The Affordable Care Act was passed by Congress and signed by the President in March 2010 and debate on it has come and gone. But the health insurance reforms it put in place continue to roll out over four years and beyond.
On Jan. 1, 2014, one of the most controversial provisions of the act kicks in, a mandate that all U.S. citizens and legal residents must have health insurance by the start of the year. If they do not, they could face a tax penalty in 2014 of $95, in 2015 of $326, and in 2016 of $695 per individual.
In order to assist all who qualify to have access to affordable healthcare, the act included the creation of new, competitive marketplaces in each state called Affordable Insurance Exchanges. Starting in the fall of 2013, families and small business owners across America will to be able to shop in the exchanges, where they will have access to the same kinds of private insurance choices as members of Congress.
States were required to notify the U.S. Department of Health and Human Services in February of this year if they planned to establish a state-based health benefits Exchange. If HHS did not receive notification, the state is deemed to default to a federally run Exchange. Regardless of whether the state or federal government is in charge, the Patient Protection and Affordable Care Act (PPACA) requires that exchanges be operational by October 1.
As of last month, 26 states defaulted to a federal exchange.
As a result, the federal government will be tasked with implementing and maintaining exchanges in at least half of the country. The divide largely mirrors the political divide in Washington