As states across the country attempt to mitigate the public health crisis brought on by COVID-19, it’s clear the Affordable Care Act’s coverage gains and consumer protections are crucial. Without the ACA in place 20 million more people would not have access to health insurance, millions of parents would be worrying about health coverage for their adult children, and tens of millions with pre-existing health conditions might not have the coverage they need. Wisconsin and the rest of the country would be in a far more precarious situation without the health care reform law.

The ACA turns ten this week, and despite Republicans’ ongoing efforts to repeal or sabotage the ACA, the health reform law remains relatively strong and has broad public support. The fate of the ACA is still a major source of debate, and there is yet another lawsuit that will be decided by the Supreme Court. However, it has weathered the Trump administration’s and Congress’s attacks and sabotage rather well. In the coming months, candidates for office and supreme court justices will surely debate the law and the state of health care in the country. Here’s 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 $300 million over a two-year period by fully expanding BadgerCare under the ACA.
• Nearly 200,000 Wisconsinites signed up for 2020 coverage through the Affordable Care Act’s federal Marketplace. Most of them qualified for tax credits to help pay their health care costs.
• The rate of people without insurance coverage decreased from nearly 9% in 2013 to about 5.5% in 2018—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.
• Because of the ACA, children are allowed to stay on their parent’s insurance through age 26. About 41,000 young adults in Wisconsin have benefited from this rule

Protecting people with pre-existing conditions and high health care needs.

• The ACA prohibits annual and lifetime caps, so coverage is there when it is  needed.
• All insurance plans must cover treatment for people regardless of their health status. About one in four Wisconsinites have a pre-existing health condition.
• Most insurance companies have to cover care people may need like hospitalization, behavioral health, and prescription drugs.

This doesn’t list all the ACA’s accomplishments and it doesn’t address its shortcomings either. The most well-known is rising premiums and deductibles, which many people are insulated from because they receive tax credits and other subsidies. 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.

For ten 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, and this current health crisis is showing us the importance of making sure everyone in this country has access to affordable health care. We are only as safe as those who are most vulnerable, and we should do everything we can to expand health coverage.

This chart makes two important points, first we’ve seen significant reductions in the uninsured rate. Because of the ACA about 200,000 Wisconsinites have access to health insurance. Second, we still have more than 300,000 people who are uninsured. But there are steps we can take to make sure more people are covered. Perhaps the most obvious is for Wisconsin to fully expand Medicaid. That single decision would allow us to cover thousands more people and save hundreds of millions in state dollars.

We could use savings from Medicaid expansion to make much needed investments in our public health safety net so we are better prepared to protect the health of all our children, families, and communities. That will become even more important as the repercussions of the COVID-19 pandemic reverberate throughout our families, our communities, our healthcare system, and our economy.

William Parke-Sutherland