ACA: A Brief Overview of the Law, Implementation, and Legal Challenges

C. Stephen Redhead, Coordinator
Specialist in Health Policy

Jennifer Staman
Legislative Attorney

Vanessa K. Burrows
Legislative Attorney

Bernadette Fernandez
Specialist in Health Care Financing

In March 2010, the 111th Congress passed health reform legislation, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) and other laws. ACA increases access to health insurance coverage, expands federal private health insurance market requirements, and requires the creation of health insurance exchanges to provide individuals and small employers with access to insurance. The costs for expanding access to health insurance and other provisions are projected to be offset by increased taxes and revenues and reduced spending on Medicare and other federal health programs. Implementation of ACA, which began upon the law’s enactment and is scheduled to unfold over the next few years, involves all the major health care stakeholders, including the federal and state governments, as well as employers, insurers, and health care providers.

Following the enactment of ACA, individuals, states, and other entities challenged various provisions of ACA on constitutional grounds. Many of these suits address ACA’s requirement for individuals to have health insurance (i.e., the individual mandate), and claim that it is beyond the scope of Congress’s enumerated powers. Appellate courts evaluating the constitutionality of this requirement have reached varying conclusions. The expansion of the Medicaid program has also been challenged, as state plaintiffs contend that the expansion impermissibly infringes upon states’ rights, coercing them into accepting onerous conditions in exchange for federal funds. Several petitions for Supreme Court review have been filed in these cases, and on November 14, 2011, the Supreme Court agreed to hear arguments relating these provisions of ACA. The arguments are now scheduled to occur the week of March 26, 2012.

This report provides a brief summary of major ACA provisions, implementation and oversight activities, and current legal challenges. For more detailed information on ACA’s provisions, CRS has produced a series of more comprehensive reports, which are available at http://www.crs.gov. The information provided in these reports ranges from broad overviews of ACA provisions, such as the law’s Medicare provisions, to more narrowly focused topics, such as dependent coverage for children under age 26.


Date of Report: February 6, 2012
Number of Pages: 11
Order Number: R41664
Price: $29.95

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