March 23, 2024 marks the 14th anniversary of the passage of the landmark Affordable Care Act, the most significant and comprehensive healthcare reform since the 1960s passage of Medicare and Medicaid. The law took two years to pass, over a decade to implement and countless resources to defend from attacks in the courts, in legislatures and in Congress. Today, the Affordable Care Act is supported by a majority of Americans and has reached record enrollment thanks to powerful consumer protections, comprehensive coverage and new premium tax credits that President Biden renewed under the 2022 Inflation Reduction Act.
There are hundreds of reasons to celebrate the ACA, but on the law’s 14th birthday, here’s HCANEF’s top 14:
- The ACA reduced the number of uninsured people in the United States to record lows. Before the ACA, the rate of uninsurance was about 16%–one of the highest rates in the developed world. Today, the rate of uninsurance is just under 8%.
- The ACA improved the quality of insurance for over 150 million people who already had coverage by creating new rules for insurance companies that stopped them from discriminating against people with pre-existing conditions by denying them coverage, charging them more, capping services and setting arbitrary limits on coverage.
- The ACA for the first time created standards for health insurance that requires every insurance policy sold on the individual and small group market to cover basic Essential Health Benefits like mental health, birth control, and pediatric care. These services were often excluded from plans before the ACA.
- The ACA made it illegal to discriminate against women: insurance companies can no longer charge women more than men for the same policy or treat pregnancy and the potential to get pregnant as pre-existing conditions to charge women more for insurance.
- The ACA made it possible for states to vastly expand coverage through Medicaid, the health insurance program with the lowest administrative costs and greatest reach, by funding the full cost of Medicaid coverage for the expanded population – bringing billions of dollars of new revenue into states to support coverage, rural hospitals and providers, and local economies.
- The ACA saves millions of people of all ages money by making preventive care free under all health plans. Annual check ups, Pap smears, colonoscopies, and other procedures that identify disease early are now provided at no cost to people under private insurance, Medicaid and Medicare.
- The ACA also made no cost birth control available to millions more Americans as part of the no-cost preventive care provisions. Before the ACA, many policies had no coverage for birth control and people had to pay out of pocket.
- The ACA provided more than $11 billion in funding to bolster and expand community health centers: nearly 1,400 of these health centers operate more than 14,000 service delivery sites that provide comprehensive and preventive health care to nearly 29 million people – 1 in 11 nationwide – in every corner of the country.
- The ACA closed the Medicare Part D “donut hole” coverage gap that forced millions of seniors to pay the full price of their prescriptions out of pocket.
- The ACA expanded home-care options for aging people and people with disabilities by rebalancing the funding between institutional care and home-based care and expanding the amount provided for people who want to receive services and support in their homes rather than in an institution or facility setting.
- The ACA reduced racial health disparities by providing affordable coverage to Latino, Black and Native American people who were most likely to lack coverage before passage of the law as well as by establishing the Offices of Minority Health within six agencies at HHS to dedicate attention, support and data tracking for health disparities information.
- The ACA also for the first time explicitly prohibited discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity), in covered health programs, activities, and health insurance.
- The ACA expanded coverage for young people by enabling for the first time parents to keep children on their insurance plans until age 26.
- The ACA provided all these benefits while lowering overall health care costs and paid for the improvements with taxes on wealthy households making over $200,000, on providers, insurers, medical device manufacturers and pharmaceutical corporations.
The ACA provides all these benefits and many more and the law is just getting better under President Biden’s leadership. This year, over 21 million people enrolled in ACA marketplace plans–the largest number of all time and that number will grow as long as the ACA remains the law of the land. But that’s not guaranteed: despite the law’s many successes, ACA opponents like former President Trump continue to threaten the law, vowing to end it before its next birthday.
