Health insurance in the United States and the Affordable Care Act
The ACA was signed into law by President Barack Obama on march 23,2010, and the majority of the law was upheld by the Supreme Court in June 2012. While certain ACA provisions took effect immediately, other provisions, including the creation of insurance "marketplaces" (referred to as exchanges in the ACA) and the imposition of the individual mandate to have health insurance, were implemented over time. By 2014, most provisions of the law were in place, although due to delays in writing certain rules and implementing some technology combined with political and industry lobbying, other provisions, such as the requirement for businesses with 50 or more employees to provide health insurance for their workers or face a penalty, were delayed (see exhibit 2). The ACA promised to change the U.S. health insurance market, which comprised three segments: those covered by government insurance programs, those covered by private insurance (either employer-sponsored or individually purchased), and the uninsured.