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Addendum to Executive Summary Policy: The Affordable Care Act (ACA) Where is this policy in effect? The ACA is a federal law that was enacted in 2010. It is in effect in all 50 states and the District of Columbia. Who is in charge or writing this policy? The ACA was written by a bipartisan group of lawmakers and signed into law by President Barack Obama. The policy is overseen by the Department of Health and Human Services (HHS). Who oversees the enforcement of this policy? The HHS is responsible for overseeing the enforcement of the ACA. The agency has a number of offices that are responsible for different aspects of the law, such as the Centers for Medicare and Medicaid Services (CMS), which oversees the health insurance marketplaces, and the Office of Civil Rights, which enforces the law's anti-discrimination provisions. How long has it been in effect? The ACA has been in effect since 2010. However, some of the law's provisions, such as the individual mandate, were not fully implemented until 2014. What is the goal of the policy? The goal of the ACA is to expand access to affordable health insurance and to improve the quality of health care in the United States. The law has a number of provisions to achieve these goals, including:

• Expanding Medicaid eligibility to cover more low-income Americans
• Creating health insurance marketplaces where individuals and small businesses can shop for and purchase health insurance plans
• Providing subsidies to help low- and middle-income Americans afford health insurance
• Requiring most Americans to have health insurance or pay a penalty
• Regulating the health insurance industry to make it more transparent and competitive
• Investing in preventive care and public health

Who does it benefit? The ACA benefits a wide range of people, including:

• Low- and middle-income Americans, who have gained access to affordable health insurance through Medicaid expansion and subsidies
• People with pre-existing conditions, who can no longer be denied coverage or charged higher premiums
• Women, who now have access to preventive care services such as mammograms and contraception without cost-sharing
• Young adults, who can stay on their parents' health insurance plans until age 26
• Small businesses, which can offer their employees affordable health insurance through the health insurance marketplaces

Impact on civil rights The ACA has a number of provisions that protect civil rights, including:

• Prohibiting discrimination on the basis of race, sex, age, national origin, disability, or pre-existing conditions
• Requiring health insurance plans to cover essential health benefits, including mental health and substance abuse treatment
• Allowing consumers to appeal denials of coverage to an independent third party
• Creating the Office of Civil Rights to enforce the law's anti-discrimination provisions

Does this policy affect one group of individuals more than another? Why or why not? The ACA has had a particularly positive impact on low-income Americans, people with pre-existing conditions, and women. These groups were disproportionately uninsured before the ACA was enacted, and they have benefited the most from the law's expansion of access to affordable health insurance. Changes to improve potential conflicts involving civil rights While the ACA has made significant progress in protecting civil rights, there are still some areas where the law could be improved. For example, the law does not explicitly prohibit discrimination on the basis of sexual orientation or gender identity. Additionally, the law's religious exemption has been used to deny coverage to certain individuals and groups. To better protect civil rights, the ACA could be amended to explicitly prohibit discrimination on the basis of sexual orientation and gender identity. Additionally, the law's religious exemption could be narrowed to prevent it from being used to discriminate against individuals and groups. Data to support suggestions A 2021 study by the Kaiser Family Foundation found that the ACA has led to a significant decline in the number of uninsured Americans. The study found that the uninsured rate fell from 16% in 2010 to 9% in 2020. The decline in the uninsured rate was particularly pronounced among low-income Americans, people with pre-existing conditions, and women. The study also found that the ACA has had a positive impact on access to mental health and substance abuse treatment. The study found that the number of adults with mental health or substance abuse disorders who received treatment increased by 15% between 2010 and 2020. These findings suggest that the ACA has been effective in expanding access to affordable health insurance and improving the quality of