Health Care Policy
December 22, 2020
Can the Affordable Care Act be reformed?

More than a decade after passage of the Affordable Care Act (ACA), the number of Americans without health insurance is rising again. The increase, in part, is due to job losses caused by the COVID-19 pandemic and to President Trump’s executive actions seeking to unwind the sweeping health care law. After a bruising presidential campaign and election, where health care was a key issue, President-elect Joe Biden is planning to strengthen the law, but a partisan divide will likely impede his efforts. Meanwhile, the Supreme Court is considering whether to rule the ACA unconstitutional in a case brought by Republican state officials. The legal challenge involves the law’s requirement known as the individual mandate — but legal experts predict the justices will uphold the ACA.

Photo of people lining up outside a food pantry in New York City in November. People line up outside a food pantry in New York City in November. As many as 7.7 million Americans who became unemployed were dropped from their health insurance plans between February and June 2020. (Getty Images/Xinhua News Agency/Michael Nagle/Wang Ying)

Even before the coronavirus reached the United States last winter, the latest figures from the U.S. Census Bureau showed that the share of Americans without health insurance rose in 2019 for the third time since the Affordable Care Act (ACA) was enacted in 2010.

About 9.2 percent of Americans, or 29.6 million people, lacked health insurance, up from 8.9 percent, or 28.6 million people, in 2018. 1 Experts cite multiple factors for the increase, including a decline in enrollment in Medicaid (the joint federal-state health insurance program for low-income people), and in the ACA marketplaces. These marketplaces were created under the law to enable individuals and families to buy affordable health insurance plans.