Statement

Washington, D.C. — On Sunday it will have been fifteen years since President Obama signed the Affordable Care Act (ACA) into law, improving the health and well-being of millions across the nation. Since that historic day, the ACA has become a pillar of health care that Americans depend on. Not a single Republican voted for the ACA, and they continue to do everything in their power to undermine the law. The ACA has survived countless repeal attempts from the GOP, but they still want to destroy the law, the lifesaving access to health care it provides, and its protections for over 100 million people with pre-existing conditions. As threats to destroy the ACA escalate, Donald Trump and Republicans in Congress are dead-set on raising premium costs, slashing Medicaid funding, and hiking prescription drug costs for seniors. The Trump-led Republican scheme to gut the ACA will throw the entire health care system into chaos.

In response, Protect Our Care President Brad Woodhouse issued the following statement: “It’s hard to think back to a time before the Affordable Care Act, but Trump and his Republican allies want to force millions of Americans who depend on it to go there. Back to a time when insurance companies ran the show, denying coverage for people with pre-existing conditions was the norm, young adults were thrown off their parents’ coverage, and older adults were charged an age tax. Republicans are turning that dark past into reality by pushing for premium hikes and by ripping away coverage from people who are struggling to pay their bills, just to give tax breaks to the wealthiest Americans. On this important anniversary, it’s critical that we defend the ACA and its lifesaving protections from the GOP war on health care.”

Background:

Over the past fifteen years, health outcomes have improved across all age groups, inequities in access to care have narrowed, families have benefited from stronger financial security, and millions of people with pre-existing conditions have gotten the health care they need at an affordable cost thanks to the ACA. But this progress has not come easily. Trump and Republicans are working hand over fist to tear away the ACA and its protections and raise premium costs, slash Medicaid funding, and raise prescription drug costs for seniors.

Health care costs would soar if Republicans repeal the ACA.

More Than 24.2 Million People Could Lose Coverage If The ACA Is Repealed. In 2025, a record-breaking 24.2 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 largely due 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. However, the ACA and Inflation Reduction Act are under Republican threat. If either is repealed, health care will become inaccessible and unaffordable for millions of Americans. Americans who lose Marketplace coverage will have to enroll through a private insurer, if they don’t qualify for Medicaid, to maintain coverage.

Premium Prices Will Rise and People Will Lose Coverage If Premium Tax Credits Aren’t Extended. Most people receiving coverage through the Marketplace qualify for tax credits to help pay for their premiums, and the American Rescue Plan and Inflation Reduction Act made these savings more generous and available to more people. Four out of five people enrolling in a Marketplace plan have a plan for less than $10. The Inflation Reduction Act ensures all ACA enrollees never pay more than 8.5 percent of their household income on premiums. The law also expanded the eligibility for premium tax credits above 400 percent of the federal poverty level through 2025 — roughly $54,000 for a single person or $111,000 for a family of four. Previously, families earning more than 400 percent of the federal poverty level spent an average of 15 percent of their incomes on health insurance. Americans earning up to 150 percent of the federal poverty level (roughly $20,000 for a single person and $41,000 for a family of four) who buy their coverage on the Marketplace are able to enroll in a plan with $0 premiums. However, Republicans are putting these tax credits that help families at risk. At the end of 2025, tax credits will expire unless extended by Congress. If Republicans take away these tax credits, they’ll be taking away health care. Costs will skyrocket by an average of $2,400 for millions of families, and 5 million people will lose their health care.

Prescription Drugs Would No Longer Be Considered Essential. If the ACA is repealed, insurers will no longer have to cover what are known as “essential health benefits,” which includes prescription drugs. This required all health insurance plans to cover at least one drug in every category and class of approved medicines.

Repealing the ACA Will Make Birth Control Harder to Access and Afford. The ACA guarantees that private health plans cover all FDA-approved forms 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. In 2013 alone, women saved $1.4 billion on birth control pills. Without this ACA provision, the costs of contraception would fall on women and their families.

Patients would no longer be protected from discrimination based on pre-existing conditions, gender, and sexuality if the ACA is repealed.

Up To 129 Million Americans With Pre-Existing Conditions Could Be Booted From Their Insurance. 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. If the ACA is repealed, up to 129 million Americans who have a pre-existing health condition could lose coverage or see their cost of insurance increase.

Essential Health Benefits Would No Longer Be Covered. If Republicans get rid of the ACA, insurers will no longer be required 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. 

Repealing the ACA Would Bring Back Annual And Lifetime Limits, Including For People With Employer-Based Coverage. The ACA put an end to insurers putting 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, in addition to the millions with ACA Marketplace coverage, will not be protected from lifetime limits if the ACA is repealed.

Women Won’t Be Protected Against Being Charged More Than Men. The ACA ensures that 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. The United States has the highest rate of maternal mortality in the industrialized world, with 30 percent of maternal deaths occurring between six weeks and one year following delivery, after Medicaid coverage has ended. Repealing the ACA, and therefore getting rid of the expansions made to Medicaid to provide coverage for mothers, pregnant people will go back to being uncovered during 12 months postpartum and women will no longer be guaranteed fairly priced coverage from insurance companies, putting many women at risk to go uninsured. 

LGBTQI+ Americans Will No Longer Be Protected From Discrimination By Health Insurance Companies. Starting in April 2024, President Biden and HHS began requiring 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 their non-LGBTQI+ counterparts. 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. The repeal of the ACA would put access to affordable, quality health care plans in jeopardy for LGBTQI+ Americans and nearly 210,000 LGBTQI+ enrollees who currently have access to zero-premium plans would see prices rise.

ACA repeal would eliminate health care for millions of Americans on Medicaid:

States Would No Longer Have The Option To Expand Medicaid. Because of the ACA, states can expand Medicaid to millions of adults who previously did not qualify for affordable health care. Between 2013 and 2020, states that expanded their programs saw a 33.9 percent increase in Medicaid enrollment. 24.3 million Americans who enrolled in Medicaid thanks to Medicaid expansion would lose coverage if the ACA is repealed.

Rural Hospitals’ Uncompensated Care Costs Would Increase. 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. Studies published in 2021 found that Medicaid expansion resulted in hospitals receiving higher reimbursements and decreased uncompensated care costs. 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. If Republicans get their way and repeal the ACA, rural hospitals will see uncompensated care costs rise to where they were pre-2010. This will put rural hospitals at a higher risk of closing, making it harder for rural Americans to access lifesaving care in times of need.

ACA Repeal Would Undo Major Gains Made By Medicaid Expansion. 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. ACA repeal would rip Medicaid coverage away from Americans in all expansion states and put millions of people at risk to not be able to access or afford the care they need. 

Repeal of Medicaid Expansion Would Put Children At Risk. When parents have health insurance, their children are more likely to be insured. A study in Health Affairs found that 710,000 children gained public coverage as a result of their parents enrolling in Medicaid between 2013 and 2015. Without Medicaid as an option for parents, children are more likely to go uninsured. Having health insurance during childhood is paramount and has been shown to improve outcomes later in life. For each additional year of Medicaid eligibility as a child, adults by age 28 had higher earnings and made $533 additional cumulative tax payments due to their higher incomes.

Getting Rid of Medicaid Expansion Would Send People in Financial Peril. 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. 

Republican repeal of the ACA would reduce access to preventive services and increase racial inequity:

Health Plans Would No Longer Be Required To Cover Preventive Screenings. Without the ACA, health plans would no longer be required to 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 also requires plans to cover all vaccinations recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). Preventive care is essential to comprehensive coverage and 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. 

Racial Disparities In Health Outcomes Will Continue Without Preventive Care Protections. 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. If Republicans get rid of the ACA, the number of uninsured Americans will grow creating more of a rift in racial disparities.

Without Medicaid Expansion Infant And Maternal Health Will Deteriorate. Health care coverage has been shown to improve 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. Republican threats to repeal the ACA’s Medicaid expansion would lead to increased death rates during pregnancy, postpartum, and infancy, especially among Black mothers and babies.

Disease-Specific Diagnosis And Treatment Will Suffer Without Preventive Care. 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.” Yet, Republicans are threatening to rip it away along with the rest of the ACA. 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.