In depth: How the Affordable Care Act changed America

Thirteen years ago today, President Obama signed the Affordable Care Act into law, a bill that  has been called (Opens in a new tab)  the most important piece of legislation since Medicare and Medicaid. Since 2010, The ACA has given more than 40 million Americans access to health care, expanded Medicaid to 40 states to cover 21 million low-income adults under 65, and protected as many as  133 million (Opens in a new tab)  with pre-existing conditions from losing their health insurance.

To mark the anniversary of the ACA, we’re collecting stories of how the law has affected Americans’ lives.

As proud as he is of the ACA, President Obama never intended for the law to remain as is. During a  speech (Opens in a new tab)  in the final months of his presidency, he called the ACA, “a first step” and compared it to “buying a starter home….you hope that over time you make some improvements.”

In the past year alone, the Affordable Care Act has been expanded at the federal and state levels, allowing for more Americans to access quality healthcare without worrying about going bankrupt. To mark the anniversary we took a look back at how the law has evolved over the past year, and a new report that shows how the ACA is continuing to reduce racial and ethnic disparities in care.

Affordable Care Act Subsidies Expanded Through 2025 (Opens in a new tab)

For families living in or near the poverty threshold, the ACA’s premium subsidies make quality care more affordable by reducing the cost of health insurance based on family size and household income. The 2022 Inflation Reduction Act has extended these premium subsidies to 2025, keeping out-of-pocket premium costs from rising for the nearly  13 million (Opens in a new tab)  Americans who benefit from them.

Fix of the Affordable Care Act’s ‘family glitch’ makes millions more Americans eligible for premium subsidies (Opens in a new tab)

Last April, President Obama appeared with President Biden at the White House to talk about the “family glitch” that made health care more expensive for many people families with children. In the fall, the Internal Revenue Service updated their interpretation of an administrative rule in the Affordable Care Act. Since 2013, the rule had based a family’s eligibility for premium subsidies on whether employer-sponsored insurance was affordable for just the employee, without factoring in costs for the whole family.

According to a KFF estimate, 5.1 million Americans, primarily children, fell into this regulatory loophole meaning they were either uninsured or their families were paying more than they could afford.

South Dakota votes to expand Medicaid through referendum (Opens in a new tab)

Last fall, South Dakotans approved a referendum that would allow more than 40,000 South Dakotans access to affordable and high-quality health care through Medicaid. This makes South Dakota one of seven states where voters, not legislators, have approved the expansion of Medicaid.

Bipartisan Agreement makes Medicaid expansion likely in North Carolina (Opens in a new tab)

Lawmakers of both parties came together this spring to support the expansion of Medicaid in North Carolina. Should the agreement become law, it will expand access to coverage to another 600,000 North Carolinians and make North Carolina the 41st state, including Washington, D.C. to have expanded Medicaid under The Affordable Care Act over the past decade.

New Report Showcases How ACA continues to reduce disparities in health care (Opens in a new tab)

A new report released this week from the Commonwealth Fund has documented the role the ACA has played in reducing racial and ethnic disparities in health care. As the report notes, “Since its passage in 2010, the Affordable Care Act (ACA) has helped cut the U.S. uninsured rate nearly in half while significantly reducing racial and ethnic disparities in both insurance coverage and access to care — particularly in states that expanded their Medicaid programs.”

While the ACA has been responsible for much progress over the past 13 years, more work remains.  Nearly 30 million Americans (Opens in a new tab)  continue to lack health care coverage and 10 states have no plans to expand Medicaid. President Obama has  always believed (Opens in a new tab)  that access to health care is a right, not a privilege – building on the progress of the ACA to expand care to all will require citizens to continue to pick up the baton and drive change forward.