What’s in the Rest of the ACA?

August 20, 2025

When the Affordable Care Act (ACA) passed in 2010, many (most) of us worried about how we would adapt to new requirements. Over time, most agents, employers, and HR professionals have become familiar with Title I, which covers insurance reforms, marketplaces, employer responsibilities, and individual coverage. In fact, when Senator Ted Cruz campaigned for president, his health care proposal essentially boiled down to: repeal Title I and allow insurance sales across state lines.

But the ACA is more than just Title I. The law is actually divided into 10 titles (think of them as chapters). So what’s in the rest of the ACA—and should we be paying attention to it?

The 10 Titles of the ACA

  1. Title I – Quality, Affordable Health Care for All Americans
    This is the part most of us know: marketplaces, guaranteed issue, essential health benefits, the employer mandate, subsidies, and more.

  2. Title II – The Role of Public Programs
    Expands Medicaid eligibility and funding, simplifies enrollment, and strengthens the Children’s Health Insurance Program (CHIP).

  3. Title III – Improving the Quality and Efficiency of Health Care
    Focuses on Medicare payment reforms, hospital quality initiatives, and efforts to reduce fraud and abuse.

  4. Title IV – Prevention of Chronic Disease and Improving Public Health
    Establishes the Prevention and Public Health Fund, supports wellness programs, and requires chain restaurants to post calorie counts.

  5. Title V – Health Care Workforce
    Invests in training for doctors, nurses, and other health professionals to address provider shortages.

  6. Title VI – Transparency and Program Integrity
    Adds oversight for nursing homes, strengthens rules for nonprofit hospitals, and increases transparency in the health system.

  7. Title VII – Improving Access to Innovative Medical Therapies
    Streamlines the approval of generic biologic drugs (biosimilars) and makes prescription drug coverage more affordable.

  8. Title VIII – CLASS Act (Community Living Assistance Services and Supports)
    This was a voluntary long-term care insurance program, but it was later repealed because it wasn’t financially sustainable.

  9. Title IX – Revenue Provisions
    Includes new taxes and fees to help pay for the law (e.g., the “Cadillac Tax,” medical device tax, tanning tax, and higher Medicare taxes for high earners). Many of these have since been delayed or repealed.

  10. Title X – Strengthening Quality, Affordable Health Care for All Americans
    A “miscellaneous” title that makes technical corrections and additions to the other parts of the law.

Do Employers and Agents Need to Worry About the Rest?

For most employers and insurance professionals, Title I is still the main focus—it’s where the rules affecting health benefits and compliance live.

That said, the other titles can still shape the broader health care landscape:

  • Title II (Medicaid expansion) affects state programs and coverage levels.

  • Title III (Medicare reforms) influences provider reimbursement and may impact costs.

  • Title IV (prevention) and Title V (workforce) push trends in wellness programs and provider availability.

In short: if you’re advising employers, or if you are an employer, your day-to-day compliance work is rooted in Title I. But if you want to understand the bigger picture of U.S. health policy, it’s worth knowing what’s in the rest of the ACA.

Quick Summary: The ACA isn’t just about exchanges and employer mandates. It’s a 10-title law that reshaped Medicaid, Medicare, public health, the health care workforce, and more. While only Title I directly governs most employer health plans, the other titles set the stage for the health care system we all work within today.