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A Brief History of the Affordable Care Act
Oct 1, 2024
Favorable public opinion about the Affordable Care Act (ACA) is at its high point according to KFF polling. With other policy issues getting voters’ attention, it’s not surprising the law’s future doesn’t rank highly as a voter concern. However, the law has been the topic of presidential campaign rhetoric, especially its history. With Election Day just over a month away, here is a timeline of significant ACA moments.
The ACA was signed into law in 2010 and was fully implemented by 2014 during the Obama administration.
The ACA has had legal challenges, and the U.S. Supreme Court has ruled on several of them. In 2012, the Court ruled that the ACA’s Medicaid expansion provision was coercive, making the expansion effectively optional for states. In 2014, the Court ruled that privately held for-profit companies could be exempt from the mandate to cover contraceptives. Then, in 2017, the Court affirmed the Trump administration’s ability to exempt employers with a “religious or moral objection” from providing such coverage. In 2015, the Court upheld the legality of tax-credit subsidies for people purchasing insurance from federal ACA marketplaces.
The Trump administration took several actions impacting the ACA. In 2017, President Trump and a Republican-controlled Congress unsuccessfully attempted to repeal and replace the law.
As part of COVID-19 relief legislation, the Biden administration temporarily expanded eligibility for ACA health insurance subsidies and increased the financial assistance for people at lower incomes who were already eligible under the ACA. These temporary measures were extended through 2025 as part of the Inflation Reduction Act (IRA), and Vice President Harris has proposed extending them permanently.
As a result of the enhanced IRA subsidies, there has been record-high enrollment (over 21 million) in ACA marketplace plans, along with the millions more from the law’s Medicaid expansion. There are ten states remaining that have not expanded Medicaid under the ACA.