In addition to expanding access to healthcare through Medicaid expansion, the ACA has also made health insurance more affordable for millions of Americans through its premium tax credits and cost-sharing reductions. Other consumer protections, including elimination of lifetime limits and guaranteed issue/renewability, have helped to make the health care system fairer for all. The ACA has also helped to curb health care costs through initiatives like value-based payment models, transparency, and fraud prevention.

Despite ongoing political and legal debates, the ACA has continued to be a popular source of public support. A 2024 KFF poll found that a majority of Americans consider the ACA’s key provisions to be “very important,” and most want to see the next president and Congress maintain or even expand these benefits.

The Affordable Care Act (ACA) requires most employers to offer health insurance coverage to their full-time employees. The ACA also sets a standard for “affordable” coverage, which is defined as a plan that costs no more than a set percentage of household income. The ACA also establishes state-based American Health Benefit Exchanges through which individuals can purchase coverage and receive financial help to pay their premiums and cost-sharing, and creates separate exchange markets for small businesses. It also requires that employers who do not offer affordable coverage pay penalties, with exceptions for small businesses.

One of the most significant aspects of the ACA was its expansion of the Medicaid program, to allow states to extend eligibility to people with incomes up to 138% of the federal poverty level ($15,060 for an individual in 2024). The ACA also prohibits insurers from denying coverage or charging exorbitant rates for pre-existing conditions and allows young adults to stay on their parents’ plans until age 26. It also provides an annual open enrollment period for people to enroll in or change their insurance plans and a special enrollment period for qualifying life events such as marriage, birth, loss of employment, etc.

In order to remain financially neutral, the ACA is funded through a variety of taxes and fees on individuals, families, employers, insurers, and some medical device manufacturers. Some of these taxes have since been repealed or reduced, and others—including the individual mandate penalty and the so-called Cadillac Tax—are currently on hold. The ACA also includes a standardized process for appeals when an insurer makes a decision that a consumer finds unfair.