It has been over 13 years since Congress implemented the Affordable Care Act, also popularly known as Obamacare or the ACA, amid praise and criticism in equal measure. In a nutshell, the Act’s primary objectives were to transform the healthcare system, improve access to affordable care, and enhance the quality and value of healthcare services provided to individuals and families.

Overarching Objectives The Affordable Care Act Sought to Achieve

• Diminish the uninsured population and create a viable avenue for individuals with limited or no coverage options to obtain health insurance.
• Enhance health coverage affordability for minority and lower-income individuals by offering subsidies and premium tax credits to reduce out-of-pocket expenses.
• Enhance consumer protections in healthcare by prohibiting insurance companies from denying coverage or imposing higher premiums based on pre-existing high-risk conditions while implementing measures to safeguard consumers against unfair insurance practices.
• Promote quality and value in the delivery of health care services, leading to the adoption of electronic health records, the establishment of accountable care organizations (ACOs), and the implementation of payment reforms to incentivize providers to deliver better-coordinated and higher-quality care.
• Address the rising costs of healthcare coverage, including incentives to promote cost containment, such as payment reforms tied to quality and efficiency outcomes, initiatives to reduce waste and fraud, and investments in research and innovation to improve the overall efficiency of the healthcare system.

The Impact of the Affordable Health Care Since its Enactment

There have been tremendous strides in the healthcare landscape since the Affordable Care Act’s implementation. The achievements have made the healthcare system more inclusive, accessible, and beneficial for individuals and families nationwide. A closer look at the notable changes shows the following changes.

A Reduction in the Number of the Uninsured

The number of uninsured people hit a record low in 2016 thanks to the provisions made in the Affordable Care Act. Statistics from a report published by the Assistant Secretary for Planning and Evaluation show the numbers for nonelderly uninsured Americans dropped from 48 million in 2010 to 28 million in 2016. However, there has been a 2 million increase as of 2020.

Despite the rise, the numbers are still lower than the initial number of Americans who lacked health insurance. Provisions in the Affordable Care Act influencing the plunge include:

• The implementation of health insurance marketplaces or exchanges, which allows people to compare different coverage options and access subsidies or tax credits, increased the affordability of private health insurance.
• The expansion of the Medicaid program (a government-funded healthcare program for low-income individuals and families) increased eligibility, allowing states to extend coverage to more individuals, particularly those with incomes up to 133% of the federal poverty level.
• The introduction of the individual mandate, requiring most individuals to have health insurance or face a penalty, contributed to the overall decrease in the uninsured population. However, the fine was eliminated in 2019.
• Coverage expansion to young adults, permitting them to stay on their parent’s health insurance plans until they reach 26 years

Comprehensive Coverage for Essential Healthcare Services

The ACA addressed the healthcare affordability disadvantage faced by women, minority communities, and people with pre-existing conditions. Previously, discriminatory practices like gender rating unfairly impacted pregnant women’s ability to afford healthcare, as insurers treated pregnancy as a pre-existing condition. Additionally, coverage plans could exclude crucial women’s health benefits.

Minority communities also faced barriers to accessing employer-sponsored group health plans. They also grappled with high uninsured rates limiting their access to healthcare services, wellness services, preventive care, and essential treatments. Unfortunately, minority communities are disproportionately affected by lower income levels and high poverty rates, making it difficult to afford healthcare premiums, deductibles, and out-of-pocket costs.

Provisions in Obamacare expanded access to affordable coverage options, implemented consumer protections, and reduced barriers to healthcare for minority populations and women, the demographic most affected by pre-existing conditions. The Affordable Care Act requires health insurance plans to cover essential health benefits, including preventive care, prescription drugs, maternity care, mental health services, and more.

An All-Inclusive Approach Benefiting People with Pre-existing Conditions

Another milestone for Obamacare is the protection of individuals with pre-existing conditions. Prior to this Act, health insurers denied coverage or charged higher premiums based on an individual’s health status or pre-existing conditions. The Practice made healthcare too expensive or unaffordable for people in this demographic.

Under the Affordable Care Act,

• Insurers cannot deny coverage or impose exclusions based on a person’s health status.
• Medical underwriting became prohibited, preventing insurers from considering an individual’s health history when determining eligibility or premium rates.
• Premiums can only vary based on age, geographic location, family size, and tobacco use— not individual health status.
• All health insurance plans cover essential health benefits comprehensively, including hospitalization, prescription drugs, preventative services, screenings, maternity care, mental health services, and more for all individuals, regardless of underlying conditions.
• Insurance companies cannot impose lifetime or annual dollar limits on essential health benefits. Thus, individuals with pre-existing conditions can receive the necessary care without the fear of reaching coverage limits.
• Insurance companies cannot deny coverage to children under 19 years solely based on a pre-existing condition. Young people remain under their parent’s health coverage until they turn 26.

At the height of the Obamacare repeal in 2019, about 20 million people with pre-existing conditions lost out on healthcare coverage, setting the number of uninsured back by 7%. Furthermore, 135 million people with underlying medical conditions faced discrimination in the healthcare system. The statistics prove the efficacy of the Affordable Care Act in keeping Americans insured and healthcare accessible for all.

The Future of the Affordable Care Act

Despite the groundbreaking strides of the Affordable Care Act, the disorganization in the healthcare system makes every impact costly and low in value. Other issues threatening this Act include rising healthcare costs, insurance market instability, ongoing political debates, and pushback from small business owners and taxpayers.

The entire healthcare system needs an overhaul to address affordability and accessibility issues effectively. Presently, every stakeholder is looking for a way to make a profit at the expense of the most disadvantaged. Until then, minority communities, women, people with existing conditions, and low-income earners can survive by leveraging the system. 

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