3.7.13: The Affordable Care Act
The Affordable Care Act (ACA, and also referred to as Obamacare) was signed into law in 2010 by President Barack Obama, and included some of the most recent major efforts to expand access to healthcare. This plan created a marketplace for health insurance plans that were subsidized by government funds for people with lower incomes. Insurance companies were prevented from denying coverage for pre-existing conditions or setting limits on how much they would pay for healthcare on a yearly or lifetime basis. In this law, children were allowed to stay on their parent’s insurance until age 26 - protecting these young adults who tended to be the largest group of uninsured individuals. Preventative care was also provided for free, including important health screenings for chronic diseases (like type II diabetes) and sexually transmitted infections (STIs) as well as many other health concerns - a big step towards a more preventative healthcare model. The original law also had an “individual mandate”, which required individuals to either sign up for health insurance on the marketplace, provide proof of private or employer-funded health insurance (or Medicare/Medicaid coverage), or pay a fine on their tax bill. The rationale for this individual mandate was to encourage as close to 100% healthcare coverage as possible and to help to pay for the program by including healthy individuals in insurance pools (since healthy folks cost less for insurance companies and their premiums subsidize costs for those who are ill). In 2017, under president Donald Trump’s administration, the tax penalty was eliminated, thereby essentially eliminating the individual mandate. Otherwise, most of the legal provisions of the ACA remained (Anderson, 2021).