Health Reform Action Center

Ob-Gyn Roadmap to Implementation

Implementation of ACA is enormously complex. It requires a significant State effort. States face imposing tasks as they work with the federal government to expand access to care, improve quality and control costs – including setting up a health insurance exchange and whether or not to expand Medicaid. States must accomplish these tasks during a time of weakened budgets.

ACA gives States new responsibilities and choices for reforming health care and coverage as well as new tools, resources and money to achieve reform goals. Some States opposed ACA. Other States have harnessed ACA to jump-start local health improvement strategies underway or on the drawing board.

ACA implementation is an opportunity for ob-gyns to help shape reforms in their individual States. Implementation of ACA cuts across many State agencies requiring unprecedented coordination among state departments including those responsible for Medicaid, public health, insurance regulation, and state employee and retiree coverage. Many governors have established multi-agency task forces to coordinate their State’s reform efforts. State officials are engaging stakeholders through task forces or public comment processes.

State implementation activity slowed considerably for most of 2012 as the US Supreme Court deliberated the law’s constitutionality. State activity is expected to increase now that ACA has been upheld. Click the various aspects of implementation below to view a short description and link to a page with detailed information and resources to help you inform your advocacy.

  Medicaid Expansion   Midwives
  Women's Health Benefits   Medical Liability
  Exchanges   Quality/Delivery System Reform
  Ob-Gyn Direct Access   Federal Grant Opportunities


Medicaid Expansion

The ACA requires States to expand their Medicaid programs by January 1, 2014 to cover all non-elderly, non-pregnant Americans with incomes at or below 133% of the federal poverty level (FPL). The Supreme Court in June 2012, however ruled that the federal government cannot penalize States for not implementing the expansion by withholding federal matching funds for other parts of the Medicaid program.

The ACA also expands coverage of free-standing birth centers, midwifery services, smoking cessation counseling and institutes several delivery system reform changes, such as quality measure reporting and enhanced support of primary care.


Women's Health Benefits

After 2014, all health plans within the newly established State exchanges must cover a minimum floor of services. The 10 core requirements, or Essential Health Benefit Package, include maternity and newborn care. States will be responsible for determining exactly what services will make up each core requirement. Click below to learn more about women’s health benefits, find out ACOG’s recommendations for services that should be included and learn how far along your state is in determining its EHB package.



The Affordable Care Act requires all States to set-up a health insurance exchange and have it operational by 2014. The exchanges are where individuals and families find out whether they are eligible for assistance to buy insurance and where they choose a health plan. States have moved toward establishing exchanges with varying enthusiasm and speed. Follow the link to learn where your state is in the process of establishing an exchange, what guidance the federal government has offered in establishing exchanges and exactly what an exchange in your state may look like.





Ob-Gyn Direct Access

The ACA established a requirement that all non-grandfather private health insurance plans beginning in the first full plan year on or after September 23, 2010 allow women direct access to ob-gyn services, without having to first receive a referral or pre-authorization from the plan or another primary care provider. Plans offered in state health insurance exchanges must also meet other network adequacy requirements and Medicaid programs will increase reimbursements for primary care providers (excluding ob-gyns) for a two-year period.


Medical Liability

Aside from establishing grants for MLR innovation, the Affordable Care Act did little to enact any meaningful liability reform. Despite that, ACOG continues work to address a broken system that only drives costs up for providers. Learn about ACOG work on meaningful medical liability reform, including recommendations on the national and state as well as an overview of how staggering insurance cost hurts healthcare.


Quality/Delivery System Reforms

The Affordable Care Act brought sweeping changes to how health care is delivered and is done so under the framework that quality health care is an active process as opposed to reactive. These changes that are conceived with the goal of easing the budgetary burden that are high health care costs, are to be accomplished by investing in innovation. This portion of the health care reform action center is devoted to those changes, both positive, like the Strong Start initiative and problematic, such as the IPAB. Read about these many, interesting new modifications to how care is delivered.


Federal Grant Opportunites

The Affordable Care Act not only seeks to expand access to health care to all Americans, but is fundamentally works to change how health care is delivered in the United States. By investing in innovation, the ACA is improves both quality and efficiency, focusing on a shift from reactive medicine to promoting universal wellness. To this end, the ACA provides funding for a vast array of projects geared toward modernizing the delivery of health care. From grants awarded to state health systems to improve access and efficiency down to funding issued to providers, aimed at improving patient wellness, the ACA invests in care. Click below to find information on many of the ACA’s grant opportunities and how different States and health systems are using this funding.



Government Affairs Staff 
Mailing Address:
PO Box 96920
Washington, DC 20090-6920
Phone (202) 863-2509
Fax (202) 488-3985

American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998