6 Key Accomplishments from the Affordable Care Act

The numbers are eye-popping: 230 million guaranteed free preventive care, widespread coverage for less than $10/month, and uninsured rates cut in half. The Affordable Care Act (ACA) has truly transformed the stability and security of health care in this country. Amid that, it has had an incredible impact on the broad Democratic coalition.

Former President Trump’s promise to repeal the ACA would roll back a decade of progress which is why voters must understand how transformational the law has been for them and their families. Despite widespread support for ACA provisions, voters often don’t know about them. For example, only 39% of adults know about the ACA’s protection for those with pre-existing conditions.¹ Here’s a quick rundown of some key ACA accomplishments and what they mean to the Democratic base:

Protecting Those with Pre-Existing Conditions

More than half of Americans have at least one chronic illness or pre-existing condition, but Black and Hispanic Americans are disproportionately affected.² People of color have higher rates of diabetes, asthma, obesity, stroke, heart disease, and cancer, all of which require more frequent medical care.³

Before the ACA was enacted, insurance companies were able to deny or upcharge people with pre-existing conditions. People could be declined health insurance if they had HIV, diabetes, epilepsy, and even if they were pregnant.⁴ Now, the ACA protects all Americans, including more than 129 million people with pre-existing conditions, from such discrimination—ensuring they can afford the medical care they need.⁵

Lowering Costs

High health care costs plagued Americans for years, especially those with low and middle incomes. About half of adults say it’s very or somewhat difficult to afford their health care, with 60% of Black and 65% of Hispanic adults agreeing.⁶

The ACA has taken tremendous strides toward lowering health care costs. The premium tax credit ensures that health care premiums are affordable. For those with low incomes, premiums cost nothing. For others, premiums are capped at 8.5% of household income. Four out of five ACA customers can find insurance plans for $10 or less a month thanks to the premium tax credit.⁷ The ACA also offers subsidies that lower deductibles, copayments, and out-of-pocket maximums. The median deductible for an ACA plan in 2021 was just $750.⁸

Providing Free Preventive Care

For many reasons—cost, insurance status, discrimination—people of color are less likely to have a regular source for medical care, such as a primary care doctor.⁹ This means they’re less likely to receive preventive care, which includes yearly checkups, vaccines, contraceptives, cancer screenings, and more. Preventive care is meant to keep patients healthy and catch any health issues before they get worse.

The ACA made these services more accessible by requiring all insurance plans to cover recommended preventive services free of charge.¹⁰ Currently, more than 100 preventive services are free for more than 230 million Americans.¹¹ Studies have found that removing the financial barrier to preventive care has increased use of these services.¹²

Covering Essential Health Benefits

Before the ACA, the federal government didn’t require insurance companies to cover essential health benefits. For example, more than 60% of people buying coverage on their own didn’t have maternity coverage.¹³ Around 20% didn’t have coverage for mental health care. And 10% didn’t have any coverage for prescription medications.

The ACA required that all insurance companies cover 10 essential health benefits:

• Outpatient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services
• Laboratory services
• Preventive services
• Pediatric services

The ACA also prohibited health plans from setting annual and lifetime limits on how much they would spend on essential health benefits.¹⁴ Before the ACA, patients were required to cover all costs above this limit. For patients with chronic illnesses, this was especially debilitating. Now, patients can get the medical care they need without having to worry about insurance cutting them off.

Expanding Medicaid

People of color are more likely to have lower incomes and receive health insurance through Medicaid—30% of Medicaid recipients are Hispanic and 19% are Black, higher than their proportion of the broader US population.¹⁵

The ACA expanded Medicaid, allowing states to extend eligibility to more working adults with low incomes. As of today, 40 states have taken the federal government up on that deal.¹⁶ Medicaid enrollment has increased 63% since the ACA, covering an additional 32 million low-income adults.¹⁷ Expanding Medicaid in the remaining states could help millions more afford health care.

Democrats built on this progress in 2021 by giving states a new option to extend Medicaid postpartum coverage to 12 months as opposed to the 60 days it provided. Forty-three states have implemented this new option with a few more states in the process of implementation. In a country with such a high maternal mortality rate, especially for Black women, policies like this are much needed.

Cutting Uninsured Rates in Half

In 2010, 48.6 million Americans (16%) didn’t have health insurance.¹⁸ By 2022, uninsured rates were cut nearly in half to 27.6 million (8.4%).¹⁹ Gains were made across the board, for people of color, low-income people, and more. From 2010-2022:

• The rate of Black adults without insurance dropped from 19% to 13.3%.²⁰
• The rate of uninsured Hispanic adults dropped from 30.4% to 27.6%.²¹
• The rate of low-income adults without health insurance dropped from 43% to 22.7%.²²
• The rate of uninsured adults with just a high school education dropped from 22.5% to 18.2%.²³

We’ve made great strides in improving access to health insurance through the ACA and have taken even more steps over the past few years through the American Rescue Plan and Inflation Reduction Act.

Conclusion

The Affordable Care Act has provided more accessible and affordable health care for millions of American families, especially for the Democratic base. Democrats should tout these accomplishments and continue to run on the highly popular ACA.