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Affordable Care Act: Difference between revisions
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ACA included an excise tax of 40% ("[[Cadillac tax]]") on total employer premium spending in excess of specified dollar amounts (initially $10,200 for single coverage and $27,500 for family coverage<ref>{{cite journal |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 |journal=Issue Brief (Commonwealth Fund) |volume=36 |pages=1–8 |pmid=26702468 |access-date=July 4, 2017 |archive-date=May 15, 2018 |archive-url=https://web.archive.org/web/20180515202525/http://www.commonwealthfund.org/publications/issue-briefs/2015/dec/aca-cadillac-tax |url-status=live }}</ref>) indexed to inflation. This tax was originally scheduled to take effect in 2018, but was delayed until 2020 by the [[Consolidated Appropriations Act, 2016]] and again to 2022. The excise tax on high-cost health plans was completely repealed as part of H.R.1865 - Further Consolidated Appropriations Act, 2020. | ACA included an excise tax of 40% ("[[Cadillac tax]]") on total employer premium spending in excess of specified dollar amounts (initially $10,200 for single coverage and $27,500 for family coverage<ref>{{cite journal |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 |journal=Issue Brief (Commonwealth Fund) |volume=36 |pages=1–8 |pmid=26702468 |access-date=July 4, 2017 |archive-date=May 15, 2018 |archive-url=https://web.archive.org/web/20180515202525/http://www.commonwealthfund.org/publications/issue-briefs/2015/dec/aca-cadillac-tax |url-status=live }}</ref>) indexed to inflation. This tax was originally scheduled to take effect in 2018, but was delayed until 2020 by the [[Consolidated Appropriations Act, 2016]] and again to 2022. The excise tax on high-cost health plans was completely repealed as part of H.R.1865 - Further Consolidated Appropriations Act, 2020. | ||
Excise taxes totaling $3 billion were levied on importers and manufacturers of prescription drugs. An excise tax of 2.3% on medical devices and a 10% excise tax on indoor tanning services were applied as well.<ref>{{cite book|url=http://www.taxpolicycenter.org/briefing-book/what-are-major-federal-excise-taxes-and-how-much-money-do-they-raise| archive-url = https://web.archive.org/web/20220526181331/https://www.taxpolicycenter.org/sites/default/files/briefing-book/tpc_briefing_book-may2022.pdf | archive-date = May 26, 2022 | title = A citizen's guide to the fascinating (though often complex) elements of the US tax system. | newspaper = Tax Policy Center |format =Briefing book|publisher=Urban-Brookings [[Tax Policy Center]]}}</ref> The tax was repealed in late 2019.<ref name="auto1">{{Cite news |last=Maurer |first=Mark |date=2019-12-23 |title=Finance Chiefs Relieved After Repeal of Cadillac Tax |work= | Excise taxes totaling $3 billion were levied on importers and manufacturers of prescription drugs. An excise tax of 2.3% on medical devices and a 10% excise tax on indoor tanning services were applied as well.<ref>{{cite book|url=http://www.taxpolicycenter.org/briefing-book/what-are-major-federal-excise-taxes-and-how-much-money-do-they-raise| archive-url = https://web.archive.org/web/20220526181331/https://www.taxpolicycenter.org/sites/default/files/briefing-book/tpc_briefing_book-may2022.pdf | archive-date = May 26, 2022 | title = A citizen's guide to the fascinating (though often complex) elements of the US tax system. | newspaper = Tax Policy Center |format =Briefing book|publisher=Urban-Brookings [[Tax Policy Center]]}}</ref> The tax was repealed in late 2019.<ref name="auto1">{{Cite news |last=Maurer |first=Mark |date=2019-12-23 |title=Finance Chiefs Relieved After Repeal of Cadillac Tax |work=The Wall Street Journal |publisher=News Corp |oclc=781541372 |archive-url=https://web.archive.org/web/20191225192330/https://www.wsj.com/articles/finance-chiefs-relieved-after-repeal-of-cadillac-tax-11577137387 |archive-date=2019-12-25 |url=https://www.wsj.com/articles/finance-chiefs-relieved-after-repeal-of-cadillac-tax-11577137387 |access-date=2022-05-20 |issn=0099-9660}}</ref> | ||
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Public views became increasingly negative in reaction to specific plans discussed during the legislative debate over 2009 and 2010. Approval varied by party, race and age. Some elements were more widely favored (preexisting conditions) or opposed (individual mandate). | Public views became increasingly negative in reaction to specific plans discussed during the legislative debate over 2009 and 2010. Approval varied by party, race and age. Some elements were more widely favored (preexisting conditions) or opposed (individual mandate). | ||
In a 2010 [[Opinion poll|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.<ref>{{cite news |url=http://i2.cdn.turner.com/cnn/2010/images/03/22/rel5a.pdf |title=CNN Opinion Research Poll |date=March 22, 2010 |publisher=CNN |access-date=December 28, 2010 |archive-date=February 16, 2021 |archive-url=https://web.archive.org/web/20210216230530/http://i2.cdn.turner.com/cnn/2010/images/03/22/rel5a.pdf |url-status=live }}</ref> Other polls found that people were concerned the law would cost more than projected and would not do enough to control costs.<ref>{{cite news |title=Why Obama Can't Move the Health-Care Numbers |last1=Rasmussen |first1=Scott |date=March 9, 2010 |work= | In a 2010 [[Opinion poll|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.<ref>{{cite news |url=http://i2.cdn.turner.com/cnn/2010/images/03/22/rel5a.pdf |title=CNN Opinion Research Poll |date=March 22, 2010 |publisher=CNN |access-date=December 28, 2010 |archive-date=February 16, 2021 |archive-url=https://web.archive.org/web/20210216230530/http://i2.cdn.turner.com/cnn/2010/images/03/22/rel5a.pdf |url-status=live }}</ref> Other polls found that people were concerned the law would cost more than projected and would not do enough to control costs.<ref>{{cite news |title=Why Obama Can't Move the Health-Care Numbers |last1=Rasmussen |first1=Scott |date=March 9, 2010 |work=The Wall Street Journal |last2=Schoen |first2=Doug |publisher=News Corp |oclc=781541372 |issn=0099-9660 |archive-url=https://web.archive.org/web/20150402002455/https://www.wsj.com/articles/SB10001424052748704784904575111993559174212 |archive-date=April 2, 2015 |url=https://www.wsj.com/articles/SB10001424052748704784904575111993559174212}}</ref> | ||
In a 2012 poll 44% supported the law, with 56% against. By 75% of Democrats, 27% of Independents and 14% of Republicans favored the law. 82% favored banning insurance companies from denying coverage to people with preexisting 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.<ref name="most" /> Other polls showed additional provisions receiving majority support, including the exchanges, pooling small businesses and the uninsured with other consumers and providing subsidies.<ref>{{cite news |issn=0190-8286 |oclc=2269358 |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 |website=Wonkblog |publisher=[[The Washington Post]] |author=Klein, Ezra |date=June 26, 2012 |access-date=June 28, 2012 |archive-url=https://web.archive.org/web/20120629112038/http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/26/poll-republicans-hate-obamacare-but-like-most-of-what-it-does/ |archive-date=June 29, 2012 |url-status=dead}}</ref><ref>{{cite web |author=Sargent, Greg |issn=0190-8286 |oclc=2269358 |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 Plum Line |publisher=[[The Washington Post]]|date=June 25, 2012 |archive-url=https://web.archive.org/web/20120707184007/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 |archive-date=July 7, 2012 |access-date=June 28, 2012}}</ref> | In a 2012 poll 44% supported the law, with 56% against. By 75% of Democrats, 27% of Independents and 14% of Republicans favored the law. 82% favored banning insurance companies from denying coverage to people with preexisting 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.<ref name="most" /> Other polls showed additional provisions receiving majority support, including the exchanges, pooling small businesses and the uninsured with other consumers and providing subsidies.<ref>{{cite news |issn=0190-8286 |oclc=2269358 |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 |website=Wonkblog |publisher=[[The Washington Post]] |author=Klein, Ezra |date=June 26, 2012 |access-date=June 28, 2012 |archive-url=https://web.archive.org/web/20120629112038/http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/26/poll-republicans-hate-obamacare-but-like-most-of-what-it-does/ |archive-date=June 29, 2012 |url-status=dead}}</ref><ref>{{cite web |author=Sargent, Greg |issn=0190-8286 |oclc=2269358 |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 Plum Line |publisher=[[The Washington Post]]|date=June 25, 2012 |archive-url=https://web.archive.org/web/20120707184007/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 |archive-date=July 7, 2012 |access-date=June 28, 2012}}</ref> | ||
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As of October 2013, approximately 40% were in favor while 51% were against.<ref>{{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 |website=RealClearPolitics |date=October 13, 2013 |access-date=March 26, 2014 |archive-date=March 16, 2021 |archive-url=https://web.archive.org/web/20210316053944/http://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html#polls |url-status=live }}</ref><ref>{{cite news |last=Swanson |first=Emily |date=July 30, 2009 |url=http://www.huffingtonpost.com/2009/07/30/healthplan_n_725503.html |title=Health Care Plan: Favor/Oppose |work=Pollster.com |access-date=July 14, 2011 |archive-date=October 1, 2018 |archive-url=https://web.archive.org/web/20181001170205/http://www.huffingtonpost.com/2009/07/30/healthplan_n_725503.html |url-status=live }}</ref> About 29% of [[Non-Hispanic whites|whites]] approved of the law, compared with 61% of [[Hispanic and Latino Americans|Hispanics]] and 91% of [[African American]]s.<ref>{{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 |date=September 16, 2013 |publisher=Pew Research Center |access-date=December 18, 2013 |archive-date=April 24, 2018 |archive-url=https://web.archive.org/web/20180424151816/http://www.people-press.org/files/legacy-pdf/9-16-13%20Health%20Care%20Release.pdf |url-status=live }}</ref> A solid majority of seniors opposed the idea and a solid majority of those under forty were in favor.<ref>{{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]] |access-date=March 24, 2010 |archive-date=June 20, 2012 |archive-url=https://web.archive.org/web/20120620184320/http://www.usatoday.com/news/washington/2010-03-23-health-poll-favorable_N.htm |url-status=live }}</ref> | As of October 2013, approximately 40% were in favor while 51% were against.<ref>{{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 |website=RealClearPolitics |date=October 13, 2013 |access-date=March 26, 2014 |archive-date=March 16, 2021 |archive-url=https://web.archive.org/web/20210316053944/http://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html#polls |url-status=live }}</ref><ref>{{cite news |last=Swanson |first=Emily |date=July 30, 2009 |url=http://www.huffingtonpost.com/2009/07/30/healthplan_n_725503.html |title=Health Care Plan: Favor/Oppose |work=Pollster.com |access-date=July 14, 2011 |archive-date=October 1, 2018 |archive-url=https://web.archive.org/web/20181001170205/http://www.huffingtonpost.com/2009/07/30/healthplan_n_725503.html |url-status=live }}</ref> About 29% of [[Non-Hispanic whites|whites]] approved of the law, compared with 61% of [[Hispanic and Latino Americans|Hispanics]] and 91% of [[African American]]s.<ref>{{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 |date=September 16, 2013 |publisher=Pew Research Center |access-date=December 18, 2013 |archive-date=April 24, 2018 |archive-url=https://web.archive.org/web/20180424151816/http://www.people-press.org/files/legacy-pdf/9-16-13%20Health%20Care%20Release.pdf |url-status=live }}</ref> A solid majority of seniors opposed the idea and a solid majority of those under forty were in favor.<ref>{{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]] |access-date=March 24, 2010 |archive-date=June 20, 2012 |archive-url=https://web.archive.org/web/20120620184320/http://www.usatoday.com/news/washington/2010-03-23-health-poll-favorable_N.htm |url-status=live }}</ref> | ||
A 2014 poll reported that 26% of Americans support ACA.<ref>{{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 |date=March 28, 2014 |access-date=March 30, 2014 |publisher=[[Associated Press]] |archive-date=April 1, 2014 |archive-url=https://web.archive.org/web/20140401024529/http://bigstory.ap.org/article/poll-obama-health-law-fails-gain-support |url-status=dead}}</ref> A later 2014 poll reported that 48.9% of respondents had an unfavorable view of ACA versus 38.3% who had a favorable view (of more than 5,500 individuals).<ref>{{cite web |url=https://www.rand.org/health/projects/health-reform-opinion.html |title=RAND Health Reform Opinion Study |date=May 1, 2014 |publisher=RAND Health |access-date=May 10, 2014 |archive-date=November 29, 2018 |archive-url=https://web.archive.org/web/20181129194516/https://www.rand.org/health/projects/health-reform-opinion.html |url-status=live }}</ref> Another held that 8% of respondents agreed the Affordable Care Act "is working well the way it is".<ref>{{cite web |archive-url=https://web.archive.org/web/20140503034720/https://online.wsj.com/news/articles/SB10001424052702303678404579533362696579096 |archive-date=May 3, 2014 |url=https://online.wsj.com/news/articles/SB10001424052702303678404579533362696579096 |title=The ObamaCare 8% |newspaper= | A 2014 poll reported that 26% of Americans support ACA.<ref>{{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 |date=March 28, 2014 |access-date=March 30, 2014 |publisher=[[Associated Press]] |archive-date=April 1, 2014 |archive-url=https://web.archive.org/web/20140401024529/http://bigstory.ap.org/article/poll-obama-health-law-fails-gain-support |url-status=dead}}</ref> A later 2014 poll reported that 48.9% of respondents had an unfavorable view of ACA versus 38.3% who had a favorable view (of more than 5,500 individuals).<ref>{{cite web |url=https://www.rand.org/health/projects/health-reform-opinion.html |title=RAND Health Reform Opinion Study |date=May 1, 2014 |publisher=RAND Health |access-date=May 10, 2014 |archive-date=November 29, 2018 |archive-url=https://web.archive.org/web/20181129194516/https://www.rand.org/health/projects/health-reform-opinion.html |url-status=live }}</ref> Another held that 8% of respondents agreed the Affordable Care Act "is working well the way it is".<ref>{{cite web |archive-url=https://web.archive.org/web/20140503034720/https://online.wsj.com/news/articles/SB10001424052702303678404579533362696579096 |archive-date=May 3, 2014 |url=https://online.wsj.com/news/articles/SB10001424052702303678404579533362696579096 |title=The ObamaCare 8% |newspaper=The Wall Street Journal |publisher=News Corp |oclc=781541372 |issn= 1042-9840 |date=April 30, 2014 |access-date=May 1, 2014}}</ref> In late 2014, a [[Rasmussen Reports|Rasmussen]] poll reported Repeal: 30%, Leave as is: 13%, Improve: 52%.<ref>[[Alan Colmes]], "[http://www.alan.com/2014/12/01/poll-voters-no-longer-want-to-repeal-obamacare/ Poll: Voters No Longer Want To Repeal Obamacare] {{Webarchive |url=https://web.archive.org/web/20171023012206/http://www.alan.com/2014/12/01/poll-voters-no-longer-want-to-repeal-obamacare/ |date=October 23, 2017 }}", ''Liberaland'', December 1, 2014.</ref> | ||
In 2015, a poll reported that 47% of Americans approved the health care law. This was the first time a major poll indicated that more respondents approved than disapproved.<ref>{{cite web |url=http://www.cbsnews.com/news/poll-obamacare-and-the-supreme-court/ |title=Poll: Obamacare and the Supreme Court |work=[[CBS News]] |date=June 22, 2015 |access-date=June 23, 2015 |archive-date=December 1, 2020 |archive-url=https://web.archive.org/web/20201201040030/https://www.cbsnews.com/news/poll-obamacare-and-the-supreme-court/ |url-status=live }}</ref> A December 2016 poll 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.<ref>{{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 |access-date=December 3, 2016 |archive-date=February 25, 2021 |archive-url=https://web.archive.org/web/20210225032025/https://www.kff.org/health-reform/press-release/after-the-election-the-public-remains-sharply-divided-on-future-of-the-affordable-care-act/ |url-status=live }}</ref> | In 2015, a poll reported that 47% of Americans approved the health care law. This was the first time a major poll indicated that more respondents approved than disapproved.<ref>{{cite web |url=http://www.cbsnews.com/news/poll-obamacare-and-the-supreme-court/ |title=Poll: Obamacare and the Supreme Court |work=[[CBS News]] |date=June 22, 2015 |access-date=June 23, 2015 |archive-date=December 1, 2020 |archive-url=https://web.archive.org/web/20201201040030/https://www.cbsnews.com/news/poll-obamacare-and-the-supreme-court/ |url-status=live }}</ref> A December 2016 poll 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.<ref>{{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 |access-date=December 3, 2016 |archive-date=February 25, 2021 |archive-url=https://web.archive.org/web/20210225032025/https://www.kff.org/health-reform/press-release/after-the-election-the-public-remains-sharply-divided-on-future-of-the-affordable-care-act/ |url-status=live }}</ref> | ||
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Texas and 19 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 eliminated the tax for not having health insurance, the individual mandate no longer had a constitutional basis and thus the entire ACA was no longer constitutional.<ref>{{cite web |title=Complaint for Declaratory and Injunctive Relief |id=Case 4:18-cv-00167-O |date=2018-02-26 |url=https://www.courtlistener.com/recap/gov.uscourts.txnd.299449/gov.uscourts.txnd.299449.1.0.pdf |access-date=December 15, 2018 |archive-date=July 26, 2020 |archive-url=https://web.archive.org/web/20200726051600/https://www.courtlistener.com/recap/gov.uscourts.txnd.299449/gov.uscourts.txnd.299449.1.0.pdf |url-status=live }}</ref> The [[United States Department of Justice|Department of Justice]] said it would no longer defend the ACA in court, but 17 states led by California stepped in to do so.<ref name="cnn 20181214" /> | Texas and 19 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 eliminated the tax for not having health insurance, the individual mandate no longer had a constitutional basis and thus the entire ACA was no longer constitutional.<ref>{{cite web |title=Complaint for Declaratory and Injunctive Relief |id=Case 4:18-cv-00167-O |date=2018-02-26 |url=https://www.courtlistener.com/recap/gov.uscourts.txnd.299449/gov.uscourts.txnd.299449.1.0.pdf |access-date=December 15, 2018 |archive-date=July 26, 2020 |archive-url=https://web.archive.org/web/20200726051600/https://www.courtlistener.com/recap/gov.uscourts.txnd.299449/gov.uscourts.txnd.299449.1.0.pdf |url-status=live }}</ref> The [[United States Department of Justice|Department of Justice]] said it would no longer defend the ACA in court, but 17 states led by California stepped in to do so.<ref name="cnn 20181214" /> | ||
District Judge [[Reed O'Connor]] of Texas ruled for the plaintiffs on December 14, 2018, writing 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 was not severable, making the entire law unconstitutional.<ref>{{Cite web |last=Sullivan |first=Peter |date=December 14, 2018 |url=https://thehill.com/policy/healthcare/421511-federal-judge-in-texas-strikes-down-obamacare/ |title=Federal judge in Texas strikes down ObamaCare |website=[[The Hill (newspaper)|The Hill]] |issn=1521-1568 |oclc=31153202 |access-date=December 15, 2018 |archive-date=December 15, 2018 |archive-url=https://web.archive.org/web/20181215013835/https://thehill.com/policy/healthcare/421511-federal-judge-in-texas-strikes-down-obamacare |url-status=live }}</ref><ref>{{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 |publisher=News Corp |oclc=781541372 |issn=0099-9660 |website= | District Judge [[Reed O'Connor]] of Texas ruled for the plaintiffs on December 14, 2018, writing 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 was not severable, making the entire law unconstitutional.<ref>{{Cite web |last=Sullivan |first=Peter |date=December 14, 2018 |url=https://thehill.com/policy/healthcare/421511-federal-judge-in-texas-strikes-down-obamacare/ |title=Federal judge in Texas strikes down ObamaCare |website=[[The Hill (newspaper)|The Hill]] |issn=1521-1568 |oclc=31153202 |access-date=December 15, 2018 |archive-date=December 15, 2018 |archive-url=https://web.archive.org/web/20181215013835/https://thehill.com/policy/healthcare/421511-federal-judge-in-texas-strikes-down-obamacare |url-status=live }}</ref><ref>{{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 |publisher=News Corp |oclc=781541372 |issn=0099-9660 |website=The Wall Street Journal |access-date=December 15, 2018 |archive-date=December 15, 2018 |archive-url=https://web.archive.org/web/20181215043107/https://www.wsj.com/articles/federal-judge-rules-affordable-care-act-is-unconstitutional-11544838743 |url-status=live }}</ref> O'Connor's decision regarding severability turned on several passages from the Congressional debate that focused on the importance of the mandate.<ref>{{Cite web |url=https://lawshelf.com/blog/post/federal-judge-in-texas-strikes-down-obamacare |title=Federal Judge in Texas Strikes Down "Obamacare" |website=lawshelf.com |access-date=May 14, 2019 |archive-date=May 14, 2019 |archive-url=https://web.archive.org/web/20190514121812/https://lawshelf.com/blog/post/federal-judge-in-texas-strikes-down-obamacare |url-status=live }}</ref> While he ruled the law unconstitutional, he did not overturn the law.<ref name="cnn 20181214">{{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 |access-date=December 14, 2018 |publisher=CNN |archive-date=December 15, 2018 |archive-url=https://web.archive.org/web/20181215021340/https://www.cnn.com/2018/12/14/politics/texas-aca-lawsuit/index.html |url-status=live }}</ref> | ||
The intervening states appealed the decision to the [[United States Court of Appeals for the Fifth Circuit|Fifth Circuit]]. These states argued that Congress's change in the tax was only reducing the amount of the tax, and that Congress had the power to write a stronger law to this end.<ref>{{cite web |url=https://www.cnn.com/2019/07/08/politics/affordable-care-act-court/index.html |title=Affordable Care Act gears up for momentous test in court |last=Biskupic |first=Joan |author-link=Joan Biskupic |date=July 8, 2019 |publisher=CNN |access-date=July 8, 2019 |archive-date=July 8, 2019 |archive-url=https://web.archive.org/web/20190708130932/https://www.cnn.com/2019/07/08/politics/affordable-care-act-court/index.html |url-status=live }}</ref><ref name="wapost 20181214">{{cite news |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 |access-date=December 14, 2018 |issn=0190-8286 |oclc=2269358 |newspaper=[[The Washington Post]] |archive-date=December 15, 2018 |archive-url=https://web.archive.org/web/20181215021631/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 |url-status=live }}</ref> O'Connor stayed his decision pending the appeal.<ref>{{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 |access-date=December 31, 2018 |publisher=CNN |archive-date=December 31, 2018 |archive-url=https://web.archive.org/web/20181231012052/https://www.cnn.com/2018/12/30/politics/judge-affordable-care-act-remain-in-effect-appeal/index.html |url-status=live }}</ref> The Fifth Circuit heard the appeal on July 9, 2019; in the interim, the U.S. Department of Justice joined with Republican states to argue that the ACA was unconstitutional, while the Democratic states were joined by the Democrat-controlled U.S. House of Representatives. An additional question was addressed, as the Republican plaintiffs challenged the Democratic states' [[Standing (law)|standing]] to defend the ACA.<ref>{{cite web |url=https://www.nytimes.com/2019/07/09/health/obamacare-appeals-court.html |title=Appeals Court Seems Skeptical About Constitutionality of Obamacare Mandate |first=Abby |last=Goodnough |date=July 9, 2019 |access-date=July 9, 2019 |archive-date=July 10, 2019 |archive-url=https://web.archive.org/web/20190710222740/https://www.nytimes.com/2019/07/09/health/obamacare-appeals-court.html |issn=0362-4331 |oclc=1645522 |work=The New York Times}}</ref> | The intervening states appealed the decision to the [[United States Court of Appeals for the Fifth Circuit|Fifth Circuit]]. These states argued that Congress's change in the tax was only reducing the amount of the tax, and that Congress had the power to write a stronger law to this end.<ref>{{cite web |url=https://www.cnn.com/2019/07/08/politics/affordable-care-act-court/index.html |title=Affordable Care Act gears up for momentous test in court |last=Biskupic |first=Joan |author-link=Joan Biskupic |date=July 8, 2019 |publisher=CNN |access-date=July 8, 2019 |archive-date=July 8, 2019 |archive-url=https://web.archive.org/web/20190708130932/https://www.cnn.com/2019/07/08/politics/affordable-care-act-court/index.html |url-status=live }}</ref><ref name="wapost 20181214">{{cite news |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 |access-date=December 14, 2018 |issn=0190-8286 |oclc=2269358 |newspaper=[[The Washington Post]] |archive-date=December 15, 2018 |archive-url=https://web.archive.org/web/20181215021631/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 |url-status=live }}</ref> O'Connor stayed his decision pending the appeal.<ref>{{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 |access-date=December 31, 2018 |publisher=CNN |archive-date=December 31, 2018 |archive-url=https://web.archive.org/web/20181231012052/https://www.cnn.com/2018/12/30/politics/judge-affordable-care-act-remain-in-effect-appeal/index.html |url-status=live }}</ref> The Fifth Circuit heard the appeal on July 9, 2019; in the interim, the U.S. Department of Justice joined with Republican states to argue that the ACA was unconstitutional, while the Democratic states were joined by the Democrat-controlled U.S. House of Representatives. An additional question was addressed, as the Republican plaintiffs challenged the Democratic states' [[Standing (law)|standing]] to defend the ACA.<ref>{{cite web |url=https://www.nytimes.com/2019/07/09/health/obamacare-appeals-court.html |title=Appeals Court Seems Skeptical About Constitutionality of Obamacare Mandate |first=Abby |last=Goodnough |date=July 9, 2019 |access-date=July 9, 2019 |archive-date=July 10, 2019 |archive-url=https://web.archive.org/web/20190710222740/https://www.nytimes.com/2019/07/09/health/obamacare-appeals-court.html |issn=0362-4331 |oclc=1645522 |work=The New York Times}}</ref> | ||
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The [[Government Accountability Office]] released a non-partisan study in 2014 that concluded the administration had not provided "effective planning or oversight practices" in developing the exchanges.<ref name="AP-20140731" /> In ''[[Burwell v. Hobby Lobby]]'' the Supreme Court exempted closely held corporations with religious convictions from the contraception rule.<ref name=":2" /> At the beginning of the 2015, 11.7 million had signed up (ex-Medicaid).<ref>{{Cite news |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 |date=June 2, 2015 |access-date=August 21, 2016}}</ref> By the end of the year about 8.8 million consumers had stayed in the program.<ref>{{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 |date=March 11, 2016 |access-date=June 18, 2022 |archive-date=April 11, 2016 |archive-url=https://web.archive.org/web/20160411120015/https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-03-11.html |location=Baltimore, MD |publisher=Health and Human Services |website=cms.gov}}</ref> Congress repeatedly delayed the onset of the "[[Cadillac tax]]" on expensive insurance plans first until 2020<ref>{{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 |publisher=[[Politico]]|access-date=August 21, 2016}}</ref> and later until 2022 and repealed it in late 2019.<ref name="auto1"/> | The [[Government Accountability Office]] released a non-partisan study in 2014 that concluded the administration had not provided "effective planning or oversight practices" in developing the exchanges.<ref name="AP-20140731" /> In ''[[Burwell v. Hobby Lobby]]'' the Supreme Court exempted closely held corporations with religious convictions from the contraception rule.<ref name=":2" /> At the beginning of the 2015, 11.7 million had signed up (ex-Medicaid).<ref>{{Cite news |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 |date=June 2, 2015 |access-date=August 21, 2016}}</ref> By the end of the year about 8.8 million consumers had stayed in the program.<ref>{{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 |date=March 11, 2016 |access-date=June 18, 2022 |archive-date=April 11, 2016 |archive-url=https://web.archive.org/web/20160411120015/https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-03-11.html |location=Baltimore, MD |publisher=Health and Human Services |website=cms.gov}}</ref> Congress repeatedly delayed the onset of the "[[Cadillac tax]]" on expensive insurance plans first until 2020<ref>{{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 |publisher=[[Politico]]|access-date=August 21, 2016}}</ref> and later until 2022 and repealed it in late 2019.<ref name="auto1"/> | ||
An estimated 9 to 10 million people had gained Medicaid coverage in 2016, mostly low-income adults. The five major national insurers expected to lose money on ACA policies in 2016,<ref>{{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= | An estimated 9 to 10 million people had gained Medicaid coverage in 2016, mostly low-income adults. The five major national insurers expected to lose money on ACA policies in 2016,<ref>{{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=The Wall Street Journal|publisher=News Corp |oclc=781541372 |issn=0099-9660 |access-date=August 16, 2016}}</ref> in part because the enrollees were lower income, older and sicker than expected.<ref>{{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=The Wall Street Journal |issn=0099-9660 |access-date=August 23, 2016}}</ref> | ||
More than 9.2 million people (3.0 million new customers and 6.2 million returning) enrolled on the national exchange in 2017, down some 400,000 from 2016. This decline was due primarily to the election of President Trump.<ref name="ACA_NYT2017" /> The eleven states that run their own exchanges signed up about 3{{nbsp}}million more.<ref name="ACA_NYT2017">{{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=The New York Times |last1=Pear |first1=Robert |access-date=June 18, 2022 |archive-date=February 5, 2017 |issn=0362-4331 |oclc=1645522 |archive-url=https://web.archive.org/web/20170205110857/https://www.nytimes.com/2017/02/03/us/politics/affordable-care-act-obama-care-sign-up.html |date=February 3, 2017}}</ref> The IRS announced that it would not require that tax returns indicate a person has health insurance, reducing the effectiveness of the individual mandate, in response to Trump's executive order.<ref>{{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=February 16, 2017}}</ref> The CBO reported in March that the healthcare exchanges were expected to be stable.<ref name="CBO_Score1">{{Cite web |url=https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact_0.pdf |title=American Healthcare Act Cost Estimate |website=United States. Congressional Budget Office |date=March 13, 2017 |access-date=March 24, 2017 |archive-date=February 15, 2021 |archive-url=https://web.archive.org/web/20210215012927/https://www.cbo.gov/ |url-status=dead }}</ref> In May the House voted to repeal the ACA using the American Health Care Act (AHCA), but the AHCA was defeated in the Senate.<ref>{{cite news |title=House Passes Bill to Repeal Obamacare: Live Updates |publisher=News Corp |oclc=781541372 |issn=1042-9840|url=https://www.wsj.com/livecoverage/house-gop-obamacare-repeal-bill-vote |access-date=May 5, 2017 |work= | More than 9.2 million people (3.0 million new customers and 6.2 million returning) enrolled on the national exchange in 2017, down some 400,000 from 2016. This decline was due primarily to the election of President Trump.<ref name="ACA_NYT2017" /> The eleven states that run their own exchanges signed up about 3{{nbsp}}million more.<ref name="ACA_NYT2017">{{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=The New York Times |last1=Pear |first1=Robert |access-date=June 18, 2022 |archive-date=February 5, 2017 |issn=0362-4331 |oclc=1645522 |archive-url=https://web.archive.org/web/20170205110857/https://www.nytimes.com/2017/02/03/us/politics/affordable-care-act-obama-care-sign-up.html |date=February 3, 2017}}</ref> The IRS announced that it would not require that tax returns indicate a person has health insurance, reducing the effectiveness of the individual mandate, in response to Trump's executive order.<ref>{{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=February 16, 2017}}</ref> The CBO reported in March that the healthcare exchanges were expected to be stable.<ref name="CBO_Score1">{{Cite web |url=https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact_0.pdf |title=American Healthcare Act Cost Estimate |website=United States. Congressional Budget Office |date=March 13, 2017 |access-date=March 24, 2017 |archive-date=February 15, 2021 |archive-url=https://web.archive.org/web/20210215012927/https://www.cbo.gov/ |url-status=dead }}</ref> In May the House voted to repeal the ACA using the American Health Care Act (AHCA), but the AHCA was defeated in the Senate.<ref>{{cite news |title=House Passes Bill to Repeal Obamacare: Live Updates |publisher=News Corp |oclc=781541372 |issn=1042-9840|url=https://www.wsj.com/livecoverage/house-gop-obamacare-repeal-bill-vote |access-date=May 5, 2017 |work=The Wall Street Journal}}</ref><ref>{{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/ |publisher=News Corp |oclc=781541372 |issn=1042-9840 |access-date=May 5, 2017 |work=The Wall Street Journal|date=May 5, 2017}}</ref> The Tax Cuts and Jobs Act set the individual mandate penalty at $0 starting in 2019.<ref name="hatchsays" /> The CBO estimated that the change would cause 13 million fewer people to have health insurance in 2027.<ref>{{cite web |last=O'Brien |first=Elizabeth |date=December 2, 2017 |title=The Senate's Tax Bill Eliminates the Individual Mandate for Health Insurance. Here's What You Need to Know |url=https://money.com/gop-tax-reform-bill-individual-mandate/ |url-status=live |website=Money |issn=0149-4953 |location=New York City |archive-url=https://web.archive.org/web/20200302102755/https://money.com/gop-tax-reform-bill-individual-mandate/ |archive-date=March 2, 2020}}</ref> | ||
The 2017 Individual Market Stabilization Bill was proposed to fund cost cost-sharing reductions,<ref>{{Cite news |url=https://www.nytimes.com/2017/10/17/us/politics/alexander-murray-deal-obamacare-subsidies.html |title=2 Senators Strike Deal on Health Subsidies That Trump Cut Off |first1=Thomas |last1=Kaplan |first2=Robert |last2=Pear |date=October 17, 2017 |issn=0362-4331 |oclc=1645522 |work=The New York Times |archive-url=https://web.archive.org/web/20171018072702/https://www.nytimes.com/2017/10/17/us/politics/alexander-murray-deal-obamacare-subsidies.html?_r=0 |archive-date=October 18, 2017 |access-date=June 18, 2022}}</ref> provide more flexibility for state waivers, allow a new "Copper Plan" offering only catastrophic coverage, allow interstate insurance compacts, and redirect consumer fees to states for outreach. The bill failed. | The 2017 Individual Market Stabilization Bill was proposed to fund cost cost-sharing reductions,<ref>{{Cite news |url=https://www.nytimes.com/2017/10/17/us/politics/alexander-murray-deal-obamacare-subsidies.html |title=2 Senators Strike Deal on Health Subsidies That Trump Cut Off |first1=Thomas |last1=Kaplan |first2=Robert |last2=Pear |date=October 17, 2017 |issn=0362-4331 |oclc=1645522 |work=The New York Times |archive-url=https://web.archive.org/web/20171018072702/https://www.nytimes.com/2017/10/17/us/politics/alexander-murray-deal-obamacare-subsidies.html?_r=0 |archive-date=October 18, 2017 |access-date=June 18, 2022}}</ref> provide more flexibility for state waivers, allow a new "Copper Plan" offering only catastrophic coverage, allow interstate insurance compacts, and redirect consumer fees to states for outreach. The bill failed. | ||
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<ref name="WashPost-04092010">{{cite news |title=Anger over health-care reform spurs rise in threats against Congress members |issn=0190-8286 |oclc=2269358 |first1=Sari |last1=Horwitz |first2=Ben |last2=Pershing |date=April 9, 2010 |newspaper=[[The Washington Post]] |url=https://www.washingtonpost.com/wp-dyn/content/article/2010/04/08/AR2010040805476.html?nav=hcmodule |access-date=April 9, 2010}}</ref> | <ref name="WashPost-04092010">{{cite news |title=Anger over health-care reform spurs rise in threats against Congress members |issn=0190-8286 |oclc=2269358 |first1=Sari |last1=Horwitz |first2=Ben |last2=Pershing |date=April 9, 2010 |newspaper=[[The Washington Post]] |url=https://www.washingtonpost.com/wp-dyn/content/article/2010/04/08/AR2010040805476.html?nav=hcmodule |access-date=April 9, 2010}}</ref> | ||
<ref name="WSJ">{{cite news |title=Union Letter: Obamacare Will 'Destroy The Very Health and Wellbeing' of Workers |publisher=News Corp |oclc=781541372 |issn=1042-9840 |newspaper= | <ref name="WSJ">{{cite news |title=Union Letter: Obamacare Will 'Destroy The Very Health and Wellbeing' of Workers |publisher=News Corp |oclc=781541372 |issn=1042-9840 |newspaper=The Wall Street Journal |date=July 12, 2013 |url=https://blogs.wsj.com/corporate-intelligence/2013/07/12/union-letter-obamacare-will-destroy-the-very-health-and-wellbeing-of-workers/ |access-date=October 7, 2013 |archive-url=https://web.archive.org/web/20131207095718/https://blogs.wsj.com/corporate-intelligence/2013/07/12/union-letter-obamacare-will-destroy-the-very-health-and-wellbeing-of-workers/ |archive-date=December 7, 2013}}</ref> | ||
<ref name="WSJ-mar25">{{cite news |title=What Health Overhaul Means for Small Businesses |last=McNamara |first=Kristen |date=March 25, 2010 |publisher=News Corp |oclc=781541372 |issn=0099-9660 |newspaper= | <ref name="WSJ-mar25">{{cite news |title=What Health Overhaul Means for Small Businesses |last=McNamara |first=Kristen |date=March 25, 2010 |publisher=News Corp |oclc=781541372 |issn=0099-9660 |newspaper=The Wall Street Journal |url=https://www.wsj.com/articles/SB10001424052748703312504575141533342803608 |archive-url=https://web.archive.org/web/20150421054808/https://www.wsj.com/articles/SB10001424052748703312504575141533342803608 |archive-date=April 21, 2015}}</ref> | ||
<ref name="trauma_medicaid">{{cite journal |title=Impact of the Affordable Care Act on trauma and emergency general surgery: An Eastern Association for the Surgery of Trauma systematic review and meta-analysis |year=2019 |doi=10.1097/TA.0000000000002368 |pmid=31095067 |last1=Zerhouni |first1=Y. A. |last2=Scott |first2=J. W. |last3=Ta |first3=C. |last4=Hsu |first4=P. C. |last5=Crandall |first5=M. |last6=Gale |first6=S. C. |last7=Schoenfeld |first7=A. J. |last8=Bottiggi |first8=A. J. |last9=Cornwell Ee |first9=3rd |last10=Eastman |first10=A. |last11=Davis |first11=J. K. |last12=Joseph |first12=B. |author13=Robinson BRH |last14=Shafi |first14=S. |last15=White |first15=C. Q. |last16=Williams |first16=B. H. |last17=Haut |first17=E. R. |last18=Haider |first18=A. H. |journal=The Journal of Trauma and Acute Care Surgery |volume=87 |issue=2 |pages=491–501 |s2cid=155102212}}</ref> | <ref name="trauma_medicaid">{{cite journal |title=Impact of the Affordable Care Act on trauma and emergency general surgery: An Eastern Association for the Surgery of Trauma systematic review and meta-analysis |year=2019 |doi=10.1097/TA.0000000000002368 |pmid=31095067 |last1=Zerhouni |first1=Y. A. |last2=Scott |first2=J. W. |last3=Ta |first3=C. |last4=Hsu |first4=P. C. |last5=Crandall |first5=M. |last6=Gale |first6=S. C. |last7=Schoenfeld |first7=A. J. |last8=Bottiggi |first8=A. J. |last9=Cornwell Ee |first9=3rd |last10=Eastman |first10=A. |last11=Davis |first11=J. K. |last12=Joseph |first12=B. |author13=Robinson BRH |last14=Shafi |first14=S. |last15=White |first15=C. Q. |last16=Williams |first16=B. H. |last17=Haut |first17=E. R. |last18=Haider |first18=A. H. |journal=The Journal of Trauma and Acute Care Surgery |volume=87 |issue=2 |pages=491–501 |s2cid=155102212}}</ref> | ||