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FACT SHEET: The Affordable Care Act Has Lowered Costs and Improved Health Care for Children and Young People

By March 19, 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 Affordable Care Act (ACA) has become an essential pillar 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 by expanding the ACA, 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. Four out of five individuals can find coverage on the Marketplace for under $10 per month.

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 children and young adults. Donald Trump has fully reignited his calls to repeal the ACA. As Trump is escalating these threats, Republicans in Congress and their allies are working overtime to dismantle access to reproductive care and 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


Before the passage of the ACA, young Americans could be thrown off their parent’s health insurance the moment they turned 18. Many young adults were left uninsured after graduating college and were forced to navigate adulthood with entry-level or part-time jobs that didn’t offer employer-sponsored health care. An estimated 3 million young adults had coverage between 2010 and 2016 because of the ACA’s dependent coverage requirement. This coverage policy was responsible for a rapid 14 percent reduction in the number of uninsured young adults immediately after the passage of the ACA. Uninsurance rates for young adults continued to decrease, by 8.7 percent, in the following years, except during the Trump administration. Research has overwhelmingly shown that young adults have had dramatically improved self-reported physical and mental health, increased early-stage cancer diagnosis, reduced poor birth outcomes, and are less likely to die of opioid overdose following the passage and expansions of the ACA. President Biden and Democrats in Congress are working to further lower costs so everyone can afford the health care they need. 

By The Numbers:

  • More than 28 million children and young adults with pre-existing conditions gained protection.
  • Uninsurance in young adults fell by about 14 percent in the years following the passage of the ACA thanks to Medicaid expansion and ACA provisions.
  • 710,000 children gained coverage through Medicaid expansion when their parents enrolled. 
  • In 2023, more than one in four, or 4.1 million of those enrolled in Marketplace coverage were between the ages of 18 and 34.

Thanks To The ACA

Expanded Medicaid. Uninsurance rates among young adults fell by nearly half as a result of the ACA’s Medicaid expansion, improving access to care. Research confirms expanding access to Medicaid for parents has had ripple effects on their children. In states that expanded Medicaid, more children gained health coverage and were more likely to have regular access to health care. Children in states that have not expanded Medicaid are almost twice as likely to be uninsured — and that gap is growing. 

Young Adults Can Stay On Their Parents’ Plan Until Age 26. People younger than 26 years old are eligible to be on their parents’ insurance even if they are married, a parent, don’t live with their parents, attend school, are not financially dependent on their parents, or are eligible to enroll in their employers’ plan. In 2023, more than one in four, or 4.1 million of those enrolled in Marketplace coverage were between the ages of 18 and 34.

More Than 28 Million Children & Young Adults With Pre-Existing Conditions Gained Protections. Thanks to the ACA, children with pre-existing conditions like asthma and diabetes cannot be charged more or denied coverage by their insurers. Nationwide, over 100 million Americans have a pre-existing condition, including more than 17 million people under the age of 18 and 11.3 million people aged 18 to 24.

Free Preventive Services And Annual Check-Ups. The ACA guarantees well-child visits with no cost-sharing for patients. These visits help prevent the development of chronic conditions and increase vaccinations among children. Plans sold on the ACA Marketplace must also cover preventive pediatric health benefits, including oral health and vision services. More than 36 million children with private insurance are also guaranteed free preventive care and are protected from lifetime and annual limits. However, these free preventive health services are now at risk of being overturned in the courts in the Braidwood Management v. Becerra case. 

Ended annual and lifetime limits. Because of the ACA, insurers can no longer put annual or lifetime limits on the care you receive, which is critical for children with complex medical needs. According to First Focus, without these protections, “children with cancer and other pediatric conditions, or babies that were born prematurely and spent the first weeks or months of their lives in the neonatal intensive care unit, could exhaust their annual and lifetime limits in a short time.” 

Improvements To CHIP & Medicaid Coverage. The ACA improved children’s coverage by increasing the federal matching rate for the Children’s Health Insurance Program (CHIP) and standardizing–and in many states, expanding–Medicaid eligibility for children. The ACA also ensures that states provide Medicaid coverage to children in foster care up to age 26. 

Contraception Use Covered Under The ACA Has Led To A Sharp Decrease In Unintended Pregnancies. Among young adults, the contraception mandate under the ACA has led to increased use of contraception, increased use of more effective contraceptives, and decreased risk of unintended pregnancy. The racial disparity between Black and white women using contraceptives has also reduced by an incredible 70.5 percent when analyzing contraceptive use pre- and post-passage of the ACA. 

Mental Health And Substance Abuse Treatment Are More Accessible Than Ever. Over 62 million Americans gained expanded benefits for mental health and substance use disorder because of the ACA. With over one-third of young Americans aged 18-25 living with mental illness, this coverage has been life-changing for many. Additionally, the ACA provided increased access to services for the 5.1 million young adults living with substance use disorder. Particularly, the ACA’s Medicaid expansion has played a direct role in reducing opioid-related mortality by 3.6 percent by expanding access to services for rural Americans, racial and ethnic minorities, and impoverished communities most affected by the opioid epidemic.