Thirteen Years After Being Signed Into Law, the ACA is Covering More People Than Ever But More Action is Needed to Finish the Job of Affordable Coverage for All

Mar 23, 2023

On March 23, 2010, after years of advocacy from groups like HCAN that mobilized thousands of people to demand action, President Barack Obama signed the Affordable Care Act (ACA) into law. Marcelas Owens, an HCAN activist from Washington state who lost his 27-year old mother because of lack of insurance, stood next to President Obama as he made history with the largest healthcare reform since passage of Medicare and Medicaid in 1965. 

Thanks to the ACA, over thirty million uninsured Americans were able to get coverage and millions more gained improved coverage thanks to consumer protections and new benefits – like no cost preventive care – that applied to all private coverage. Over 150 million people now benefit from protection against denials because of pre-existing conditions, an end to lifetime caps and limits on coverage, and elimination of gender discrimination that used to enable insurance corporations to charge women more than men for the exact same insurance policy. The ACA closed the Medicare Part D “donut hole” in prescription drug coverage, expanded funding for community and home based care for aging people and people with disabilities, and for the first time mandated coverage of essential health benefits in ACA plans like inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, and mental health services, that were previously excluded from many plans. 

A record-breaking 16.3 million Americans signed up for insurance through the ACA in the most recent enrollment period. Thanks in large part to the ACA and to Medicaid expansion under the law as well as improvements made during the pandemic which made continuous enrollment easier and lowered costs, the United States currently has the lowest uninsured rate in history, with only 8% of Americans going without health insurance. 

The lesson of healthcare reform is clear: unless we keep pushing for more affordable and accessible coverage, progress will erode. Despite the tremendous success of the ACA and Medicaid, some elected leaders are still trying to roll back the law, shrink coverage and leave millions on their own to fight the big insurance and prescription drug corporations. For over a decade, Republicans tried to repeal, weaken, preempt and overturn the Affordable Care Act, both in whole and in parts. There have been well over 60 repeal votes in Congress, countless attacks in state legislatures, and a half dozen Supreme Court lawsuits to dismantle the law. 

The ACA has prevailed, but Republicans have not stopped trying to take away healthcare, whether it’s spending cuts to Medicaid, repealing the Inflation Reduction Act that lowers costs for ACA coverage through 2024 and undoes Medicare negotiation for lower drug prices, or extending the Trump tax cuts, which will force cuts in healthcare to finance more tax breaks for high-income people. 

Fortunately, President Biden has proposed a different direction on healthcare. His budget plan, proposed on March 9th, would lower healthcare costs by making permanent the affordability improvements in the ACA; increase access to mental health care, substance abuse treatment, and home based care for the elderly and people with disabilities; and reduce drug prices for more people in Medicare and private insurance. President Biden is urging Congress to increase taxes on wealthy households making more than $400,000 annually and on rich corporations who got big tax breaks under the Trump tax law to support these investments and reduce the deficit. 

Under this plan, people stuck in the 11 states that have refused to fully implement the Affordable Care Act by expanding Medicaid coverage could get that coverage from the federal ACA exchange, drug corporations that raise their prices faster than the rate of inflation–currently 6.0%–would have to pay a rebate back to consumers, and the $800 average annual savings that individuals get under the ACA would become permanent. The President’s plan also ensures that Medicare can continue to pay 100% of benefits through 2050 by taking on corporate price-gouging and increasing taxes on the wealthy. 

The ACA has allowed millions of Americans to get affordable health coverage they can depend on. It has improved the quality of coverage and consumer protections for tens of millions more and reduced racial health disparities by providing Black and Brown Americans, who are least likely to have access to healthcare, affordable coverage options. 

History shows that we can keep building on this progress to ensure that more and more people get access to affordable coverage and care, to rein in corporate price-gouging, and to address long-standing racial health disparities in coverage. As we reach new heights of progress, the time is now to finish the job on healthcare and finally guarantee that everyone can get the healthcare they need, no matter where they live, what they look like or how much money is in their wallets.