“patient protec- tion”

aimed at providing health care coverage to all Americans and preventing growth of health care costs. The Act followed decades of unsuccessful calls for universal health care coverage, and passed despite intense opposition. Some of the main provisions of the extensive piece of legislation included requiring that all individuals who can afford it purchase insurance or pay a penalty; creating state health care exchanges for purchasing insurance coverage; penalizing businesses, except small businesses, that do not offer employees sufficiently affordable insurance; prohibiting insurance companies from denying coverage based on pre-existing conditions; prohibiting insurance companies from rescinding coverage when an insured becomes ill; extending coverage of children to age 26; prohibiting insurance companies from placing lifetime limits on insurance benefits; providing tax credits to small businesses for providing health insurance to employees; encouraging more efficiency in health care through organizational changes; creating agencies to promote innovation and improvement in care; requiring insurance companies to spend a minimum percentage of premium money on health care rather than administration or profit; requiring preventive care to be provided free of cost; increasing taxes on higher income earners, certain health care-related businesses, and businesses that provide employees with high-end insurance coverage; expanding Medicare to cover low income individuals; providing tax credits for health care for the unemployed or to workers whose employers do not offer insurance; expanding prescription drug benefits for seniors; creating an advisory board to study extending the life of the Medicare Trust Fund; and using agencies and laws to discourage fraud and waste in the health care system. The U.S. Supreme Court upheld the constitutionality of the Act in National Federation of Businesses v. Sebelius, 567 U.S. ___ (2012), and King v. Burwell, 576 U.S. ___ (2015), although a provision requiring states to expand Medicaid coverage or lose federal Medicaid funding was deemed unconstitutional in the 2012 decision.