Nine years after the Affordable Care Act (ACA) became law, millions more people have access to health insurance and insurers are required to cover more services. But a number of factors threaten the law’s long-term stability. The nation’s uninsured population has begun to rise again, and drug prices and other health care costs are increasing. President Trump continues to use his rule-making authority to erode key ACA provisions, and a federal judge recently declared the law unconstitutional in a case expected to reach the Supreme Court. The 2010 law and overall health care policy will be key issues in the 2020 presidential campaign, with some Democratic candidates calling for a Medicare-for-All plan that they say would keep health care cost increases in check. Critics of the proposal call it overly disruptive and expensive.

Sen. Bernie Sanders speaks at a July rally in Philadelphia. Sanders and at least 11 other Democratic presidential candidates support some version of Medicare for All. (Getty Images/NurPhoto/Bastiaan Slabbers)

As Democrats and Republicans in Congress continue fighting over the future of the Affordable Care Act (ACA), the latest figures from the Census Bureau show that the share of all Americans without health insurance rose last year for just the second time since the law was enacted in 2010.

About 8.5 percent, or 27.5 million people, lacked health insurance during 2018, up from 7.9 percent, or 25.6 million people, in 2017. Much of the increase was due to a decline in Medicaid enrollment. 1