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The Affordable Care Act is Working

For the last 50 years, Americans have struggled to navigate a health care system that has failed to put patients first. Millions who were uninsured struggled to pay for even a doctor’s visit, while those who had insurance risked losing it when they needed it most. Quality care, especially preventive screenings and checkups that keep people healthy, was a luxury for many. And doctors were encouraged to focus on the amount of care they delivered, rather than effectively treating patients’ big-picture health.

Today, as a nation, we are at the threshold of a truly historic opportunity. The promise of positive transformative change in the U.S. health care system is at hand, thanks to:

  • The Affordable Care Act working to improve access, affordability and quality in health care
  • Private and public sector alignment around better care, smarter spending, and healthier people
  • New initiatives to advance Precision Medicine
  • Newly unlocked health data to inform providers and empower consumers
  • An increased interest among Americans in prevention and wellness

The evidence is clear when it comes to access, affordability, and quality the Affordable Care Act is working.


Strong Enrollment in the Health Insurance Marketplace. On March 31, 2015 about 10.2 million Americans had paid their premiums and had active coverage through the Health Insurance Marketplace.

Historic Reduction in the Uninsured. We have seen the largest reduction in the uninsured in four decades. Since the passage of the Affordable Care Act five years ago, about 16.4 million uninsured people have gained health coverage. Those gains come primarily from the Marketplace, young adults who can stay on their parents’ plans until they turn 26, and Medicaid expansions.

Progress in Fighting Health Inequity. Since 2013, the uninsured rate has declined 9.2 percentage points for African Americans, resulting in 2.3 million adults gaining coverage and 12.3 percentage points for Latinos, resulting in 4.2 million adults gaining coverage. Since 2013, the uninsured rate among women declined 7.7 percentage points, resulting in 7.7 million women gaining coverage. An estimated 55 million women are also benefiting from preventive services coverage with no out-of-pocket costs.  And health insurers can no longer discriminate based on gender, so being a woman is no longer a preexisting condition.

Medicaid Expansion. Over 12.3 million additional individuals are enrolled in Medicaid and CHIP as of April 2015, compared to before October 2013.  To date, 28 states plus DC have expanded Medicaid under the Affordable Care Act.  This is one of the areas where we know more can be done. We want to work with all the states that have yet to expand — to get as many people covered as possible.

Reducing Uncompensated Care in Hospitals. As a result of Marketplace coverage and Medicaid expansion, hospital uncompensated care costs were reduced by an estimated $7.4 billion in 2014, compared to what they would have been in the absence of the coverage expansion. Medicaid expansion states account for $5 billion, or 68 percent, of that reduction. If all States fully expanded Medicaid, uncompensated care costs would be about $8.9 billion lower in 2016 than they would be if no additional states expanded Medicaid.

From Coverage to Care. Now that millions of Americans have health coverage, we are working to educate consumers about their coverage and to reduce barriers so that they can get the care they need to live longer and healthier lives. 


Health Care Coverage is now Affordable for Millions of Americans. Of the about 10.2 million consumers who had paid their premium and had active Marketplace coverage on March 31, 2015, nearly 8.7 million (85 percent) nationwide and 6.4 million in the 34 states with Federally-facilitated Marketplaces received an average premium tax credit of $272 per month. And in 2015, nearly 80 percent of Marketplace shoppers using HealthCare.gov could purchase coverage for $100 or less after tax credits.  A recent Commonwealth Fund study found that in 2014, fewer Americans had problems paying medical bills or medical debt, and fewer went without care because they couldn’t afford it. This is the first decline and lowest level in these areas since 2005.

Choice, Competition and Premiums. Insurers have decided that the Marketplace is a good place to do business and as a result, consumers have more choices. Twenty-five percent more issuers joined the Marketplace for the 2015 Open Enrollment, and consumers could choose from an average of 40 health plans, up from 30 in 2014.  Studies show more issuers are associated with more affordable premiums.

Health Care Cost Growth Has Slowed Sharply. Since the Affordable Care Act became law, the price of health care has risen at the slowest rate in 50 years. Medicare has paid out nearly $316 billion less through 2013 than it would have had previous trends continued. The average premium for employer-based family coverage rose just 3 percent in nominal terms in 2014. Just more than a decade ago, surveys by the Kaiser Family Foundation frequently registered double-digit premium increases for this type of coverage.


Improved Patient Safety. Since 2011, patient harms like hospital-acquired conditions, pressure ulcers, central line associated infections, falls and traumas have fallen by 17 percent, saving an estimated 50,000 lives and $12 billion dollars.

Fewer Avoidable Hospital Readmissions. The Medicare all-cause 30-day readmission rate fell to approximately 17.5 percent in 2013, translating to an estimated 150,000 fewer hospital readmissions among Medicare beneficiaries between January 2012 and December 2013.

Alternative Care Models are Driving Value. Accountable Care Organizations (ACOs) are groups of providers and insurers who work together to put patients in the center of their care and create better health outcomes. Today, more than one in every 14 Americans gets their health care from one of more than 700 ACOs established by Medicare and other payers.  ACOs have generated a combined $417 million in savings for Medicare. In addition, the Pioneer ACO model has been certified as the first patient care model to meet the stringent criteria for expansion to a larger population of Medicare beneficiaries.

Higher Quality Coverage. After years of dropped coverage, flimsy plans and barriers to care, everyone’s coverage has improved because consumers have new protections, including those who get health insurance through their employers. They can’t be turned away because of pre-existing conditions; they can’t be dropped just because they get sick and insurance has to cover care that Americans count on like trips to the emergency room, prescriptions and preventive services.

We are transforming the way Americans get health care and they have sent a clear message that the Affordable Care Act’s benefits are needed, wanted, and liked.


Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on June 24, 2015
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