Today, March 23, 2020, marks the ten-year anniversary of the Affordable Care Act (ACA) being signed into law. Despite multiple judicial challenges, congressional action to halt key provisions, and unsuccessful attempts to repeal and replace the law, the ACA remains largely intact, and public opinion has shifted in recent years. Today, 55% of all Americans view the law favorably, compared with just 33% in 2013, although sentiments on the law remain split across political party affiliations.1
Even in the midst of a global pandemic and a time of uncertainty for the U.S. healthcare system, it is important to look back at how the law has impacted the U.S. healthcare system over the past decade—increasing access, improving quality and slowing the growth of healthcare spending. The ACA’s coverage expansion resulted in millions more Americans having coverage than in 2010, but recent events are a reminder that more work is needed to continue to expand access to comprehensive healthcare coverage.
The ACA had several essential goals:
- Making coverage more affordable for millions through Medicaid expansion and offering premium tax credits for individual insurance. Most notably, the ACA expanded Medicaid coverage to adults up to 138% of the federal poverty level (FPL). Between 2013 and 2019, enrollment in Medicaid expansion states increased by 13.1 million people. In addition to encouraging employers to provide coverage, the ACA also created a platform for purchasing individual health insurance coverage and subsidies to make premiums and cost-sharing more affordable based on income. In 2019, 11.4 million people enrolled in coverage through these state and federal Marketplaces.
- Improving consumer protections in both public and private coverage. Provisions in the ACA reduced Medicare cost-sharing by phasing out the Medicare Part D coverage gap, or “donut hole”—a phase of cost-sharing in which the beneficiaries pay all drug costs out of pocket—by 2020. In employer-sponsored and individual market plans, the ACA eliminated lifetime limits; instituted an out-of-pocket maximum for consumers; required coverage of preventive services without cost-sharing; and required most healthcare plans to charge consumers the same price regardless of health status, preexisting conditions or age (within a 3:1 band).
- Promoting value-based care and delivery system reform. The ACA created the Center for Medicare and Medicaid Innovation (CMMI) to develop and test innovative healthcare payment and service delivery models in Medicare and Medicaid, and promoted the use of alternative payment arrangements throughout the healthcare sector to slow rising healthcare costs nationwide.
To mark the 10th anniversary of the passage of the ACA, Manatt Health has created an infographic highlighting its impact on the U.S. healthcare industry. Click here to view the infographic.
1 Kaiser Family Foundation, Health Tracking Poll: The Public’s Views on the ACA
