The United States Treasury Department announced today, September 10th, that almost 50 million people have obtained healthcare coverage through marketplace exchanges created by the Affordable Care Act since its enactment more than a decade ago. The Department data show that one in seven Americans have been or are covered by the law. And since President Biden was inaugurated in January 2021, 18.2 million Americans have gotten ACA coverage for the first time.
Rising enrollment since 2021 has been driven by an expansion under the Biden Administration of premium tax credits to include individuals and families with household incomes up to 400% of the federal poverty level, which equates to $58,000 for a single person and $120,000 for a family of four.
The ACA has gone through a tumultuous history since it was signed in 2010. The law has faced repeated calls for repeal by Republicans. Yet the ACA is now more popular than ever, with over 60% of the public having a favorable view of the legislation, according to KFF.
The ACA is a comprehensive reform bill, passed by Congress in 2010, that increases health insurance coverage for the uninsured and implements a wide range of reforms to the health insurance market as well as an expansion of Medicaid, the public insurance program that provides health coverage to low-income families and individuals. Importantly, under the ACA, individuals who may have been uninsured due to preexisting conditions or limited finances can secure affordable health plans through the health insurance marketplaces established by the law.
The legislation has its critics. They point to certain flaws in design and implementation, Indeed, in the early years under the Obama Administration, insurers exited in droves and premiums rates increased substantially. The ACA wasn’t nearly as popular then as it is today.
Under the Trump Administration, ACA enrollment fell while numbers of uninsured rose by more than two million. Following unsuccessful efforts to scuttle the ACA, the president issued executive orders to “improve ACA market dynamics.” ACA exchanges did stabilize in the latter half of Trump’s term in office as insurers returned and the rate of premium growth decreased.
When Biden assumed office, he sought to enlarge the ACA program and reverse some of the changes implemented by the Trump Administration that had shrunk its size. As a consequence of the aforementioned premium tax credits issued to eligible enrollees and a provision incorporated in the Inflation Reduction Act passed in 2022 that includes extended subsidies for plans that sell insurance on the ACA exchanges, record numbers of Americans are now enrolled in healthcare arrangements related to the ACA.
As such, the ACA has attained its intended main purpose of a reduction in the number of Americans without health insurance. The percentage of uninsured nationwide is currently at a historically low level of 7.7%.
Fifty million people have now gotten health care coverage thanks to the ACA. On the campaign trail, Harris touts the accomplishments of the Administration she’s been part of, including the strengthening of the ACA. She also wants to expand upon these policies in addition to extending the reach of Medicare drug pricing provisions contained in the IRA.
The perennial problem for Republicans who’ve wanted to get rid of the ACA is that the law contains provisions that are popular with voters. These include guaranteed coverage along with community rating for people with pre-existing health conditions; subsidies for individuals who purchase health insurance on the federally run state exchanges; and permission for those under 26 to remain on their parents’ insurance plans.
Accordingly, it’s very unlikely Trump will attempt to quash the ACA should he win the election in November. It’s much more probable that he would try to reform the ACA and mold it to what his allies have been advocating, a leaner program and one in which individuals have control over the ACA subsidy they qualify for, rather than having the government dictate which benefits must be included in insurance packages purchased on the marketplace exchanges.
