The Affordable Care Act At Fifteen: Policy Surprises And Lessons

At its 15th anniversary, the Affordable Care Act (ACA) has largely met its original goals. At enactment in March 2010, the Congressional Budget Office (CBO) projected that 95 percent of nonelderly Americans (92 percent of residents including undocumented immigrants) would have health insurance shortly after full implementation. That target has recently been met. Indeed, the U.S. has had record-high health coverage rates in 2022, 2023, and the first half of 2024.

Similarly, the law’s twin goal of making health coverage affordable as well as accessible was achieved. Between 2010 and 2023, health spending as a percent of gross domestic product did not significantly increase, except for during the peak of the pandemic when all measures were askew. Along...