Why Is ACA Still Controversial 11 Years After Healthcare Law Known as Obamacare Was Passed?
The Supreme Court turned back the latest challenge to the Affordable Care Act, leaving the healthcare law known as Obamacare in place. Here is a look at the law and the views of its supporters and detractors. The Affordable Care Act was passed by a Democratic-controlled Congress and signed into law by then-President Barack Obama in 2010, and has had a sweeping impact on the U.S. healthcare system. The law expanded eligibility for Medicaid, though about a dozen states have still not adopted the change. It created online marketplaces where consumers could get plans from insurers, and a system of federal subsidies that help most enrollees pay for the coverage. Under a law that passed this March, eligibility for the subsidies expanded to include more people. The ACA also rewrote the rules around insurance. Because of the law, insurers can no longer deny coverage or charge more for plans based on a persons pre-existing health conditions. They cant cap the amount they pay out in benefits. Also, they have to spend a set share of the premiums they receive on healthcare-related costs, limiting the portion that goes to profits and administration. Still, most Americans, particularly those with workplace coverage or Medicare, felt only limited impact from the ACA. Employer insurance began covering preventive care for members, free of charge, while young adults up to 26 years old were added to their families coverage. Some Medicare beneficiaries saw their costs for drugs go down. Supporters of Obamacare point to its many popular provisions, including the rules against denying coverage to those with pre-existing health conditions. They have said that the law also protects vulnerable patients by ensuring that the insurance they get is robust enough to shield them from the biggest healthcare costs. The law capped what most consumers can be asked to pay out of their pockets for care. Democrats highlight the millions of Americans who have gained health coverage under the law. In a report issued June 5, the federal Department of Health and Human Services estimated that about 31 million people were enrolled in coverage related to provisions of the ACA. The law has won increasing public support in recent years, according to polling by the Kaiser Family Foundation. Overall, in the foundations most recent poll, in May 2021, 53% of adults held a favorable view of the law, while 35% had an unfavorable opinion. Newsletter Sign-up Capital Journal Scoops, analysis and insights driving Washington from the WSJ's D.C. bureau. Since its passage, the law has proved politically divisive, and the Kaiser foundations polling shows that remains the casejust 15% of Republicans in the May poll had a favorable view, while 77% didnt like the law. Republicans have argued that the laws government-backed coverage expansion is too costly. Indeed, some Republican-led states, including Texas and Florida, have declined to expand their Medicaid programs under the ACA. They have also opposed some of the ACAs prescriptive rules, saying that consumers should have more freedom to choose the types of plans they want, even if those are limited or dont cover certain things. Some also objected to provisions of the law that deal with reproductive issues, including a mandate that employer plans generally cover contraception. Some ACA opponents have pointed to sharp early increases in the premiums for individual plans, which were fueled partly by the cost of guaranteeing coverage to people who are likely to have significant healthcare costs. Premiums have generally been fairly flat in recent years, as the marketplaces have steadied, according to the Kaiser foundation. Overall, the insurance industry has benefited from the law. Insurers manage many state Medicaid programs, and they have seen their enrollments increase. While many insurers initially did badly in the ACA marketplacescausing big companies to pull back from the businessit has recently proved profitable, drawing increased participation. In the latest sign of the turnaround, CVS Health Corp. in February announced that it will offer marketplace plans next year. Its Aetna unit sharply reduced its early role in the exchanges in 2017 and 2018, citing financial losses. There are new insurers coming in, and insurers that had left are coming back, said Cynthia Cox, a vice president at the Kaiser foundation, who said participation by the companies now is as strong as it was when the marketplaces launched in 2014. Write to Anna Wilde Mathews at anna.mathews@wsj.com