KevinMD December 11, 2025
When Americans decide something is right, political inertia does not prevent us from acting, and now is the time for health care. Before the Affordable Care Act (ACA), 60 percent of Americans had employer-sponsored coverage, 20 percent relied on public programs, and the remaining 20 percent had to obtain insurance on their own, a difficult task because the individual market was unsustainable. But the ACA stabilized these issues by expanding Medicaid eligibility, eliminating adverse selection in the individual markets, requiring near-universal participation, and subsidizing insurance premiums.
These changes stabilized markets and expanded coverage to about 20 million Americans by 2016, creating access to outpatient and preventive care. Despite the ACA’s popularity, its future remained uncertain, facing repeal efforts that peaked...
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