Affordable Care Act

The Affordable Care Act is a federal statute signed into law in March, 2010, as a part of the healthcare reform agenda of the Obama administration. Signed under the title of The Patient Protection and Affordable Care Act, the law included multiple provisions that would take effect over a matter of years, including the expansion of Medicaid eligibility, the establishment of health insurance exchanges and prohibiting health insurers from denying coverage due to pre-existing conditions.

The Affordable Care Act – at the time of its enactment – was anticipated to reduce the federal deficit by nearly $145 billion in the first 10 years and between 0.25% and 0.5% of GDP thereafter, according to the Congressional Budget Office. The costs associated with the new amendments are offset by numerous taxes, such as increased taxes on items and services such as eye glasses, hearing aids and indoor tanning. Government data suggests that over 20 million Americans benefit from insurance coverage under this law.

On January 20, 2017, in his first executive order after taking office, President Donald Trump signaled his intention to de-fund the Affordable Care Act saying executive agency heads should "delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State." The intention of this order is to signal the first phase of Republican efforts to repeal and replace the ACA. Rolling back the law was one of Trump's central campaign promises aimed at reducing the fiscal burden on the government.

Attempts by the government in 2017 to repeal the law altogether were not successful. However, the government scaled back its outreach program substantially and cut the enrollment period in half. Changes have been made to the law that have addressed some of the objections that have been raised by opponents, while still keeping the markets active for users. In December, Congress removed the penalty for not having health insurance, essentially removing the mandate that many Republicans had opposed. Nonetheless, enrollment numbers in late 2017 for coverage in 2018 were only moderately lower than in the previous enrollment period: 8.8 million Americans selected a plan by the December deadline, down from 9.2 million in the previous year.

In spring 2018, President Trump issued new rules that made it easier for Americans to buy cheaper insurance that covers less health care sectors. Additionally, the Department of Health and Human Services cut the funding for the so-called navigators – insurance marketplace experts who provide one-on-one help for people looking to sign up for a health plan. 

Enrollment numbers fell again slightly in 2018 to 8.5 million, which was attributed to the Trump administration's policy decisions and the lower unemployment rate.

In March 2019, the Trump administration revealed it will seek to repeal the entire Affordable Care Act. The Justice Department in a letter to a federal appeals court said it agreed with a federal judge in Texas who declared the health care law unconstitutional and added that it will support the judgement on appeal. The case is expected to go to the Supreme Court with a coalition of 21 attorneys general defending the Affordable Care Act.

Meanwhile, House Democrats have unveiled legislation to shore up the Act and expand coverage, according to AP.