The Patient Protection and Affordable Care Act (PPACA, or ACA), enacted in March 2010, has three primary goals: - Make affordable health insurance available to more people, through premium subsidies - Expand Medicaid (Medi-Cal in California) to cover adults with income below 138% of the federal poverty level - Support new ways of delivering medical care that lower health care costs generally It did not replace private insurers. The subsidies help people buy coverage from private health insurance issuers.

Guaranteed issue: health insurance is now guaranteed issue for all new group and individual policies. In California's individual market, an insurer must fairly and affirmatively offer, market and sell all of its individual plans to everyone in its service areas, and eligibility may not be based on health status, medical condition or medical history (§10965.3).

In the individual market, an insurer may NOT: - Impose any preexisting condition provision on a plan issued on or after January 1, 2014, including a waiting period for the condition - Require a health questionnaire or health assessment before enrollment It MAY limit enrollment to open and special enrollment periods, sell only in its service areas, and vary a plan's rate for plan factors such as actuarial value and provider network.

Group market: a carrier must offer and sell all of its small employer plans to every small employer in each region where it does business (§10753.05(b)(1)), and federal law requires issuers in the individual and group markets to accept every employer and individual that applies, large groups included. Narrow exception: a network plan that lacks capacity may deny coverage if it applies the denial uniformly, without regard to claims experience or health status; it then may not offer coverage in that service area for 180 days.

Keep two ideas apart: guaranteed issue is not guaranteed renewability, and it does not mean a person can enroll on any day of the year.