first1=Reid J. |title=Analyst Sees Danger for House Republicans After Health Bill Vote |url=https://blogs.wsj.com/washwire/2017/05/05/analyst-sees-danger-for-house-republicans-after-health-bill-vote/ |accessdate=5 May 2017 |work=WSJ |date=5 May 2017}}
306. ^{{cite journal|url=http://time.com/money/5043622/gop-tax-reform-bill-individual-mandate/|title=The Senate's Tax Bill Eliminates the Individual Mandate for Health Insurance. Here's What You Need to Know|journal=Money|date=December 2, 2017|first=Elizabeth|last=O'Brien}}
307. ^{{Cite web |url=https://www.advisory.com/daily-briefing/resources/primers/medicaidmap |title=Where the states stand on Medicaid expansion |website=Advisory.com |date=February 6, 2019}}
308. ^{{Cite news |url=https://www.nytimes.com/2017/10/17/us/politics/alexander-murray-deal-obamacare-subsidies.html?_r=0 |title=2 Senators Strike Deal on Health Subsidies That Trump Cut Off |authors=Thomas Kaplan and Robert Pear |date= |work=|access-date=}}
309. ^{{Cite news |url=https://www.vox.com/2017/8/15/16153094/voxcare-cbo-trump-obamacare-sabotage-premiums |title=CBO says Trump's Obamacare sabotage would cost $194 billion, drive up premiums 20% |work=Vox|access-date=2017-10-17}}
310. ^¹{{cite court |litigants=Burwell v. Hobby Lobby |vol=573 |reporter=U.S. |opinion= |pinpoint= |court=United States Supreme Court |date=2014 |url=https://www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf |accessdate=June 30, 2014}}
311. ^¹²{{Cite web |url=http://www.cnsnews.com/news/article/medicaid-estimate-renews-cost-concerns-over-obamacare |title=Cost of Obamacare Medicaid Expansion 49% Higher Than Previously Estimated |date=August 12, 2016 |accessdate=August 13, 2016}}
312. ^¹{{cite web |url=http://www.apha.org/APHA/CMS_Templates/GeneralArticle.aspx?NRMODE=Published&NRNODEGUID=%7bD5E1C04A-0438-4FD4-A423-CEFDA0D9878D%7d&NRORIGINALURL=%2fadvocacy%2fHealth%2bReform%2fACAbasics%2fmedicaid%2ehtm |archive-url=https://web.archive.org/web/20140222184335/http://www.apha.org/APHA/CMS_Templates/GeneralArticle.aspx?NRMODE=Published&NRNODEGUID=%7BD5E1C04A-0438-4FD4-A423-CEFDA0D9878D%7D&NRORIGINALURL=%2Fadvocacy%2FHealth+Reform%2FACAbasics%2Fmedicaid.htm |dead-url=yes |archive-date=February 22, 2014 |title=Medicaid Expansion |publisher=American Public Health Association (APHA) |location=Is Medicaid eligibility expanding to 133 or 138 percent FPL, and what is MAGI? |accessdate=July 24, 2013 |df=}}
313. ^¹²{{cite web |first=Nate |last=Silver |url=http://www.fivethirtyeight.com/2009/12/in-house-many-paths-to-218.html |title=For Pelosi, Many Paths to 218 |publisher=FiveThirtyEight |date=December 26, 2009}}
314. ^¹{{cite journal |date=June 28, 2010 |title=Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule |url=http://www.gpo.gov/fdsys/granule/FR-2010-06-28/2010-15278/content-detail.html |journal=Federal Register |volume=75 |issue=123 |pages=37187–37241 |author=U.S. Department of Health and Human Services |accessdate=July 26, 2010}}
315. ^¹{{cite web |url=http://www.aflcio.org/About/Exec-Council/Conventions/2013/Resolutions-and-Amendments/Resolution-54-AFL-CIO-Convention-Resolution-on-the-Affordable-Care-Act |title=Resolution 54: AFL-CIO Convention Resolution on the Affordable Care Act |publisher=AFL-CIO |date=September 11, 2013 |accessdate=October 7, 2013}}
316. ^¹{{cite web |url=http://www.apha.org/advocacy/Health+Reform/ACAbasics/insurance.htm |title=Insurance Exchanges |publisher=American Public Health Association (APHA) |deadurl=yes |archiveurl=https://web.archive.org/web/20130801135757/http://www.apha.org/advocacy/Health+Reform/ACAbasics/insurance.htm |archivedate=August 1, 2013 |df=mdy-all }}
317. ^¹{{cite news |url=http://www.salon.com/2013/09/19/john_boehner_just_made_ted_cruz_life_a_living_hell |title=New test could expose GOP's pack of charlatans |publisher=Salon |date=September 19, 2013 |author=Beutler, Brian |accessdate=September 24, 2013}}
318. ^¹{{cite news |first=Jonathan |last=Cohn |title=Obamacare, Good for the Economy |url=https://newrepublic.com/blog/plank/104035/obamacare-romney-economy-benefit-job-regulation-noam |work=The New Republic |date=June 13, 2012}}
319. ^¹²{{cite web |url=http://www.apha.org/advocacy/Health+Reform/ACAbasics/MC_provision.htm |title=Minimum Coverage Provision ("individual mandate") |publisher=American Public Health Association (APHA) |deadurl=yes |archiveurl=https://web.archive.org/web/20140701171554/http://www.apha.org/advocacy/Health+Reform/ACAbasics/MC_provision.htm |archivedate=July 1, 2014 |df=mdy-all }}
320. ^¹{{cite news |url=http://apnews.excite.com/article/20140731/us-health-overhaul-de4c72c273.html |title=Probe exposes flaws behind HealthCare.gov rollout |last=Alonso-Zaldivar |first=Ricardo |date=July 31, 2014 |publisher=AP News |accessdate=July 31, 2014}}
321. ^{{cite news |author=Associated Press |date=March 24, 2015 |url=https://www.nytimes.com/aponline/2015/03/24/us/politics/ap-us-health-overhaul-uninsured.html |title=CDC: Uninsured Drop by 11M Since Passage of Obama's Law |newspaper=The New York Times}} {{dead link|date=August 2016|fix-attempted=yes}}
322. ^¹{{cite web |title=Employment Situation Summary |url=http://www.bls.gov/news.release/empsit.nr0.htm |publisher=Bureau of Labor Statistics |accessdate=November 11, 2014}}
323. ^¹²{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/blog/the-treatment/what-do-if-coakley-loses-contd |title=How to Pass the Bill--Whatever Happens Tuesday |work=The New Republic |date=January 17, 2010}}
324. ^¹{{Cite news |title=What does the health-care bill do in its first year? |first=Ezra |last=Klein |url=http://voices.washingtonpost.com/ezra-klein/2010/03/what_does_the_health-care_refo.html |newspaper=The Washington Post |date=March 22, 2010}}
325. ^¹²{{cite web |url=http://www.cbo.gov/ftpdocs/108xx/doc10868/12-19-Reid_Letter_Managers_Correction_Noted.pdf |title=Correction Regarding the Longer-Term Effects of the Manager's Amendment to the Patient Protection and Affordable Care Act |publisher=Congressional Budget Office |date=December 19, 2009 |accessdate=March 22, 2010}}
326. ^{{cite web |url=http://www.cbo.gov/publication/25078 |title=Health Costs and the Federal Budget |publisher=Congressional Budget Office |date=May 28, 2010 |accessdate=April 1, 2012}}
327. ^¹{{cite web |url=http://www.cbo.gov/publication/43472 |title=CBO's Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the Recent Supreme Court Decision |publisher=Congressional Budget Office |date=July 24, 2012 |accessdate=August 6, 2012}}
328. ^¹²³⁴{{cite web |url=https://www.cbo.gov/publication/50252 |title=Budgetary and Economic Effects of Repealing the Affordable Care Act |publisher=Congressional Budget Office |date=June 18, 2015 |accessdate=June 19, 2015}}
329. ^¹{{cite web |url=http://www.cbo.gov/doc.cfm?index=10781 |title=An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act}}
330. ^¹{{cite news |first=Jonathan |last=Cohn |title=Sorry, The CBO Did Not Say Health Reform Kills 800,000 Jobs |url=https://newrepublic.com/blog/jonathan-chait/83310/sorry-the-cbo-did-not-say-health-reform-kills-800000-jobs |work=The New Republic |date=February 11, 2011}}
331. ^¹²{{cite web |url=http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/113xx/doc11379/amendreconprop.pdf |title=Cost Estimate for Pending Health Care Legislation |date=March 20, 2010 |publisher=Congressional Budget Office |accessdate=March 28, 2010}}
332. ^¹²{{cite news |title=The GOP's Trick Play |first=Jonathan |last=Cohn |work=The New Republic |date=January 21, 2011 |url=http://www.tnr.com/blog/jonathan-cohn/81941/trick-play}}
333. ^¹{{cite news |title=Is the CBO Biased Against Health Care Reform? |first=Noam |last=Scheiber |work=The New Republic |date=September 17, 2009 |url=http://www.tnr.com/blog/the-stash/the-cbo-biased-against-health-care-reform}}
334. ^¹{{cite web |url=http://www.cbo.gov/ftpdocs/113xx/doc11355/hr4872.pdf |title=H.R. 4872, Reconciliation Act of 2010 |publisher=Congressional Budget Office |date=March 18, 2010 |accessdate=March 22, 2010}}
335. ^¹²³⁴{{cite web |url=http://www.cbo.gov/publication/22077 |title=CBO's Analysis of the Major Health Care Legislation Enacted in March 2010 |publisher=Congressional Budget Office |date=March 30, 2011 |accessdate=April 6, 2012}}
336. ^¹{{cite web |url=http://www.cbo.gov/publication/43104 |title=Another Comment on CBO's Estimates for the Insurance Coverage Provisions of the Affordable Care Act |publisher=Congressional Budget Office |date=March 16, 2012 |accessdate=April 6, 2012}}
337. ^¹²{{cite web |url=http://www.cbpp.org/cms/index.cfm?fa=view&id=2921 |title=Finance Committee Makes Flawed Employer Requirement in Health Reform Bill Still More Problematic |author1=Robert Greenstein |author2=Judith Solomon |publisher=Center on Budget and Policy Priorities |date=July 3, 2013}}
338. ^¹²{{cite web |first=Jonathan |last=Chait |title=Obama Employer Mandate Delay Train Wreck! Or Not |url=http://nymag.com/daily/intelligencer/2013/07/obama-employer-mandate-delay-train-wreck-or-not.html |work=New York |date=July 3, 2013}}
339. ^¹²{{Cite journal |last=Chaikind |first=Hinda |last2=Copeland |first2=Curtis W. |last3=Redhead |first3=C. Stephen |last4=Staman |first4=Jennifer |date=March 2, 2011 |title=PPACA: A Brief Overview of the Law, Implementation, and Legal Challenges |url=http://www.nationalaglawcenter.org/wp-content/uploads/assets/crs/R41664.pdf |publisher=Congressional Research Service |id=R41664 |accessdate=December 22, 2013}}
340. ^¹{{cite news |url=http://nymag.com/daily/intelligencer/2013/07/obamacare-still-not-collapsing.html |title=Obamacare Still Not Collapsing |last=Chait |first=Jonathan |date=July 3, 2013 |work=New York}}
341. ^¹{{cite news |first=Jonathan |last=Chait |url=https://newrepublic.com/blog/the-plank/the-republican-health-care-blunder |title=The Republican Health Care Blunder |work=The New Republic |date=December 19, 2009}}
342. ^¹{{cite web |url=https://www.healthcare.gov/how-do-i-choose-marketplace-insurance |title=How do I choose Marketplace insurance? |publisher=HealthCare.Gov, managed by the Centers for Medicare and Medicaid Services}}
343. ^¹{{cite web |url=https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Prevention.html |title=Health Insurance Market Reforms: Prevention |date=December 21, 2010 |publisher=Centers for Medicare and Medicaid Services |accessdate=September 8, 2013}}
344. ^¹{{cite web |url=http://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Medical-Loss-Ratio.html |title=Medical Loss Ratio |publisher=Centers for Medicaid and Medicare Services |accessdate=October 2, 2013}}
345. ^¹²{{cite web |title=Affordable Care Act Update: Implementing Medicare Cost Savings |url=http://www.cms.gov/apps/docs/aca-update-implementing-medicare-costs-savings.pdf |publisher=Centers for Medicare and Medicaid Services |date=August 2, 2010 |accessdate=October 7, 2013 |deadurl=yes |archiveurl=https://web.archive.org/web/20130418015959/http://www.cms.gov/apps/docs/aca-update-implementing-medicare-costs-savings.pdf |archivedate=April 18, 2013 |df=mdy-all }}
346. ^¹{{Cite news |url=http://www.cnn.com/2010/POLITICS/03/18/health.care.latest/index.html |publisher=CNN |title=Where does health care reform stand? |date=March 18, 2010 |accessdate=May 12, 2010}}
347. ^¹²{{cite news |url=http://money.cnn.com/2013/07/01/news/economy/medicaid-expansion-states/index.html |title=States forgo billions by opting out of Medicaid expansion |author=Tami Luhby |publisher=CNN |date=July 1, 2013}}
348. ^¹{{cite news |url=https://newrepublic.com/article/114163/limited-enrollment-periods-obamacare-means-young-people-cant-wait |title=Burn Your Obamacare Card, Burn Yourself |last=Cohn |first=Jonathan |date=August 5, 2013 |work=The New Republic}}
349. ^¹{{cite news |url=https://newrepublic.com/blog/jonathan-cohn/98928/individual-mandate-mistake-health-reform-starr-cbo-ppaca |title=Was the Mandate a Mistake? |last=Cohn |first=Jonathan |date=December 26, 2011 |work=The New Republic}}
350. ^¹{{cite news |url=https://newrepublic.com/article/112259/obamacare-sticker-shock-not-very-shocking |title=Obamacare Sticker Shock: Not Very Shocking |last=Cohn |first=Jonathan |date=April 29, 2013 |work=The New Republic}}
351. ^¹{{cite news |url=https://newrepublic.com/article/113440/obamacare-rate-shock-higher-prices-can-mean-better-benefits |title=You Call This Insurance? |last=Cohn |first=Jonathan |date=June 12, 2013 |work=The New Republic}}
352. ^¹{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/article/health-care/why-americans-should-support-individual-mandate |title=Common Sense |work=The New Republic |date=April 9, 2010}}
353. ^¹U.S. Const. art. I, § 7, cl. 1.
354. ^¹²{{cite news |url=http://www.cnn.com/2012/06/25/politics/obamacare-word-debate/ |title='Obamacare': The word that defined the health care debate |last=Wallace |first=Gregory |date=June 25, 2012 |publisher=CNN |accessdate=September 4, 2012}}
355. ^¹{{cite news |url=http://www.cnn.com/2011/HEALTH/07/19/birth.control.iom/index.html |title=Birth control should be fully covered under health plans, report says |last=Park |first=Madison |date=July 19, 2011 |publisher=CNN |accessdate=August 27, 2012}}
356. ^¹²³{{cite news |url=https://newrepublic.com/article/113745/obamacare-employer-mandate-delayed-not-what-doctor-ordered |title=Some Bad News About Obamacare That Isn't Bogus |last=Cohn |first=Jonathan |date=July 2, 2013 |work=The New Republic}}
357. ^¹{{cite web |url=http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/Jul/State-Health-Insurance-Exchange-Laws.aspx?omnicid=20 |title=State Health Insurance Exchange Laws: The First Generation |date=July 25, 2012 |publisher=The CommonWealth Fund}}
358. ^¹{{cite news |url=https://www.npr.org/blogs/thetwo-way/2010/03/health_overhaul_another_promis.html |title=Health Overhaul Another Promise U.S. Can't Afford: Expert |last=James |first=Frank |date=March 19, 2010 |publisher=NPR |accessdate=April 7, 2010}}
359. ^¹{{Cite news |url=http://edlabor.house.gov/blog/2009/10/affordable-health-care.shtml |title=Affordable Health Care for America Act |first=Mike |last=Kruger |date=October 29, 2009 |publisher=United States House Committee on Education and Labor |accessdate=March 24, 2010 |archiveurl=https://web.archive.org/web/20100106013943/http://edlabor.house.gov/blog/2009/10/affordable-health-care.shtml |archivedate=January 6, 2010}}
360. ^¹Executive Order 13535 of March 24, 2010 — Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection and Affordable Care Act, Vol. 75, No. 59 {{USFedReg|75|15599}}, March 29, 2010.
361. ^¹{{cite web |url=https://www.healthcare.gov/glossary/essential-health-benefits/ |title=Essential Health Benefits |date=September 23, 2010 |publisher=HealthCare.gov |accessdate=February 9, 2016}}
362. ^¹{{cite web |url=http://www.familiesusa.org/assets/pdfs/health-reform/Enrollment-Policy-Provisions.pdf |title=Enrollment Policy Provisions in the Patient Protection and Affordable Care Act |publisher=Families USA |date= |accessdate=April 1, 2012}}
363. ^¹{{cite press release |title=The Patients' Bill of Rights: Ending annual and lifetime limits |date=September 23, 2010 |publisher=FamiliesUSA |url=http://www.familiesusa.org/health-reform-central/september-23/Annual-and-Lifetime-Limits.pdf |accessdate=April 9, 2012 |deadurl=yes |archiveurl=https://web.archive.org/web/20120331052105/http://www.familiesusa.org/health-reform-central/september-23/Annual-and-Lifetime-Limits.pdf |archivedate=March 31, 2012 |df=mdy-all }}
364. ^¹{{cite web |url=http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/womens-preven-02012013.html |title=Women's Preventive Services Coverage and Non-Profit Religious Organizations |publisher=Centers for Medicare and Medicaid Services |accessdate=September 8, 2013}}
365. ^¹{{cite web |url=http://www.gpo.gov/fdsys/granule/FR-2011-12-07/2011-31289/content-detail.html |title=Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act |date=December 7, 2011 |publisher=Federal Register |page=76573 |volume=76 |issue=235 |accessdate=April 1, 2012}}
366. ^¹{{cite web |url=http://www.gpo.gov/fdsys/granule/FR-2012-02-15/2012-3547/content-detail.html |title=Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act – Final Rules |date=February 10, 2012 |publisher=Federal Register |format=77 FR 8725 |quote=Summary: These regulations finalize, without change, interim final regulations authorizing the exemption of group health plans and group health insurance coverage sponsored by certain religious employers from having to cover certain preventive health services under provisions of the Patient Protection and Affordable Care Act. |author=Dept. Health and Human Services |accessdate=February 15, 2012}}
367. ^¹{{Cite news |url=http://www.whitehouse.gov/the-press-office/remarks-president-barack-obama-address-joint-session-congress |title=Remarks of President Barack Obama – Address to Joint Session of Congress |date=February 24, 2009 |publisher=The White House |accessdate=March 24, 2010 |deadurl=yes |archiveurl=https://web.archive.org/web/20100308180312/http://www.whitehouse.gov/the-press-office/remarks-president-barack-obama-address-joint-session-congress |archivedate=March 8, 2010}}
368. ^¹{{cite web |last=Pecquet |first=Julian |url=http://thehill.com/blogs/healthwatch/health-reform-implementation/215795-cbo-health-law-to-cost-less-cover-fewer-people-than-first-thought |title=CBO: Obama's health law to cost less, cover fewer people than first thought |work=The Hill |date=March 13, 2012 |accessdate=June 29, 2012}}
369. ^¹²{{cite web |last=Ungar |first=Rick |title=The Real Numbers On 'The Obamacare Effect' Are In-Now Let The Crow Eating Begin |url=https://www.forbes.com/sites/rickungar/2014/03/10/the-real-numbers-on-the-obamacare-effect-are-in-now-let-the-crow-eating-begin/ |work=Forbes |accessdate=November 11, 2014}}
370. ^¹²³⁴{{cite news |work=Forbes Magazine |title=The Tortuous History of Conservatives and the Individual Mandate |first=Avik |last=Roy |date=February 7, 2012 |url=https://www.forbes.com/sites/aroy/2012/02/07/the-tortuous-conservative-history-of-the-individual-mandate}}
371. ^{{cite journal |journal=Gallup Polling |title=U.S. Uninsured Rate at 11.0%, Lowest in Eight-Year Trend |first=Stephanie |last=Marken |date=April 7, 2016 |url=http://www.gallup.com/poll/190484/uninsured-rate-lowest-eight-year-trend.aspx}}
372. ^¹{{cite web |first=Molly |last=Ball |title=Was Mitt Romney a Good Governor? |url=https://www.theatlantic.com/politics/archive/2012/05/was-mitt-romney-a-good-governor/257942 |work=The Atlantic |date=May 31, 2012 |accessdate=October 28, 2013}}
373. ^¹²{{cite web |url=http://www.gpo.gov/fdsys/pkg/USCODE-2011-title26/pdf/USCODE-2011-title26-subtitleD-chap43-sec4980H.pdf |title=Title 26 – Internal Revenue Code |author=Government Printing Office}}
374. ^¹²{{cite web |url=http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/html/PLAW-111publ148.htm |title=Public Law 111 – 148, section 1332 |publisher=Government Printing Office |accessdate=June 29, 2012}}
375. ^¹{{cite web |url=http://economics.mit.edu/faculty/gruberj |title=Jonathan Gruber (economist) |publisher=MIT Department of Economics |accessdate=September 2, 2013 }}{{cite web |url=http://economics.mit.edu/files/7840 |title=Jonathan Gruber: short biography |publisher=MIT Department of Economics |accessdate=September 2, 2013 |deadurl=yes |archiveurl=https://web.archive.org/web/20130928032016/http://economics.mit.edu/files/7840 |archivedate=September 28, 2013 |df=mdy-all }}
376. ^¹²{{cite web |url=http://www.americanprogress.org/issues/2011/02/pdf/gruber_mandate.pdf |title=Health Care Reform without the Individual Mandate |date=February 2011 |publisher=Center for American Progress |author=Jonathan Gruber (economist) |access-date=July 26, 2013 |archive-url=https://web.archive.org/web/20130922165512/http://www.americanprogress.org/issues/2011/02/pdf/gruber_mandate.pdf |archive-date=September 22, 2013 |dead-url=yes |df=mdy-all }}
377. ^¹{{cite news |first=Jacob S. |last=Hacker |url=https://newrepublic.com/blog/the-treatment/why-i-still-believe-bill |title=Why I Still Believe in This Bill |work=The New Republic |date=December 20, 2009}}
378. ^¹{{cite web |url=http://www.healthcare.gov/law/about/order/byyear.html |title=Provisions of the Affordable Care Act, By Year |publisher=HealthCare.gov |accessdate=January 9, 2012 |deadurl=yes |archiveurl=https://web.archive.org/web/20110909133159/http://www.healthcare.gov/law/about/order/byyear.html |archivedate=September 9, 2011 |df=mdy-all }}
379. ^¹{{cite web |url=https://www.healthcare.gov/glossary/essential-health-benefits |title=Essential Health Benefits |publisher=HealthCare.gov, managed by the Centers for Medicare and Medicaid Services}}
{{cite web |url=https://www.healthcare.gov/what-does-marketplace-health-insurance-cover |title=What does Marketplace health insurance cover? |publisher=HealthCare.Gov, managed by the Centers for Medicare and Medicaid Services}}
380. ^¹{{cite web |url=http://www.healthcarereformmagazine.com/article/health-reform-and-medicaid-expansion.html |title=Health Reform and MedicaidExpansion |work=HealthCare Reform Magazine |date=July 13, 2010 |accessdate=January 9, 2012}}
381. ^¹{{cite web |url=https://www.healthcare.gov/marketplace/individual/ |title=Welcome to the Marketplace |publisher=HealthCare.Gov, managed by the Centers for Medicare and Medicaid Services}}
{{cite web |url=https://www.healthcare.gov/what-is-the-health-insurance-marketplace |title=What is the Health Insurance Marketplace? |publisher=HealthCare.Gov, managed by the Centers for Medicare and Medicaid Services}}
382. ^¹{{cite web |url=https://www.hhs.gov/healthcare/facts/timeline/timeline-text.html#print |title=Key Features of the Affordable Care Act By Year |date=June 7, 2013 |publisher=HHS |accessdate=June 7, 2013}}
383. ^¹{{cite press release |title=HHS and states move to establish Affordable Insurance Exchanges, give Americans the same insurance choices as members of Congress |date=July 11, 2011 |publisher=HHS |url=https://www.hhs.gov/news/press/2011pres/07/20110711a.html |accessdate=April 9, 2012 |deadurl=yes |archiveurl=https://web.archive.org/web/20120414044029/http://www.hhs.gov/news/press/2011pres/07/20110711a.html |archivedate=April 14, 2012 |df=mdy-all }}
384. ^¹²{{cite web |url=http://kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/ |title=Explaining Health Care Reform |publisher=Kaiser Family Foundation}}
385. ^¹{{cite web |url=https://www.fas.org/sgp/crs/misc/R41137.pdf |title=Health Insurance Premium Credits Under PPACA |date=2014 |publisher=Congressional Research Service}}
386. ^¹H.R. 3590 Enrolled, section 1001 (adding section 2714 to the Public Health Service Act): "A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age."
387. ^¹²{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/article/75077/how-they-did-it |title=How They Did It |work=The New Republic |date=May 21, 2010}}
388. ^¹{{cite news |url=https://newrepublic.com/article/113257/low-wage-employers-try-avoid-obamacare-mandate |title=Weaseling Out of Obamacare |last=Cohn |first=Jonathan |date=May 21, 2013 |work=The New Republic}}
389. ^¹{{cite web |url=https://www.irs.gov/affordable-care-act/employers/small-business-health-care-tax-credit-and-the-shop-marketplace |title=Small Business Health Care Tax Credit and the SHOP Marketplace |date=October 20, 2016 |publisher=Internal Revenue Service |accessdate=January 11, 2017}}
390. ^¹{{cite news |url=https://newrepublic.com/blog/plank/103875/obamacare-supreme-court-mandate-contingency-survive |title=Just in Case: How Reform Might Survive Without the Mandate |last=Cohn |first=Jonathan |date=June 8, 2012 |work=The New Republic}}
391. ^¹²{{cite web |url=http://kff.org/health-reform/state-indicator/health-insurance-exchanges/#notes |title=State Decisions For Creating Health Insurance Exchanges, as of May 28, 2013 – Notes |date=May 28, 2013 |publisher=Kaiser Family Foundation}}
392. ^¹²³{{cite web |url=http://kff.org/health-reform/perspective/questions-about-essential-health-benefits |title=Questions About Essential Health Benefits |last=Levitt |first=Larry |last2=Claxton |first2=Gary |date=October 18, 2011 |publisher=Kaiser Family |last3=Pollitz |first3=Karen}}
393. ^¹{{cite web |url=http://healthreform.kff.org/SubsidyCalculator.aspx |title=Kaiser Family Foundation:Health Reform Subsidy Calculator – Premium Assistance for Coverage in Exchanges/Gateways}}
394. ^¹{{cite web |title=Status of State Action on the Medicaid Expansion Decision, as of September 1, 2015 |url=https://www.kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/ |publisher=Kaiser Family Foundation |date=June 22, 2015}}
395. ^¹{{cite web |url=http://kff.org/health-costs/issue-brief/explaining-health-care-reform-questions-about-health/ |title=Explaining Health Care Reform: Questions About Health Insurance Subsidies |date=July 1, 2012 |publisher=Kaiser Family Foundation |accessdate=July 1, 2012}}
396. ^¹²{{cite web |url=http://www.kaiserhealthnews.org/Graphics/2010/022310-Bill-comparison.aspx |title=Chart: Comparing Health Reform Bills: Democrats and Republicans 2009, Republicans 1993 |publisher=Kaiser Health News |date=February 23, 2010 |accessdate=July 29, 2012}}
{{cite web |url=http://www.kaiserhealthnews.org/Stories/2010/February/23/GOP-1993-health-reform-bill.aspx |title=Summary Of A 1993 Republican Health Reform Plan |publisher=Kaiser Health News |date=February 23, 2010 |accessdate=July 29, 2012}}
397. ^¹{{cite news |url=http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf |title=Summary of the Affordable Care Act |date=April 23, 2013 |publisher=Kaiser Family Foundation |deadurl=yes |archiveurl=https://web.archive.org/web/20131003011827/http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf |archivedate=October 3, 2013 |df=mdy-all }}
398. ^¹{{cite web |url=http://kff.org/medicaid/fact-sheet/where-are-states-today-medicaid-and-chip |title=Where are States Today? Medicaid and CHIP Eligibility Levels for Children and Non-Disabled Adults |date=March 28, 2013 |publisher=Kaiser Family Foundation}}
399. ^¹{{cite web |url=http://kff.org/health-costs/issue-brief/explaining-health-care-reform-what-is-an/ |title=Explaining Health Care Reform: What is Employer "Pay-or-Play" Requirement? |date=May 1, 2009 |publisher=Kaiser Family Foundation |accessdate=January 9, 2012}}
400. ^¹{{cite web |url=http://kaiserfamilyfoundation.files.wordpress.com/2013/06/8451-t.pdf |title=Pg 14 of 'Kaiser Health Tracking Poll: June 2013{{'-}}|date=June 2013|publisher=Kaiser Family Foundation}}
401. ^¹{{cite web |url=http://kff.org/state-category/health-coverage-uninsured |title=Health Coverage & Uninsured |date=June 20, 2013 |publisher=Kaiser Family Foundation}}
{{cite web |url=http://kff.org/other/state-indicator/total-population |title=Health Insurance Coverage of the Total Population |date=June 20, 2013 |publisher=Kaiser Family Foundation}}
402. ^¹{{cite news |url=http://www.kaiserhealthnews.org/Stories/2010/March/22/consumers-guide-health-reform.aspx |title=Consumers Guide To Health Reform |last=Galewitz |first=Phil |date=March 26, 2010 |publisher=Kaiser Health News}}
403. ^¹{{cite news |url=https://www.washingtonpost.com/blogs/wonkblog/wp/2012/08/01/five-facts-about-the-health-laws-contraceptive-mandate |title=Five facts about the health law's contraceptive mandate |last=Kliff |first=Sarah |date=August 1, 2012 |publisher=The Washington Post |accessdate=November 29, 2012}}
404. ^¹{{cite news |url=https://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/05/what-happens-if-a-state-opts-out-of-medicaid-in-one-chart |title=What Happens if a State Opts Out of Medicaid, in One Chart |author=Kliff, Sarah |date=July 5, 2012 |work=The Washington Post |accessdate=July 15, 2012}}
405. ^¹²³⁴{{cite news |title=Will Obamacare lead to millions more part-time workers? Companies are still deciding |author=Sarah Kliff |url=https://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/06/will-obamacare-lead-to-millions-more-part-time-workers-companies-are-still-deciding |newspaper=The Washington Post |date=May 6, 2013}}
406. ^¹{{cite news |url=https://www.forbes.com/sites/carolynmcclanahan/2013/08/04/readers-questions-about-obamacare-misinformation-abounds |title=Reader's Questions About Obamacare – Misinformation Abounds |last=McClanahan |first=Carolyn |date=August 4, 2013 |newspaper=Forbes |accessdate=August 15, 2013}}
407. ^¹{{cite news |url=https://newrepublic.com/article/health-care/why-americans-should-support-individual-mandate |title=Common Sense |last=Cohn |first=Jonathan |date=April 9, 2010 |work=The New Republic}}
{{cite news |url=https://newrepublic.com/blog/jonathan-cohn/102285/supreme-court-obamacare-mandate-severability-cbo |title=What If the Mandate Goes? |last=Cohn |first=Jonathan |date=April 2, 2012 |work=The New Republic}}
408. ^¹{{cite web |url=http://www.slideshare.net/cbo/effects-of-eliminating-the-individual-mandate-to-obtain-health-insurance |title=Effects of Eliminating the Individual Mandate to Obtain Health Insurance |last=Banthin |first=Jessica |date=March 20, 2012 |publisher=CBO}}
409. ^¹{{cite news |url=https://newrepublic.com/article/113851/obamacare-individual-mandate-republicans-push-delay |title=Obamacare's Individual Mandate Can't Wait |last=Cohn |first=Jonathan |date=July 15, 2013 |work=The New Republic}}
410. ^¹²³⁴{{cite news |title=Will Obamacare lead to millions more part-time workers? Companies are still deciding |author=Ezra Klein |url=https://www.washingtonpost.com/blogs/wonkblog/wp/2013/07/02/obamacares-employer-mandate-shouldnt-be-delayed-it-should-be-repealed |newspaper=The Washington Post |date=July 2, 2013}}
411. ^¹{{cite web |url=https://www.usnews.com/debate-club/is-medicaid-expansion-good-for-the-states |title=Is Medicaid Expansion Good for the States? |work=U.S. News & World Report |date=n.d.}}
412. ^¹²{{cite news |last=Zengerle |first=Patricia |url=https://www.reuters.com/article/2012/06/24/us-usa-campaign-healthcare-idUSBRE85N01M20120624 |title=Reuters-Most Americans Oppose Health Law But Like the Provisions |publisher=Reuters |date=June 24, 2012 |accessdate=June 28, 2012}}
413. ^¹PriceWaterHouseCoopers. "The CLASS Act." HRS Insight: Human Resource Services. 2010: 1–6. Web.
414. ^¹{{cite web |url=http://www.naic.org/documents/committees_b_Exchanges.pdf |title=Patient Protection and Affordable Care Act of 2009: Health Insurance Exchanges |date=April 20, 2010 |publisher=National Association of Insurance Commissioners |accessdate=April 9, 2012}}
415. ^¹{{cite news |first=Bob |last=Cohn |first2=Eleanor |last2=Clift |url=http://www.newsweek.com/lost-chance-188330 |title=The Lost Chance |work=Newsweek |date=September 18, 1994 |accessdate=July 2, 2012}}
416. ^¹²³{{cite news |url=http://www.csmonitor.com/USA/2010/0323/Obama-signs-health-care-bill-Who-won-t-be-covered |title=Obama signs health care bill: Who won't be covered? |last=Trumbull |first=Mark |date=March 23, 2010 |work=The Christian Science Monitor |accessdate=March 24, 2010}}
417. ^¹²³{{cite news |work=The New Yorker |first=Ezra |last=Klein |authorlink=Ezra Klein |title=Unpopular Mandate |date=June 25, 2012 |url=http://www.newyorker.com/reporting/2012/06/25/120625fa_fact_klein |accessdate=June 19, 2012}}
418. ^¹²{{cite news |work=The New Yorker |title=Romney's dilemma |url=http://www.newyorker.com/reporting/2011/06/06/110606fa_fact_lizza |first=Ryan |last=Lizza |authorlink=Ryan Lizza |date=June 6, 2011 |accessdate=June 19, 2012}}
419. ^¹²{{cite news |title=Sarah Palin falsely claims Barack Obama runs a "death panel" |publisher=PolitiFact |date=August 10, 2009 |url=http://www.politifact.com/truth-o-meter/statements/2009/aug/10/sarah-palin/sarah-palin-barack-obama-death-panel}}
420. ^¹²{{cite news |title=As Health Law Changes Loom, A Shift To Part-Time Workers |url=https://www.npr.org/2013/04/29/179864601/as-health-law-changes-loom-a-shift-to-part-time-workers |publisher=NPR |date=April 29, 2013}}
421. ^¹²{{cite news |url=https://newrepublic.com/blog/jonathan-cohn/101948/supreme-court-mandate-new-jersey-insurance-reform |title=Reform With No Mandate? Ask New Jersey About That |last=Cohn |first=Jonathan |date=March 21, 2012 |work=The New Republic}}
422. ^¹{{cite news |url=http://nymag.com/daily/intelligencer/2013/05/yuval-levin-dissembles-madly.html |title=Yuval Levin Dissembles Madly |last=Chait |first=Jonathan |date=May 29, 2013 |work=New York}}
423. ^¹{{cite web |url=http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/HealthSystemReform/Health-Care-Reform-Legislation-Timeline.pdf |title=Selected Patient Protection and Affordable Care Act (PPACA) implementation dates of interest to RNs as caregivers, RNs as patients, and RNs as employees |publisher=Nursingworld.org |accessdate=April 9, 2012 |deadurl=yes |archiveurl=https://web.archive.org/web/20120514010100/http://nursingworld.org/MainMenuCategories/Policy-Advocacy/HealthSystemReform/Health-Care-Reform-Legislation-Timeline.pdf |archivedate=May 14, 2012 |df=mdy-all }}
424. ^¹{{cite news |last=Stolberg |first=Sheryl Gay |title=States Are Focus of Effort to Foil Health Care Law |url=https://www.nytimes.com/2013/10/19/us/politics/states-are-focus-of-effort-to-foil-health-care-law.html |date=October 18, 2013 |work=The New York Times |accessdate=October 19, 2013}}
425. ^¹{{cite news |author1=The Editorial Board |title=The Koch Party |url=https://www.nytimes.com/2014/01/26/opinion/sunday/the-koch-party.html |date=January 25, 2014 |work=The New York Times |accessdate=January 25, 2014}}
426. ^¹²{{cite news |last=Baker |first=Peter |title=Democrats Embrace Once Pejorative 'Obamacare' Tag |url=https://www.nytimes.com/2012/08/04/health/policy/democrats-embrace-once-pejorative-obamacare-tag.html?_r=1 |newspaper=The New York Times |date=August 3, 2012 |accessdate=August 6, 2012}}
427. ^¹{{cite news |title=Fighting to Control the Meaning of 'Obamacare{{'-}}|url=https://www.nytimes.com/interactive/2012/03/25/us/politics/fighting-to-control-the-meaning-of-obamacare.html |newspaper=The New York Times|date=March 25, 2012|author=Amanda Cox |author2=Alicia Desantis |author3=Jeremy White |accessdate=June 29, 2012}}
428. ^¹{{cite news |last=Moore |first=Michael |authorlink=Michael Moore |title=The Obamacare We Deserve |url=https://www.nytimes.com/2014/01/01/opinion/moore-the-obamacare-we-deserve.html |date=December 31, 2013 |work=The New York Times |accessdate=January 6, 2014}}
429. ^¹{{cite news |title=Partisan Gridlock Thwarts Effort to Alter Health Law |url=https://www.nytimes.com/2013/05/27/us/politics/polarized-congress-thwarts-changes-to-health-care-law.html |newspaper=The New York Times |date=May 26, 2013 |author=Jonathan Weisman |author2=Robert Pear |accessdate=May 27, 2013 |quote=we cannot use any of the normal tools to resolve ambiguities or fix problems}}
430. ^¹²{{cite news |title=States' Policies on Health Care Exclude Some of the Poorest |url=https://www.nytimes.com/2013/05/25/us/states-policies-on-health-care-exclude-poorest.html |newspaper=The New York Times |date=May 24, 2013 |author=Robert Pear |accessdate=May 25, 2013 |quote=In most cases, [Sandy Praeger, Insurance Commissioner of Kansas], said adults with incomes from 32 percent to 100 percent of the poverty level ($6,250 to $19,530 for a family of three) "will have no assistance".}}
431. ^¹{{cite news |title=Missouri Citizens Face Obstacles to Coverage |url=https://www.nytimes.com/2013/08/03/us/missouri-citizens-face-obstacles-to-coverage.html |newspaper=The New York Times |date=August 2, 2013 |first=Robert |last=Pear |accessdate=August 3, 2013}}
432. ^¹²³{{Cite news |title=Health Vote Caps a Journey Back From the Brink |first=Sheryl |last=Stolberg |first2=Jeff |last2=Zeleny |first3=Carl |last3=Hulse |url=https://www.nytimes.com/2010/03/21/health/policy/21reconstruct.html |newspaper=The New York Times |date=March 20, 2010 |accessdate=March 23, 2010}}
433. ^¹²³{{cite news |work=The New York Times |title=Conservatives Sowed Idea of Health Care Mandate, Only to Spurn It Later |first=Michael |last=Cooper |date=February 14, 2012 |url=https://www.nytimes.com/2012/02/15/health/policy/health-care-mandate-was-first-backed-by-conservatives.html |accessdate=July 2, 2012}}
434. ^¹{{Cite journal |first=Annie |last=Lowrey |date=May 7, 2013 |url=https://www.nytimes.com/2013/05/07/business/slowdown-in-rise-of-health-care-costs-may-persist.html |title=Slowdown in Rise of Healthcare Costs May Persist |journal=The New York Times |accessdate=June 10, 2013}}
435. ^¹{{cite web |first=Louis |last=Jacobson |title=Barack Obama says that what he'd said was you could keep your plan 'if it hasn't changed since the law passed{{'-}}|url=http://www.politifact.com/truth-o-meter/statements/2013/nov/06/barack-obama/barack-obama-says-what-hed-said-was-you-could-keep/|publisher=PolitiFact |accessdate=November 9, 2013}}
436. ^¹{{cite news |url=http://money.cnn.com/2012/07/23/news/economy/health-reform |title=6 million will lose out on Medicaid expansion |first=Emily Jane |last=Fox |publisher=CNNMoney |date=July 24, 2012 |accessdate=July 25, 2012}}
437. ^¹²{{cite news |first=Norm |last=Ornstein |title=The Unprecedented and Contemptible Attempts to Sabotage Obamacare |url=http://www.nationaljournal.com/columns/washington-inside-out/the-unprecedented-and-contemptible-attempts-to-sabotage-obamacare-20130724 |work=National Journal |date=July 24, 2013}}
438. ^{{cite news |url=https://www.reuters.com/article/2012/06/28/usa-healthcare-court-idUSL2E8HS4WG20120628 |title=US top court upholds healthcare law in Obama triumph |publisher=Reuters |first=James |last=Vicini |first2=Jonathan |last2=Stempel |date=June 28, 2012}}
439. ^¹{{cite news |title=The Facts Are In and Paul Ryan Is Wrong |first=Jonathan |last=Chait |work=New York |date=May 10, 2013 |url=http://nymag.com/daily/intelligencer/2013/05/facts-are-in-and-paul-ryan-is-wrong.html}}
440. ^¹{{Cite news |title=Pelosi Defends Health Care Fight Tactics |first=Margaret |last=Aro |first2=Mark |last2=Mooney |url=http://abcnews.go.com/WN/Politics/house-speaker-nancy-pelosis-exclusive-interview-diane-sawyer/story?id=10172685 |newspaper=ABC News |date=March 22, 2010 |accessdate=March 23, 2010}}
441. ^¹²{{cite web |url=http://www.politifact.com/truth-o-meter/statements/2012/apr/19/facebook-posts/facebook-post-says-republicans-embraced-individual |title=Facebook post says Republicans embraced individual mandate in 1993 |publisher=PolitiFact |date=April 19, 2012}}
442. ^¹²{{Cite news |title=Pelosi steeled W.H. for health push |first=Carrie |last=Brown |first2=Glenn |last2=Thrush |url=http://www.politico.com/news/stories/0310/34753.html |newspaper=Politico |date=March 20, 2010 |accessdate=March 23, 2010}}
443. ^¹{{cite web |url=http://www.lifehealthpro.com/2010/10/07/after-ppaca-the-future-of-the-health-insurance-und |title=After PPACA: The Future of the Health Insurance Underwriter |last=Pool |first=Gentrie |date=October 7, 2010 |publisher=Asjonline.com |accessdate=April 9, 2012 |archive-url=https://web.archive.org/web/20120403103904/http://www.lifehealthpro.com/2010/10/07/after-ppaca-the-future-of-the-health-insurance-und |archive-date=April 3, 2012 |dead-url=yes |df=mdy-all }}
444. ^{{cite web |title=Public Law 111–148 |publisher=United States Government Printing Office |location=Washington, D.C. |date=March 23, 2010 |url=http://www.gpo.gov/fdsys/granule/PLAW-111publ148/PLAW-111publ148/content-detail.html |accessdate=December 22, 2013}}
445. ^¹{{cite web |url=http://www.ncsl.org/documents/health/hlthinspremcredits.pdf |title=Health Insurance Premium Credits in the PPACA |date=April 28, 2010 |publisher=Congressional Research Service}}
446. ^¹{{cite web |first=Andrew |last=Cline |title=How Obama Broke His Promise on Individual Mandates |url=https://www.theatlantic.com/politics/archive/2012/06/how-obama-broke-his-promise-on-individual-mandates/259183/ |work=The Atlantic |accessdate=September 26, 2013}}
447. ^¹²{{cite news |first=Jonathan |last=Cohn |url=https://newrepublic.com/blog/the-treatment/the-public-option-still-dead |title=The Public Option, Still Dead |work=The New Republic |date=March 12, 2010}}
448. ^¹{{cite web |url=https://www.rand.org/content/dam/rand/pubs/technical_reports/2012/RAND_TR1221.pdf |title=The Effect of the Affordable Care Act on Enrollment and Premiums, With and Without the Individual Mandate |last=Eibner |first=Christine |last2=Price |first2=Carter |year=2012 |publisher=Rand Health}}
449. ^¹{{cite web |url=http://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html#polls |title=Obama and Democrats' Health Care Plan |publisher=RealClearPolitics |date=October 13, 2013 |accessdate=March 26, 2014}}
450. ^¹²{{cite news |first=Jonathan |last=Chait |url=https://newrepublic.com/blog/jonathan-chait/brief-reconciliation-primer |title=A Brief Reconciliation Primer |work=The New Republic |date=February 20, 2010}}
451. ^¹{{cite web |url=http://www.shrm.org/publications/hrnews/pages/coverpreventivecare.aspx |title=Login |publisher= |accessdate=February 18, 2015}}
452. ^¹²{{cite news |url=https://newrepublic.com/blog/the-study/102118/health-care-reform-without-the-mandate |title=Health Care Reform Without The Mandate? |last=Pippenger |first=Nathan |date=March 28, 2012 |work=The New Republic}}
453. ^¹{{cite journal |last=Madara |first=Matthew R. |date=February 11, 2014 |title=ACA Employer Shared Responsibility Delay Included in Final Regs |journal=Tax Notes Today |volume=2014 TNT 28–1}}
454. ^¹²³⁴⁵{{cite news |url=https://www.reuters.com/article/idUSTRE62L0JA20100322 |publisher=Reuters |title=Timeline: Milestones in Obama's quest for healthcare reform |date=March 22, 2010 |accessdate=March 22, 2010}}
455. ^¹{{Cite news |title=CBO: Health Care Overhaul Would Cost $940 Billion |first=Steven |last=Dennis |url=http://www.rollcall.com/news/44347-1.html |newspaper=Roll Call |date=March 18, 2010 |accessdate=March 22, 2010}}
456. ^¹{{cite web |first=Brian |last=Beutler |title=A new kind of birther and death panel insanity explodes |url=http://www.salon.com/2013/08/13/republicans_still_pander_to_birthers_and_death_panelists/ |publisher=Salon |date=August 13, 2013 |accessdate=December 3, 2013}}
457. ^¹{{cite web |url=http://en.wikisource.org/wiki/Patient_Protection_and_Affordable_Care_Act/Title_I/Subtitle_E/Part_I/Subpart_A |title=Patient Protection and Affordable Care Act/Title I/Subtitle E/Part I/Subpart A}}
458. ^¹Patient Protection and Affordable Care Act: Title I: Subtitle E: Part I: Subpart A: Premium Calculation
459. ^¹{{cite web |title=Bill Summary & Status – S.334 |url=http://thomas.loc.gov/cgi-bin/bdquery/z?d110:SN00334:@@@S |publisher=Library of Congress THOMAS |accessdate=September 24, 2013}}
460. ^¹{{cite web |url=http://www.natlawreview.com/article/next-steps-to-comply-health-care-reform |title=Next Steps to Comply with Health Care Reform |date=October 10, 2012 |work=The National Law Review |accessdate=October 10, 2012}}
461. ^¹{{Cite news |url=http://elections.nytimes.com/2008/president/debates/transcripts/first-presidential-debate.html |title=The First Presidential Debate |date=September 26, 2008 |work=The New York Times}}
462. ^¹{{cite web |url=http://www.whitehouse.gov/the-press-office/remarks-president-a-joint-session-congress-health-care |title=Remarks by the President to a Joint Session of Congress on Health Care |date=September 10, 2009 |publisher=The White House |accessdate=March 24, 2010 |deadurl=yes |archiveurl=https://web.archive.org/web/20100308000433/http://www.whitehouse.gov/the-press-office/remarks-president-a-joint-session-congress-health-care |archivedate=March 8, 2010}}
463. ^¹{{Cite news |url=https://www.congress.gov/bill/111th-congress/house-bill/3590/summary/81 |title=Summary: H.R.3590 — 111th Congress (2009–2010) |publisher=Library of Congress |date=July 30, 2017}}
464. ^¹{{cite news |url=http://public.shns.com/node/52359 |title=Health reform bill will cause several near-term changes |last=Bowman |first=Lee |date=March 22, 2010 |agency=Scripps Howard News Service |accessdate=March 23, 2010 |deadurl=yes |archiveurl=https://web.archive.org/web/20101227022643/http://public.shns.com/node/52359 |archivedate=December 27, 2010 |df=mdy-all }}
465. ^¹{{cite web |url=http://snopes.com/politics/medical/euthanasia.asp |title=Euthanasia Counseling |publisher=Snopes |date=August 13, 2009}}
466. ^¹{{cite web |url=http://www.healthcare.gov/news/factsheets/stateinnovation03102011a.html |title=Preparing for Innovation: Proposed Process for States to Adopt Innovative Strategies to Meet the Goals of the Affordable Care Act |date=November 16, 2011 |publisher=U.S. Department of Health & Human Services |accessdate=April 1, 2012}}
467. ^¹{{cite news |url=http://www.huffingtonpost.com/2009/07/30/healthplan_n_725503.html |work=Pollster.com |first=Emily |last=Swanson |title=Health Care Plan: Favor/Oppose |date=July 30, 2009}}
468. ^¹{{cite news |url=http://money.cnn.com/2013/04/23/news/economy/obamacare-subsidies/index.html |title=Millions eligible for Obamacare subsidies, but most don't know it |last=Luhby |first=Tami |date=April 23, 2013 |publisher=CNNMoney |accessdate=June 22, 2013}}
469. ^¹{{cite web |last=Strauss |first=Daniel |title=Obama camp's pitch to supporters: 'Hell yeah, I'm for Obamacare{{'-}}|work=The Hill|date=March 23, 2012|url=http://thehill.com/blogs/blog-briefing-room/news/217893-obama-reelection-campaign-urges-supporters-to-say-im-for-obamacare|accessdate=March 27, 2012}}
470. ^¹²{{cite news |url=http://www.huffingtonpost.com/2010/03/22/the-top-18-immediate-effe_n_508315.html#s75147 |title=The Top 18 Immediate Effects Of The Health Care Bill |last=Binckes |first=Jeremy |date=March 22, 2010 |publisher=The Huffington Post |last2=Wing |first2=Nick |accessdate=March 22, 2010}}
471. ^¹{{cite news |author=Noam Schieber |title=How Obamacare Actually Paves the Way Toward Single Payer |url=https://newrepublic.com/article/116105/obamacare-will-lead-single-payer-michael-moore |date=January 5, 2014 |work=The New Republic |accessdate=January 7, 2014}}
472. ^¹{{cite news |url=http://articles.baltimoresun.com/2012-07-11/health/bal-republicans-repeal-health-reform_1_house-votes-repeal-care-reform-bill |title=House of representatives votes to repeal health reform for the 31st time |last1=Walker |first1=Andrea K. |work=The Baltimore Sun |date=July 11, 2012 |accessdate=July 12, 2012}}
473. ^¹{{cite news |url=http://abcnews.go.com/blogs/politics/2012/07/house-obamacare-repeal-thirty-third-times-the-charm |publisher=ABC News |title=House Obamacare Repeal: Thirty-Third Time's the Charm? |date=July 11, 2012}}
474. ^¹{{cite web |url=http://www.treasury.gov/press-center/Documents/36BFactSheet.PDF |title=Treasury Lays the Foundation to Deliver Tax Credits}}
475. ^¹{{cite web |url=https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7962-02.pdf |title=Explaining Health Care Reform |publisher=Kaiser Family Foundation}}
476. ^¹{{cite web |url=http://www.treasury.gov/connect/blog/Pages/Continuing-to-Implement-the-ACA-in-a-Careful-Thoughtful-Manner-.aspx |title=Continuing to Implement the ACA in a Careful, Thoughtful Manner |last=Mazur |first=Mark |publisher=United States Department of the Treasury |accessdate=July 16, 2013}}
477. ^{{USPL|111|148}}, {{USStat|124|119}}
478. ^¹{{cite web |url=http://clerk.house.gov/evs/2010/roll165.xml |title=Roll Call vote No. 165: On Motion to Concur in Senate Amendments (Patient Protection and Affordable Care Act) |publisher=Office of the Clerk: House of Representatives |date=March 21, 2010 |accessdate=April 9, 2012}}
479. ^¹{{cite web |url=https://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=111&session=1&vote=00396 |title=Roll Call vote No. 396 – On Passage of the Bill (H.R. 3590 as Amended) |publisher=U.S. Senate |accessdate=January 9, 2012}}
480. ^¹{{cite web |url=http://governor.vermont.gov/http%3A/%252Fgovernor.vermont.gov/node/add/media-federal-rules |title=Gov. Shumlin issued the following statement on health care rules |date=March 14, 2011 |publisher=Governor.vermont.gov |accessdate=April 1, 2012 |deadurl=yes |archiveurl=https://web.archive.org/web/20130516084059/http://governor.vermont.gov/http%3A/%252Fgovernor.vermont.gov/node/add/media-federal-rules |archivedate=May 16, 2013 |df=mdy-all }}
481. ^¹{{cite web |url=http://www.theatlanticwire.com/national/2011/05/vermont-becomes-first-state-pass-single-payer-health-care/38207 |title=Vermont Becomes First State to Enact Single-Payer Health Care |last=Estes |first=Adam Clark |date=May 26, 2011 |work=The Atlantic |accessdate=April 1, 2012}}
482. ^¹{{cite news |url=http://www.huffingtonpost.com/2011/05/26/vermont-health-care-reform-law-single-payer_n_867573.html |title=Vermont Single-Payer Health Care Law Signed By Governor |last=Wing |first=Nicholas |date=May 26, 2011 |publisher=The Huffington Post}}
483. ^¹²{{cite news |url=https://apps.washingtonpost.com/g/page/politics/labor-leaders-letter-to-harry-reid-and-nancy-pelosi/785/ |title=Labor leaders' letter to Harry Reid and Nancy Pelosi |publisher=The Washington Post |date=January 27, 2014 |accessdate=February 13, 2014}}
484. ^¹{{cite news |url=https://www.washingtonpost.com/wp-dyn/content/article/2011/02/28/AR2011022806535.html |title=Obama offers states more flexibility in health-care law |last=Goldstein |first=Amy |date=March 1, 2011 |work=The Washington Post |last2=Balz |first2=Dan}}
485. ^¹{{cite news |title=Anger over health-care reform spurs rise in threats against Congress members |first=Sari |last=Horwitz |first2=Ben |last2=Pershing |date=April 9, 2010 |url=https://www.washingtonpost.com/wp-dyn/content/article/2010/04/08/AR2010040805476.html?nav=hcmodule |work=The Washington Post |accessdate=April 9, 2010}}
486. ^¹{{cite web |url=http://www.whitehouse.gov/health-care-meeting/proposal/whatsnew/affordability |title=Policies to Improve Affordability and Accountability |publisher=The White House |deadurl=yes |archiveurl=https://web.archive.org/web/20121230013542/http://www.whitehouse.gov/health-care-meeting/proposal/whatsnew/affordability |archivedate=December 30, 2012 |df=}}
487. ^¹²{{cite news |url=https://blogs.wsj.com/corporate-intelligence/2013/07/12/union-letter-obamacare-will-destroy-the-very-health-and-wellbeing-of-workers/ |title=Union Letter: Obamacare Will 'Destroy The Very Health and Wellbeing' of Workers |publisher=The Wall Street Journal |date=July 12, 2013 |accessdate=October 7, 2013}}
488. ^¹{{cite news |url=https://www.wsj.com/articles/SB10001424052748703312504575141533342803608 |title=What Health Overhaul Means for Small Businesses |last=McNamara |first=Kristen |date=March 25, 2010 |newspaper=The Wall Street Journal}}

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Provisions

Insurance regulations

Individual mandate

Subsidies

Exchanges

Risk corridor program

Temporary reinsurance

Risk adjustment

Medicaid expansion

Medicare savings

Taxes

Medicare taxes

Excise taxes

SCHIP

Dependents' health insurance{{anchor|Dependent's Health Insurance}}

Employer mandate

Delivery system reforms

Hospital quality

Bundled Payments

Accountable Care Organizations

Medicare donut hole

State waivers

Other insurance provisions

Menu calorie listings

Legislative history

Background

Healthcare debate, 2008–10

Senate

House

Impact

Coverage

Taxes

Insurance exchanges

Medicaid expansion

Healthcare insurance costs

Effect on deductibles and co-payments

Health outcomes

Distributional impact

Federal deficit

CBO estimates of revenue and impact on deficit

Opinions on CBO projections

Economic consequences

Employer mandate and part-time work

Hospitals

Public opinion

Political aspects

"Obamacare"

Common misconceptions

"Death panels"

Members of Congress

Illegal immigrants

Exchange "death spiral"

Opposition

Legal challenges

National Federation of Independent Business v. Sebelius

Contraception mandate

House v. Price

Texas et al v. United States of America et al

Non-cooperation

Repeal efforts

2013 federal government shutdown

2017 repeal effort

Actions to hinder implementation

Ending cost-sharing reduction (CSR) payments

Implementation

Murray—Alexander Individual Market Stabilization Bill

See also

References

Further reading

Preliminary CBO documents

CMS Estimates of the impact of P.L. 111-148

CMS Estimates of the impact of H.R. 3590

Senate Finance Committee meetings

External links

PPACA text