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BIPP student intern Annie Maley ’21 explores the history and current status of the Affordable Care Act in the article below.

Past and Present: An in depth look at why the Affordable Care Act mattered then and still matters now

In December of 2018, a Federal Judge in Texas ruled against the Affordable Care Act (ACA), deeming it unconstitutional. While there has been a Republican push from the inception of the ACA to repeal the health care reform passed under President Obama, this most recent development prompts a look back at what the ACA has done, and what the future implications may be for health care in the United States.

In March of 2010, President Obama signed into law the ACA, a comprehensive reform bill aimed at overhauling the broken American health care system. The law still has the broad goal of making quality health care more accessible and economical for all people. The plan to achieve this goal involved a two fold process of expanding medicaid and subsidizing health insurance plans for individuals.[1]

Before the ACA, around 18% of all adults, and 34% of young adults ages 19-25, were uninsured. Health insurance companies could drop children from their parent’s plan after they turned 19, there was no cap for the out of pocket costs to the individual, and there were no protections for patients with pre-existing conditions.[2] This meant that millions of Americans did not have access to affordable health insurance due to circumstances beyond their control. After the ACA, in 2016, only around 10% of adults and 15% of young adults were uninsured- a significant decrease from 2010.[3] Six years after the passage of the ACA, it appeared to be achieving its broad goal of making health insurance accessible, with uninsured rates at a record low. However, it is important to note that the improvements made to the American health care landscape are by no means irreversible, and can in fact disappear rather quickly in the face of political opposition.

Two years and one new President later, the positive effects of the ACA are beginning to fade. By the end of 2018, uninsured rates had risen to 13.7%, which is roughly an increase of about seven million Americans losing coverage from 2016. These changes in uninsured rates did not occur in a vacuum, devoid of any cause or explanation. From the onset of his 2016 campaign, President Trump made ending the ACA a focal point of his rhetoric. Once in office, although he has been unable to completely repeal the health care law, he has taken small but significant steps to reduce its efficacy. The enrollment period to sign up for government-subsidized health insurance has been cut in half from the previous 90 day time frame to the current 45 day period. On top of having less time to sign up, there was also a 90% decrease in funding for advertising the ACA, potentially decreasing the visibility of changes made to the marketplace such as the shortening of the enrollment period. Notably, President Trump has also allowed for short-term, skeleton-type health care plans known as Association Health Plans (AHPs) that can deny coverage to individuals with preexisting conditions. Employers and young people may opt for these lower cost plans, but they’re not guaranteed to cover basic necessities such as prescription medication, one of the main arguments for having health insurance in the first place.[4]

The implications of stripping the ACA of its power are immense. While political division may have made health care a polarizing issue, it’s important to remember the good that the ACA did for all Americans, on both sides of the aisle. In 2008, 57% of Americans had a negative view of the health care industry. Ten years later, that number has dropped by 10%, demonstrating a slow but significant change in societal thinking about health care. Furthermore, prior to the ACA, most citizens found health care frustrating, with 69% of Americans feeling it required intervention by the federal government.[5] The ACA was put into place to address a legitimate concern, commonly held by a majority of the country. The health care system in the United States was complicated, expensive, and largely inaccessible. Although the ACA was not perfect by any means, with patients not guaranteed the ability to keep their insurance plan or doctor under ACA marketplace health insurance, it made vast improvements on a broken system. Thanks to the ACA twenty million more Americans are insured, wealth inequality has been reduced, and minimum health insurance requirements have been standardized across the industry.[6]

Twenty Republican states’ attorney generals are plaintiffs in the Texas federal court case that ruled the ACA unconstitutional in December. The individual mandate of the ACA, which requires all Americans to enroll in some form of health insurance or face a financial penalty, was the rationale behind the 2012 Supreme Court decision to uphold the ACA, as it fell under Congress’ right to tax citizens. After President Trump’s 2017 tax cuts, the financial penalty for not enrolling is now zero dollars, making the taxing rationale essentially void. Plaintiffs are arguing that due to the individual mandate no longer being a taxable amount, it is unconstitutional and cannot be separated from the rest of the ACA, making the entire law invalid.[7] The ruling will likely be appealed, but if it stands, 17 million people could lose health insurance.

Although there are improvements to be made to the ACA, repealing the law without any comprehensive replacement plan in place would be a grave mistake that could significantly diminish the quality of life of millions of Americans overnight. Protecting the health and safety of their citizens should be the primary goal of any Presidential administration. In 2010, health care in the U.S. was a problematic and inaccessible system that lawmakers and the public alike agreed needed to be addressed. President Obama took a bold and ambitious approach to making health care affordable to all people by making health insurance mandatory. While his party took major political hits in subsequent elections for the ACA, President Obama achieved his goal of decreasing uninsured rates within the United States. Even though it may win votes in the short term for partisan politics, in the long term, dismantling the improvements made to the health care system by the ACA would set the United States a decade back in public policy. What is necessary in this turbulent time for health care, especially with the 2020 elections looming on the horizon, will be political leaders that see the long term importance of American citizens’ well-being over party politics.

Sources of Information:





[5] care_Topline.pdf



*The Bucknell Institute for Public Policy (BIPP) is a nonpartisan institute. Guest writers’ views on public policy are not endorsed by the Institute.

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