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Healthcare Before the ACA

  • Prior to the ACA, 42 million people (15.7% of the population) were uninsured in the United States
  • Many of the uninsured were people who worked full-time or their dependents (e.g. their children). Poor working families were the most likely to be uninsured.

Why were so many not insured?

People in the U.S. could simply not afford health insurance because of the costs of the health insurance plans that were offered to them or because they had lost their job.

What was the impact on health for the uninsured?

  • People went without screenings and preventive care that could catch health issues before they blossomed into significant illness or disease.
  • People with pre-existing conditions could not get health insurance because insurance companies could deny them coverage due to their condition or when they were offered coverage it cost them extremely high premiums, oftentimes so high that it was completely unmanageable and they instead went without health insurance and just hoped they didn’t fall ill.
  • People delayed care for common illnesses (e.g., flu) and chronic disease (e.g., diabetes) that could have readily been treated.
  • People only sought out care when they were really sick or ended up in the emergency room, which not only meant that their conditions were harder to treat but treatment also cost more.

What was the cost of having so many people uninsured?

  • Uninsured Americans cost the U.S. healthcare system an additional $49 billion each year, which is picked up by every taxpayer.
  • Perhaps more importantly though, between 20,000 and 45,000 deaths per year could be attributed to lack of health insurance. That means those who were uninsured had a 40% increased risk of dying early due to not having health insurance.

How did the ACA affect access to healthcare and overall quality of healthcare?

Rate of the uninsured after the ACA

As of 2016, only 9.7% of the US population are uninsured. That means that over 20 million Americans who previously did not have insurance have gained coverage thanks to the ACA.

What are some of the main benefits of the ACA?

  • Access to healthcare. The ACA created a national insurance marketplace (and some states set up their own marketplaces) where individuals had access to a menu of health insurance plans, they could easily compare and contrast different healthcare options, and choose the one that best fit their needs and their wallets. More than 9 million low and middle income individuals receive tax credits (~$300 per month) to help them get covered, which not only reduces the insurance premiums they pay but also reduces other out of pocket costs for the healthcare they receive.
  • Medicaid expansion. Over 70 million children, seniors, and people with disabilities are covered by Medicaid or the Children’s Health Insurance Program.The ACA expanded Medicaid to allow those at 138% of the Federal Poverty Level—America’s poorest working families–to get coverage through Medicaid. Today, 15.7 million more people have coverage through Medicaid because of the ACA.
  • Coverage available to children up to age 26 on their parents’ health insurance. An estimated 2.3 million young adults are covered because of this provision.
  • Women pay the same as men: Before the ACA, women were often charged more for health insurance than men just because of their gender. Thanks to the ACA, that is now illegal. Moreover, pregnancy, maternity, and newborn care (both before and after birth) are considered essential health benefits that insurance is now required to provide.
  • No discrimination based on pre-existing conditions: Up to 129 million Americans have a pre-existing health condition. Because of the ACA, health insurance companies cannot discriminate against people based on of their medical history—that means they cannot deny you insurance or make you pay more for insurance because of your pre-existing condition.
  • Free preventive care. The ACA requires all insurance providers to offer preventive services without additional charges (no copay). These include services such as immunizations (e.g., flu shots), mammograms, cancer screenings, depression screenings, etc.
  • Lower costs for prescription drugs. Insurance providers are now expected to offer prescription drug benefits as essential services. More than 11 million Medicare beneficiaries, many of whom are seniors, saved more than $23 billion total (an average of more than $2,000 per person).
  • No annual and lifetime limits on insurance policies. Prior to the ACA insurance policies could create a cap on how much of the costs they would cover of your healthcare in a year and/or over your lifetime. That means that if you had a major health event (or even the birth of a child) you could max out your limits, leaving you to pick up any remaining costs for healthcare that you needed. Because of the ACA, providers are not allowed to create these limits.
  • Better addiction and behavioral health coverage: The ACA provided states funding to improve care (including counseling and psychotherapy) for people struggling with addictions or mental illness.
  • Insurance companies held accountable. Prior to the ACA insurance companies could hike their premiums without notice. Due to the ACA, insurers must justify any premium increase of 10% or more before the rate takes effect, thereby creating greater accountability for their practices. Information retrieved from Department of Health & Human Services and

How is Congress going about repealing the ACA?

The Republican-led Congress is using a process called reconciliation to dismantle the ACA.

What is Reconciliation?

The process of reconciliation allows Congress to expedite changes to an existing law by calling into question the taxes, spending, and debt limits pertaining to the budget for that program.

Why use Reconciliation instead of putting the ACA to a vote?

Usually at least 60 votes are required to pass a bill in the Senate without filibuster.

Legislation that is “reconciled” between the House and Senate budget committees requires only a simple majority to pass the Senate, without the possibility of a filibuster. So, because reconciliation bills aren’t subject to filibuster and amendments are limited, it allows a faster way to enact controversial budget and tax measures.

Republican leadership in both the House of Representatives and the Senate have directed their respective budget committees to begin this fast-track reconciliation process to dismantle the ACA.

More importantly, Republicans have not offered a plan to replace the ACA, thereby leaving over 20 million Americans in jeopardy of losing their healthcare by its repeal.

Information above retrieved from Department of Health & Human Services and

Author:  Jennifer La Guardia

Summary impact of ACA repeal on the Central Coast