What Is the Affordable Care Act (ACA)?

The Affordable Care Act (ACA) is the comprehensive healthcare reform signed into law by then-President Barack Obama in March 2010. Formally known as the Patient Protection and Affordable Care Act and commonly referred to as Obamacare, the law includes a list of healthcare policies intended to expand access to health insurance to millions of uninsured Americans.

The law expanded Medicaid eligibility, created health insurance exchanges, mandated that Americans purchase or otherwise obtain health insurance, and prohibited insurance companies from denying coverage due to preexisting conditions.

Understanding the Affordable Care Act (ACA)

The ACA was designed to reform the health insurance industry and help reduce the cost of health insurance coverage for individuals who qualify. The law includes premium tax credits and cost-sharing reductions to help lower expenses for lower-income individuals and families.

The ACA requires most insurance plans, including those sold on the Health Insurance Marketplace, to cover a list of preventive services at no cost to policyholders that include checkups, patient counseling, immunizations, and numerous health screenings.

All ACA-compliant health insurance plans must cover specific “essential health benefits,” such as emergency services, family planning, maternity care, hospitalization, prescription medications, mental health services, and pediatric care.

The law allows states to extend Medicaid coverage to a wider range of people. As of September 2022, 39 states and the District of Columbia had exercised that option.

Every year, there is an open enrollment period on the Health Insurance Marketplace during which people can buy or switch insurance plans. Enrollment outside of the open season is allowed only for those whose circumstances change, such as marrying, divorcing, becoming a parent, or losing a job that provided health insurance coverage.

Key Features of the Affordable Care Act

Provisions included in the ACA expand access to insurance, increase consumer protections, emphasize prevention and wellness, improve quality and system performance, expand the health workforce, and curb rising healthcare costs.

Expand Access to Insurance

The ACA requires employers to cover their workers and provides tax credits to certain small businesses that cover specified costs of health insurance for their employees. It created state- or multistate-based insurance exchanges to help individuals and small businesses purchase insurance. 

The law expanded Medicaid coverage for low-income individuals and allows young adults to remain on parents’ policies until age 26.

Part of the ACA until 2017 was the individual mandate, a provision requiring all Americans to have healthcare coverage, either from an employer or through the ACA or another source, or face tax penalties.

Increase Consumer Insurance Protections

The ACA prohibits lifetime monetary caps on insurance coverage, limits the use of annual caps, and establishes state rate reviews for insurance premium increases. It prohibits insurance plans from excluding coverage for children with preexisting conditions and canceling or rescinding coverage.

Prevention and Wellness

The Prevention and Public Health Fund, established under the ACA, provides grants to states for prevention activities, such as disease screenings and immunizations, and the National Prevention, Health Promotion, and Public Health Council addresses tobacco use, physical inactivity, and poor nutrition.

The ACA requires insurance plans to cover preventive care such as immunizations; preventive care for children; screening for certain adults for conditions such as high blood pressure, high cholesterol, diabetes, and cancer; and a public education campaign for oral health.

Improve Health Quality and Curb Costs

The ACA requested investments in health information technology. It addressed guidelines to reduce medical errors and create payment mechanisms to improve efficiency and results and improve care coordination among providers.

The law requires oversight of health insurance premiums and practices, reducing healthcare fraud and uncompensated care to foster comparison shopping in insurance exchanges to increase competition and price transparency.

Pros and Cons of the Affordable Care Act

Updates to the Affordable Care Act

With his election in 2016, then-President Donald Trump launched efforts to repeal and replace the ACA, stating that the United States should delay “the implementation of any provision or requirement of the [Patient Protection and Affordable Care] Act that would impose a fiscal burden on any State.”

In December 2017, the Tax Cuts and Jobs Act (TCJA) removed the penalty for individuals not having health insurance and substantially scaled back the outreach program to help Americans sign up for the ACA, cutting the enrollment period in half. By 2018, the number of Americans covered under the ACA had dropped to 13.8 million from 17.4 million in 2015, according to a report from the Kaiser Family Foundation, a healthcare research organization.

In 2021, President Biden signed an executive order to focus on the “rules and other policies that limit Americans’ access to health care,” prompting federal agencies to examine five areas, including preexisting conditions, policies undermining the Health Insurance Marketplace, enrollment roadblocks, and affordability. COVID-19 relief legislation, the American Rescue Plan Act (ARPA), extended eligibility for ACA health insurance subsidies to those buying their health coverage on the Marketplace with incomes over 400% of poverty.

With the passage of the Inflation Reduction Act, signed into law by Biden on Aug. 16, 2022, financial assistance was extended for people enrolled in the ACA through 2025 instead of 2022. It also expands eligibility, allowing more middle-class citizens to receive premium assistance. The legislation passed in both the House of Representatives and the Senate.

The Bottom Line

The Patient Protection and Affordable Care Act (ACA) was passed in 2010 and is commonly known as Obamacare. It extended healthcare coverage to millions of previously uninsured Americans. The ACA launched the Health Insurance Marketplace, through which eligible people may find and buy health insurance policies.

All ACA-compliant health insurance plans, including those sold through the Marketplace, must cover several essential health benefits. The ACA has continued to evolve through three presidencies.

What Is an Autoregressive Integrated Moving Average (ARIMA)?

An autoregressive integrated moving average, or ARIMA, is a statistical analysis model that uses time series data to either better understand the data set or to predict future trends. 

A statistical model is autoregressive if it predicts future values based on past values. For example, an ARIMA model might seek to predict a stock’s future prices based on its past performance or forecast a company’s earnings based on past periods.

Understanding Autoregressive Integrated Moving Average (ARIMA)

An autoregressive integrated moving average model is a form of regression analysis that gauges the strength of one dependent variable relative to other changing variables. The model’s goal is to predict future securities or financial market moves by examining the differences between values in the series instead of through actual values.

An ARIMA model can be understood by outlining each of its components as follows:

• Autoregression (AR): refers to a model that shows a changing variable that regresses on its own lagged, or prior, values.
• Integrated (I): represents the differencing of raw observations to allow the time series to become stationary (i.e., data values are replaced by the difference between the data values and the previous values).
• Moving average (MA):  incorporates the dependency between an observation and a residual error from a moving average model applied to lagged observations.

ARIMA Parameters

Each component in ARIMA functions as a parameter with a standard notation. For ARIMA models, a standard notation would be ARIMA with p, d, and q, where integer values substitute for the parameters to indicate the type of ARIMA model used. The parameters can be defined as:

• p: the number of lag observations in the model, also known as the lag order.
• d: the number of times the raw observations are differenced; also known as the degree of differencing.
• q: the size of the moving average window, also known as the order of the moving average.

For example, a linear regression model includes the number and type of terms. A value of zero (0), which can be used as a parameter, would mean that particular component should not be used in the model. This way, the ARIMA model can be constructed to perform the function of an ARMA model, or even simple AR, I, or MA models.

ARIMA and Stationary Data

In an autoregressive integrated moving average model, the data are differenced in order to make it stationary. A model that shows stationarity is one that shows there is constancy to the data over time. Most economic and market data show trends, so the purpose of differencing is to remove any trends or seasonal structures. 

Seasonality, or when data show regular and predictable patterns that repeat over a calendar year, could negatively affect the regression model. If a trend appears and stationarity is not evident, many of the computations throughout the process cannot be made and produce the intended results.

How to Build an ARIMA Model

To begin building an ARIMA model for an investment, you download as much of the price data as you can. Once you’ve identified the trends for the data, you identify the lowest order of differencing (d) by observing the autocorrelations. If the lag-1 autocorrelation is zero or negative, the series is already differenced. You may need to difference the series more if the lag-1 is higher than zero.

Next, determine the order of regression (p) and order of moving average (q) by comparing autocorrelations and partial autocorrelations. Once you have the information you need, you can choose the model you’ll use.

Pros and Cons of ARIMA

ARIMA models have strong points and are good at forecasting based on past circumstances, but there are more reasons to be cautious when using ARIMA. In stark contrast to investing disclaimers that state “past performance is not an indicator of future performance…,” ARIMA models assume that past values have some residual effect on current or future values and use data from the past to forecast future events.

The following table lists other ARIMA traits that demonstrate good and bad characteristics.

The Bottom Line

The ARIMA model is used as a forecasting tool to predict how something will act in the future based on past performance. It is used in technical analysis to predict an asset’s future performance.

ARIMA modeling is generally inadequate for long-term forecastings, such as more than six months ahead, because it uses past data and parameters that are influenced by human thinking. For this reason, it is best used with other technical analysis tools to get a clearer picture of an asset’s performance.

What Is Assemble-to-Order (ATO)?

Assemble-to-order (ATO) is a business production strategy where products that are ordered by customers are produced quickly and are customizable to a certain extent. It typically requires that the basic parts of the product are already manufactured but not yet assembled. Once an order is received, the parts are assembled quickly and the final product is sent to the customer.

Understanding Assemble-to-Order (ATO)

The assemble-to-order strategy is a hybrid between the make-to-stock strategy (MTS) and the make-to-order strategy (MTO). A make-to-stock strategy is one where products are fully produced in advance. The idea is to build an inventory that matches expected or anticipated consumer demand. This method would consist of setting a production level, building up inventory, and then attempting to sell as much assembled product as possible. It’s used mostly for high-volume goods, consumables, and items that can be bought in bulk or as a single unit.

A make-to-order strategy is one where products are manufactured once the order has been received. Production is driven by demand and items are only produced when orders are confirmed. In other words, the supply chain operation does not begin until there is evidence of sufficient customer demand. This strategy is often employed for high-end goods or items made individually or in small batches.

The ATO strategy attempts to combine the benefits of both make-to-order and make-to-stock—getting products into customers’ hands quickly while allowing for the product to be adapted or altered in certain ways, as per customer request. In most cases, the time and costs associated with building the product from its components are minimal. However, the time and costs to build the components, which are usually ordered from a supplier, can be considerable.

Enabled by technology, advancements in production processes and inventory management systems have played a big part in making assemble-to-order strategies a reality. Add cheaper methods of shipping products, and the strategy has been a boon for product customization opportunities.

Pros and Cons Assemble-to-Order (ATO)

Like many methods that chart a middle course, assemble-to-order has both advantages and disadvantages.

Example of Assemble-to-Order (ATO)

Consider a manufacturer of personal computers. It might have all of the essential parts of a computer—motherboards, graphic cards, processors, monitors, keyboards—in stock and already manufactured. The company depends on various suppliers for these components.

When orders for new PCs arrive, it is easy for the company to assemble and customize the computers using the various components. The process is driven by customer demand, however, and until the order arrives, the components sit on shelves.

What Is Administrative Services Only (ASO)?

Administrative services only (ASO) refers to an agreement that companies use when they fund their employee benefit plan but hire an outside vendor to administer it. For example, an organization may hire an insurance company to evaluate and process claims under its employee health plan while maintaining the responsibility of paying the claims itself. An ASO arrangement contrasts with a company that purchases health insurance for its employees from an external provider.

Understanding Administrative Services Only (ASO)

Plan specifics for administrative services only (ASO) vary depending on the agreement a company establishes with insurance companies and third-party administrators (TPA). In ASO arrangements, the insurance company provides little to no insurance protection, which is in contrast to a fully insured plan sold to the employer.

As such, an ASO plan is a type of self-insured or self-funded plan. The employer takes full responsibility for claims made to the plan. For this reason, many employers using ASO plans also establish aggregate stop-loss policies in which the insurance company takes responsibility for paying claims that exceed a certain level—for example, $10,000 per insured person in exchange for a premium.

ASO insurance plans typically cover short-term disability, health, and dental benefits. Occasionally, they cover long-term disability for larger employers. ASO services are gaining popularity as many employers, particularly larger ones, explore the potential financial advantages that this type of plan can provide. An ASO may allow an employer to take greater control of benefit costs to meet the organization’s needs. However, ASO arrangements may not be suitable for all companies, and they come with certain risks. 

Traditional Administrator vs. Administrative Services Only (ASO)

A traditional administrator agreement is an arrangement whereby an insurance company fully administers claims. The insurance company is responsible for the services to maintain and manage plans, including making decisions on and covering the costs of claims.

Alternatively, under the ASO, the insurance company only provides administrative services for plans. The insurer serves as a third-party administrator to the employer, who assumes the duty to cover claim costs.

Under the traditional administrator agreement, premiums are fixed and reviewed annually. This arrangement makes it difficult for employers to know the impact of claims until premiums are assessed for the next year. With ASO arrangements, employers can, in real-time, keep track of fluctuating costs and plan accordingly.

Considering costs, when they exceed what was expected, premiums increase the following year with the traditional administrator. If costs are less than expected, the surplus remains with the insurance company. On the other hand, with an ASO agreement, the surplus is reinvested with the employer.

Advantages and Disadvantages of Administrative Services Only (ASO)

The costs for fully insured plans depend on an insurer’s evaluation of anticipated claims for a given year. For an ASO, however, annual funding levels are based on actual paid claims. If there are fewer claims than anticipated, then employers keep the surplus and reinvest the reserves. The surplus can translate into employers offering additional benefits, many of which would not be ordinarily covered by conventional health plans.

The total costs for an ASO are typically lower than those for a traditional administrator as the employer pays a negotiated fee to the third party rather than salaries and benefits to dedicated staff. These cost savings can offset rises in claims and be used to help the company grow. Alternatively, if claims consistently exceed forecasts, the cost for ASO may exceed that of a traditional administrator plan.

On the other hand, employers would be responsible for any deficit if claims exceed budgeted amounts. Catastrophic claims or sudden and unexpected events are of particular concern as they can exceed projected budgets and erode profits. Employers often invest in a stop-loss insurance policy to provide an additional level of protection in the event of these cases.

In some cases, an ASO arrangement may not be suitable for life insurance and extended healthcare benefits. Employers need to weigh the risks and benefits of how different ASO arrangements might affect their organizations.

Administrative Services Only FAQs

What Is a Recommended Stop Loss Level for an ASO Plan?

A common stop loss level for an ASO plan is $10,000 per eligible employee.

Is Self-Funded Healthcare the Same as Administrative Services Only?

Self-funded healthcare and administrative services only (ASO) are the same. These terms indicate an insurance arrangement in which the employer or organization assumes full responsibility for the cost of covered claims.

Who Keeps the Profits in Fully Insured Coverage?

Under a fully insured plan, the insurance company retains profits.