March 2024

SCOTUS Set To Hear Oral Arguments In a Case That Will Decide the Fate of Drugs Relied on by Millions

Tomorrow, extreme anti-abortion activists are scheduled to present arguments before the Supreme Court in FDA v. Alliance for Hippocratic Medicine and Danco v. Alliance for Hippocratic Medicine. This case could dramatically curtail access to mifepristone, a safe and effective medication essential for abortion access that was approved by the FDA 24 years ago. Last year, Republican-appointed judges in Texas and on the Fifth Circuit Court of Appeals ruled in favor of plaintiffs, issuing separate orders severely restricting access to mifepristone, but the Supreme Court stayed this decision. A decision to ban mifepristone would threaten millions of women’s access to safe and legal abortions, but it would also open the door for the politically-motivated removal of other safe and effective drugs from the market — throwing the entire U.S. drug approval process into chaos. 

What Happens Next

• March 26: The Supreme Court will hear oral arguments on the case.
• By early July: The Supreme Court will issue a ruling on the case.

Background 

In April 2023, a Trump-appointed federal judge in Texas attempted to revoke authorization for mifepristone, issuing a ban on the medication. His ruling was partially stayed pending appeal, but two MAGA judges on the Fifth Circuit Court of Appeals allowed some restrictions on the drug to remain. The federal government quickly appealed the partial stay to the Supreme Court, which rejected the Fifth Circuit’s restrictions and stayed the ruling in its entirety pending appeal. In August 2023, the Fifth Circuit ruled in favor of anti-abortion advocates, but the ban on mifepristone remains on hold while the Supreme Court weighs an appeal of the ruling.

The anti-abortion advocates, represented by a far-right legal organization, brought this suit with the sweeping aim of achieving a nationwide mifepristone ban. The consequences of this ruling will be most detrimental for women of color, people living in rural areas, and poorer Americans who face the steepest barriers to accessing care.

What the Experts Are Saying

Carrie Flaxman, Senior Advisor at Democracy Forward: “What the lower courts did was utterly fail to defer to the FDA’s scientific judgment that the changes that it made were appropriate and that the drug is safe and effective. In doing so, it is the first time that courts have second-guessed the safety decisions that the FDA has made in approving the drug so there are much broader consequences for the FDA.” [Protecting Our Care in the Courts, 3/12/24]

• This Case Could Throw Everything Into Chaos and “Open The Floodgate.” “If the Court allows these plaintiffs to go forward, it really could open the door to a floodgate of potential plaintiffs. Any group could create a nonprofit, perhaps in a favorable District, and file a lawsuit without really showing the kind of injury that courts have required.”
• “A Huge Threat” to Mifepristone And Drug Approvals. “I want to be clear that even if the court orders those [REMS] restrictions reimposed, that that is a huge threat to access to mifepristone. It is also a threat to drug approvals, not just of [mifepristone], but of really everything on the market.”

Jocelyn Frye, President of the National Partnership for Women & Families: “People do rely on the FDA. They rely on science for a number of decisions. They rely on consistency in the law. What Dobbs did is upend that entirely. Many of the factors in traditional ways you would expect the Supreme Court to look at in that case they threw out the window, and arguably because there’s now a conservative wing on that court that has a different agenda in mind.” [Protecting Our Care in the Courts, 3/12/24]

• “It Should Be An Easy Decision.” “This court is sensitive to the public perception that they are driven by ideology and not by law…[The Supreme Court] should look at precedent, they should look at the law, they should look at the informed judgment of the FDA , and rely on sound science. If they do those things then it should be an easy decision.”
• Mifepristone Is Widely Used And “Extraordinarily Safe.” “The real test is not necessarily the popularity of mifepristone, but mifepristone is widely used. People have used it; it is extraordinarily safe. And people…have come to rely on that [as an available tool]…The other thing is that it is a tool that as part of the evolution of health care practice it is something that can be used in the context of telemedicine. So as we see health care practices become more accessible to more groups of people, it is troubling to see any reversal that is going to make it harder to access care.”

William Schultz, Partner at Zuckerman Spaeder, and former General Counsel for the Department of Health and Human Services: “One of the reasons why Americans across the country should be concerned about the potential outcome of this case is the overturning of an FDA decision and the effects on the approval process. This can really diminish the confidence that patients, doctors, and health professionals have in drugs approved by the FDA. The inevitable result is it’s going to back up the process. They will require more studies. They will hesitate to approve improvements to drug labels. It will be slower in making these decisions, and the consequences of that are going to be patient lives – you’re talking about life-saving drugs.” [Protecting Our Care in the Courts, 3/12/24]

• “When The FDA Is Undermined, There’ll Be Less Faith In Approved Drugs.” “When the FDA is undermined, there’ll be less faith in approved drugs. People will be more likely to turn to dietary supplements and alternative remedies, which, if you have a serious treatable disease, is a public health disaster.” 
• “This Will Chill Investment Into Life-Saving Drugs.” “This will chill investment into life-saving drugs. It costs a lot of money to develop some of the most important drugs we have. PhRMA said in its Amicus brief that affirming the 5th Circuit will add uncertainty about its research, whether it can get drugs approved and if it gets approved whether that approval will be sustained so we will do less research which means less approval of lifesaving drugs. The interest in investment in lifesaving drugs will be diminished.”

What’s At Stake

Access To Safe And Effective Reproductive Care For Millions Of Women Nationwide. The combination of mifepristone and misoprostol, an ulcer medicine, has been found to have a 98 percent efficacy rate, and mifepristone is safer than Tylenol and Viagra. The plaintiffs argue that the FDA’s authorization of the drug over two decades ago was flawed and that the drug which has been used by over 2.5 million women is, in fact, dangerous. Twelve of the nation’s leading medical and scientific organizations have filed an amicus brief demonstrating that the drug is safe and studies and meta-analyses involving tens of thousands of women have shown the same thing. 

• Outsized Impact On Women Of Color, Rural Populations, and Low-Income Women. An analysis by the Guttmacher Institute found that this decision will have an especially severe impact on people living in states where medication abortion plays a particularly critical role in ensuring access to care, including heavily rural states like Montana, Maine, and Iowa. As is true for all abortion restrictions, people of color, low-income individuals, and those without regular access to a nearby health care provider will be disproportionately harmed by restrictions and uncertainty around medication access. 

The Science-Based FDA Drug Approval Process That Has Served America Well Since 1938. The Justice Department warned in an earlier brief that this lawsuit has the potential to undermine the country’s process for regulating pharmaceuticals. If the courts ultimately side with the plaintiffs, it will be an unprecedented situation. Professor Greer Donley of the University of Pittsburgh Law School says, “We’re talking about a judge who is a non-scientist overriding an agency full of experts about the safety and efficacy of a drug. That, to my knowledge, has never happened before.” Lawrence O. Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University called the ruling, “A frontal assault on the legitimacy of the F.D.A. and their discretion to make science-based decisions and gold standard approval processes.” 

Safe And Legal Medications Targeted For Political Purposes. A ruling affirming plaintiffs’ claims would open the door to any third party with a political agenda to challenge a medication that they object to. Ameet Sarpatwari, an expert on pharmaceutical policy and law at Harvard Medical School, said the ruling is likely to encourage a spate of additional challenges. “This opens the door to the courts’ second-guessing any FDA approval — especially for drugs for controversial areas like gender-affirming care, or PrEP for HIV prevention.” He argued it would also instill uncertainty in the pharmaceutical industry. “This should worry every manufacturer out there,” he said. “They are now not assured of a uniform market for their drug based on FDA approval.” Other experts have echoed this fear that a wide range of approved medicines could be targeted including mRNA vaccines, COVID-19 vaccines, HIV medications, hormone therapies, drugs that are derived from stem cells, or any class of medicines that may be politically unpopular. 

Access To Life-Saving Drugs That Patients Count On Every Day. An earlier amicus brief filed by 19 leading scholars of food and drug law states, “We are not aware of any case in which a court has removed a drug from the market over FDA’s objection. The effects could extend far beyond mifepristone. No drug is without risk, and a ruling for Plaintiffs could lead to challenges to the FDA’s benefit-risk determinations for drugs it has approved to treat other diseases and conditions. Patients who rely on life-saving medications could see their drugs removed from the market with little notice.” 

Innovation And Investment In New Drug Development. Pharmaceutical companies must plan years in advance which diseases and therapies to invest in. Injecting a huge dose of political uncertainty into the process could make investors and companies more hesitant to pursue innovative new treatments. Law Professor Rachel Sachs and Professor Donley recently explained that “[o]btaining approval for a new drug is expensive, time-consuming and risky. It typically involves years or decades of research and can cost hundreds of millions, or even billions, of dollars. Most drugs that enter the research and development process fail, never making it to market. The prize at the end of this ordeal is the FDA’s approval to sell the product.” Therefore, “[i]t could chill innovation nationwide if political actors could circumvent the agency’s data-driven process by engaging the courts. Manufacturers might become wary of investing time and money into products for a wide range of conditions which may — decades down the line — be the subject of nuisance litigation.” 

Chaos In The Established Regulatory System. Following the initial ruling, R. Alta Charo, a professor emerita of law and bioethics at the University of Wisconsin said, “The biggest threat that a decision like this brings is the threat of creating chaos.” Charo also told the New York Times that a decision to invalidate an F.D.A. drug approval could have ripple effects for other federal agencies with technical expertise, including those that oversee regulations related to the environment, energy, and digital communications. “Imagine what you could do when you’ve got commercial interests that are upset about a whole slew of” issues, he said, adding, “There’s just no end to this really.”

Who Is Behind It 

An “Alliance” Of Right-Wing Medical Groups Is The Lead Plaintiff In The Case. The plaintiffs in this case are led by the Alliance for Hippocratic Medicine, a group seemingly created for the sole purpose of filing this lawsuit. The Alliance was only incorporated in August of 2022 and the group’s sparse website is even newer than that. 

The Other Plaintiffs Include Peddlers Of Anti-Choice Misinformation And Anti-LGBTQI+ Extremist Groups. The other plaintiffs include the American Association of Pro-Life Obstetricians and Gynecologists, the American College of Pediatricians, and the Christian Medical & Dental Associations. The American College of Pediatricians is a fringe extremist group that trades on its name similar to the premiere U.S. Association of Pediatricians to push anti-LGBTQI+ junk science via the far-right media and filing amicus briefs in cases related to abortion or LGBTQI+ rights. The American Association of Pro-Life Obstetricians and Gynecologists and the Christian Medical and Dental Associations are other far-right groups that use their members’ medical certifications to push false information regarding abortion and birth control. Including the dangerous pseudoscience of “abortion reversal.” 

The Plaintiffs Are Represented By The Alliance Defending Freedom, An SPLC-Designated Hate Group. The legal team for the plaintiffs is the Alliance Defending Freedom (ADF), one of the most prolific extremist advocacy groups in the country. Designated a hate group by the Southern Poverty Law Center, the ADF has advocated both in the U.S. and abroad for forced sterilization of trans people, criminalization of same-sex relationships, and strict restrictions on abortions. ADF receives tens of millions of dollars in dark money annually, coming often from the same sources that led the right-wing attacks on the Affordable Care Act, Social Security, and Medicare. 

Nearly 150 Congressional Republicans Have Filed An Amicus Brief Supporting The Extreme Case. 145 Republican Members of Congress, including 26 Senators and 119 Representatives, have filed an amicus brief in support of the plaintiffs. In the brief, they argue that the 23-year-old FDA approval of mifepristone was an “unlawful deregulation of chemical abortion drugs” that “has endangered patient health and safety,” despite presenting no evidence that the drug is anything but safe and effective.

More Than 20 Republican Attorneys General Have Filed An Amicus Brief Supporting The Suit. Twenty-two GOP attorneys general led by Mississippi have filed an amicus brief in support of the plaintiffs. In the brief, they argue that the 24-year-old FDA approval of mifepristone represents an “elective-abortion policy that Congress could never pass.” This brief argues that federal agencies themselves “erode the separation of powers,” “imperil federalism,” and “seize power,” and pushes the Supreme Court to subject the FDA’s actions to “searching review.” 

Three Republican Attorneys General For Missouri, Idaho, and Kansas Filed A Separate Amicus Brief Supporting The Suit. Three Republican Attorneys General representing Missouri, Idaho, and Kansas – who all signed onto the 22-state amicus brief led by Mississippi – have filed a separate amicus brief in support of the plaintiffs, arguing that the FDA’s 24-year-old approval of mifepristone “has imposed increased costs to state-funded medical insurance and public hospitals.” If accepted, this dangerous legal argument, which claims that the drug’s approval created “sovereign harms that radically interfere with the ability of the States to set policy,” opens the door for challenges to any drug that increases costs to state-funded public health programs.

Why The Plaintiffs’ Legal Arguments Are Wrong

The plaintiffs assert several different claims:

• They contend that the FDA’s approval of mifepristone in 2000 should be invalidated because (a) the agency cited regulations governing drugs that “treat serious or life-threatening illnesses” and, plaintiffs contend, mifepristone does not fall within that category, and (b) the conditions for use specified by the agency were inadequate.
• When the agency approved the drug in 2000, it used its “risk evaluation and mitigation strategy” (REMS) authority to impose restrictions designed to ensure the drug is distributed and prescribed safely. In 2016, the FDA loosened those restrictions, allowing the drug to be used later in a woman’s pregnancy (up to 70 gestational days), prescribed after only one in-person clinic visit and by a broader set of healthcare providers, and taken by the woman at home rather than in a doctor’s office. The plaintiffs assert that these changes were not supported by the data relied upon by the FDA and ask the court to restore the original, more stringent restrictions.
• The plaintiffs also invoke the Comstock Act, a criminal law prohibiting the “knowing[]” mailing of “obscene or crime-inciting matter” that includes in its long list of items “article[s] or thing[s] designed, adapted, or intended for producing abortion.” They claim that this law required the FDA to prohibit the distribution of mifepristone by mail or common carrier.

This is a meritless lawsuit that should have been thrown out of court – for multiple reasons.

• The plaintiffs lack “standing” to sue. To file a lawsuit in federal court, a plaintiff must assert an “actual” or “certainly impending” real-world injury. These plaintiffs are not regulated by the FDA and do not prescribe mifepristone. Their claim – that patients will come to them for help after taking the drug, which will require them to divert attention from other patients, inflicting costs and risking potential liability and emotional distress – is indistinguishable from standing arguments that have been repeatedly rejected by the Supreme Court because they “depend[] on the unfettered choices made by independent actors not before the courts and whose exercise of broad and legitimate discretion the courts cannot presume either to control or to predict.”
• Most of the claims are, in addition, barred by the statute of limitations and/or failure to raise the arguments before the FDA. Federal law provides that a party seeking to challenge a decision by an administrative agency must file suit no later than six years after the decision. The challenge to the FDA’s approval of the drug in 2000 is therefore untimely. (The plaintiffs try to rely on their 2002 petition to the FDA challenging that approval, but that petition was denied in 2016, more than six years before the filing of this lawsuit.) The plaintiffs filed a separate petition urging the FDA to withdraw its 2016 decision loosening the REMS standards applying to mifepristone, which the agency denied in 2021 – making the challenge to the REMS standards timely; but the plaintiffs did not challenge the 2000 approval in that petition and their claim that the petition implicitly “reopened” the approval decision is contrary to basic principles of administrative law. Also, the plaintiffs have never raised their Comstock Act argument before the FDA. Finally, even the challenge to the 2016 REMS standards is not properly before the court because it has been superseded by the FDA’s 2023 action further revising those standards: the 2016 decision, therefore, is no longer operative.
• The plaintiffs are wrong on the merits. As the Justice Department and a company that manufactures the drug explain in detail: there is no basis for overturning the FDA’s expert determination in 2016 regarding the proper REMS standard for this drug, which was fully supported by the data cited by the agency; FDA properly rested its approval of mifepristone on its authority over drugs treating serious illnesses, because pregnancy can be, many times is, accompanied by complications posing serious risks to a woman’s health; and FDA’s 2000 approval and accompanying standards were a proper exercise of the agency’s expertise. The REMS and approval decisions are subject to deferential review and may be set aside only if found to be “arbitrary and capricious” – a high standard that the plaintiffs do not come close to satisfying. Concerning the Comstock Act, the government explained that, by 1960, “federal courts of appeals settled upon a consensus view that the Comstock Act did not prohibit the mailing or other conveyance of contraceptives or items designed to produce abortions where the sender does not intend them to be used unlawfully.” (A Justice Department opinion explains in detail the basis for this conclusion.) Therefore, “even if FDA were required to consider the Comstock Act, because the Comstock Act does not prohibit the mailing or other conveyance of abortion-inducing drugs where the sender does not intend them to be used unlawfully, and given that these drugs may be used lawfully, neither FDA’s decisions related to in-person dispensing nor the absence of a prior FDA affirmative prohibition on distribution by mail was inconsistent with the Comstock Act.”
• The plaintiffs are not suffering, or threatened with, irreparable injury. A party is entitled to an injunction only if it can show that, without the injunction, it will suffer irreparable injury. Here, for the same reasons they lack standing, their speculative arguments about harm cannot satisfy the irreparable injury requirement. And plaintiffs’ delay in filing suit – more than two decades after the drug was first approved and nearly a year after the FDA denied their petition regarding the REMS standards – further supports that conclusion.
• The balance of harms weighs sharply against the plaintiffs. Even when a plaintiff can demonstrate irreparable injury, a court may not grant injunctive relief if the harm to the plaintiff is outweighed by the harm that would be suffered by other parties and the harm to the public interest. Eliminating the availability of a drug that millions of women have used over two decades will inflict serious harm on Americans across the country who rely on the drug for safe and effective reproductive care. (Plaintiffs’ claims that mifepristone is unsafe are wrong: a mountain of evidence demonstrates the drug’s safety.) As the government explains, “[r]emoving access to mifepristone would cause worse health outcomes for patients who rely on the availability of mifepristone to safely and effectively terminate their pregnancies.” It would interfere with Congress’s decision to entrust the FDA with technical decisions regarding the safety and efficacy of drugs. It would also create a legal precedent that could disrupt the new drug approval system that has produced myriad life-saving treatments that benefit tens of millions of Americans.

***MEDIA ADVISORY FOR SATURDAY, MARCH 23 AT 10 AM PT // 1 PM ET***

President Biden and Congressional Democrats are Building on the ACA by Lowering Costs and Expanding Health Care for Nevadans, while Trump and Congressional Republicans Threaten Repeal

Las Vegas, NV– On Saturday, March 23 at 10 AM PT // 1 PM ET, Congresswoman Dina Titus, For Our Future and Protect Our Care Nevada will celebrate the 14th anniversary of the Affordable Care Act and highlight how the law has protected people with pre-existing conditions, lowered costs for people who buy the own coverage, and increased access to quality, affordable health care for Nevadans since it’s passage. President Biden and congressional Democrats are committed to building on and protecting the historic successes of the ACA by making lower Marketplace premiums permanent to keep plans affordable for the 96,706 Nevadans enrolled, lowering prescription drug prices, cracking down on junk plans, and expanding Medicaid. A record breaking 21 million Americans enrolled in health coverage through ACA marketplaces for 2024, an increase of approximately 8 million since President Biden took office.

Meanwhile, Donald Trump and Republicans are threatening to repeal the ACA, despite record-setting enrollment numbers and the law’s overwhelming popularity. Repealing the ACA means losing protections for the 135 million Americans with pre-existing conditions, dramatically increasing premium costs, ending coverage for young people on their parents’ health plan until age 26, and ripping away access to preventive services without cost-sharing. It will also reverse the progress made to eliminate health equity disparities. Speakers will contrast Republican efforts to cut Medicaid and rip away health care with the Biden administration’s record of ensuring health care remains accessible and affordable for Nevadans and Americans across the country.

PRESS CALL

WHO:
Congresswoman Dina Titus
For Our Future
Protect Our Care Nevada Director Sandra Jauregui 

WHAT: 14 Years of the Affordable Care Act Rally

WHEN: Saturday, March 23 at 10 AM PT // 1 PM ET

WHERE: Martin Luther King Jr. Senior Center, 2420 N M.L.K. Blvd Building B, North Las Vegas, NV 89032 or Livestream Here

Today marks the 14th anniversary of the passage of the Affordable Care Act (ACA). In the years since President Obama signed the ACA into law, it has become woven into the fabric of our nation. Thanks to President Biden’s efforts to lower the cost of health care, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. The Inflation Reduction Act has built on the law’s strong foundation by lowering premiums for people who buy their own coverage by an average of $2,400 a year per family.

The ACA is not just about coverage. It includes a broad range of cost savings and protections that touch nearly every household in the country. For example, if the ACA is repealed, over 135 million Americans with pre-existing conditions would lose critical protections, 50 million seniors would have to pay more for prescription drugs, and insurance companies would not be required to cover preventative care, such as vaccinations, contraception, and cancer screening. Here are 14 things to know about the ACA: 

1. More Americans than ever have signed up for coverage through the Marketplaces. In 2024, a record-breaking 21.3 million people signed up for health coverage through the ACA Marketplace. This is the highest number of Americans to ever enroll in an Open Enrollment Period. Families are now saving an average of $2,400 a year on their health insurance premiums.
2. Not a single Republican voted to pass the Affordable Care Act. 14 years ago, not a single Republican voted for the ACA and since then, they have continuously called for repeal. The repeal attempts started in 2016, when Republicans passed the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, only to be vetoed by President Obama. 2017 brought numerous attempts at repeal all of which failed to pass and become law.
3. Millions of Americans with pre-existing conditions are protected. Because of the ACA, insurers in the individual market can no longer drop or deny coverage, or charge more because of a pre-existing condition. An estimated 129 million Americans have a pre-existing health condition. 
4. The ACA requires free preventive care. Because of the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no cost to consumers. This includes the 179 million Americans with employer coverage. Importantly, the ACA requires plans to cover all vaccinations recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP), including vaccines for COVID-19. 
5. Prescription drugs are considered essential. Thanks to the ACA, insurers have to cover what are known as “essential health benefits,” and that includes prescription drugs. This required all health insurance plans to cover at least one drug in every category and class of approved medicines. The ACA has also increased access to affordable drugs. The ACA’s Biologics Price Competition and Innovation Act paved the way for the Food and Drug Administration (FDA) to approve biosimilars, cheaper alternatives to expensive biologics. This provision is projected to save $54 billion between 2017 and 2026.
6. Women no longer can be charged more than men for the same coverage. Because of the ACA, insurers can no longer charge women more than men for the same coverage, and insurers are now required to cover important health benefits like maternity care. Before the ACA, only 12 percent of individual market plans offered maternity care. The ACA established maternity coverage as one of the ten essential health benefits required on all new individual and small group policies. The American Rescue Plan created a pathway to coverage for pregnant Americans, allowing states to extend postpartum coverage under Medicaid from 60 days to 12 months following pregnancy. 
7. More than 60 million gained access to birth control with no out-of-pocket costs. The ACA guarantees that private health plans cover 18 methods of contraception and make them available to 58 million patients with no out-of-pocket costs. More than 99 percent of sexually active women have used contraceptives at some point in their lifetimes, and approximately 60 percent of women of reproductive age currently use at least one birth control method. This ACA provision has saved money for women and their families: women saved $1.4 billion on birth control pills alone in 2013.
8. The ACA ended annual and lifetime limits, including for people with employer-based coverage. Insurers can no longer put annual or lifetime limits on the care you receive. At the time the ACA was passed, 91 million Americans had health care through their employers that imposed lifetime limits. Many such plans capped benefits at $1 million, functionally locking people with complex medical needs out of coverage. 179 million Americans with employer coverage are protected from lifetime limits, in addition to the millions with ACA Marketplace coverage. 
9. 40 states plus the District of Columbia have expanded Medicaid coverage. Because of the ACA, states can expand Medicaid to millions of adults who previously did not qualify for affordable health care. Nearly 25 million Americans were enrolled in Medicaid thanks to Medicaid expansion. Between 2013 and 2020, states that expanded their programs saw a 33.9 percent increase in Medicaid enrollment. 
10. Medicaid expansion has improved health outcomes and saved lives. A study published in the Journal of Health Economics found that Medicaid expansion reduced all-cause mortality in people aged 20 to 64 by 3.6 percent. According to the Center on Budget and Policy Priorities, Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017. At the same time, 15,600 older adults died prematurely as a result of their state’s decision not to expand the program. 
11. Rural hospitals benefit from Medicaid expansion and lower premiums. Through lower premiums and expanded Medicaid, the ACA has profoundly reduced uncompensated care costs, which are often the direct result of individuals who are uninsured or underinsured. In 2019, uncompensated care costs in expansion states were less than half of those in non-expansion states. Compared to 2013, hospitals’ uncompensated care costs decreased by more than $14 billion in 2017, or 26 percent. 
12. Medicaid expansion leads to a decrease in income inequality. A January 2021 study found the ACA helped reduce income inequality across the board, but far more dramatically in Medicaid expansion states. The bottom 10th percentile of earners In Medicaid expansion states saw a 22.4 percent boost in their income, compared to 11.4 percent in non-expansion states. A 2019 study found that Medicaid Expansion also caused a “significant” reduction in poverty. 
13. Medicaid expansion leads to more access to preventive care services. Medicaid expansion has helped patients access preventive care, including colon cancer screenings and access to kidney transplants, and has made diabetes medication more affordable for low-income patients. Access to preventive care through Medicaid expansion reduced racial disparities in cancer care and resulted in earlier diagnosis and treatment for Black patients. According to the Center for American Progress, Black women were more likely to receive care because of the ACA.
14. Medicaid expansion and coverage through ACA marketplaces have improved infant and maternal health. Health coverage improves infant and maternal mortality outcomes. One study found that reductions in maternal mortality in expansion states were concentrated among Black mothers, “suggesting that expansion could be contributing to decreasing racial disparities in maternal mortality.” Expansion has also been tied to improving health outcomes for Black babies, significantly reducing racial disparities in low birth weight and premature birth.

As MAGA Republicans Refuse to Give Up on Their War on Health Care, A Record Number of People Rely on the ACA

Washington, D.C. — Fourteen years ago tomorrow, President Barack Obama signed the Affordable Care Act (ACA) into law, and millions of Americans gained access to quality, affordable health care as a result. Thanks to the tireless work of President Biden and Democrats in Congress, the 2024 open enrollment period was the most successful in history — a record-breaking 21.4 million Americans signed up for coverage. Coupled with the health law’s expansion of Medicaid, protections for people with pre-existing conditions, and cost-saving measures, the ACA has touched the lives of nearly every person in the nation. Read Protect Our Care’s ACA anniversary fact sheet here. 

The ACA has survived countless repeal attempts, and now it’s stronger than ever. President Biden has shown what it means to make health care more affordable — he has lowered prescription drug costs for seniors, helped millions of families afford coverage, and taken on big drug companies and other corporate interests. Over 100 million Americans now rely on marketplace and Medicaid for coverage. Yet, Republicans still want to destroy the ACA and all of its protections for over 100 million people with pre-existing conditions. Just this week, they once again introduced a budget that would strip away protections for people with pre-existing conditions, increase insurance premiums and prescription drug costs, and put Medicaid coverage for millions in jeopardy. Presumptive GOP presidential nominee Donald Trump sabotaged affordable health care and pre-existing condition protections while he was in office, and has renewed his calls to “terminate” the ACA at least seven times over the last several months.

“Fourteen years in, the law is now woven into the fabric of America and is only getting stronger,” said Protect Our Care Chair Leslie Dach. “Thanks to the ACA, millions of people with pre-existing conditions like diabetes or asthma are protected from being refused coverage or charged more for it, over 45 million people who get insurance on their own have affordable coverage thanks to premium tax credits and Medicaid expansion, and over 150 million patients have access to free cancer screenings and other preventive care. We’ve seen people’s health and financial security improve. The ACA has been essential to reducing inequities in health care and has laid a strong foundation to do more to ensure everyone — no matter who they are or where they live — has access to the health care they need.” 

“On the ACA’s 14th anniversary, it’s important not to lose sight of Republicans’ war on health care,” said Protect Our Care Executive Director Brad Woodhouse. “They want to raise costs on families, they want to go back to a time where people with pre-existing conditions paid more, and they want to put big pharmaceutical and insurance companies back in charge. While President Biden and Democrats in Congress are working tirelessly to build on the ACA and expand affordable, quality health care to every American, the MAGA-Republicans are still fighting in Congress and in the courts to gut the ACA and undermine the law’s protections. Some things never change: Republicans want to gut health care, only taking us backwards and throwing the entire health care system into chaos.”

Over the last 14 years, the Affordable Care Act (ACA) has helped tens of millions of Americans gain access to affordable health coverage. Thanks to President Biden’s efforts to lower the cost of health care, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. The Inflation Reduction Act lowered premiums for people who buy their own coverage by an average of $2,400 a year per family.

The ACA has survived countless repeal attempts, and now it’s stronger than ever. Yet Republicans still want to destroy the ACA and all of its protections for over 100 million people with pre-existing conditions. Donald Trump has fully reignited his calls to repeal the ACA. As Trump is escalating his threat, Republicans in Congress and their allies are working overtime to dismantle reproductive care and access to vital preventive care, hike premiums, slash Medicare and Medicaid, reverse recent coverage gains, and raise prescription drug costs for the American people. 

Over the next five days, Protect Our Care is highlighting five key ways the ACA is working across the nation: 

Monday, March 18: How the ACA helps women
Tuesday, March 19: How the ACA helps seniors & young people
Wednesday, March 20: How the ACA helps people with pre-existing conditions
Thursday, March 21: How the ACA helps people of color
Friday, March 22: How the ACA expanded affordable coverage to tens of millions of Americans

Background:

The ACA’s marketplace has been a vital lifeline for millions of Americans. President Biden delivered on his promise to build upon the successes of the ACA with advanced premium tax credits, which has led to nearly 14.8 million people signing up for affordable health insurance seeing lower costs for their health plans. Over 21 million Americans have signed up for affordable health insurance for 2023. 

Among the many benefits of the ACA, it also expanded Medicaid coverage. As of March 2024, 40 states have expanded their Medicaid programs, covering approximately 24 million Americans. Its implementation in states has saved tens of thousands of lives, provided people with health services that they otherwise would not be able to afford, and has advanced the goal of ending ethnic and racial inequities in health care. However, in the 10 states that refuse to expand Medicaid, approximately 1.5 million Americans do not have access to the life-saving coverage provided through Medicaid because of Republican efforts to block expansion.

By the Numbers:

• Approximately 45 million people have health coverage thanks to the ACA.
• Nearly 5 million Americans have newly signed up for a Marketplace plan for 2024. 
• Since the ACA was enacted, the uninsured rate has dropped from 17.8% in 2010 to 9.6% in 2022.
• The uninsured rate for low-income adults dropped from 35 percent to 16 percent in rural areas and small towns in states that expanded Medicaid.
• Around one in four non-elderly Americans living in rural areas have health coverage through Medicaid thanks to the ACA’s Medicaid expansion.
• Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017 while 15,600 older adults died prematurely as a result of their state’s decision not to expand the program.
• Medicaid expansion reduced mortality in non-elderly adults by nearly four percent. 
• Around 710,000 children gained public coverage as a result of their parents enrolling in Medicaid between 2013 and 2015.

More Than 21.3 Million People Signed Up For Coverage They Can Afford Through The Marketplace. In 2024, a record-breaking 21.3 million people who buy insurance on their own signed up for health coverage through the ACA Marketplace. This is the highest number of Americans to ever enroll during an Open Enrollment Period and it is thanks to policies that lowered premiums in President Biden’s American Rescue Plan and Inflation Reduction Act. Families are now saving an average of $2,400 a year on their health insurance premiums.

Lower Health Costs Have Improved Access To Care And Financial Security. Between 2010 and 2018, the share of non-elderly adults with a problem paying a medical bill fell by 17 percent, the share who didn’t fill a prescription fell by 27 percent, the share who skipped a test or treatment fell by 24 percent, and the share who didn’t visit a provider when needing care fell by 19 percent.

Medicaid Expansion Saves Lives. According to the Center on Budget and Policy Priorities, Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017. At the same time,15,600 older adults died prematurely as a result of their states’ decision not to expand the program. A study published in the Journal of Health Economics found that Medicaid expansion reduced mortality in non-elderly adults by nearly four percent.

Americans With Pre-Existing Conditions Are Able To Access Affordable Coverage. Because of the ACA, insurers in the individual market can no longer drop or deny coverage, or charge more because of a pre-existing condition. Half of all Americans have a pre-existing health condition. As well, insurers can no longer put annual or lifetime limits on the care one receives. Over 179 million Americans with employer-based coverage are protected from these lifetime limits, in addition to the millions with ACA Marketplace coverage.

Expanding Health Services. Marketplace coverage and Medicaid expansion have helped patients access preventative care, including colon cancer screenings. Expansion also increased patient access to kidney transplants and made diabetes medication more affordable for low-income patients. The program was also tied to earlier diagnosis of colorectal cancer and reducing diabetes-related amputations.

Medicaid Expansion Reduces Income Inequality. A January 2021 study found that the ACA helped reduce income inequality across the board, but much more dramatically in Medicaid expansion states. The bottom 10th percentile of earners In Medicaid expansion states saw a 22.4 percent boost in their income, compared to 11.4 percent in non-expansion states. Over the past decade research also has shown the gap in medical debt between Medicaid expansion and holdout states has grown approximately 30 percent. In 2020, Americans living in holdout states carried an average of $375 more in medical debt than their counterparts in expansion states. 

Washington, D.C. — Yesterday, Republican lawmakers in Georgia and Kansas shot down legislation to expand Medicaid in both states, blocking coverage for more than half a million people. Not only does refusing to expand Medicaid leave hundreds of thousands of people uninsured, but it also leaves critical funding on the table that could reduce health disparities, strengthen rural hospitals, and boost local economies. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement:

“Republicans in Georgia and Kansas are putting politics over the lives of their constituents. All but 10 states have adopted Medicaid expansion because of the results: it makes communities healthier, keeps hospitals open, increases families’ financial stability, and saves lives. Unfortunately, this is all part of the GOP’s decades-long war on American health care. They are not backing down on their fight to cut Medicaid and throw people off the rolls, and they want to repeal the Affordable Care Act and raise costs for middle-class Americans. It’s an absolute disgrace that MAGA Republicans are still trying to go backwards and sabotage the ACA and Medicaid — all for pure politics.” 

Background:

Republicans Stopped More Than Half A Million People From Gaining Affordable Coverage. The Kaiser Family Foundation estimates that more than 430,000 Georgians and 150,000 Kansans would gain coverage if each state adopted Medicaid expansion.

***MEDIA ADVISORY FOR FRIDAY, MARCH 22 AT 10 AM CT // 11 AM ET***

Virtual Event Will Highlight Efforts To Build on the ACA by Lowering Costs and Expanding Health Care for Wisconsinites

WISCONSIN – On Friday, March 22nd at 10 AM CT // 11 AM ET, U.S. Senator Tammy Baldwin and Wisconsin Attorney General Josh Kaul will join Protect Our Care Wisconsin to celebrate the 14th anniversary of the Affordable Care Act and highlight how the law has protected people with pre-existing conditions, lowered costs for people who buy their own coverage, and increased access to quality, affordable health care for Wisconsinites since it’s passage. 

Speakers will also discuss efforts to build on and protect the historic successes of the ACA by making lower Marketplace premiums permanent to keep plans affordable for Wisconsinites, lowering prescription drug prices, cracking down on junk plans, and expanding Medicaid. A record-breaking 21 million Americans enrolled in health coverage through ACA marketplaces for 2024.

Despite the historic success of the Affordable Care Act, some are (still) threatening to repeal the ACA, despite record-setting enrollment numbers and the law’s overwhelming popularity. Repealing the ACA means losing protections for the 135 million Americans with pre-existing conditions, dramatically increasing premium costs, ending coverage for young people on their parent’s health plan until age 26, and ripping away access to preventive services without cost-sharing. It will also reverse the progress made to eliminate health equity disparities. 

PRESS CALL

WHO:
U.S. Senator Tammy Baldwin
Wisconsin Attorney General Josh Kaul
Wisconsinites who have benefitted from the Affordable Care Act

WHAT: Virtual Press Conference

WHEN: Friday, March 22nd at 10 AM CT // 11 AM ET

WHERE: Register to join the Zoom event (Registration required)

Over the last 14 years, the Affordable Care Act (ACA) has helped tens of millions of Americans gain access to affordable health coverage. Thanks to President Biden’s efforts to lower the cost of health care, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. The Inflation Reduction Act lowered premiums for people who buy their own coverage by an average of $2,400 a year per family.

The ACA has survived countless repeal attempts and now it’s stronger than ever. Yet Republicans still want to destroy the ACA and all of its protections for over 100 million people with pre-existing conditions. Donald Trump has fully reignited his calls to repeal the ACA. As Trump is escalating his threat, Republicans in Congress and their allies are working overtime to dismantle reproductive care and access to vital preventive care, hike premiums, slash Medicare and Medicaid, reverse recent coverage gains, and raise prescription drug costs for the American people. 

This week, Protect Our Care is highlighting five key ways the ACA is working across the nation: 

Monday, March 18: How the ACA helps women
Tuesday, March 19: How the ACA helps seniors & young people
Wednesday, March 20: How the ACA helps people with pre-existing conditions
Thursday, March 21: How the ACA helps people of color
Friday, March 22: How the ACA expanded affordable coverage to tens of millions of Americans

Background:

There is overwhelming evidence that the ACA has made a historic contribution to improving health care for communities of color. In addition to increasing coverage and improving health outcomes, the health care law has helped narrow racial disparities in maternal health, cancer care, and more. Even as the ACA is more popular than ever, Republicans are still trying to repeal and sabotage the health care law.  Meanwhile, Democrats continue their work to lower costs and expand affordable coverage. Democrats’ policies to lower costs are an essential step in reducing ethnic and racial inequities in health care, as research shows better access to care as well as a more diverse health care workforce – two goals advanced by the ACA – improve health outcomes.

By the Numbers:

• The uninsured rate among nonelderly Black and Hispanic/Latino young adults between 2010 and 2022 was cut in half from 19.9 percent to 10 percent and 32.6 percent to 18 percent respectively.
• American Indians and Alaskan Natives saw both private and public health insurance enrollment increase by 1.2 percent and 3.2 percent respectively after the implementation of the ACA with an additional 6.3 percent increase in public insurance enrollment in Medicaid expansion states.
• Medicaid expansion has reduced racial disparities in timely treatment with one study showing its introduction in states completely erases disparities in timely cancer care.
• Although less directly researched, the ACA has also empirically benefited first-generation immigrants with one study showing post-ACA that the rates of insurance increase for Latino and Asian immigrants by 14.3 percent and 9.9 percent respectively in just the state of California.
• Black and Hispanic individuals are 59.2 percent more likely to have gained health coverage due directly to the expanded premium subsidies than White individuals in non-expansion states.

Lowering the Uninsured Rate. Before the passage of the ACA, more than 16 percent of the nearly 50 million Americans lacking health insurance were African Americans. According to the Kaiser Family Foundation, the ACA helped lower the uninsured rate for nonelderly African Americans by nearly half between 2010 and 2022 from 19.9 percent to 10 percent. The percentage of people gaining health insurance under the ACA was higher for Latinos than for any other racial or ethnic group in the country. According to a study from Families USA, 5.4 million Latinos would lose coverage if the health care law were overturned. Research also shows the ACA cut uninsurance rates among Asian Americans by more than half–from nearly 20 percent to just under 8 percent — eliminating coverage disparities with white Americans.

Reductions in Racial Disparities In Health Outcomes. Access to preventive care starts with access to affordable coverage. The ACA led to historic reductions in racial disparities in access to health care, but racial gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. The ACA significantly reduced racial disparities in the share of people who went without care because of cost. Positive medical outcomes have also increased significantly with one study showing Black heart transplant recipients had a 8 percent increase in post-surgery survival after the passage of the ACA.

Improvements To Infant And Maternal Health. Whether coverage comes from Medicaid expansion or increased access to affordable coverage on the ACA Marketplace, coverage improves infant and maternal mortality outcomes. One study found that reductions in maternal mortality in expansion states were concentrated among Black mothers, “suggesting that expansion could be contributing to decreasing racial disparities in maternal mortality.” Expansion has also been tied to improving health outcomes for Black babies, significantly reducing racial disparities in low birth weight and premature birth. 

Preventive Care Leads To Improvements In Disease-Specific Diagnosis And Treatment. A 2017 study called preventive care “one of the most important health care strategies to facilitate early diagnosis and treatment, improve quality of life, and prevent premature death.” Access to preventive care through Medicaid expansion reduced racial disparities in cancer care and resulted in earlier diagnosis and treatment for Black patients. According to the Center for American Progress, Black women were more likely to receive care because of the ACA.

In MAGA Republicans’ latest attack on American health care, the Republican Study Committee (RSC) released a disastrous budget proposal for FY2025. The plan would increase prescription drugs prices by repealing the Inflation Reduction Act, hike annual premiums by thousands of dollars, expand junk plans that don’t cover basic benefits like prescription drugs or maternity care, strip away protections for people with pre-existing conditions, and put Medicaid coverage for millions in jeopardy. 

While President Biden and Democrats in Congress are hard at work bringing down the cost of health care in order to keep food on the table and a roof over the heads of millions of people, MAGA Republicans are working to rip away protections, raise health care costs, and throw the health care system into chaos. Here’s just a few of the catastrophic changes Republicans want: 

Kill the Inflation Reduction Act’s Drug Pricing Savings. The RSC budget proposal would fully repeal the Inflation Reduction Act, which is saving Americans thousands of dollars on health care by holding big pharmaceutical companies accountable and bringing down the cost of prescription drugs, making health care plans more affordable with premium tax credit subsidies, and capping the price of insulin at $35 per month for Medicare Part D beneficiaries. Here are just a few of the impacts this disastrous plan would have on American health care:

• GONE: Insulin co-pays will no longer be capped at $35 per month for 4 million Americans on Medicare who use insulin.
• GONE: 52 million Medicare beneficiaries will no longer be able to receive the shingles vaccination and other recommended vaccinations free of cost.
• GONE: Seniors on Medicare will no longer be protected from drug company price hikes through inflation rebates.
• GONE: Medicare will be banned from negotiating drug prices. Nearly 9 million people take the first ten drugs that were selected for Medicare negotiation, which account for 20 percent of the annual Medicare Part D spending. Negotiated prices will take effect in 2026.
• GONE: 400,000 low-income seniors will no longer receive more help affording prescription drugs through the Medicare Part D Extra Help program.
• GONE: Medicaid and CHIP beneficiaries will no longer have access to recommended vaccinations free of cost.
• GONE: Seniors with the highest brand-name drug costs will no longer have their out-of-pocket costs capped at $3,250 for the year and $2,000 in 2025, which would save nearly 19 million Americans an average of $400 each year

Strike Premium Tax Credits, Raising Premiums By Thousands of Dollars. The RSC budget proposal would rescind temporary enhancements to premium tax credits originally enacted in the American Rescue Plan and extended by the Inflation Reduction Act until 2025. These enhanced tax credits have reduced ACA Marketplace enrollees’ premiums by an average of $800 per year.

• GONE: Premium tax credits that make premiums affordable for 80 percent of people who purchase health care on the Marketplace, saving millions of Americans an average $527.
• GONE: Annual health insurance premiums will increase by an average $7,676 for a family of four making $125,000 a year if premium tax credit enhancements are rescinded.

Expand Junk Plans. The RSC proposal would codify rules put forth by the Trump administration that expanded health insurance plans known as association health plans (AHPs). These plans are not required to cover the essential health benefits put in place by the Affordable Care Act and are allowed to charge people more based on their age, health status, and gender. AHPs have a long history of fraud and unpaid claims and provide weaker cost and protection coverage. The proposal also applauds efforts by the Trump administration to expand short-term limited-duration plans, which engage in predatory marketing practices, fail to protect people with pre-existing conditions, and put patients at risk of bankruptcy when they get sick. The Trump administration’s decision to expand access to these plans exposed consumers to scams and reduced transparency about coverage limits and hidden fees. 

Rip Away the ACA’s Protections For Pre-Existing Conditions. The RSC proposal would remove many protections for the over 100 million Americans with pre-existing conditions made possible through the Affordable Care Act, and would allow insurers to deny coverage, except for people who have had continuous coverage through an employer or the individual market.

Threaten Coverage For People With High-Risk Medical Conditions, Leaving Millions of Americans At The Mercy of State Coverage Pools. The RSC proposal would funnel people with high-risk medical conditions into state-run coverage pools, leaving states with the final say on how insurers can determine premiums based on health risks. These high risk coverage pools often impose high premiums and deductibles, with premiums as much as 200 percent higher than average and deductibles substantially greater than allowed under the ACA – all at a higher cost to American taxpayers. Numerous studies have shown that high risk coverage pools often provide worse care, with many having exclusions for pre-existing conditions, limited benefits, lifetime and annual limits on coverage, waiting periods, and often result in delayed or forgone care.

Loosen Restrictions For Hospitals Providing Worse Care At Higher Costs For Patients. The RSC proposal would eliminate the ban on physician-owned hospitals, which provide limited or no emergency services, cherry-pick the most potentially profitable patients, and incur significantly higher costs on the Medicare program. According to the HHS, up to one-third of these hospitals may violate Medicare requirements by relying on publicly funded services to stabilize patients while still charging the patients exorbitantly.

Jeopardize Medicaid Coverage For Millions Through Block Grants. MAGA Republicans want to radically restructure Medicaid by changing it into five block grants. Block grants would shift costs to states and inevitably result in deep cuts to Medicaid programs by capping the amount of federal Medicaid funding states receive. As CBPP found in 2017, a block grant would force states to make deep cuts to their Medicaid programs to compensate for the federal funding cuts.

Over the last 14 years, the ACA has helped tens of millions of Americans gain access to affordable health coverage. Thanks to President Biden’s efforts to lower the cost of health care, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. The Inflation Reduction Act lowered premiums for people who buy their own coverage by an average of $2,400 a year per family.

The ACA has survived countless repeal attempts and now it’s stronger than ever. Yet Republicans still want to destroy the ACA and all of its protections for over 100 million people with pre-existing conditions. Donald Trump has fully reignited his calls to repeal the ACA. As Trump is escalating his threat, Republicans in Congress and their allies are working overtime to dismantle reproductive care and access to vital preventive care, hike premiums, slash Medicare and Medicaid, reverse recent coverage gains, and raise prescription drug costs for the American people. Additionally, Republican allies in the courts are attacking access to free preventive services under the ACA, jeopardizing lifesaving care for millions. Read more about the case here. 

This week, Protect Our Care is highlighting five key ways the ACA is working across the nation: 

Monday, March 18: How the ACA helps women
Tuesday, March 19: How the ACA helps seniors & young people
Wednesday, March 20: How the ACA helps people with pre-existing conditions
Thursday, March 21: How the ACA helps people of color
Friday, March 22: How the ACA expanded affordable coverage to tens of millions of Americans

Background:

Prior to the passage of the ACA, people with pre-existing conditions could be charged more, denied coverage, or denied certain benefits simply for having a diagnosis ranging from specific conditions like cancer, diabetes, or pediatric asthma, or simply for being a woman. Without the ACA, a change in life circumstances, such as changing jobs, getting divorced, or retiring could mean losing access to lifesaving health care for the over 100 million Americans with pre-existing conditions.

Republicans in Congress are working to dismantle protections for pre-existing conditions. Under the guise of offering cheaper insurance, MAGA-Trump Republicans want to expand the availability of short-term “junk plans” and association health plans that don’t cover basic benefits like prescription drugs or maternity care and can drop and deny coverage for people with pre-existing conditions. The GOP also wants to cut funding for Medicaid and kick people off the program by imposing burdensome paperwork requirements. All of these actions would be devastating for the tens of millions of Americans who rely on the ACA’s protections to access affordable health care. 

A Closer Look:

• Over 100 million people with pre-existing conditions are protected from being charged more for, dropped from, or denied health coverage. 
• 179 million Americans with employer coverage are protected from lifetime and annual limits, in addition to over 20 million with ACA Marketplace coverage. 
• Insurers can no longer charge women more than men for the same coverage and are required to cover important health benefits like maternity care.
• Health insurance companies can not discriminate by charging more or denying coverage based on sexual orientation or gender identity. 

Thanks to the ACA:

Over 100 Million Americans With Pre-Existing Conditions Are Protected. Because of the ACA, insurers in the individual market can no longer drop or deny coverage, or charge more because of a pre-existing condition. Over 100 million Americans have a pre-existing health condition, including nearly 30 million Americans with diabetes, 26 million with asthma, and millions more with cancer, arthritis, and heart disease.

The ACA Guarantees Comprehensive Coverage. Because of the ACA, insurers have to cover what are known as “essential health benefits,” such as maternity care, prescription drugs, and substance and mental health. Before the ACA, individual market plans often failed to cover these basic, and oftentimes preventive, health services. 

The ACA Ended Annual And Lifetime Limits, Including For People With Employer-Based Coverage. Thanks to the ACA, insurers can no longer put annual or lifetime limits on the care you receive. At the time the ACA was passed, 91 million Americans had health care through their employers that imposed lifetime limits. Many such plans capped benefits at $1 million, functionally locking people with complex medical needs out of coverage. 179 million Americans with employer coverage are protected from lifetime limits, in addition to the millions with ACA Marketplace coverage. 

Women Can No Longer Be Charged More Than Men. Because of the ACA, insurers can no longer charge women more than men for the same coverage, and insurers are now required to cover important health benefits like maternity care. Before the ACA, only 12 percent of individual market plans offered maternity care. The ACA established maternity coverage as one of the ten essential health benefits required on all new individual and small group policies. President Biden’s American Rescue Plan expanded on this by creating an incentive for states to offer a full year of Medicaid coverage postpartum instead of the required 60 days, and 46 states and DC have done so. 

LGBTQI+ Americans Are Protected From Discrimination By Health Insurance Companies. Republicans have worked to sabotage the Biden administration’s efforts to require health insurance plans offered through the ACA to include sexual orientation and gender identity as protected characteristics. LGBTQI+ Americans are more likely to be without health insurance than straight individuals. According to a Center for American Progress survey, in 2019, the LGBTQI+ uninsured rate was 20 percent in holdout states, compared to 8 percent in states that adopted Medicaid expansion. Access to affordable, quality health care plans under the ACA help combat the number of LGBTQI+ Americans who are uninsured. Premium subsidies made available by the American Rescue Plan and extended by the Inflation Reduction Act have helped nearly 210,000 LGBTQI+ enrollees have access to zero-premium plans.