Publications

The path to health care coverage under the Affordable Care Act: A flow chart

December 16, 2011
Author(s): Josh Fangmeier, MPP, Patrice Eller, MSW, MPH, Tomi Ogundimu, MPH, Karen Stock

aca-flowchart-v2-custom-imageUpdated February 12, 2013.

Following the U.S. Supreme Court’s decision to uphold the constitutionality of the Patient Protection and Affordable Care Act (ACA), efforts continue at the state and federal levels to prepare for implementation of key provisions of the Act scheduled to take effect in 2014. These provisions, such as the (now optional) Medicaid expansion, the individual mandate to purchase insurance, state insurance exchanges, and employer “play or pay” rules will create new or different pathways to health coverage for many.

This flow chart provides a high-level picture of the ways that people will obtain health coverage in 2014, assuming the Act is implemented as it exists today. The flow chart clearly reflects the complexity of the existing system for health coverage in the U.S., a public/private hybrid the ACA builds upon, but does not fundamentally change.

This diagram is intended as an overview of the pathways to coverage: while individuals may follow the flow chart to determine possible options, it is not intended to be comprehensive for that purpose. Rather, it is offered as a way to look ahead and better understand the many pathways to coverage that will exist in 2014, specifically in states that accept the option to expand Medicaid eligibility to individuals and families with incomes up to 138 percent of the federal poverty level (FPL).

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