Fifteen Years Later, The ACA Has An HSA Problem — But It’s Easily Fixable

Health Affairs March 20, 2025
Lanhee J. Chen, Tom Church, Daniel L. Heil

President Obama’s signature health care law, the Affordable Care Act (ACA), has now been shaping the private health insurance market for over a decade. The law survived several repeal efforts by Republicans. And then-President Biden twice delivered temporary expansions of subsidies offered under the law for the purchase of insurance. Despite its political staying power, however, the ACA has failed to meet the early promises of its proponents.

Until the pandemic led to temporary expanded subsidies, enrollment remained far below what was expected from the law. In 2010, the Congressional Budget Office (CBO) predicted 24 million Americans would purchase insurance on the exchanges by 2019. Actual enrollment in that year was only 10.6 million. After the Biden Administration expanded eligibility...

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