March 2024

Protect Our Care Is Marking the 14th Anniversary of the Affordable Care Act With 5 Days Celebrating the Growing Success of the Health Care Law Under President Biden

Over the last 14 years, the Affordable Care Act (ACA) has become an essential pillar of the American health care system and has helped tens of millions of Americans gain access to affordable health coverage. Thanks to President Biden’s efforts to lower the cost of health care by expanding the ACA, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. The Inflation Reduction Act lowered premiums for people who buy their own coverage. Four out of five individuals can find coverage on the Marketplace for under $10 per month.

The ACA has survived countless repeal attempts, and now it’s stronger than ever. Yet Republicans still want to destroy the ACA and all of its protections for children and young adults. Donald Trump has fully reignited his calls to repeal the ACA. As Trump is escalating these threats, Republicans in Congress and their allies are working overtime to dismantle access to reproductive care and vital preventive care, hike premiums, slash Medicare and Medicaid, reverse recent coverage gains, and raise prescription drug costs for the American people. Additionally, Republican allies in the courts are attacking access to free preventive services under the ACA, jeopardizing lifesaving care for millions. Read more about the case here. 

This week, Protect Our Care is highlighting five key ways the ACA is working across the nation: 

Monday, March 18: How the ACA helps women
Tuesday, March 19: How the ACA helps seniors & young people
Wednesday, March 20: How the ACA helps people with pre-existing conditions
Thursday, March 21: How the ACA helps people of color
Friday, March 22: How the ACA expanded affordable coverage to tens of millions of Americans

Background:

Before the passage of the ACA, young Americans could be thrown off their parent’s health insurance the moment they turned 18. Many young adults were left uninsured after graduating college and were forced to navigate adulthood with entry-level or part-time jobs that didn’t offer employer-sponsored health care. An estimated 3 million young adults had coverage between 2010 and 2016 because of the ACA’s dependent coverage requirement. This coverage policy was responsible for a rapid 14 percent reduction in the number of uninsured young adults immediately after the passage of the ACA. Uninsurance rates for young adults continued to decrease, by 8.7 percent, in the following years, except during the Trump administration. Research has overwhelmingly shown that young adults have had dramatically improved self-reported physical and mental health, increased early-stage cancer diagnosis, reduced poor birth outcomes, and are less likely to die of opioid overdose following the passage and expansions of the ACA. President Biden and Democrats in Congress are working to further lower costs so everyone can afford the health care they need. 

By The Numbers:

• More than 28 million children and young adults with pre-existing conditions gained protection.
• Uninsurance in young adults fell by about 14 percent in the years following the passage of the ACA thanks to Medicaid expansion and ACA provisions.
• 710,000 children gained coverage through Medicaid expansion when their parents enrolled. 
• In 2023, more than one in four, or 4.1 million of those enrolled in Marketplace coverage were between the ages of 18 and 34.

Thanks To The ACA

Expanded Medicaid. Uninsurance rates among young adults fell by nearly half as a result of the ACA’s Medicaid expansion, improving access to care. Research confirms expanding access to Medicaid for parents has had ripple effects on their children. In states that expanded Medicaid, more children gained health coverage and were more likely to have regular access to health care. Children in states that have not expanded Medicaid are almost twice as likely to be uninsured — and that gap is growing. 

Young Adults Can Stay On Their Parents’ Plan Until Age 26. People younger than 26 years old are eligible to be on their parents’ insurance even if they are married, a parent, don’t live with their parents, attend school, are not financially dependent on their parents, or are eligible to enroll in their employers’ plan. In 2023, more than one in four, or 4.1 million of those enrolled in Marketplace coverage were between the ages of 18 and 34.

More Than 28 Million Children & Young Adults With Pre-Existing Conditions Gained Protections. Thanks to the ACA, children with pre-existing conditions like asthma and diabetes cannot be charged more or denied coverage by their insurers. Nationwide, over 100 million Americans have a pre-existing condition, including more than 17 million people under the age of 18 and 11.3 million people aged 18 to 24.

Free Preventive Services And Annual Check-Ups. The ACA guarantees well-child visits with no cost-sharing for patients. These visits help prevent the development of chronic conditions and increase vaccinations among children. Plans sold on the ACA Marketplace must also cover preventive pediatric health benefits, including oral health and vision services. More than 36 million children with private insurance are also guaranteed free preventive care and are protected from lifetime and annual limits. However, these free preventive health services are now at risk of being overturned in the courts in the Braidwood Management v. Becerra case. 

Ended annual and lifetime limits. Because of the ACA, insurers can no longer put annual or lifetime limits on the care you receive, which is critical for children with complex medical needs. According to First Focus, without these protections, “children with cancer and other pediatric conditions, or babies that were born prematurely and spent the first weeks or months of their lives in the neonatal intensive care unit, could exhaust their annual and lifetime limits in a short time.” 

Improvements To CHIP & Medicaid Coverage. The ACA improved children’s coverage by increasing the federal matching rate for the Children’s Health Insurance Program (CHIP) and standardizing–and in many states, expanding–Medicaid eligibility for children. The ACA also ensures that states provide Medicaid coverage to children in foster care up to age 26. 

Contraception Use Covered Under The ACA Has Led To A Sharp Decrease In Unintended Pregnancies. Among young adults, the contraception mandate under the ACA has led to increased use of contraception, increased use of more effective contraceptives, and decreased risk of unintended pregnancy. The racial disparity between Black and white women using contraceptives has also reduced by an incredible 70.5 percent when analyzing contraceptive use pre- and post-passage of the ACA. 

Mental Health And Substance Abuse Treatment Are More Accessible Than Ever. Over 62 million Americans gained expanded benefits for mental health and substance use disorder because of the ACA. With over one-third of young Americans aged 18-25 living with mental illness, this coverage has been life-changing for many. Additionally, the ACA provided increased access to services for the 5.1 million young adults living with substance use disorder. Particularly, the ACA’s Medicaid expansion has played a direct role in reducing opioid-related mortality by 3.6 percent by expanding access to services for rural Americans, racial and ethnic minorities, and impoverished communities most affected by the opioid epidemic.

Over the last 14 years, the ACA has helped tens of millions of Americans gain access to affordable health coverage. Thanks to President Biden’s efforts to lower the cost of health care, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. President Biden built upon the ACA by further lowering premium and prescription drug costs through the Inflation Reduction Act. The new law has lowered annual premiums for people who buy their own coverage by an average of $2,400 per family and has saved the average 60-year-old couple with a household income of $75,000 approximately $1,900 in monthly premiums for Marketplace coverage. Building on the ACA’s closure of the prescription drug donut hole, President Biden’s Inflation Reduction Act reduces out-of-pocket drug costs for Medicare enrollees by capping monthly insulin costs at $35, providing recommended vaccines at no cost, introducing a new annual out-of-pocket spending cap, and negotiating lower drug prices. 

The ACA has survived countless repeal attempts and now it’s stronger than ever. Yet Republicans still want to destroy the ACA and all of its protections for over 100 million people with pre-existing conditions. Donald Trump has fully reignited his calls to repeal the ACA. As Trump is escalating his threat, Republicans in Congress and their allies are working overtime to dismantle reproductive care and access to vital preventive care, hike premiums, slash Medicare and Medicaid, reverse recent coverage gains, and raise prescription drug costs for the American people. 

This week, Protect Our Care is highlighting five key ways the ACA is working across the nation:

Monday, March 18: How the ACA helps women
Tuesday, March 19: How the ACA helps seniors & young people
Wednesday, March 20: How the ACA helps people with pre-existing conditions
Thursday, March 21: How the ACA helps people of color
Friday, March 22: How the ACA expanded affordable coverage to tens of millions of Americans

Background:

Among the many benefits of the ACA, the health care law ensures that the more than 50 million people enrolled in Part D coverage who may have otherwise fallen into a prescription drug coverage gap “donut hole” have their vital medications covered. The ACA guarantees no-cost coverage of preventive services, which has led to an increase in utilization among seniors and a decrease in catastrophic health costs. The ACA also laid a strong foundation for the Inflation Reduction Act’s measures to lower drug prices, including the new out-of-pocket cap on drug costs that went into effect in January 2024 and drops to $2,000 out-of-pocket cap in 2025, which will save nearly 19 million seniors about $400 per year. These benefits, along with the expansion of Medicaid, have improved the health of seniors across the country.

By the Numbers:

• Over 50 million seniors are protected from the Medicare ‘donut hole’ coverage gap. 
• Lifesaving free preventive care has led to an increase in utilization with one study showing that implementation of the ACA led to a 9 percent increase in colonoscopies among seniors.
• The Balancing Incentives Program under the ACA has led to a 3.2 percent increase in daily home caregiving and better quality care for seniors.
• Spillover effects from ACA coverage have resulted in a 17.4 percent increase in SNAP enrollment, leading to better health outcomes among low-income seniors.
• The ACA’s 2014 Medicaid expansion led to seniors being 4 percent more likely to have dual Medicare and Medicaid coverage, allowing for more affordable health care and better health outcomes.
• Through Medicaid expansion, 7.2 million Americans over 65 are enrolled in Medicaid and more than 8.5 million Americans ages 50 to 64 have health coverage.

People Over The Age Of 50 Save Thousands On Premiums. The Affordable Care Act limited the amount older people could be charged to three times more than younger people. If insurers were to charge five times more, as was proposed in the Republican repeal bills, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market, according to AARP. People who buy insurance on their own, especially early retirees, have been able to save thousands on health insurance thanks to the enhanced premium subsidies passed in the ARP and extended in the IRA.

Seniors Are Guaranteed Free Preventive Services And Annual Check-Ups. Around 61 million people with Medicare have access to free preventive services because of the Affordable Care Act. Additionally, Medicare beneficiaries likely see lower premiums thanks to the cost-saving measures implemented under the ACA.

Millions of Medicare Beneficiaries Are Benefiting From Higher Quality, More Coordinated Care. Provisions in the ACA encouraged groups of doctors, hospitals, and other health care providers to come together to provide coordinated high-quality care to the Medicare patients they serve, affecting nearly 9 million seniors.

32 Million Older Adults With Pre-Existing Conditions Gained Protections. Thanks to the ACA, people with pre-existing conditions like asthma and diabetes cannot be charged more or denied coverage by their insurers. Nationwide, half of all Americans have a pre-existing condition, including 32 million people aged 55-64. And now, millions of Americans who have contracted the coronavirus are also protected from discrimination by their insurance companies. 

A Closer Look At How The Affordable Care Act Is Working For Seniors Across The Country:

Seniors Saved Thousands On Prescription Drug Costs Thanks To The ACA. From 2010 to 2016, “More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary,” according to a January 2017 Centers on Medicare and Medicaid Services report.

The ACA’s Medicaid Expansion Saved The Lives Of At Least 19,200 Older Adults. According to the Center on Budget and Policy Priorities, Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017. At the same time,15,600 older adults died prematurely as a result of their state’s decision not to expand the program.

Read the Full PDF Here

Next week marks the 14th anniversary of the passage of the Affordable Care Act (ACA). Since President Obama signed the ACA into law on March 23, 2010, it has become woven into the fabric of our nation. Thanks to President Biden’s efforts to lower the cost of health care, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. The Inflation Reduction Act has built on the law’s strong foundation by lowering premiums for people who buy their own coverage by an average of $2,400 a year per family.

At the same time, about 24 million people have gained health care coverage through the ACA’s Medicaid expansion. Right now, one in four Americans is covered by Medicaid or the Children’s Health Insurance Program (CHIP). Medicaid expansion has decreased income inequality, increased access to preventative care, and saved lives. 

Millions of Americans depend on the ACA in order to stay healthy and financially secure. It’s not just about coverage. It includes a broad range of cost savings and protections that touch nearly every household in the country. For example, if the ACA is repealed, over 100 million Americans with pre-existing conditions could be denied coverage or charged more, 52 million seniors would have to pay more for prescription drugs, and insurance companies would not be required to cover preventative care, such as vaccinations, contraception, and cancer screening.

The ACA has survived countless repeal attempts, and now it’s stronger than ever. Yet Republicans still want to destroy the ACA and all of its protections for over 100 million people with pre-existing conditions. Donald Trump has reignited his calls to repeal the ACA. As Trump is escalating his threats to repeal the ACA, Republicans in Congress and their allies are working overtime to dismantle reproductive care, hike premiums, slash Medicare and Medicaid, reverse recent coverage gains, and raise prescription drug costs for the American people. 

14 years ago, not a single Republican voted for the ACA and since then, they have continuously called for repeal. In 2016, Republicans passed the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, only to be vetoed by President Obama. 2017 brought numerous attempts at repeal all of which failed to pass and become law.

Yet the threats did not stop there. Several Republican candidates up for election in 2024 have campaigned on overturning the ACA. Donald Trump alone has promised to overturn the ACA at least seven times last year. 

President Biden has shown what it means to make health care better — he has lowered prescription drug and insurance costs, helped families connect to coverage, and taken on big drug companies and other corporate interests. The MAGA-Republican plan to gut health care will only take us backwards and throw the entire health care system into chaos.

A Closer Look at How the Affordable Care Act Is Lowering Health Care Costs Across the Country:

About 46 Million Americans Have Affordable Health Coverage. Because of the ACA, about 46 million Americans have health coverage through the Marketplace, Medicaid, or CHIP. 

More Than 21.3 Million People Signed Up For Coverage They Can Afford Through The Marketplace. In 2024, a record-breaking 21.3 million people who buy insurance on their own signed up for health coverage through the ACA Marketplace. This is the highest number of Americans to ever enroll during an Open Enrollment Period and it is thanks to policies that lowered premiums in President Biden’s American Rescue Plan and Inflation Reduction Act. Families are now saving an average of $2,400 a year on their health insurance premiums.

Americans Are Saving More Than Ever On Health Care Premiums. Most people receiving coverage through the Marketplace qualify for tax credits to help pay for their premiums, and the American Rescue Plan and Inflation Reduction Act made these savings more generous and available to more people. Four out of five people enrolling in a Marketplace plan have a plan for less than $10. The Inflation Reduction Act builds on the ACA by ensuring all enrollees never pay more than 8.5 percent of their household income on premiums. The Inflation Reduction Act expanded the eligibility for premium tax credits above 400 percent of the federal poverty level through 2025 — roughly $54,000 for a single person or $111,000 for a family of four. Previously, families earning more than 400 percent of the federal poverty level spent an average of 15 percent of their incomes on health insurance. Americans earning up to 150 percent of the federal poverty level (roughly $20,000 for a single person and $41,000 for a family of four) who buy their coverage on the Marketplace are able to enroll in a plan with $0 premiums.

Lower Health Costs Have Improved Access To Care And Financial Security. Between 2010 and 2018, the share of non-elderly adults with a problem paying a medical bill fell by 17 percent, the share who didn’t fill a prescription fell by 27 percent, the share who skipped a test or treatment fell by 24 percent, and the share who didn’t visit a provider when needing care fell by 19 percent.

Prescription Drugs Are Considered Essential. Thanks to the ACA, insurers have to cover what are known as “essential health benefits,” and that includes prescription drugs. This required all health insurance plans to cover at least one drug in every category and class of approved medicines.

More Than 60 Million Gained Access To Birth Control With No Out-Of-Pocket Costs. The ACA guarantees that private health plans cover all FDA-approved forms of contraception and make them available to 58 million patients with no out-of-pocket costs. More than 99 percent of sexually active women have used contraceptives at some point in their lifetimes, and approximately 60 percent of women of reproductive age currently use at least one birth control method. In addition to increasing access to this essential treatment, this ACA provision has saved money for women and their families: women saved $1.4 billion on birth control pills alone in 2013.

A Closer Look at How the Affordable Care Act Is Protecting Patients Across the Country:

Over 100 Million Americans With Pre-Existing Conditions Are Protected. Because of the ACA, insurers in the individual market can no longer drop or deny coverage, or charge more because of a pre-existing condition. Over 100 million Americans have a pre-existing health condition. Without the ACA, millions of Americans who have contracted COVID-19 would likely be deemed as having a pre-existing condition and be at the mercy of their insurance companies who could refuse to pay for needed care. 

The ACA Guarantees Comprehensive Coverage. Because of the ACA, insurers have to cover what are known as “essential health benefits,” such as maternity care, prescription drugs, and substance and mental health. Before the ACA, individual market plans often failed to cover these basic, and oftentimes preventive, health services. 

The ACA Ended Annual And Lifetime Limits, Including For People With Employer-Based Coverage. Thanks to the ACA, insurers can no longer put annual or lifetime limits on the care you receive. At the time the ACA was passed, 91 million Americans had health care through their employers that imposed lifetime limits. Many such plans capped benefits at $1 million, functionally locking people with complex medical needs out of coverage. 179 million Americans with employer coverage are protected from lifetime limits, in addition to the millions with ACA Marketplace coverage. 

Women Can No Longer Be Charged More Than Men. Because of the ACA, insurers can no longer charge women more than men for the same coverage, and insurers are now required to cover important health benefits like maternity care. Before the ACA, only 12 percent of individual market plans offered maternity care. The ACA established maternity coverage as one of the ten essential health benefits required on all new individual and small group policies. The American Rescue Plan created a pathway to coverage for pregnant Americans, allowing states to extend postpartum coverage under Medicaid from 60 days to 12 months following pregnancy. The United States has the highest rate of maternal mortality in the industrialized world, with 30 percent of maternal deaths occurring between six weeks and one year following delivery, after Medicaid coverage has ended.

LGBTQI+ Americans Are Protected From Discrimination By Health Insurance Companies. Republicans have worked to sabotage the Biden administration’s efforts to require health insurance plans offered through the ACA to include sexual orientation and gender identity as protected characteristics. LGBTQI+ Americans are more likely to be without health insurance than straight individuals. According to a Center for American Progress survey, in 2019, the LGBTQI+ uninsured rate was 20 percent in holdout states, compared to 8 percent in states that adopted Medicaid expansion. Access to affordable, quality health care plans under the ACA and its expansion under the American Rescue Plan and Inflation Reduction Act help combat the number of LGBTQI+ Americans who are uninsured. Premium subsidies made available by the ARP helped nearly 210,000 LGBTQI+ enrollees have access to zero-premium plans.

A Closer Look at How the Affordable Care Act Is Expanding Health Care Access Across the Country:

States Have The Option To Expand Medicaid. Because of the ACA, states can expand Medicaid to millions of adults who previously did not qualify for affordable health care. 24.3 million Americans were enrolled in Medicaid thanks to Medicaid expansion. Between 2013 and 2020, states that expanded their programs saw a 33.9 percent increase in Medicaid enrollment. 

Rural Hospitals Benefit From Medicaid Expansion And Lower Premiums. Through lower premiums and expanded Medicaid, the ACA has profoundly reduced uncompensated care costs, which are often the direct result of individuals who are uninsured or underinsured. Studies published in 2021 found that Medicaid expansion resulted in hospitals receiving higher reimbursements and decreased uncompensated care costs. In 2019, uncompensated care costs in expansion states were less than half of those in non-expansion states. Compared to 2013, hospitals’ uncompensated care costs decreased by more than $14 billion in 2017, or 26 percent. 

Medicaid Expansion Improved Health Outcomes And Saved Lives. A study published in the Journal of Health Economics found that Medicaid expansion reduced all-cause mortality in people aged 20 to 64 by 3.6 percent. According to the Center on Budget and Policy Priorities, Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017. At the same time, 15,600 older adults died prematurely as a result of their state’s decision not to expand the program. 

Children Benefit From Medicaid Expansion. When parents have health insurance, their children are more likely to be insured. A study in Health Affairs found that 710,000 children gained public coverage as a result of their parents enrolling in Medicaid between 2013 and 2015. 

Medicaid Expansion Leads To Decrease In Income Inequality. A January 2021 study found the ACA helped reduce income inequality across the board, but far more dramatically in Medicaid expansion states. The bottom 10th percentile of earners In Medicaid expansion states saw a 22.4 percent boost in their income, compared to 11.4 percent in non-expansion states. A 2019 study found that Medicaid Expansion also caused a “significant” reduction in poverty. 

A Closer Look at How the Affordable Care Act Improves Access to Preventive Services and Reduces Racial Inequity:

ACA Requires Free Preventive Care. Because of the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no cost to consumers. This includes the 179 million Americans with employer coverage. Importantly, the ACA requires plans to cover all vaccinations recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP), including vaccines for COVID-19. Preventive care is essential to comprehensive coverage and because of the ACA, insurers have to cover what are known as “essential health benefits,” such as maternity care, prescription drugs, and substance and mental health. 

Medicaid Expansion Leads To Expansion In Available Preventive Care Services. Medicaid expansion has helped patients access preventive care, including colon cancer screenings. Expansion has also increased patient access to kidney transplants and made diabetes medication more affordable for low-income patients. The program was also tied to earlier diagnoses of colorectal cancer and reducing diabetes-related amputations.

Preventive Care Has Reduced Racial Disparities In Health Outcomes. Access to preventive care starts with access to affordable coverage. The ACA led to historic reductions in racial disparities in access to health care, but racial gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. The ACA significantly reduced racial disparities in the share of people who went without care because of cost. 

Medicaid Expansion Has Led To Improvements To Infant And Maternal Health. Whether coverage comes from Medicaid expansion or increased access to affordable coverage on the ACA Marketplace, coverage improves infant and maternal mortality outcomes. One study found that reductions in maternal mortality in expansion states were concentrated among Black mothers, “suggesting that expansion could be contributing to decreasing racial disparities in maternal mortality.” Expansion has also been tied to improving health outcomes for Black babies, significantly reducing racial disparities in low birth weight and premature birth. 

Preventive Care Leads To Improvements In Disease-Specific Diagnosis And Treatment. A 2017 study called preventive care “one of the most important health care strategies to facilitate early diagnosis and treatment, improve quality of life, and prevent premature death.” Access to preventive care through Medicaid expansion reduced racial disparities in cancer care and resulted in earlier diagnosis and treatment for Black patients. According to the Center for American Progress, Black women were more likely to receive care because of the ACA.