Fact Sheet: Celebrating the Affordable Care Act
12 Years of Advancing Health Equity for All Americans
Since its enactment on March 23, 2010, the Affordable Care Act has led to an historic advancement of health equity in the United States. This landmark law improved the health of all Americans, including women and families, kids, older adults, people with disabilities, LGBTQI+ and communities of color. Thanks to the ACA, millions more Americans have gained health coverage without limits, and protections are in place for people with preexisting conditions. People have access to essential health benefits, including preventive and rehabilitative care, prescription drugs, wellness visits and contraceptives, mental health and substance use treatment, among many others. The Biden-Harris Administration is committed to building on the success of the ACA and making health care a right for all Americans.
Below is the fact sheet highlighting some of the accomplishments of the ACA:
Health of Women and Families
- Required plans cover women’s preventive health services, including birth control and counseling, well-woman visits, breast and cervical cancer screenings, prenatal care, interpersonal violence screening and counseling, and HIV screening and STI counseling, with no cost-sharing to the woman. [HRSA] [CMS]
- An estimated 58 million women with private insurance currently benefit from these preventive service provisions, in addition to 37 million children with access to free preventive care. [Assistant Secretary for Planning and Evaluation]
- Allowed states to expand Medicaid eligibility up to 138% of the Federal Poverty Level ($17,774 for an individual; $36,570 for a family of four) and remove categorical requirements that previously prevented many low-income people from being able to enroll in the program. Medicaid expansion – adopted by 38 states and Washington DC, as of March 2022, has connected people to coverage and improved health outcomes for women of color and families. [CMS]
- Created the Pregnancy Assistance Fund (PAF) to improve the health, educational, social, and economic outcomes of expectant and parenting teens, women, fathers, and their families. The PAF has provided funds to grantees in 32 states and seven tribal organizations, serving nearly 110,000 expectant and parenting young people. [OASH]
- Created the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), which has appropriated over $4.7 billion in grants to states, territories and tribes to support home visiting services to pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes. [HRSA and ACF]
- MIECHV (HRSA) provided over 7.1 million home visits between 2012 and 2020, with over 925,000 home visits provided in fiscal year 2020 alone.
- Since programs started implementing services, Tribal MIECHV (ACF) recipients have provided over 142,500 home visits, including virtual visits during the COVID-19 pandemic, and served over 3,500 caregivers and children during FY 2021.
- Provided $11 billion in funding to bolster and expand community health centers: Nearly 1,400 HRSA-funded health centers operate more than 14,000 service delivery sites that provide comprehensive and preventive health care to nearly 29 million people – 1 in 11 nationwide – in every U.S. state, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin. [HRSA]
Health of Older Adults and People with Disabilities
- Extended protection for Americans with disabilities from being discriminated against by health insurance plans on the basis of medical history or pre-existing conditions; and eliminated lifetime dollar caps on essential health benefits. As a result, many more people with disabilities are able to access quality health insurance that meets their needs, and they will no longer lose coverage based on their health status when they need it most. Lowered the share of adults with disabilities under age 65 who were uninsured for a full year by nearly half. [ASPE]
- Created the Center for Medicare & Medicaid Innovation (CMS Innovation Center) to develop and test new health care payment and service delivery models. This was intended to improve patient care, lower costs, and promote patient-centered practices in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). [CMS]
- Brought community living options to more people through Medicaid options such as Community First Choice, the Balancing Incentive Program and Money Follows the Person. [CMS]
- Provided $50 million to support further development of the Aging and Disability Resource Center (ADRC) Program, which works to assist individuals in critical pathways, defined as times or places where people make important decisions about long-term care. [ACL]
- Supported 33 states with grant funding to plan and implement a “No Wrong Door System,” a partnership between the ACL, the Centers for Medicare & Medicaid Services (CMS), and the Veterans Health Administration, to make it easier for consumers to learn about and access Long Term Supports and Services (LTSS). [ACL]
- Closed the Part D prescription drug “donut hole” to make drugs more affordable for older adults.
- Reformed payments in traditional Medicare through payment updates to hospitals, skilled nursing facilities, and certain other providers, partly to account for economy-wide productivity improvements and reduced excessive payments to home health agencies and inpatient rehabilitation facilities. [CMS]
- Created the largest value-based purchasing program in the country, the Medicare Shared Savings Program (SSP); there are now 483 SSP Accountable Care Organizations (groups of doctors, hospitals, and other health care providers) that serve over 11 million Medicare beneficiaries, with over 525,000 participating clinicians. [CMS]
Coverage Gains & Patient Protections
- Produced historic gains in health insurance, reducing the number of uninsured Americans by approximately 20 million, and extending Marketplace insurance or Medicaid expansion coverage to more than 31 million people as of early 2021. [ASPE]
- This year, the Biden-Harris Administration announced a record-breaking 14.5 million people have signed up for 2022 health care coverage through the Marketplaces during the historic Marketplace Open Enrollment Period (OEP) from November 1, 2021 through January 15, 2022. [CMS]
- Protected more than 133 million people with pre-existing conditions, like cancer, asthma or diabetes, pregnancy, from being denied coverage for their pre-existing condition.
- Mandated that most insurers cover 10 essential health benefits, including mental health and prescription drugs. It covered young people up to age 26 on their parent’s health plans.
- Established vaccinations as a routine and expected part of the health care visit and required that people had a right to the full set of vaccinations recommended for them. For example, hepatitis A and hepatitis B vaccination covered without deductible or co-pay. [CMS, CDC]
- Established the Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office) which serves people who are dually enrolled in both Medicare and Medicaid, also known as dually eligible individuals or Medicare-Medicaid enrollees, to make sure dually eligible individuals have full access to seamless, high quality health care and to make the system as cost-effective as possible. [CMS]
Mental Health and Substance Use Support
- Established the Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Behavioral Health Equity, which coordinates efforts to reduce disparities in mental and substance use disorders across populations. [SAMHSA]
- Extended parity protections to individual health insurance, including qualified health plans offered through exchanges and required coverage of mental and substance use disorder treatment services as a category of Essential Health Benefits, guaranteeing coverage for consumers enrolled in individual and small group market plans. This impacted approximately 30.4 million enrollees in insurance plans and helped reduce stigma while supporting treatment for vulnerable populations. [CMS]
- Created the Health Home State Plan Option to provide comprehensive care coordination for individuals with chronic conditions, including mental and substance use disorders. [CMS]
- Contributed millions of dollars to the Garrett Lee Smith State and Tribal Program, GLS Campus Suicide Prevention, and Primary Behavioral Health Care Integration grant programs. This successful program has trained more than 143,000 individuals who work in the mental health field or a related profession and more than 300,000 people in communities across the country on suicide prevention and mental health promotion. It has reached approximately 55 million people with mental health awareness messaging. [SAMHSA]
Health of LGBTQI+ and Communities of Color
- Established the Offices of Minority Health within six agencies at HHS: Agency for Healthcare Research and Quality (AHRQ); Centers for Disease Control and Prevention (CDC); Centers for Medicare & Medicaid Services (CMS); Food and Drug Administration (FDA); Health Resources and Services Administration (HRSA); and Substance Abuse and Mental Health Services Administration (SAMHSA). [HHS]
- Elevated the NIH National Institute on Minority Health and Health Disparities to lead and coordinate activities that improve the health of racial and ethnic minority populations and reduce health disparities. [NIH]
- Prohibited discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity), in covered health programs or activities, including health insurance. [OCR]
- Reduced the uninsured rate among LGBTI+ populations by nearly half since 2010. [ASPE]
- Provided coverage to approximately 4 million Latinos and 3 million Black Americans since 2010 when the ACA was enacted. [ASPE]
- Strengthened the safety net of HIV care and treatment services to people with HIV served by HRSA’s Ryan White HIV/AIDS Program by helping cities, states, counties, and locally-based community organizations stretch their resources to build a comprehensive system of HIV care. [HRSA]
- Established the Health Profession Opportunity Grant, a unique training and employment program that enrolled low-income individuals from historically underserved and marginalized communities in high demand health care training programs, thus providing career pathways for low-income individuals to assist families in becoming self-sufficient. [ACF]
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