The affordable care act has been a major driver of coverage gains in the United States, helping millions of Americans gain access to health insurance. The ACA’s Medicaid expansion, for example, has helped advance health outcomes, support financial security, and reduce health disparities. The ACA has also made individual health insurance more affordable, including by providing premium subsidies to help people pay for their coverage.

In the private marketplace, the ACA limits how much insurance companies can charge individuals and small groups. In addition, the ACA includes important new consumer protections that protect individuals and families from discrimination based on preexisting conditions.

Since the ACA’s implementation, health insurance coverage has steadily increased and the uninsured rate has dropped to historic lows. The ACA’s coverage expansion, the Individual Mandate (which requires all Americans to purchase health insurance or face a penalty), and the ACA’s premium subsidies have played an integral role in these gains.

The ACA also prohibits insurers from discriminating against consumers based on their age, health status, or tobacco use. It also imposes an important new requirement on all plans to cover preventive services without charging patients copayments or deductibles. Finally, the ACA expands access to critical behavioral health and mental health services, which can be an essential component of overall wellness.

In 2022, nearly 26.4 million Americans were enrolled in a plan purchased in the health insurance marketplace, also known as the ACA’s exchanges. These marketplaces are a resource for those who cannot get insurance through their job, can’t afford employer-based plans, or are self-employed. The ACA’s marketplace rules require all coverage options to offer essential health benefits and provide cost-sharing reductions for people with incomes below a certain threshold.

The ACA’s expansion of Medicaid eligibility to adults with family incomes up to 138% of the federal poverty level has also played an important role in expanding coverage. However, the Supreme Court is considering a challenge to this provision.

In the remaining 10 states that haven’t adopted the ACA’s Medicaid expansion, 1.5 million people are in the coverage gap and do not qualify for either Medicaid or financial assistance for marketplace plans. The ACA has addressed this issue by allowing young adults to stay on their parents’ plans until they turn 26, and by providing a monthly special enrollment period for those who experience changes in circumstances that make them eligible for these coverage options.

The ACA has been the basis for many other public and private initiatives that help communities serve their most vulnerable residents, including efforts to improve HIV prevention and treatment, reduce racial/ethnic disparities in health outcomes, and enhance delivery of culturally competent healthcare to LGBTQIA+, HIV, and sexually transmitted disease patients. These efforts will be at risk if the ACA is repealed and replaced without a comprehensive plan to replace it.