Even though it’s almost 15 years old, many people still wonder, “What is the Affordable Care Act?” The question is understandable because the Affordable Care Act (sometimes called “Obamacare” or by its abbreviation, “ACA.”) has been part of a confusing and intense political debate since it was enacted as a law in March 2010.
Why the ACA matters for Americans
Health insurance is necessary to gain access to medical care. However, the United States is the only developed country that ties health insurance to being employed. No job, no coverage. About 60% of Americans are covered by employer-sponsored health insurance.
Fortunately, the ACA is a key step towards health equity. It allows individuals without health insurance to shop for and purchase affordable medical coverage. The law also provides “premium tax credits,” paid to insurance carriers by the government, on behalf of qualified consumers.
Before the ACA was enacted in 2010, nearly 50 million Americans had no health insurance—about 1 in 5 people under age 65. As of 2023, 1 in 7 citizens have purchased a Marketplace policy. Every state has a Marketplace (or Exchange) to help individuals and small businesses get an appropriate policy at a fair price.
The Affordable Care Act Is especially important for women
The ACA offers substantial benefits for women’s health:
- Women can’t be charged more for medical insurance than men.
- No denial of coverage due to pre-existing “female” conditions, such as pregnancy, c-section, gestational diabetes, breast/ovarian/cervical cancer, or treatment for domestic or sexual violence.
- No denial of coverage due to other common pre-existing conditions that affect women, including arthritis, asthma, diabetes, high blood pressure, heart disease, stroke, kidney disease, lupus, and Alzheimer’s disease. Even a history of carpal tunnel syndrome, or chronic pain can no longer be denied coverage.
- There is no fee for preventive care, including birth control, wellness appointments, breast and cervical cancer screenings, or testing for HIV and sexually transmitted infections (STIs).
Women are also entitled to other ACA “essential health benefits”
The Affordable Care Act requires plans for individuals and small-group businesses (50 or fewer employees) to include ten “essential health benefits” with no cost limits for treatment. Imagine your relief, knowing you don’t have to worry about receiving quality healthcare.
Besides benefits listed above, the others are:
- Ambulatory services
- Emergency services
- Hospitalization
- Laboratory tests
- Prescription drugs
- Mental health and substance abuse
- Rehabilitation and necessary devices
- Pediatric care, including oral and vision
What happens if the ACA law is repealed?
The 2024 election results could eliminate or drastically alter the Affordable Care Act. President-elect Donald J. Trump has repeatedly called for repeal, calling it a “disaster.” Despite 62% of Americans having a positive view of ACA, House Speaker Mike Johnson has stated a “massive reform” is necessary.
If the ACA is fully repealed, comprehensive care and market reforms included within the law will end. The number of uninsured individuals will immediately soar by up to 24 million. An additional 8 million people with low- to-moderate incomes will be impacted due to loss of premium tax credits.
A partial repeal will involve only the budgetary aspect of the ACA. The ten essential health benefits remain intact, but Insurance premiums rise sharply, because insurers are still unable to deny coverage. Without subsidies, healthy people will drop out. Only the sickest, high-cost people will enroll, causing an upward fee spiral. One more thing: Providers who have administered care under the 2010 law will be uncompensated by “hundreds of billions of dollars.”
As ACA enrollment declines, health care providers will see a reduction in income because of fewer appointments and treatments. Emergency departments will be flooded by the uninsured. Preventive screenings, such as mammograms and Pap smears, will be eliminated. Prenatal and pediatric care will become unaffordable. Americans will get sick or sicker, and the preventable mortality rate will rise.
What can women expect in 2025 and beyond?
More than 50% of people enrolled in the ACA live in Republican districts and receive premium tax credits. Because of its popularity, the incoming administration is aware of its importance to voters. Hopefully, any attempt to change the law will be unsuccessful.
The current premium tax credit rates will expire at the end of 2025. They will likely continue in 2026 and beyond, but at a smaller amount.
Become an advocate for the ACA
Whether you rely on the Affordable Care Act or not, recognize it’s crucial to Americans. You can contact your House representative and Senator to express your support for the current ACA. Ask them to keep it completely intact.
To conclude, if you are enrolled in the ACA, tell your story. Many women have been able to access care to everything from birth control to breast cancer. Health care is a human right. Let’s all come together to make it available and affordable for everyone.
Sources:
Claxton G, Rae, M, Winer A. KFF.org. Employer-Sponsored Health /Insurance 101. Published 28 May 2024. Accessed online 29 November 2024.
Gorenstein D. What a big Republican win Tuesday could mean for Obamacare. NPR Health News. Published 3 November 2024. Accessed online 29 November 2024.
HealthCare.gov. (https://healthcare.gov). (Government website for Affordable Care Act information and enrollment) Accessed online 26 November 2024
Holman J. How Undoing the Affordable Care Act Would Affect Americans’ Health Care. The Commonwealth Fund Explainer. Published 5 September 2024. Accessed online 29 November 2024.
Marquardt M. What does a Trump Presidency Mean for the ACA? The ACA Times. Published 7 November 2024. Accessed online 29 November 2024.
U.S. Department of Health and Human Services, Fact Sheet: Celebrating the Affordable Care Act. Press Release 18 March 2022. Accessed online 26 November 2024.
U.S. Department of the Treasury, Number of People Who Have Enrolled in ACA Marketplace Coverage, 2014-2024. Published 3 September 2024. Accessed online 29 November 2024.
Scott D. Why the US is the only country that ties your health insurance to your job. Vox, Policy/Health Care. Published 16 October 2023. Accessed online 29 November 2024