The Affordable Care Act (ACA), also known as the Patient Protection and Affordable Care Act, became law in 2010. It aimed to improve access to healthcare in the U.S. by enabling more people to have coverage and protecting existing policyholders.

President Barack Obama signed in the ACA. It is informally known as Obamacare.

The ACA aimed to ensure that more people had more health insurance coverage in the United States. It also aimed to:

  • improve the quality of healthcare and health insurance
  • regulate the health insurance industry
  • reduce healthcare-related spending in the U.S.

However, the change of administration in 2016 brought some changes to the ACA, and more may be on the horizon.

Read on to learn more about where the ACA currently stands.

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Image credit: Courtney Hale/Getty Images

This new law aimed to improve access to healthcare in the U.S. by widening health coverage to more people and protecting existing health insurance policyholders.

Several parts of the bill had important implications for many people.

These relate especially to coverage for preexisting conditions (including pregnancy), children on parental plans, and help for small businesses to have their employees insured.

The following sections will look at these factors in more detail.

Coverage for preexisting conditions

Since 2014, insurance companies have not been allowed to raise the premiums for infants or children due to a preexisting health condition or disability.

Adults who previously could not get coverage due to a preexisting condition and those who had had no insurance for 6 months or longer would now get insurance.

The Pre-existing Condition Insurance Plan was aimed at adults who could not get coverage because of a preexisting condition, such as diabetes or cancer. From 2014, the ACA made access available to them.

Currently, health insurers cannot deny or cancel coverage for someone with a preexisting health condition. The insurance must also cover that condition, and insurers cannot charge someone more for having that condition.

Insurers still consider pregnancy to be a preexisting condition, so insurance now covers all prenatal care and the birth from the first day of coverage.

In 2018, President Trump’s administration announced that they would no longer support this provision in the ACA. The Supreme Court have been considering whether or not to uphold this. A decision is expected in 2021.

Children remain on parental plans

The ACA means that young adults can stay on their parents’ health plans until they are 26 years old.

This includes those who:

  • do not live with their parents
  • are out of school
  • are not financially dependent on their parents
  • are married

A child who has health insurance under their parents’ plan will lose coverage on their 26th birthday.

This is considered a special enrollment period. It means that they can sign up for a new plan without having to wait for open enrollment at the end of the year.

However, insurance does not cover spouses and offspring of adult children.

Tax credits for small businesses

The ACA also aims to help small businesses get health insurance for their workers.

Small businesses can receive help in funding the cost of providing health insurance. New tax credits make it more affordable for them to buy health insurance for their employees.

Under the Small Business Health Options Program, employers may benefit from tax credit if they:

  • provide healthcare for their employees
  • have fewer than 25 full-time workers
  • pay an average yearly salary of under $50,000

Greater insurance coverage and security for all

Since 2014, more people in the U.S. have had health coverage — including those with a low income and those with preexisting health conditions.

In the past, individuals enrolled in Medicare Part D often fell into a coverage gap, or “donut hole.” Once they had spent a predetermined amount of money, they had to pay any further expenses out of pocket.

Following the introduction of the ACA, people with Medicare Part D could receive a 50% discount on brand-name prescription drugs and a 7% discount on generic ones.

People with Medicare also became eligible for mammograms, colonoscopies, and some other preventive services. All new health policies have to offer these types of screening and preventive service free of charge.

Learn more about the costs of Medicare Part D here.

The Trump administration have introduced a number of changes to the law. The sections below will look at these in more detail.

Fees for not having coverage

When the law first came into effect, people who could afford to pay for health insurance but chose not to purchase a plan could face a tax penalty on their yearly income taxes.

However, this stopped in 2019. Individuals who do not have coverage will now not have to pay a fee.

Enrollment period

The open enrollment period to sign up for a new plan is significantly shorter now.

At first, the enrollment period lasted into January or February of the following year. Now, it runs only from November 1 to December 15. Without a special circumstance — such as changing jobs, getting married, having a baby, or adopting a child — a person cannot purchase insurance outside of these dates.

Work requirements for Medicaid

In 2018, the Centers for Medicare and Medicaid Services provided new guidelines that would allow states to implement work requirements for people enrolled in Medicaid.

This means that some people will have to find work if they want to retain their Medicaid benefits.


As of 2019, companies can ask for an exemption that will allow them not to offer or pay for coverage for contraceptives due to a religious or moral objection.

When the ACA came into effect, many people disagreed with it. There seemed to be overall agreement on many points, but the idea of making health insurance compulsory for everyone was not popular.

The introduction of the ACA caused the number of people with health insurance coverage to rise. It still continues to be higher than before, but the numbers appear to be declining.

Contributing factors to this likely include the rising cost of insurance and removing the fee for people who do not have insurance.

People are still monitoring the status of the ACA and its provisions closely. Of particular concern is the protection for people with preexisting health conditions.

A 2018 poll by the Kaiser Family Foundation found that almost 64% of people did not want the Supreme Court to overturn these protections. Meanwhile, 52% did not want the Supreme Court to overturn the ACA overall.

The ACA aimed to increase people’s access to healthcare provision in the U.S. However, recent changes to the ACA may already be eroding its benefits, and there are concerns about future changes.

Recent factors that make future decisions on healthcare provision more crucial than ever include:

  • tensions surrounding the 2020 elections
  • the impact of COVID-19
  • an existing lack of health equity, especially for populations of color

The website is available for anyone to find out whether or not they qualify for help, to apply for coverage, or to change their status.

Does Medicare cover COVID-19 testing? Learn more here.