The Patient Protection and Affordable Care Act

• Pages: 217-224

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CHAPTER XII

THE PATIENT PROTECTION AND

AFFORDABLE CARE ACT

The Patient Protection and Affordable Care Act952 (ACA) was signed

into law on March 23, 2010. It was intended to increase the number of

Americans covered by health insurance and decrease the overall cost of

health care. The Act includes a broad range of reforms: an individual

mandate requiring most Americans to maintain “minimum essential”

health insurance coverage;

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state-based exchanges through which

individuals and small businesses can purchase insurance;

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a prohibition

on preexisting condition exclusions;

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limitations preventing insurers

from factoring health status into pricing;

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a new federal minimum

medical loss ratio of 80-85 percent;

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and the establishment of the

Medicare Shared Savings Program for eligible Accountable Care

Organizations (ACOs).

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Although the Act expressly provides that it has

no effect on existing antitrust laws,

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several of the Act’s key provisions

could have antitrust implications for insurers. This chapter briefly

discusses some of the antitrust issues likely to arise in light of the creation

of American Health Benefit Exchanges and the Medicare Shared Savings

Program for ACOs.

952. The Patient Protection and Affordable Care Act, Pub. L. 111-148, 124 Stat.

119 (2010).

953. 26 U.S.C. §5000A(a) (“An applicable individual shall for each month

beginning after 201 3 ensure that the i ndividual, and any d ependent of the

individual who is an applicable individual, is covered under minimum

essential coverage fo r such month.”).

954. 42 U.S.C. § 18031(b)(1).

955. 42 USC § 300gg-3(a) (“A group health pla n and a health insur ance issuer

offering group or ind ividual health insurance cove rage may not impose any

preexisting conditi on exclusion with respect to such plan o r coverage.”).

956. 42 USC § 300gg(a)(1)(A)(i-iv).

957. 42 USC §300gg–18(b)(1)(A).

958. 42 USC §1395jjj.

959. See 42 U.S.C. § 18118 (“Nothin g in this title (or a n amendment made by

this title) shall be construed to modify, impair, or supersede the operation

of any of the antitrust laws.”).