The Affordable Care Act (ACA) turns eight tomorrow, Friday, March 23. Despite Republicans’ ongoing efforts to repeal, replace, or sabotage the ACA, the health reform law has some impressive accomplishments. During this challenging year, public sentiment regarding the health care law has become more and more positive. In February, more than half of Americans had a favorable view of the ACA.

The fate of the ACA is still a major source of debate, but it has weathered the Trump administration’s and Congress’s attacks and sabotage rather well. In the coming months, candidates will surely debate the law and the state of health care in the country. Let’s review some of the law’s accomplishments:

Huge gains in health insurance coverage.

• Nationally nearly 20 million people have gained coverage, most from states who expanded Medicaid. Wisconsin could cover about 80,000 more adults and save nearly $200 million annually by fully expanding BadgerCare under the ACA.
• About 240,000 Wisconsinites signed up for 2017 coverage through the Affordable Care Act’s federal Marketplace. About 83% of those people qualified for tax credits to help pay their premiums, and one out of two received additional assistance to pay deductibles and copays.
• The rate of people without insurance coverage decreased from nearly 9% in 2013 to about 5% in 2016—about 200,000 more Wisconsinites now have insurance coverage.
• The ACA has been especially important to people in rural communities where they are more likely to be self-employed or work for smaller employers who do not offer affordable insurance. Nearly 40% of Wisconsinites who purchased a Marketplace insurance plans live in rural areas.
• People of all races and ethnicities have had large coverage gains due to the ACA, but African-American, Native American, and Latino Wisconsinites are still more likely to be uninsured than the white population.

Protecting people from annual and life-time limits.

• The ACA prohibits annual and lifetime limits on policies, so all Wisconsinites with employer plans and those on the Marketplace now have coverage that’s there when they need it.

Protections for people with pre-existing conditions and requiring insurance to cover essential health benefits.

• All insurance plans on the Marketplace must cover treatment for people regardless of their health status. About one in four Wisconsinites have a pre-existing health condition.
• The ACA required that insurance cover care people may need like hospitalization, mental health & substance use, emergency services, and prescription drugs.

Allowing kids to stay on their parent’s health plans through age 26.

• About 41,000 young adults in Wisconsin have benefited from this rule

Increased access to preventive care and screenings, like cancer screening, flu shots, and contraception.

• Private health plans are required to cover a number of preventive care services for adults and children without any cost-sharing. In 2016, about 3.2 million Wisconsinites were covered through their employer.

This doesn’t list all of the ACA’s accomplishments and it doesn’t address its shortcomings either. The most well-known is rising premiums, which many people are insulated from because they receive tax credits. The Trump administration and Congress’s actions throughout the past year are largely responsible for much of the recent spikes in insurance premiums people are facing.

Despite all the uncertainty and the Trump administration’s efforts to sabotage the law, such as refusing to make cost-sharing reduction payments, a shortened enrollment period, and deep cuts to outreach and enrollment funding—millions of Americans still signed up for health insurance for 2018. In Wisconsin, about 230,000 people signed up for coverage this year.

Throughout this very challenging year, the Affordable Care Act has demonstrated incredible resiliency and staying power. However, the Trump administration is still taking steps to destabilize the marketplace—like allowing people to buy plans that won’t cover all their health needs and can discriminate against people with pre-existing conditions. These plans would siphon healthier, younger people away from the marketplace, causing premiums to increase. People with these skimpier plans might find they reach their annual limit or need something that isn’t covered by their so-called insurance.

For eight years the ACA has endured lawsuits, repeal efforts, attack ads, and deliberate sabotage—but it is still largely unscathed and is gaining in popularity. The Affordable Care Act greatly expands coverage to kids and adults, protects people with pre-existing conditions, stops insurers from discriminating against women by charging them more, and has enabled many states to expand their coverage for low-income adults.

The ACA isn’t perfect, but millions of people have successfully fought off attempts to repeal it and go back to the bad old days. We aren’t going to erase the gains we’ve made these past years. We aren’t going back. Health care is the right of every kid, every family, and every community.

Happy birthday, ACA!

William Parke-Sutherland