This week marks the 13th anniversary of the Affordable Care Act (ACA). On March 23, 2010, President Barack Obama signed the ACA into law and millions of Americans gained lifesaving coverage as a result. Thanks to the ACA, more than 21 million Americans have gained coverage through Medicaid expansion and a total of one in four Americans has coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Once viewed as a safety net, Medicaid has evolved to demonstrate the overwhelming need and desire for affordable health coverage. Without question, Medicaid has become a pillar of the American health care system.
Thanks to the ACA, health plans are also required to cover preventive care services without cost-sharing. Access to preventive care has improved health outcomes and reduced economic inequity. The ACA has helped reduce longstanding disparities in coverage rates, improving health care access for children, rural Americans, people with disabilities, and people of color across the nation.
A record-breaking 16.3 million Americans enrolled in a Marketplace plan for their health coverage for 2023, and millions more are able to purchase prescription medications at a lower cost. The American Rescue Plan (ARP) and the Inflation Reduction Act (IRA) have built on the strong foundation of the ACA by lowering premiums for middle and working class families by an average of $2,400 a year. 1 in 2 Americans with a pre-existing condition are now protected against losing their coverage, and the ACA’s robust protections don’t stop there. Insurers are banned from setting annual and lifetime limits on health coverage and cannot charge women more for the same care as men. Historic investments into the Navigator program have helped connect even more people to coverage, with a focus on outreach to racial and ethnic minorities, people in rural areas, LGBTQ+ people, and other underserved communities. These programs are key tools in addressing access as a driver of health and, together with a broader set of policies, to ultimately achieve better health outcomes for the communities who need it most.
After years of Republican efforts to repeal and sabotage the law, President Biden and Democrats in Congress have made historic investments to secure the future of American health care. Thanks to their vision and determination, 2023 saw 91.7 million Americans receiving their coverage through Medicaid or CHIP. Americans can now sleep easier at night knowing that Medicaid expansion is here to stay and President Biden is hard at work to expand health coverage.
|How Health Coverage Has Expanded 13 Years After The Affordable Care Act:GAINED: Over 35 million people have health coverage thanks to the Affordable Care Act.GAINED: 39 states now have Medicaid expansion.GAINED: More than 21 million people are now covered thanks to Medicaid expansion. GAINED: 91.7 million Americans have coverage through Medicaid and CHIP, including 41.5 million kids.GAINED: Thousands of lives saved from Medicaid expansion. Where Preventive Care Stands 13 Years After The Affordable Care Act: GAINED: All plans must cover preventive care at no out-of-pocket cost to patients.GAINED: Improved access to care and financial security for families. GAINED: Improved health outcomes for communities of color, rural Americans, people with disabilities, and more.GAINED: Requirements that insurance companies cover prescription drugs and contraception, benefiting even the 179 million Americans with employer coverage.How The U.S. Is Lowering Costs 13 Years After The Affordable Care Act: GAINED: 16.3 million Americans have coverage they can afford on the Marketplace.GAINED: 3.6 million Americans newly insured by a Marketplace plan, with four out of five covered for under $10 a month.GAINED: Improved access to care and financial security for families. GAINED: Record savings, with a family of four now saving an average of $2,400 annually on coverage. GAINED: Children can stay on their parents’ plan until age 26. Where Patient Protections Stand 13 Years After The Affordable Care Act: GAINED: Protections for the 1 in 2 Americans with pre-existing conditions. GAINED: Insurance companies are banned from charging women more for the same care as men.GAINED: Ban on insurance companies having annual and lifetime caps on coverage.|
A closer look at how the Affordable Care Act is expanding health care access across the country:
Allowed States To Expand Medicaid. Because of the ACA, states can access additional federal money to expand Medicaid. Tens of millions of Americans were able to enroll in Medicaid during the COVID-19 pandemic, bringing the total of individuals covered by Medicaid and CHIP to over 92 million, more than one in four Americans. As of April 2022, 21 million Americans were enrolled in Medicaid due to Medicaid expansion, with an estimated 4 million previously-eligible adults gaining coverage under expansion due to enhanced outreach, streamlined processes, and increased federal funding under the ACA. Between 2013 and 2020, states that expanded their programs saw a 33.9 percent increase in Medicaid enrollment. Additional research has shown that Medicaid expansion states were better positioned to handle the economic fallout of the pandemic, with fewer residents becoming uninsured.
Key Support For Rural Hospitals. Through lower premiums and expanded Medicaid, the ACA has profoundly reduced uncompensated care costs, which are often the direct result of individuals who are un-or-underinsured. 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 plays a large role in reducing uncompensated care costs.
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.
Medicaid Expansion Leads To Expansion In Available Services. Medicaid expansion has helped patients access preventive care, including colon cancer screenings. Expansion 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.
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.
When Medicaid Is Expanded, Income Inequality Drops. 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 ACA improves access to preventive services and reduces racial inequity:
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.
Comprehensive Coverage. 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. As it stands, ACA-compliant plans must cover COVID-19 testing, treatment, and hospitalization.
Increased Access To Preventive Care Results In Better Health Outcomes. Medicaid expansion has helped millions of patients access preventive care. Preventive care has allowed for earlier diagnosis of colorectal cancer and reduced diabetes-related amputations.
Preventive Care Leads To Improved Primary Care And Family Planning. Two studies from Michigan showed Medicaid expansion doubled low-income patients’ access to primary care, and enrollees experienced improved access to birth control and family planning.
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.
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.
A closer look at how the Affordable Care Act is lowering health care costs across the country:
More Than 35 Million Americans Have Affordable Health Coverage. Because of the ACA, more than 35 million Americans have health coverage through the Marketplace, Medicaid, or CHIP.
More Than 16.3 Million People Have Coverage They Can Afford Through The Individual Market. In 2023, a record-breaking 16.3 million people signed up for health coverage through the ACA Marketplace. This is the highest number of Americans to ever enroll in a Special Enrollment Period (SEP) and it is thanks to President Biden’s American Rescue Plan. Premium savings under the American Rescue Plan benefit all Americans, with families now saving an average of $2,400 a year on their health insurance premiums.
Americans Are Saving More Than Ever On Health Care Premiums.