50 populations whose lives are better thanks to the ACA

Millions of Americans would have worse health insurance – or none at all – without Obamacare. But the law's protections extend beyond insurance benefits.

The Affordable Care Act (ACA) has faced numerous legal challenges, but has been upheld three times by the Supreme Court. Over the years, the headlines surrounding the possibility of the ACA (aka Obamacare) being overturned have often focused on people with pre-existing conditions who buy their own health insurance. (This is certainly a valid concern, as those individuals would undoubtedly be worse off without the ACA.)

But the impact of the ACA goes well beyond securing access to healthcare for people with pre-existing conditions. Who are these Americans, whose lives are better off, thanks to the ACA? See if you can find yourself – or your loved ones – in this list:

1. More than 14 million Americans (91% of all Marketplace/exchange enrollees) who are receiving premium subsidies in the exchanges that make their coverage affordable. The average full-price premium is $605/month in 2023, but the average subsidy amount ($527/month) covers the majority of the average premium.
2. More than 7.5 million people who are receiving cost-sharing reductions that make medical care more affordable and accessible.
3. People who are (or want to be) self-employed and wouldn’t have been able to qualify for and/or afford a privately purchased health insurance plan without the ACA’s guaranteed-issue provisions and premium subsidies.
4. People with pre-existing conditions who gain access to an employer-sponsored plan after being uninsured for 63+ days. HIPAA guaranteed that they could enroll in the employer-sponsored plan, but there were waiting periods for pre-existing conditions. The ACA eliminated those waiting periods.
5. People who lose access to an employer’s plan and no longer have to rely on COBRA (or mini-COBRA/state continuation) for health coverage.
6. People who gain access to an employer’s plan and have a waiting period of no more than 90 days before their coverage takes effect. Pre-ACA, employers could determine their own waiting periods, which were sometimes longer than three months.
7. Full-time (30+ hours/week) workers at large businesses who are offered real health insurance instead of “mini-med” plans, thanks to the employer mandate. (Employers can choose not to comply, but they face a penalty in that case.)

People with serious conditions often exhausted their coverage under pre-ACA plan because of annual or lifetime benefits caps.

ACA’s marketplace plans must cover a list of vaccinations for children from birth to age 18.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.