Health Law & Policy

Affordable Care Act (ACA) & Health Care and Education Reconciliation Act of 2010 (HCERA)

The Affordable Care Act (ACA) (also known as the Patient Protection and Affordable Care Act or Obamacare) fundamentally changed healthcare coverage, insurance, and regulation in the United States. Due to the strong views in favor of and opposed to the ACA, it was enacted in an unorthodox and controversial process.  An important result of the process used to enact the law is that the ACA is not one single health care bill that became law, but is actually composed of two laws: Patient Protection and Affordable Care Act (ACA) (Pub. L. No. 111-148, 124 STAT. 119) and Health Care and Education Reconciliation Act of 2010 (HCERA) (Pub. L. No. 111-152, 124 Stat. 1029).  

The ACA was enacted on March 23, 2010. HCERA was enacted on March 30, 2010, to reconcile major differences between the Senate bill and the House version of the health care legislation. Prior to this law, Congressional Democrats had intended to have a conference committee merge the ACA with the “Affordable Health Care for America Act” (H.R. 3962) that had passed the House of Representatives. Due to the election of Republican Scott Brown in a special election to fill the seat vacated by the death of Sen. Edward Kennedy (D-MA), Republicans had the votes needed to filibuster a conference report on the House and Senate bills. Although HCERA significantly amends the ACA, because it is a budget reconciliation bill it could only be used to make budget amendments. However, it was legislatively expedient; and most importantly, a reconciliation bill can be passed with a simple majority and cannot be filibustered under Senate rules, which became the only way to pass it after Senator Brown’s election.

The ACA is divided into 10 titles and Title X significantly amends the other titles (requiring consolidation of the other titles with their Title X amendments). Thus, understanding the ACA requires knowledge about the amendments made by Title X of the ACA, the changes made by HCERA, and other subsequently enacted amendments.  The ACA, HCERA and summaries about them and their legislative history and commentary are available below:

GovTrack.us and Congress.Gov also provide legislative history for these two laws:

ACA regulations are available on the websites of three federal departments responsible for implementing various provisions of the ACA: Center for Consumer Information & Insurance Oversight (CCIIO); Internal Revenue Service (IRS); U.S. Department of Labor (DOL):

The Affordable Care Act has been challenged in court numerous times. Some of these cases have involved very important constitutional issues. The sources below provide coverage about various litigation involving the ACA: