Thirteen Years After Passage of ACA: Real Progress Has Been Made, But US Needs Medicare for All

Signed by President Obama 13 years ago, the Affordable Care Act was an essential step toward ensuring that health care is a right, not a privilege, in the United States. About 48 million non-elderly people were uninsured in 2010 when the ACA became law. The number of uninsured people under age 65 declined sharply — by about 16 million — in the two years following the ACA’s passage. Although an attempt to repeal the law failed by one vote in July 2017, the number of uninsured started to rise during the Trump administration due in part to successful executive actions that sabotaged parts of the law. Subsequent federal actions to respond to the pandemic have helped bring the numbers back down. Today, about 20 million fewer non-elderly people are uninsured than in 2010. 


Still, that leaves 27 million uninsured Americans, including about 3 million children; and tens of millions more people are underinsured. To make health care a human right and bring down exorbitant costs, we need Medicare for All. As studies by the Congressional Budget Office and other analysts have documented, Medicare for All would provide universal high-quality public coverage while expanding benefits, eliminating nearly all out-of-pocket healthcare costs, and reducing the overall amount we spend on healthcare in the United States. 

The current composition of Congress means that Medicare for All will not happen soon. But broad-based public concern about the high costs of prescription drugs should make it possible to build on provisions in last year’s Inflation Reduction Act that cap the cost of insulin at $35 and reduce the costs of prescription drugs for seniors. 

A dark cloud on the horizon is the end of a provision prohibiting states from disenrolling people from Medicaid in exchange for enhanced federal funding. In April, states will start disenrolling people from Medicaid, and the federal government will start phasing down the enhanced funding it provides to states, with enhanced funding fully phased out by the end of the year. As many as 15 million people are projected to lose Medicaid coverage. Because the disenrollment prohibition reduced the “churn” in Medicaid enrollments — people losing eligibility due to administrative paperwork and other burdens — nearly 7 million of those who lose Medicaid will likely remain eligible for it. 

The ongoing COVID-19 pandemic speaks to the urgency of aiming higher than the pre-pandemic normal in the US. Rather than scaling back what remains of efforts to mitigate a disease that continues to kill and disable thousands, the US must move to a system that treats health care — and health — as rights rather than privileges.

Recent work and commentary by CEPR experts on the ACA and healthcare costs include:​​

Massive Public Investment Made COVID-19 Vaccines Possible

The Crushing Health Care Cost Burden that Never Came

As the Affordable Care Act Enters Adolescence, US Health Care Still Has Growing to Do

Young Men Need More Medicaid

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