The Affordable Care Act (ACA) has faced numerous legal challenges but has been upheld three times by the Supreme Court. Over the years, discussions about the possibility of the ACA (commonly known as Obamacare) being overturned have often focused on individuals with pre-existing conditions who purchase their own health insurance. While this is a legitimate concern, as those individuals would be significantly worse off without the ACA, the law’s impact extends far beyond that.
Who are the Americans whose lives have improved thanks to the ACA? See if you or your loved ones are on this list:
- More than 14 million Americans (91% of all Marketplace/exchange enrollees) who receive premium subsidies that make their coverage affordable. The average full-price premium was $605/month in 2024, but the average subsidy amount ($527/month) covered most of the typical premium.
- More than 7.5 million people who receive cost-sharing reductions that make medical care more affordable and accessible.
- Self-employed individuals who otherwise would not have been able to obtain or afford an independently purchased health insurance plan without the ACA’s guaranteed-issue provisions and premium subsidies.
- People with pre-existing conditions who gain access to an employer-sponsored plan after being uninsured for 63+ days. Before the ACA, HIPAA ensured they could enroll in an employer-sponsored plan, but waiting periods for pre-existing conditions applied. The ACA eliminated those waiting periods.
- Individuals who lose access to an employer’s plan and no longer have to rely on COBRA (or mini-COBRA/state continuation) for health insurance.
- Employees who gain access to an employer’s plan and have a waiting period of no more than 90 days before their coverage takes effect. Before the ACA, employers could set their own waiting periods, sometimes exceeding three months.
- Full-time (30+ hours/week) employees at large companies who are provided comprehensive health insurance rather than “mini-med” plans, thanks to the employer mandate. (Employers can choose not to comply but face a penalty in that case.)
- People with serious medical conditions who would have exhausted their coverage under pre-ACA plans due to annual or lifetime benefit caps.
- People with severe medical conditions who otherwise would have reached their benefit limits in private insurance, including employer-sponsored plans. Before the ACA, annual and lifetime benefit caps were standard and could be easily exceeded with a premature baby or a serious illness.
- Coal miners with black lung disease and their survivors, as the ACA expanded benefits under the Black Lung Benefits Act of 1972.
- Medicare beneficiaries who use Part D prescription coverage and who previously would have fallen into the coverage gap (“donut hole”). The ACA fully closed the donut hole by 2020.
- Medicare recipients who receive free preventive care.
- American taxpayers and Medicare recipients who benefit from ACA cost controls, which have extended the solvency of the Medicare Hospital Insurance trust fund and improved Medicare’s long-term financial outlook.
- Seniors who can remain in their homes as they age, thanks to the ACA’s expansion of Medicaid funding for in-home long-term care services and supports.
- Nursing home residents—and their loved ones—who benefit from federal funding for background checks on employees who interact with patients.
- The 12 million low-income Americans who are elderly and/or disabled and covered simultaneously by both Medicare and Medicaid, benefiting from the ACA’s improvements for the dual-eligible population.
- College students who are no longer limited to inadequate health insurance plans.
- Women (and their partners) who have access to birth control at no cost—including highly effective but costly methods such as IUDs, implants, and tubal ligations.
- Pregnant women who receive free routine prenatal care.
- Expectant parents (both male and female) who can enroll in a health plan in the private market. Before the ACA, pregnant parents’ applications were denied in nearly every state.
- People who purchase their own health insurance and plan to have a child. Before the ACA, individual health insurance rarely covered maternity care.
- Nursing mothers who receive coverage for breast pumps and breastfeeding counseling. The ACA also guarantees that breastfeeding mothers working for large employers have access to reasonable break time and a private, non-bathroom space for pumping milk.
- Anyone who benefits from improved access to mental health care, as insurers are required to cover it and cannot deny coverage based on mental health history.
- People with substance use disorders who can access treatment that would otherwise be prohibitively expensive.
- The 21 million individuals who have gained access to Medicaid thanks to the ACA’s expansion of coverage for low-income adults.
- Low-income families and individuals who no longer have to meet asset tests to qualify for Medicaid or CHIP, as eligibility is now based on the ACA’s modified adjusted gross income. (Some groups, including the elderly and disabled, are still subject to asset tests for Medicaid eligibility.)
- Residents of rural areas where hospitals have remained open thanks to Medicaid expansion.
- Young adults who can stay on their parents’ health insurance while starting their careers.
- Young adults who were in foster care until age 18 and can continue their Medicaid coverage until age 26, regardless of income.
- Early retirees who can enroll in self-purchased health insurance before becoming eligible for Medicare, without worrying about pre-existing conditions.
- Children who have access to free vaccinations and well-child care under ACA marketplace plans.
- Adults who receive a broad range of preventive health services at no cost.
- Families whose health insurance covers their children’s dental care.
- Residents of New York and Minnesota who earn slightly too much for Medicaid but qualify for coverage under Basic Health Programs. (Oregon plans to introduce a Basic Health Program in mid-2025.)
- People who need to appeal a health insurance plan’s decision on a prior authorization request or claim.
- Medicare Advantage enrollees whose plans are required to spend at least 85% of revenue on members’ medical claims and quality improvements.
- Individuals and businesses whose insurers must spend at least 80% or 85% of premiums on members’ medical claims and quality improvements.
- People aged 65 and older, including recent immigrants, who can enroll in ACA-compliant health insurance if they are not eligible for premium-free Medicare. (Before the ACA, individual market insurers typically would not enroll individuals over 64.)
- Women, who no longer pay higher premiums than men.
- Older individuals (including those 65+ who are ineligible for premium-free Medicare), whose premiums are capped at three times the cost of a 21-year-old’s premium.
- People who purchase their own health insurance and no longer fear their policy being rescinded for minor omissions on their applications.
- Everyone who benefits from stronger rate review processes implemented by states due to the ACA.
- Everyone who benefits from the ACA’s risk adjustment program, which levels the playing field and discourages insurers from avoiding high-cost individuals.
- People with individual and small-group coverage that includes all essential health benefits.
- People in several states who pay full price for private health insurance but see lower premiums due to reinsurance programs established under ACA Section 1332.
- Native Americans and Alaska Natives who can enroll year-round in exchange plans and qualify for zero-cost-sharing plans if their income does not exceed 300% of the federal poverty level ($90,000 for a family of four in 2025).
- Native Americans and Alaska Natives who receive care through Indian Health Services, as the ACA permanently reauthorized the Indian Health Care Improvement Act.
- People protected from discrimination in healthcare based on race, national origin, sex, age, or disability under ACA Section 1557.
- People who make more informed food choices thanks to calorie and nutrition information on restaurant menus, mandated by ACA Section 4205 (implemented in 2018).
- Individuals who find the new star rating system for health plans helpful when selecting coverage in the marketplace.
- People who benefit from the development of biosimilar drugs, facilitated by ACA Section 7002, which created the FDA approval pathway for biosimilars.