Has The Affordable Care Act Lived Up To Its Name?

Congress and the Trump Administration are contemplating health insurance reforms, such as Medicaid work requirements, that could substantially affect the coverage expansions implemented under the Affordable Care Act (ACA). With potential changes afoot, it is useful to consider what has and has not worked about the ACA.

Enrollment Increases Stemming From Lowering Costs To Enrollees

The law’s titular purpose is to make health care more affordable, and—if insurance enrollment signals affordability—it has been an unquestionable success. Within three years of implementation, 20 million people had gained coverage. As of late 2024, the share of Americans without insurance was 8.5 percent, a decline of more than 40 percent since 2013. The slow-but-steady trend of hold-out states adopting Medicaid expansion suggests...

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