The Affordable Care Act: First 31 days of the Exchanges and Legal Action Updates

Health Insurance Marketplace – “Exchanges”

October 1, 2013 kicked-off the open enrollment period for the new health insurance exchanges created by the Affordable Care Act (ACA), in the midst of a federal government shutdown and immediate technical difficulties. Though unaffected by the 16-day shutdown, website glitches–mainly within the federal exchange responsible for facilitating exchanges for 27 states–caused a slow start for enrollment. As a result of online enrollment delays, the Obama administration clarified that individuals purchasing coverage through the exchanges until March 31, 2014 will be in compliance with ACA and will not face tax penalties for lack of insurance coverage. Reports released on October 31, 2013 showed that just 248 Americans had signed up for health insurance coverage through the federal exchange, though enrollment in state exchanges was more successful, as tracked by the New York Times.[1]

Beyond the numbers, it is important to remember that as a result of the ACA, health insurance plans made available on the federal and state exchanges and non-grandfathered existing plans offer no cost-sharing coverage of preventive health services--including sexual and reproductive health care services.

With proponents and opponents of ACA busy slinging information and accusations at one another during the first month of open enrollment, myths around the ACA, or “Obamacare” as it is now referenced by both sides, are rampant. The Washington Post attempted to clarify some of the more prevalent myths at the end of the month in a helpful articleaddressing such questions as to who has to buy health insurance, current plans that are ending, and the ACA’s cost.[2] Additional information on the exchanges and coverage information is available through Enroll Americaor HealthCare.Gov.

Women’s Preventive Health Coverage Legal Battles

Another provision of the ACA requires all new private insurance plans to cover a wide range of preventive services, such as mammograms, pap smears, smoking prevention, and contraceptives without co-payments or other cost sharing provisions. To date, 84 lawsuits have been filed in federal court challenging the ACA’s no cost-sharing contraceptive coverage benefit: 39 filed by non-profit organizations, 43 filed by for-profit companies, and two others falling outside either distinction. While action has been limited on the suits filed by non-profits due to ongoing reaction to an “accommodation” rule offered by the administration, the for-profit suits have been making their way through the legal system with action as recently as the final week of October. Multiple U.S. Courts of Appeals have addressed the constitutionality of the no cost-sharing coverage of contraception to differing results. Some of these cases have been dismissed, some companies have been granted temporary relief, meaning they do not have to provide the benefits while in court, and some companies have been denied temporary relief, meaning they must provide the benefits. The growing split among the circuits makes it more likely that the U.S. Supreme Court will take up the issue.[3] For more information on the lawsuits, the National Women’s Law Center has published anOverview of the Lawsuits Challenging the Affordable Care Act’s No Cost-Sharing Contraceptive Coverage Benefit.

Immigrants and the ACA

While the ACA did not address the health coverage needs of undocumented immigrants, in late October, the U.S. lmmigration and Customs Enforcement (ICE) agency, confirmed that citizen children of undocumented immigrant parents can enroll in the ACA exchanges without fear of triggering immigration enforcement actions. Further information meant to allay fears of mixed-status families and encourage health care insurance coverage for all those who are eligible is available in ICE’s memo, Clarification of Existing Practices Related to Certain health Care Information.

[1]Susan Cornwell and David Morgan, “Enrollment in Obamacare very small in first days: documents.” Reuters. October 31, 2013, accessed November 4, 2013 at

[2]Sarah Kliff, “Five myths about the Affordable Care Act” Washington Post, October 31, 2014, accessed on November 4, 2014 at

[3]Karen Gullo,Obamacare Birth Control Mandate Ruled Unconstitutional” Bloomberg, November 2, 2013, accessed November 5, 2014 at

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