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The voluminous bill known as the PPACA of 2010 enabled substantial changes to our health care delivery system, some of which remain to be enacted for several years to come. While the overarching goal is to align incentives and improve quality and access, implementing PPACA initiatives in a highly complex environment is fraught with economic and political implications. The purpose of this and future AJNR Health Care Vignettes is to provide relevant updated information as it becomes available.

The Affordable Care Act of 2010 (ACA) was grafted onto a complex structure employment-based health benefit plans supplemented by a number of federal and state health care programs including Medicare, Medicaid and the Child Health Insurance Program (CHIP). This article examines the development of health care benefits in the United States before 2010. A following article will appraise the ACA.

Cover title. ; "Bibliography with reference to Michigan public acts by year and number as itemized in Michigan compiled laws 1948 by section": p. 15. ; Mode of access: Internet.

Intro -- Contents -- Preface -- Chapter 1 -- Examining the Impact of Healthcare Consolidation( -- Opening Statement of Hon. Gregg Harper, a Representative in Congress from the State of Mississippi -- Prepared Statement of Hon. Gregg Harper -- Opening Statement of Hon. Diana Degette, a Representative in Congress from the State of Colorado -- Prepared Statement of Hon. Diana Degette -- Opening Statement of Hon. Greg Walden, a Representative in Congress from the State of Oregon -- Prepared Statement of Hon. Greg Walden -- Opening Statement of Hon. Frank Pallone, Jr., a Representative in Congress from the State of New Jersey -- Prepared Statement of Hon. Frank Pallone, Jr. -- Statements of Martin Gaynor, Ph.D., E.J. Barone University Professor of Economics and Health Policy, Heinz College, Carnegie Mellon University -- Leemore S. Dafny, Ph.D., Bruce V. Rauner Professor of Business Administration, Harvard Business School -- And... -- Statement of Martin Gaynor -- Examining the Impact of Health Care Consolidation, Statement before the Committee on Energy and Commerce Oversight and Investigations Subcommittee, U.S. House of Representatives -- Summary of Statement -- Statement -- 1. My Background -- 2. Introduction -- 3. Consolidation -- 3.1. Hospitals -- 3.2. Physicians -- 3.3. Insurers -- 4. Evidence on the Impacts of Consolidation -- 4.1. Impacts on Prices -- 4.1.1. Hospitals -- 4.1.2. Physicians -- 4.1.3. Insurers -- 4.2. Impacts on Quality -- 4.2.1. Hospitals -- 4.2.2. Physicians -- 4.3. Impacts on Costs, Coordination, Quality -- 5. Policies to Make Health Care Markets Work -- Bibliography -- Statement of Leemore S. Dafny.

Intro -- THE AFFORDABLE CARE ACT DEVELOPMENTS AND CONSIDERATIONS -- Library of Congress Cataloging-in-Publication Data -- Contents -- Preface -- Chapter 1 Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act -- Introduction -- Background on the Affordable Care Act -- How ACA Implementation Affects Federal Spending -- Mandatory Spending on Expanding Insurance Coverage -- Mandatory Spending for Other Programs -- Discretionary Spending -- Appendix A. ACA Provisions in Enacter Authorizing Legislation in the 111th and 112th Congresses -- Appendix B. ACA Provisions in Bills Approved by the House in the 112th and 113th Congresses -- Appendix C. ACA Provisions in Appropriations Acts (FY2011-FY2014) -- Appendix D. Administrative Actions to Delay Implementation of Specific ACA Provisions -- End Notes -- Chapter 2 Health Insurance Exchanges under the Patient Protection a nd Affordable Care Act (ACA) -- Summary -- Introduction -- ACA Exchanges -- Establishment of ACA Exchanges -- State-based Exchange (SBE) -- Operational Structure of a SBE -- Governance of a SBE -- Federally-Facilitated Exchange (FFE) -- Partnership Exchange -- What Exchanges Do -- Eligibility and Enrollment -- Individual Exchange -- Eligibility for Enrollment in a QHP -- Eligibility for Premium Tax Credits and Cost-Sharing Subsidies -- Eligibility for Medicaid and CHIP -- Eligibility for Enrollment in a BHP -- SHOP Exchange -- Plan Management Responsibilities -- Consumer Assistance and Accountability -- Financial Management -- Federal Responsibilities for Establishment and Administration of All Exchanges -- Federal Oversight -- Federal Financial Assistance -- ACA Risk Mitigation Programs -- Coverage Offered through the Exchanges -- Coverage Levels and Benefits -- Essential Health Benefits (EHB) -- Cost-Sharing Requirements -- Levels of Plan Generosity.