Joe Biden talks ACA (photo: Adam Schultz/Biden for President)

Rewind the clock ten years, and you’ll find a much unhealthier America with significantly less access to quality, affordable healthcare. What do pregnancy, seasonal allergies, and diabetes have in common? Besides all being physical traits, up until ten years ago these were grounds for insurers to charge a higher monthly premium or deny coverage altogether. Premiums were high, coverage was paltry, and 60 million Americans were forgoing insurance altogether.

The picture this paints is a bleak one, but in November 2012 the Affordable Care Act – also known as Obamacare – came into effect and proved to be literally life-changing for millions of Americans, from low-income people to those with pre-existing conditions to those under the age of 26.

As we celebrate the ACA turning ten, it’s important to reflect on the sea change this landmark legislation had on how Americans get their healthcare, how frequently they rely on healthcare, and how expensive and how selective health insurers were when it came to who got healthcare and who did not.

Ten years later, there is much to be celebrated. And even as the Biden Administration makes strides in fortifying the ACA, it is apparent that more work is yet to be done.

So how has the ACA benefited the average American? For starters, prior to the enactment of the ACA, some 54 million Americans, or 27% of the U.S. population, had “declinable” pre-existing conditions, meaning they were “uninsurable” (other estimates put this number at 133 million). Virtually any medical condition that was known to the individual prior to applying for healthcare was considered a pre-existing condition, whether it was as benign as acne or as malignant as chronic heart disease. The discrimination health insurers levied against these individuals caused the average premium to skyrocket and left much of the country without any insurance whatsoever.

The ACA didn’t stop with banning such discrimination based on pre-existing conditions. Thanks to the law, all insurance plans have since been required to adequately cover the ten “Essential Benefits.” These benefits range from emergency care to pregnancy to prescription drugs, comprehensively ensuring that no American is forced to go without these services or pay a higher premium for them. The anxiety – now covered under wellness services and behavioral health treatment, both essential benefits – that Americans faced when deciding whether they could afford healthcare has since dissipated significantly.

Affordability is likewise tantamount to a larger share of Americans being enrolled in a healthcare plan. Soaring premiums a decade ago were a barrier for many who simply could not afford to be insured; today, roughly 13 million Americans receive subsidies in the form of tax credits that keep their healthcare within their means. 

President Biden has kept the momentum going. While certain subsidies were set to expire in 2022, a three-year extension was passed earlier this year to the relief of millions of Americans, who are set to continue saving approximately $800 per month in insurance premiums.

The budget for navigators is also getting a boost. Navigators help Americans maneuver through the enrollment process, explaining the differences between plans and finding the right plan for everyone. Funding for navigators was drastically cut under President Trump, but is set to jump 24% this year from last.

And as the momentum to strengthen the ACA persists, the popularity of the landmark legislation continues to underscore the importance of a more affordable, quality healthcare system. Sign-ups last year reached an all-time high of 14.5 million Americans and is on track to meet or even surpass that figure for 2023. If the trends continue, there will be a steady decrease in the number of Americans forgoing health insurance altogether.

This is all good news for the Biden Administration, which has made the ACA a key focus of its agenda, and for the Americans who benefit from it. Yet the dichotomy between the popularity of the ACA and the perception of our healthcare system overall indicates that much is left to be desired and more work must be done. A majority – 55% – approved of the ACA in 2022. This is a stark contrast from the 44% of Americans who gave the overall healthcare system a D or F grade this year; a whopping 75% of Americans also gave healthcare affordability a D or F.

These numbers don’t exist in a vacuum. While the concept of the ACA is highly popular, in reality the approximate $456 average for monthly premiums next year is still enough to turn people away from enrolling in a plan, especially when that’s a slight increase over the average cost last year. The fact that the ACA has drastically cut healthcare costs for Americans gets overlooked when premiums remain a financial obstacle for much of the country. However, if the popularity of the ACA retains a majority of Americans’ votes, it’s clear that many are cognizant of how much worse off they could be without the law.

The momentum can’t stop here. There is no reason a nation with the level of prosperity enjoyed in the U.S. should have a healthcare system that many Americans can’t afford. More must be done to continue to work towards the goal of enrolling every American who lacks a healthcare plan.

But it is undeniable that the Affordable Care Act has left a largely positive, lasting imprint on the country. In the decade since the first enrollment season, America has become more insured, more affordable, and should President Biden and his predecessor have their way, will continue to trend in the right direction. For now, let’s celebrate this milestone and toast to the next ten years.

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Colin Wolfgang is a political and communications consultant. On Twitter @ColinWolfgang.