The Affordable Care Act (ACA) – formally known as the Patient Protection and Affordable Care Act and often referred to as Obamacare – is the landmark health care legislation passed by Congress during the Obama Administration in 2010.
The two major goals of the ACA were to:
(1) Expand access to insurance coverage, most notably by expanding Medicaid for working-age adults with income below 133 percent of the federal poverty level; providing premium tax credits to subsidize the cost of health insurance for individuals with incomes from 133 to 400 percent of poverty; creating new federal and state marketplaces for the purchase of insurance; allowing parents to cover their children through age 26; requiring most individuals to purchase coverage, and requiring most businesses to cover their employees. A Supreme Court ruling in 2012 made the expansion of Medicaid optional for states, and several other key coverage provisions have been amended or repealed by Congress. As of 2019, Oklahoma was one of 14 states that has refused to expand Medicaid, leaving many adults with incomes below the poverty level in a coverage crater.
(2) Increasing consumer health insurance protections, most notably by prohibiting insurance plans from excluding individuals with preexisting conditions, discriminating based on health status, or imposing lifetime or annual monetary caps on coverage; requiring guaranteed issue and renewal of policies; and restricting insurance plans from rescinding coverage.
The ACA also included extensive provisions aimed at improving health quality and system performance, promoting wellness and prevention, and curbing rising health costs.
Under the ACA, the number of uninsured Americans plummeted from 44 million in 2013 to 27 million in 2016. Since 2016, the uninsured rate has risen as Congress has rolled back some ACA provisions and the Trump Administration has severely curtailed outreach and enrollment efforts.