Analysis Examines the Affordable Care Act’s Impact on Nearly All Americans

A week after the 2020 elections, the Supreme Court is scheduled to hear arguments on a legal challenge, supported by the Trump administration, that seeks to overturn the Affordable Care Act, an outcome that would have major effects throughout the health care system as the law’s provisions have affected nearly all Americans in some way.

A KFF analysis examines key provisions of the 2010 law that have changed the nation’s health care system, including what’s known about their impact on people’s access to affordable care and coverage, including state-by-state data where available. Key impacts include:

• About 12 million Medicaid enrollees in 33 states and D.C. became newly eligible for the program through Medicaid expansion as of June 2019. This includes 3.7 million in California and at least half of a million each in Pennsylvania, Michigan, Illinois, Washington, Ohio and New Jersey.
• As of February, 10.7 million people were enrolled in coverage through the health insurance marketplaces created under the ACA, including 9.2 million who received premium tax credits and 5.3 million who got cost-sharing reductions. In Florida, Mississippi, Alabama, Nebraska and Oklahoma, at least 95% of marketplace enrollees receive premium tax credits and/or cost-sharing subsidies.

• Insurers can no longer deny coverage for pre-existing conditions, charge higher premiums based on health status or gender, revoke coverage when someone gets sick or impose annual or lifetime limits. About 54 million people have a pre-existing condition that could have resulted in them being denied coverage in the pre-ACA individual market. This includes more than a third of residents in Alabama, Arkansas, Kentucky, Louisiana, Mississippi and West Virginia.
• Private insurers now must cover a wide range of preventive services at no out-of-pocket costs to consumers. This includes recommended cancer and chronic condition screenings, immunizations, and other services. Nearly 150 million people are enrolled in employer plans or through individual market insurance that must provide these free preventive services.
• The law phased out the Medicare coverage gap, often called the “doughnut hole” by gradually reducing the share of total drug costs paid by Part D enrollees in the coverage gap. About 46 million Medicare beneficiaries are enrolled in Part D drug plans.
• About 2.3 million young adults gained coverage due to the ACA’s provision allowing adult children to remain on their parents’ insurance plan up to age 26.

The analysis is part of KFF’s ongoing efforts to provide useful information related to the health policy issues relevant for the 2020 elections, including policy analysis, polling, and journalism. Find more on our Election 2020 resource page.