ABC's of Health Care Reform and You


The Affordable Care Act has endured two Supreme Court challenges, more than four dozen repeal attempts, regulatory revisions, and de-funding of some provisions. For now, it is the law of the land, but Congress will work to change that in the coming months.

Update: The Affordable Care Act in Transition

The Affordable Care Act (ACA) became law in March 2010, but under the Trump administration its future is uncertain. Congress is committed to the repeal of the law and, hopefully, will also provide Americans with a replacement plan in tandem with repeal. Congress passed a budget resolution in January 2017. This is a framework for repealing the law. The budget resolution includes instructions to four key House and Senate committees, providing target levels for spending in different areas. It is expected that these committees will have a bill to repeal parts of the ACA by the spring. Through the reconciliation process, items in the bill must be related to taxes or spending and the long-term federal debt in some way.

A total of 3.6 million New Yorkers obtained health coverage under the ACA, nearly 18 percent of New York’s population. Since 2013, New York’s uninsured rate has gone from 10 percent to five percent. Nationwide, 22 million people gained insurance through the ACA. Without an immediate replacement plan, the ranks of the uninsured will swell once again, overburdening hospital emergency departments and pushing the cost of health insurance up for everyone. Further, there will be those who forego care completely due to its cost. Illnesses, such as chronic diseases, which are more easily and inexpensively treated in early stages, will again proliferate and erase economic and public health gains.

Hospitals, however, will continue to absorb planned cuts that were set in motion during the negotiation of the ACA. In exchange for more insured patients, hospitals agreed to cuts in Disproportionate Share (DSH) payments. These are payments hospitals receive for caring for uninsured and poor patients. This means hospitals are looking at an additional revenue loss of $24 billion statewide and $2.5 billion for Long Island’s hospitals during the next 10 years.

Lawmakers must find the balance between coverage options and the cost to provide those options. Popular provisions, such as no pre-existing condition exclusions, no cap on coverage limits, and insurance for children up to age 26 on a parent’s plan, must be paid for. Actuaries, specialists who forecast financial risk of insurance, maintain that an adequate number of healthy people must hold insurance to leverage the cost of the sicker patients in any given insurance plan.

A Brief History

The year 2014 was pivotal for the law. That is when all Americans were required to have health insurance (known as the individual mandate provision) and the numbers of uninsured Americans began to decline. The law provides credits and subsidies for small businesses, individuals, and those with employer-based insurance to participate affordably. However, the constitutionality of the individual mandate was challenged and the Supreme Court heard arguments about the law in March 2012. On Thursday, June 28, 2012, the Supreme Court of the United States upheld the individual mandate on individuals to purchase health insurance. The 2012 Supreme Court decision also limited the federal government’s ability to expand Medicaid by deeming it unconstitutional for the federal government to hold back existing Medicaid dollars to the states if they did not expand their Medicaid programs. However, states opting to not develop an insurance exchange would lose out on those new federal Medicaid funds designed to assist in the states’ development of exchanges. Medicaid is a joint federal/state program.

The constitutionality of the ACA was again challenged in 2015 and the Supreme Court once again heard arguments. This time challengers maintained that the federal subsidies provided to qualifying individuals were not constitutional because language in the ACA refers to tax credits for those who buy insurance on marketplaces that are “established by the state.” Federal exchanges were authorized for states that did not set up their own. The law’s opponents argued that this meant those who signed up for coverage through a federal exchange were not entitled to subsidies. The court disagreed and said Congress’ intent with the original language was clear. To date, millions of Americans have received subsidies, enabling them to afford health insurance.

Go to to read the hospital industry’s full statement on these two Supreme Court decisions.

Architects of the Affordable Care Act say its design will enhance care, improve coordination and communication among all health providers, and move everyone in the direction of cost savings. In fact, the nation’s hospitals pledged $155 billion over the course of 10 years to help fund the law. By 2020, Long Island’s hospitals will have contributed nearly $2 billion in reimbursement cuts to the effort. This investment will be offset, in part, by the influx of insured patients. That’s a goal that is in everyone’s best interests.

The law will affect different age groups and segments of the population in different ways, at different times. The law tries to strike a reasonable balance between insurance reforms, provider cuts, and the individual mandate. That’s why Long Island’s hospitals want you to understand the basic ABC’s of the law.

A… Access (click here for information on how access is and will be affected)

B… Benefits (click here for information on benefits currently in place and those still to come)

C… Cost (Click here for information on what the law may cost you and how it is financed)

For more information contact: Janine Logan, Senior Director of Communications and Population Health

Related Links and More information:

Animated videos:

Recent reports:

Government websites:

Health Care Associations:

Consumer-Friendly, Illustrated Book:

  • Health Care Reform: What It Is, Why It’s Necessary, How It Works by economist Jonathan Gruber

This information brought to you as a public service by the member hospitals of the Nassau-Suffolk Hospital Council (NSHC). The NSHC is the association that represents hospitals on Long Island. It advocates for reasonable and rationale health care legislation and policy that positively enhances the provision of health care for all Long Islanders.

Disclaimer: This information is provided purely as a public service and does not substitute for legal and/or financial advice related to the Affordable Care Act. The law is complicated and requires one to connect with a variety of sources to understand its implications for individuals.

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