Health care reform has had many impacts, but few are as visible and impactful as the Affordable Care Act (ACA). The ACA expanded financial assistance for people who buy their insurance on the marketplace and created a pathway to affordable coverage for the millions of low-income Americans in states that expanded Medicaid. The ACA also ended lifetime limits on coverage and banned insurers from charging higher premiums for people with pre-existing conditions. And the ACA made sure that people get value for their premium dollar by requiring plans to spend at least 80 percent of their premiums on medical care and quality improvements, rather than marketing and overhead.

The ACA also strengthened initiatives to ensure that communities receive culturally competent care, including establishing a new National LGBTQIA+ Health Education CenterExit Disclaimer and expanding existing centers. The ACA has also increased funding to provide HIV prevention, treatment, and care services for LGBTI+ communities disproportionately affected by HIV.

Despite a number of attempts to repeal or fundamentally alter the law, support for the ACA has continued to grow. This is largely due to the fact that people have experienced firsthand the significant benefits of the law and the significant damage that would be caused by its repeal or alteration.

Since the ACA’s passage, we have seen historic declines in the uninsured rate, which is a direct result of the ACA’s major coverage expansions and consumer protections. In 2022, the number of uninsured individuals fell to its lowest level ever — 26.4 million people – a drop of nearly forty-nine million since 2013.

This decrease in the uninsured was driven by a variety of factors: increased access to financial help that lowers the cost of marketplace coverage; expanded eligibility for a range of private and public health insurance programs, such as Medicaid and Medicare; increased competition in the individual market, which has reduced premiums and out-of-pocket costs; and the elimination of a penalty for not having health insurance, which was later repealed as part of a tax reform package.

The ACA has also established online health insurance marketplaces, or exchanges, where individuals and small businesses can shop and compare plans to find the best coverage for their needs and budget. These exchanges are available nationwide, making it easier for individuals and small businesses to purchase affordable marketplace coverage. In addition, the ACA prohibited lifetime limits on coverage and required insurers to provide guaranteed issue and renewability for all applicants, regardless of their health status. The ACA also prohibited caps on annual out-of-pocket costs and banned rescissions of coverage. The ACA also placed restrictions on the types of benefits that insurers could offer, including a requirement that large group plans spend at least 85% of their premiums on clinical services and quality improvement activities, and that individual and small group markets spend at least 80 percent of their premiums for these purposes. Any amount of a premium that isn’t spent on these purposes must be returned to consumers as rebates.