Notwithstanding widely reported problems with the rollout of the Marketplace websites, sizable numbers of previously uninsured people were able to obtain coverage over the first and second enrollment periods. Analysis of survey data about Americans' health insurance enrollment from October to April showed that The total number of uninsured Americans dropped from Much of this increase was driven by gains in employer-sponsored coverage.
Among those newly insured, 9. The study also estimated that One of the reasons why people are signing up is the individual mandate. After the law was enacted, the Supreme Court took up a legal challenge to the individual mandate. The plaintiffs sued to have the individual mandate voided as unconstitutional. In the run-up to the court decision, RAND analyzed the likely effect of eliminating the individual mandate and found that without it, an estimated 12 million people who would otherwise sign up for coverage would be uninsured.
The analysis found that eliminating the individual mandate would cause the number of people enrolled in the individual exchanges to fall by more than 20 percent. During the early enrollment period, debate erupted over the enrollment of young adults in the individual exchanges.
Some news stories and commentators maintained that unless roughly 40 percent of enrollees in the individual exchanges were young adults — between ages 18 and 34 — then the costs associated with older, less healthy adults would lead to higher premiums and ultimately destabilize these markets. At the end of the first open enrollment period in March , enrollment figures from the U. Department of Health and Human Services showed that 28 percent of enrollees were between the ages of , while 48 percent were 45 or older.
In addition, the spending data used as input to COMPARE suggest that, for most enrollees of all ages, premium payments exceed health care spending. To encourage enrollment in the new individual insurance exchanges, the ACA offers tax credits to help lower-income individuals and families buy coverage. These tax credits have faced multiple court challenges. In late , the U. Supreme Court agreed to hear King v Burwell , a case that challenges the legality of government subsidies that help low- and moderate-income people buy health insurance in marketplaces operated by the federal government.
Each of these gains remains at risk as long as the Trump administration-backed lawsuit remains unresolved. The ACA generated one of the largest expansions of health coverage in U. In , 16 percent of all Americans were uninsured; by , the uninsured rate hit an all-time low of 9 percent.
About 20 million Americans have gained health insurance coverage since the ACA was enacted. Two of the biggest coverage expansion provisions of the ACA went into full effect in the expansion of Medicaid and the launch of the health insurance marketplaces for private coverage.
Together, these programs now cover tens of millions of Americans. Nationwide, Medicaid expansion currently covers Prior to the ACA, insurers in the individual market routinely set pricing and benefit exclusions and denied coverage to people based on their health status, a practice known as medical underwriting. Nearly 1 in 2 nonelderly adults have a preexisting condition, and prior to the ACA, they could have faced discrimination based on their medical history if they sought to buy insurance on their own.
The ACA added a number of significant new protections for people with preexisting conditions. One group of reforms involved changes to the rating rules , prohibiting insurers from making premiums dependent on gender or health status and limiting their ability to vary premiums by age. The ACA also established guaranteed issue, meaning that insurers must issue policies to anyone and can no longer turn away people based on health status.
This prevents insurance companies from effectively screening out higher-cost patients by excluding basic benefits from coverage. The law also banned insurers from setting annual and lifetime limits on benefits, which had previously prevented some of the sickest people from accessing necessary care and left Americans without adequate financial protection from catastrophic medical episodes.
To date, 36 states and Washington, D. While the Medicaid program has historically covered low-income parents, children, elderly people, and disabled people, the ACA called for states to expand Medicaid to adults up to percent of the federal poverty level and provided federal funding for at least 90 percent of the cost.
Medicaid expansion has led to better access to care and health outcomes for low-income individuals and their families across the country. A large body of evidence shows that Medicaid expansion increases utilization of health services and diagnosis and treatment of health ailments, including cancer, mental illness, and substance use disorder. Medicaid expansion is associated with improvements in health outcomes such as cardiac surgery outcomes, hospital admission rates for patients with acute appendicitis, and improved mortality rates for cardiovascular and end-stage renal disease.
Evidence shows that Medicaid expansion saves lives. According to a study , Medicaid expansion was associated with 19, fewer deaths among older low-income adults from to ; 15, preventable deaths occurred in states that did not expand Medicaid. As the Center on Budget and Policy Priorities points out, the number of adults ages 55 to 64 whose lives would have been saved in had all states expanded Medicaid equals about the number of lives of all ages that seatbelts saved in the same year.
In , nearly 9 out of 10 , or 87 percent, of marketplace enrollees qualified for financial help with premiums, and roughly half—54 percent—received reduced cost sharing. What is the ACA? What provisions are included under the ACA legislation? The ACA: implemented coverage standards that prevent insurers from discriminating against applicants — or charging them higher plan premiums — based on pre-existing conditions or gender; eliminated waiting periods that employer-sponsored plans would impose before starting coverage of pre-existing conditions; made health policies guaranteed issue — meaning health coverage is guaranteed to be issued to applicants regardless of their health status, age or income; mandated minimum-value standards for employer-sponsored plans offered by large employers; rescued ACA-compliant plan buyers from lifetime benefit limits and annual benefit limits; improved plan benefits by requiring ACA-compliant plans to include essential health benefits ; required ACA-compliant plans to include a long list of free preventive health care services.
How does the ACA make individual health insurance more affordable? How do consumers buy ACA health insurance? When can Americans enroll in ACA-compliant health plans? Every year, there is an open enrollment period on the Health Insurance Marketplace during which people can buy or switch insurance plans. If you miss this time, you cannot enroll until the following year unless you qualify for a special enrollment period because your circumstances change—for example, you marry, divorce, become a parent, or lose a job that provided health insurance coverage.
A critical part of the original ACA was the individual mandate, a provision requiring all Americans to have healthcare coverage—either from an employer or through the ACA or another source—or face tax penalties. The mandate was eliminated in This mandate served the double purpose of extending healthcare to uninsured Americans and ensuring that there was a sufficiently broad pool of insured individuals to support health insurance payouts.
Critics of the ACA have pointed out that it represented an unprecedented expansion of federal power within the healthcare industry because it required all individuals to purchase a service health insurance whether they wanted to or not.
This aspect of the law was a major focus of debate, and it was challenged in the U. The court ruled in favor of the individual mandate as a constitutional exercise of the taxing authority of Congress, characterizing the penalties levied against the uninsured as a tax.
On Jan. Attempts by the government in to repeal the law altogether were not successful. However, the government substantially scaled back its outreach program to help Americans sign up for the ACA and cut the enrollment period in half.
Changes have been made to the law that addressed some of the objections raised by opponents, while still keeping the Marketplace open for users. Starting with the tax year , the individual mandate penalty was reduced to zero dollars, essentially removing the requirement that many Republicans had opposed. By , the number of Americans covered under the ACA had dropped to By , there were In March , House Democrats unveiled legislation to shore up the act and expand coverage, while the Trump administration revealed it would seek to repeal the entirety of the ACA.
In a letter to a federal appeals court, the Justice Department said it agreed with a federal judge in Texas, who declared the healthcare law unconstitutional and added that it will support the judgment on appeal.
President Joseph Biden, who helped Obama pass the law, is widely expected to make efforts to strengthen the ACA during his term and veto further legislative attempts to overturn it.
In addition to setting up a new special enrollment period, the executive order President Biden signed on Jan. It extended healthcare coverage to millions of previously uninsured Americans.
The act required that all Americans purchase or otherwise obtain health insurance and prohibited insurance companies from denying coverage or charging more due to pre-existing conditions. The ACA also created the Health Insurance Marketplace , through which eligible people may find and buy health insurance policies. All ACA-compliant health insurance plans, including those sold through the marketplace, must cover a number of essential health benefits.
The Biden administration is expected to extend the ACA over the next few years. Commonwealth Fund. House of Representatives.
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