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 AARP?

The American Association of Retired Persons, commonly known by its acronym AARP, is America’s leading organization for people aged fifty and older, providing member benefits, marketing services, and lobbying on their behalf.

Founded in 1958 by retired educator Dr. Ethel Percy Andrus as the American Association of Retired Persons, AARP is a nonprofit, nonpartisan association with a membership of more than 38 million.

How AARP Works

AARP provides information, education, research, advocacy, and community services through a nationwide network of local chapters and experienced volunteers. It focuses its work on consumer issues, economic security, work, health, and independent living issues, and engages in legislative, judicial, and consumer advocacy in these areas.

AARP is considered a powerful lobbying group as well as a successful business, selling life and health insurance, investment products, and other financial and non-financial services. It is also an independent publisher, offering Modern Maturity magazine and the monthly AARP Bulletin. AARP produced $1.70 billion in revenue in 2019, which came from a variety of endeavors, including advertising revenue from its publications, and from royalties for licensing its name and logo.

However, membership fees represent the most significant source of revenue. It is registered as a 501(c)(4) non-profit by the Internal Revenue Service (IRS), which means it is permitted to engage in lobbying. It also administers some 501(c)(3) public charity operations while some of its other operations are for-profit.

AARP Affiliates

There are several AARP-affiliated organizations, and they include the following:

• The AARP Foundation is a non-profit charity that assists people over age 50 who may be at economic and social risk. Within the foundation operates AARP Experience Corps., which encourages tutoring and mentoring of children, and AARP Institute, which holds its gift annuity funds.
• AARP Services develop and manage new products and services and are for-profit.
• Legal Counsel for the Elderly is a non-profit that provides legal services for seniors in Washington, D.C.
• AARP Financial Services holds AARP real estate and is for-profit.
• The AARP Insurance Plan administers some AARP group insurance plans.

AARP also has many other initiatives, including promoting driver safety (AARP Driver Safety), producing television programming that targets seniors, and engaging in sponsorships that support social causes, such as raising awareness of and fighting hunger in America.

AARP manages outreach programs that address housing issues and social isolation among seniors. AARP has also initiated and managed programs that advocate for the strengthening of Social Security and Medicare.

Criticism of the AARP

AARP is one of the strongest lobbying groups in America, and because of its efforts, it often receives attention for exerting its influence in Washington, D.C., and in state capitals. Its non-profit operations also receive millions of dollars per year in the form of federal grants. Some argue that its positions fall into the more liberal part of the political spectrum.

What Is a 408(k) Plan?

The term 408(k) account refers to an employer-sponsored retirement savings plan. A 408(k) plan allows employees to put aside pretax dollars for retirement that grow on a tax-deferred basis, making it a type of individual retirement account (IRA). This means that individuals pay taxes when they make withdrawals after they turn 59½. The 408(k) is commonly referred to as a simplified employee pension (SEP) plan. In fact, it is the SEP version of the popular 401(k) plan.

Understanding 408(k) Plans

Section 408(k) of the Internal Revenue Code (IRC) outlines the rules and regulations associated with SEP and salary reduction simplified employee pension (SARSEP) accounts, notably individual retirement accounts (IRAs) or individual retirement annuities. That is why SEP plans are often referred to as 408(k) plans.

The IRC highlights the requirements needed in order to participate in a 408(k) plan. Plans are available to small businesses of any size and to self-employed individuals. Participants qualify if they are:

• Over the age of 21
• Worked for at least three of the last five years for the employer
• Were compensated at least $650 by the employer (for 2022; compensation requirements increase to $750 for 2023)

Annual employer contributions cannot exceed the lesser of 25% of the employee’s pay or $61,000 for 2022 ($66,000 for 2023). The annual compensation limit cannot be calculated on incomes exceeding $305,000 for 2022 ($330,000 in 2023). The maximum deduction claimed on a business tax return for contributions is the lesser of the total contributions into employees’ accounts or 25% of compensation.

Plan holders can make withdrawals from their 408(k) plans at any time—the same way they would from traditional IRAs. But there are certain conditions that apply. For instance, most individuals make withdrawals after they turn 59½. Any distributions from these plans before that age incur a 10% early withdrawal penalty. Withdrawals must be made as required minimum distributions (RMDs) as of April 1 the year after you turn 72 if you were that age on or before Dec. 31, 2022. You must begin taking RMDs if you turn 73 on or after Jan. 1, 2023.

408(k) Plans vs. 401(k) Plans

As noted above, a 408(k) is one type of employer-sponsored retirement plan. The 401(k) plan is the most common option and is offered by the vast majority of American corporations. The plan allows taxpayers to make pre-tax contributions through automatic payroll deductions and employer matches for those that make them.

Plan reform has made several changes to benefit employees, including lower fees and investment options. The average 401(k) plan now offers nearly two dozen investment options by balancing risk and reward, in accordance with an employee’s preferences. Unlike an SEP, employees may contribute to a 401(k) plan. And self-employed individuals who work for a company with a 401(k) can contribute to that plan, too.

Participation in traditional 401(k) plans continues to grow. These plans held roughly $7.7 trillion in assets by the end of 2021, which represented about one-fifth of the retirement market in the United States. There were 600,000 active plans in the country with a total of 60 million employees and retirees at the end of September 2021.

Here are a few other facts related to the 401(k) that taxpayers should know:

• Contribution limits for 401(k) plans are indexed to inflation. The Internal Revenue Service (IRS) allows employees to save up to $20,500 for 2022 and $22,500 for 2023. Catch-up contributions of $6,500 per year (increasing to $7,500 in 2023) are also allowed for people 50 or older.
• Withdrawals before the age of 59½ often result in a 10% early withdrawal penalty, unless an exemption is applied. Taxes are imposed on any withdrawals made as contributions are made with pretax earnings.
• Individuals who turn 72 between Jan. 1, 2020, and Dec. 31, 2022, must begin taking RMDs the following April 1. The SECURE ACT 2.0 raised that age to 73 for anyone who turned that age on or after Jan. 1, 2023.

Correction—Jan. 27, 2023: A previous version of this article misstated that 408(k) plans are available to companies with 25 employees or less. It was corrected to state that plans are open to companies of any size.

What Is the Additional Child Tax Credit?

The additional child tax credit was the refundable portion of the child tax credit. It could be claimed by families who owed the IRS less than their qualified child tax credit amount. Since the child tax credit was non-refundable, the additional child tax credit refunded the unused portion of the child tax credit to the taxpayer. This provision was eliminated from 2018 to 2025 by the Tax Cuts and Jobs Act (TCJA).

However, under the TCJA, the child tax credit includes some provisions for refundable credits. In addition, on March 11, 2021, President Biden’s American Rescue Plan was voted into law and made child tax credits fully refundable in 2021.

Understanding the Additional Child Tax Credit

A tax credit is a benefit given to eligible taxpayers to help reduce their tax liabilities. If Susan’s tax bill is $5,550 but she qualifies for a $2,500 tax credit, she will only have to pay $3,050. Some tax credits are refundable, meaning that if the tax credit amounts to more than what is owed as tax, the individual will receive a refund. If Susan’s tax credit is actually $6,050 and is refundable, she will be given a check for $6,050 – $5,550 = $500.

Depending on what tax group a taxpayer falls in, they may be eligible to claim a tax credit. For example, taxpayers with children may qualify for the child tax credit which helps to offset the costs of raising kids.

For the 2022 through 2025 tax year, the child tax credit allows eligible tax filers to reduce their tax liability by up to $2,000 per child. To be eligible for the child tax credit, the child or dependent must:

• Be 16 years or younger by the end of the tax year
• Be a U.S. citizen, national, or resident alien
• Have lived with the taxpayer for more than half of the tax year
• Be claimed as a dependent on the federal tax return
• Not have provided more than half of their own financial support
• Have a Social Security number

Child Tax Credit vs. Additional Child Tax Credit

Previously, the child tax credit was non-refundable, which means the credit could reduce a taxpayer’s bill to zero, but any excess from the credit would not be refunded. Families who wanted to keep the unused portion of the child tax credit could go the route of another available tax credit called the additional child tax credit.

This credit was a refundable tax credit that families could qualify for if they already qualified for the non-refundable child tax credit. The additional child tax credit was ideal for families who owed less than the child tax credit and wanted to receive a refund for the surplus credit.

While the additional child tax credit was eliminated in 2018 under the Tax Cuts and Jobs Act (TCJA), up to $1,400 of the $2,000 child tax credit can be refundable for each qualifying child if certain conditions are met. For example, a taxpayer needs to earn more than $2,500 for the tax year to qualify for any refund. To claim a refund, filers must complete Schedule 8812.

The American Rescue Plan created major changes to the child tax credit for 2021. The maximum credit rose to $3,000 (children up to 17) or $3,600 (children younger than six). Qualifying families started receiving monthly checks (half of the full credit) in July 2021. The credit also became fully refundable in 2021, and families may claim the second half of the credit on their 2021 tax return. This child-related tax benefit begins to phase out for individual filers with children who earn more than $75,000 and joint filers earning more than $150,000.

Example of the Additional Child Tax Credit

Before the TCJA, the IRS allowed families with an annual income of more than $3,000 to claim a refund using the additional child tax credit. The tax credit depended on how much the taxpayer earned and was calculated by taking 15% of the taxpayer’s taxable earned income over $3,000 up to the maximum amount of the credit, which was then $1,000 per child. The total amount above $3,000 (subject to annual adjustments for inflation) was refundable.

For example, a taxpayer with two dependents qualifies for the child tax credit. Their earned income is $28,000, which means income over $3,000 is $25,000. Since 15% x $25,000 = $3,750 is greater than the maximum credit of $2,000 for two kids, they would have received the full portion of any unused credit.

So if the taxpayer received an $800 child tax credit, they would be refunded a $1,200 Additional child tax credit. However, if the taxable earned income was $12,000 instead, 15% of this amount over $3,000 is 15% x $9,000 = $1,350. Because the refundable portion of the credit cannot exceed 15% of earned income above $3,000, the taxpayer would receive a maximum refund of $1,350, not $2,000.

Taxpayers who were residents of Puerto Rico with income below $3,000 were eligible if they had at least three qualifying dependents and paid Social Security tax in excess of the amount of their earned-income credit for the year.