By Nikki Tishler, Federal Policy and Communications Fellow
July has been a busy month for the Affordable Care Act (ACA). The Obama administration delayed implementation of the ACA employer mandate, the Republican controlled U.S. House of Representatives responded with their 38th – 40th attempts to wholly or partially dismantle the ACA, and the Centers for Medicare & Medicaid Services (CMS) released a final rule related to Medicaid eligibility, implementing key provisions of the ACA. While not necessarily specific to ensuring access to sexual health coverage and services, the updates below are indicative of implementation of the ACA moving forward despite efforts by some to derail its provisions and expanding insurance coverage and preventive health services.
Obama Administration Delays Implementation of Employer Mandate
On July 2, 2013, the Obama administration announced that it will delay enforcement of an ACA requirement that all employers with more than 50 employees provide health insurance coverage to their workers or face a penalty for each employee not offered affordable coverage (employer mandate). Employers now have until 2015 to comply with the law. Since 96% of all firms in the U.S. employ less than 50 people and 96% of firms with more than 50 employees already offer health insurance, the employer mandate will impact less than 0.2 percent of all firms (about 10,000 out of six million) hence having little impact on consumers.
House Votes to Dismantle ACA
On Wednesday July 17, 2013, the House of Representatives responded to the administration’s decision to delay the employer mandate reporting requirement by passing two bills postponing the implementation of key provisions of the ACA. The Authority for Mandate Delay Act (H.R. 2667), which passed 264-161, delays the employer mandate for one year. While the administration maintains that its decision does not delay the mandate, only the reporting requirements, House Republicans claim that this bill codifies the administration’s decision. The Fairness for American Families Act (H.R. 2668), which passed 251-174, delays the individual mandate to acquire health insurance for one year. Republicans said that it was unfair for President Obama to delay enforcement of the employer mandate without also delaying enforcement for individuals.
House Majority Leader Eric Cantor stated, “… the House is going to codify the President’s delay, because he does not have the authority to do so unilaterally. And will we do [sic] what the President didn’t. We will extend the basic fairness to all Americans. No family’s health, well-being, or employment should suffer while businesses get a break.”
A new study from the Urban Institute challenges this claim, revealing that the employer mandate has little effect on expanding healthcare coverage, while the individual mandate is integral. Eliminating the employer mandate increases the rate of nonelderly uninsured individuals by just one-tenth of a percentage point, to 10.2%. Eliminating the individual mandate, however, would result in a rate of 15.1% uninsured, leaving an additional 13.7 million people uninsured, according to the study. 
House Minority Leader Nancy Pelosi called the bills “political stunts [and] an excuse for a legislative agenda that is not worthy of this House of Representatives…” proposing that Congress instead work together to grow the economy and strengthen the middle class.
On August 2, 2013, the House held its 40th vote since the passage of the ACA to dismantle the law. The Keep the IRS Off Your Health Care Act of 2013 (H.R. 2009), which would prohibit the Secretary of the Treasury from enforcing any part of the ACA, passed the House by a vote of 232 to 185.
The Democrat controlled Senate is expected to ignore the bills. Even if the Senate were to act, President Obama has threatened to veto the bills.
CMS Releases Final Rule
On July 5, 2013, CMS released a final rule, “Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment,” implementing key provisions of the ACA. The final rule establishes new Medicaid eligibility provisions, including the ACA’s requirement that individuals of child bearing age receive family planning services and supplies. The codification of this provision helps ensure that Medicaid beneficiaries can access essential family planning services and supplies regardless of the Medicaid plan in which they are enrolled.  This provision is particularly important as 68% of Medicaid recipients are women and 63% of adult women on Medicaid are of child bearing age.
Thus far, the ACA has greatly expanded health care in the U.S., providing coverage for an increasing number of Americans as portions of the health reform law continue to be enacted. The provision allowing young adults to stay on their parents’ insurance policies until the age of 26 has provided coverage for over two million young adults, contributing to a decline of 1.3 million in the number of uninsured Americans in 2011. Coverage exclusions for children with pre-existing conditions were prohibited as of September 23, 2010 and protections for adults will take effect in 2014.
Access to preventative services has also been greatly expanded, including preventive services for women without cost-sharing, such as all FDA-approved contraceptive methods and at least one annual well-woman visit. Additionally, the United States Preventive Services Task Force now has a grade “A” recommendation for HIV testing, strongly recommending that all adolescents and adults ages 15 to 65 and pregnant women be screened for HIV. The grade “A” recommendation means HIV testing will now be included as a routine part of preventive care at no-cost to consumers.
The U.S. Department of Health and Human Services estimates that these provisions of the ACA will provide no-cost preventive care to 71 million children and adults with private insurance and 34 million Medicare beneficiaries.
 Mark J. Mazur, U.S. Department of Treasury, “Continuing to Implement the ACA in a Careful, Thoughtful Manner,” published July 2, 2013, accessed July 25, 2013, http://www.treasury.gov/connect/blog/Pages/Continuing-to-Implement-the-ACA-in-a-Careful-Thoughtful-Manner-.aspx.
 The White House, “Health Reform for Small Businesses: The Affordable Care Act Increases Choice and Saving Money for Small Businesses,” accessed July 30, 2013, http://www.whitehouse.gov/files/documents/health_reform_for_small_businesses.pdf.
 Linda J. Blumberg, Matthew Buettgens, and John Holahan, “It’s No Contest: The ACA’s Employer Mandate Has Far Less Effect on Coverage and Costs Than the Individual Mandate,” Urban Institute, July 2013, accessed July 30, 2013, http://www.urban.org/UploadedPDF/412865-ACA-Employer-Mandate.pdf.
 Eric Cantor, “Leader Cantor: We All Agree Obamacare Will Not Work,” Press Release published July 17, 2013, accessed July 24, 2013, http://majorityleader.gov/newsroom/2013/07/leader-cantor-we-all-agree-obamacare-will-not-work.html.
 Urban Institute
 Nancy Pelosi, “Pelosi Floor Speech in Opposition to House GOP’s 38th Vote to repeal the Affordable Care Act,” Press Release published July 17, 2013, accessed July 24, 2013, http://pelosi.house.gov/news/press-releases/2013/07/pelosi-floor-speech-in-opposition-to-house-gops-38th-vote-to-repeal-the-affordable-care-act.shtml.
 Paige Winfield Cunningham, “House Votes to Block IRS from Obamacare Role,” Politico, August 2, 2013, accessed August 2, 2013, http://www.politico.com/story/2013/08/irs-obamacare-house-republicans-95132.html.
 Executive Office of the President, “Statement of Administration Policy H.R. 2667 – Authority for Mandate Delay Act H.R. 2886 – Fairness for American Families Act,” July 16, 2013, accessed July 25, 2013, http://www.whitehouse.gov/sites/default/files/omb/legislative/sap/113/saphr2667r_20130716.pdf.
 Federal Register, “Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeals Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment,” A Rule by Office of the Secretary, Department of Health and Human Services, and Centers for Medicare & Medicaid Services published July 15, 2013, accessed July 25, 2013, https://www.federalregister.gov/articles/2013/07/15/2013-16271/medicaid-and-childrens-health-insurance-programs-essential-health-benefits-in-alternative-benefit#h-50.
 Kaiser Family Foundation, “The Role of Medicaid and Medicare in Women’s Health Care,” JAMA, 2013: 309(19): 1984, accessed July 25, 2013, http://jama.jamanetwork.com/article.aspx?articleid=1687586.
 The Affordable Care Act Three Years Post-Enactment (Washington, DC: Kaiser Family Foundation, March 2013), accessed July 25, 2013, http://kaiserfamilyfoundation.files.wordpress.com/2013/04/84291.pdf.
 U.S. Preventive Services Task Force, “USPSTF A and B Recommendations,” accessed July 30, 2013, http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm.
 The Affordable Care Act Three Years Post-Enactment.