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FACT SHEET: The Affordable Care Act Has Lowered Costs and Expanded Women’s Access to Care

By March 18, 2024March 25th, 2024No Comments

Protect Our Care Is Marking the 14th Anniversary of the Affordable Care Act With 5 Days Celebrating the Growing Success of the Health Care Law Under President Biden

Over the last 14 years, the ACA has served as the backbone of the American health care system and 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 the ACA’s requirement that insurers cover preventive services like birth control and breast cancer screenings for free, jeopardizing lifesaving care for millions. Read more about the case here

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


Among the many benefits of the ACA, the health care law ensures that women cannot be charged more than men for the same coverage. Additionally, 68 million women with pre-existing conditions like diabetes and asthma are protected from discrimination, and they are no longer subject to annual or lifetime limits. The ACA also guarantees free preventive care, such as mammograms, Pap smears, and other important screenings, in addition to providing birth control with no out-of-pocket fees. These benefits, along with the creation of the ACA Marketplace and expansion of Medicaid, have improved the health of women across the country. 

By the Numbers

  • 68 million women with pre-existing conditions cannot be charged more or denied coverage. 
  • 8.7 million women received affordable health care through the Marketplace thanks to the Affordable Care Act in 2023.
  • Nearly 2.2 million more women were able to access health care from the ACA Marketplace from 2021 to 2023 who may not have been able to afford health coverage before.
  • Marketplace users have saved over $800 annually thanks to the subsidy provisions in the IRA.
  • Over 53 percent of those enrolling for health coverage through the ACA Marketplace identify as a woman, representing around one in ten of all women between 19 and 64.
  • Between 66 percent and 75 percent of women are able to access IUDs and implants at no cost.
  • Women have been found to have improved birth outcomes thanks in part to the dependent coverage expansion, with one study showing women covered saw a 2.2 percent decrease in preterm births.
  • In states that have expanded Medicaid, there are around 7.0 fewer maternal deaths per 100,000 live births than in non-expansion states.

68 Million Women With Pre-Existing Conditions Cannot Be Charged More Or Denied Coverage. Prior to the ACA, conditions like asthma, diabetes, and even pregnancy were grounds for insurance companies to charge more or deny coverage altogether. Additionally, insurance companies could impose annual and lifetime limits on coverage, which further eroded access to care for the sickest patients. 

Women Cannot Be Charged More Than Men For The Same Coverage. Before the ACA, women were often charged premiums on the nongroup market of up to 50 percent higher than men for the same coverage, and 1 in 5 women reported postponing or going without preventive care due to cost. Thanks to the ACA, insurers cannot charge women more than men for the same coverage, and women gained access to important preventive care services with no out-of-pocket costs. 

Women Have Access To Affordable Health Coverage. The share of working-aged women making at or below 400 percent of the FPL who report difficulty accessing health coverage due to cost has fallen by over 25 percent since the ACA’s implementation. Low-income women in Medicaid expansion states aged 19 to 44 have seen a 3.8 percent reduction in unmet health care needs when compared to nonexpansion states.

Women Have Access To Free Preventive Care. All Marketplace plans must cover over 27 preventive services ranging from cancer screenings to pre- and post-natal care without any co-pay. Women are 5.1 percent more likely to access cholesterol screenings, 6.9 percent more likely to receive mammograms, 3.3 percent more likely to have blood pressure screenings, and 3.1 percent more likely to have talked to a doctor over the past twelve months.

Women Have Increased Access To Mental Health Treatment. Unmet mental health care needs for women have declined since the ACA’s implementation which has led to a decrease in emergency department visits for psychiatric diagnosis.

More Than 60 Million People Have Access To Birth Control With No Out-Of-Pocket Fees. The ACA guarantees that private health plans cover 18 methods of contraception and make them available to 62.4 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 addition to increasing access to this essential treatment, this ACA provision has saved money for women and their families: women saved $1.4 billion on birth control pills alone in 2013. Between 66 percent and 75 percent of women are able to access IUDs and implants at no cost.

Women Can No Longer Face Discrimination In Health Care Settings. Section 1557 of the ACA prohibits discrimination on the basis of race, color, national origin, sex, age, or disability by any health program or activity receiving federal assistance. It also prohibits these types of discrimination in health programs and activities administered by HHS as well as the ACA marketplaces. 

Nursing Parents Gained Breastfeeding Support And Critical Workplace Protections. The Affordable Care Act requires insurance companies to cover breastfeeding support and counseling as well as breast pumps without cost-sharing for pregnant and nursing women.