Onefundamental reformof thePatientProtectionand Affordable Care Act (ACA) was to weaken the link between health status and insurance coverage. Issuers of individualpolicieswill no longerbeable tochargehigher premiums to the seriously ill or turn awayunhealthyenrollees. By adding these protections, theACAbrings individual policies more in line with other forms of insurance. Neither Medicare nor Medicaid charges higher premiums for individuals in poor health, and theHealth Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits group health plans from conditioning employee eligibility or premiums on health status– relatedfactorssuchascancer,heartdisease,ordiabetes.1 ButHIPAAdid not render health factors completely irrelevant,andneitherdoestheACA.Infact,theACAcould beconsideredtostrengthenthe linkbetweenhealthstatus and insurance coverage terms in one respect. Under theHIPAA exception for “programs of health promotion and disease prevention,” employers are permitted to tie premiumsorco-payments to tobaccouse,bodymass index (BMI), or other health factors as long as certain requirementsaremet.2TheACAcontinuesandexpandson this policy, supporting the use of outcome-based health incentiveswithin both public and private insurance. TheACA’s health incentive initiatives vary, however, depending on coverage type. This variation raises questions about the idealmixof rating restrictions andhealth incentives. InthisViewpoint,wedescribetheACA’shealth incentive initiatives and explore their implications.