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FACT SHEET: The Affordable Care Act Has Expanded Affordable Coverage to Tens of Millions of Americans

By March 22, 2024No Comments

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


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.