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FACT SHEET: The Affordable Care Act Has Lowered Costs and Protected Patients With Pre-Existing Conditions From Being Denied Coverage

By March 20, 2024No Comments

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


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.