As the Affordable Care Act turns 16, experts reflect on its impact and future

Grab the balloons and light the candles because it’s the sweet 16 of the Affordable Care Act (ACA)—as of March 23, at least!

The ACA helped bring the US uninsured rate to a record low of 7.7% by 2023, according to the Department of Health and Human Services with the number of users shooting up during the Covid-19 pandemic.

Healthcare Brew asked insurance experts to look back at the law’s impact on not just health plans but also hospitals and in emergencies, as the Centers for Medicare and Medicaid and Census report 2 in 5 people in the US are enrolled in Medicare or Medicaid. We also delved into potential changes coming from the One Big Beautiful Bill Act (OBBA), which will bring cuts to Medicaid after the Trump administration previously promised to repeal the ACA, but failed.

So grab a slice of cake, and let’s take a trip down memory lane.

Sixteen years of impact. Robert Spector, senior director of individual and family plans at Blue Shield of California, told Healthcare Brew the ACA “shifted the healthcare landscape.”

It helped California cut its uninsured rate in half and helped strengthen the market, Spector said, by “driving competition to improve access, affordability, and quality.”

“The ACA has paved the way for critical initiatives like value-based payment models, no-cost preventive care, and more,” he added.

Jenn Kerfoot, president and COO at health tech company Duos, said the ACA didn’t just expand coverage. “It changed what the medical industry had to reckon with as a baseline.”

When more people have health insurance, hospitals benefit from payments, rather than caring for a much larger uninsured population. It also leads to fewer hospital closures and revenue increases, KFF reported. “Providers can plan. Patients show up earlier and sicker less often,” Kerfoot said.

“Coverage is not just a social good. It’s economic infrastructure for an industry that depends on predictable payment,” she said. “The ACA made a fragmented system slightly more predictable. And in healthcare, predictability is everything.”

Spector said part of the ACA’s legacy is how it supported the healthcare industry through “challenging periods,” like the Covid-19 pandemic.

“When millions of Californians suddenly lost jobs and employer coverage, the ACA and Covered California functioned as an immediate safety net, allowing people to enroll quickly and avoid a massive spike in our uninsured rate,” Spector said.

OBBA and the future. Though the program has certainly had its benefits, there are changes coming to the ACA that could leave millions uninsured and providers in trouble.

Kerfoot’s big concerns are the additional administrative burdens that will make it more difficult for people to maintain their coverage as well as the increasing uninsured population, which is expected to reach 14.2 million by 2034.

“The ACA’s legacy won’t be determined by whether it survives politically. It will be determined by whether people can realistically afford to enroll, stay enrolled, and actually use their coverage. That functional test is now genuinely in question,” she said.

The future of the ACA “is not a policy question,” Kerfoot said. “It’s a math question.”

“The next chapter of the ACA will be written not in legislation, but in enrollment data. And right now, the numbers are telling a story that should concern everyone regardless of party,” she said. “It turns out the ACA wasn’t just a Democratic achievement. It became America’s fallback. And fallbacks matter most precisely when everything else fails.”