Tomorrow, March 23, 2022, is the 12th anniversary of the enactment of the Affordable Care Act. This is a day worth celebrating because of the enormous advances it made in enabling Americans, including almost a million Pennsylvanians, to secure quality, affordable health insurance.
In just twelve years, the ACA has succeeded in cutting the number of uninsured Pennsylvanians in half. The percentage of Pennsylvanians under 65 who are uninsured has declined from 11.9% in 2010 to 6.6% in 2017. The decline has been particularly striking for Black Pennsylvanians between 18 and 64 for whom the percentage of uninsured has declined from 24% in 2010 to 11.4% in 2017 and Hispanic Pennsylvanians, for whom the rate has declined from 32.2% in 2010 to 18% in 2017. The rates at which Pennsylvanians were uninsured increased by a few tenths of a percentage point after 2017 due to Trump administration restrictions on the program.
As full data for 2021 becomes available we expect to see that, despite the pandemic, the improvements to the ACA implemented by the American Rescue Plan have led to further reductions in the rate of the uninsured for everyone in the state and have also saved Pennsylvanians a great deal of money. Already, we know that enrollment in the Pennsylvania marketplace increased by 11% to 374,000 people since the enactment of ARPA. This was largely due to expanded eligibility for premium tax credits provided by the American Rescue Plan for all families. Premiums were eliminated for families earning up to 150% of the federal poverty line—$19,000 for a single person and $39,000 for a family of four. And for the first time, those credits were made available to families earning more than 400% of the federal poverty line—$51,000 for a single person and $105,000 for a family of four. Insurance premiums were limited for all families who pay premiums to 8.5% of household income. In the United States as a whole, those subsidies saved every family securing health insurance on the marketplace an average of $800 per year.
With programs from the Biden administration, the ACA has helped our country make enormous strides in reducing deaths from COVID-19 by making testing and vaccination available to everyone at no cost.
The provisions of the ACA have become so embedded in how we provide health care that we sometimes forget how much they’ve helped almost every family in the state.
- No one is denied coverage because of pre-existing conditions. Twenty to thirty percent of Pennsylvanians have pre-existing conditions that would have made it impossible or cost-prohibitive to have health insurance before the ACA was enacted.
- Young people under the age of 26 can stay on their family’s health care plan.
- The donut hole in Medicare prescription drug plans has been closed.
- All health insurance plans must provide essential benefits—including critical health care for women. Nationwide, the share of new mothers without access to health insurance has dropped by 44% since the ACA was enacted.
- Yearly and lifetime limits on insurance have been eliminated.
The consequences of the ACA for health and mortality are clear. A 2019 study of states that expanded Medicaid showed that it prevented the premature death of 7,500 people in 2017 alone and of 19,200 over four years. The consequences for Americans’ financial stability are also striking. The expansion of Medicaid reduced total medical debt sent to third-party collection agencies by an estimated $1,140 per person and saved enrollees an estimated $280 in interest.
While the American Rescue Plan is an achievement for our whole country, implementation of it required state action. The Wolf administration took two major steps that contributed to the good outcomes we see in Pennsylvania. In his first year in office, Governor Wolf accepted the Medicaid expansion in the ACA without Governor Corbett’s qualifications and limitations. The biggest reduction in the rate of the uninsured took place the next year. And more recently, with bipartisan support in the General Assembly Governor Wolf created Pennsylvania’s own insurance exchange, “Pennie,” which enabled the state to adopt risk adjustment policies that brought down insurance rates for middle-class Pennsylvanians.
The ACA remains the major achievement of post-1960s U.S. public policy. While it still needs refinement and expansion to secure quality affordable health care for all, it is the base upon which the Biden administration has built a health care system that finally makes health care a right, not a privilege.