The enactment of the Affordable Care Act (ACA) is the latest step in a continuing shift from virtually no federal regulation of employer-sponsored health insurance to extensive substantive and administrative requirements. This regulation initially included the reporting, and disclosure and claims procedure requirements enacted in the Employee Retirement Income Security Act of 1974 (ERISA). Through the years, additional federal requirements were added, including portability and coverage guarantees, minimum maternity stays, mental health parity, required coverage of reconstructive surgery following a covered mastectomy, coverage of adoptees, and pediatric vaccine requirements. During the same period there was a large increase in state insurance law benefit mandates. Additional federal laws impacting the administration of health insurance plans included the Age Discrimination in Employment Act, the Pregnancy Discrimination Act, the Americans with Disabilities Act, the Family and Medical Leave Act, the Genetic Information Nondiscrimination Act, the Mental Health Parity Act and the Mental Health Parity and Addiction Recovery Act, and the requirement for medical support orders. The ACA includes extensive requirements ranging from the elimination of annual and lifetime limits to coverage of adult children.