Since its passage in 2010, the Affordable Care Act (ACA) has dramatically reshaped the U.S. health care system. Designed to expand coverage, reduce health care costs, and improve the quality of care, the ACA has had a profound impact on millions of Americans. New avenues for gaining affordable health insurance have meant extreme coverage gains for young adults; their uninsured rate has been cut in half, and health plans are required to cover services critical to young adults’ wellbeing. However, with an administration hostile to expanding access to health care, the law continues to face ongoing, ideological, legal, and political attacks.
What We’ve Gained
1. Young Adult Coverage Expansion
One of the ACA’s most significant achievements is allowing young adults to stay on their parents’ health insurance plans until age 26. This provision has provided millions of young Americans with stable coverage during critical years of transition from school to the workforce. In some states, Medicaid expansion has allowed young adults to have affordable health care when working low-wage jobs.
2. Protections for Young Adults with Pre-existing Conditions
With an ongoing mental health crisis, and rising cancer rates in young adults, the ACA ensures that those with pre-existing conditions cannot be denied coverage or charged higher premiums, offering them financial security and continuous access to health care.
3. Increased Access to Preventive Care
The law requires insurers to cover preventive services, such as vaccinations, mental health screenings, and contraception, at no additional cost. These benefits have helped young adults maintain their health without financial strain.
What We Stand to Lose
Despite its successes, the ACA remains a target for repeal efforts, legal challenges, and policy rollbacks. Here are some of the current threats to the law:
1. Cuts to Medicaid
As budget reconciliation picks up steam in Congress, Medicaid has found itself with a major target on its back. House Republicans plan to cut $880 billion from Medicaid, which will cause millions of children, pregnant people, disabled people, people with low incomes, and seniors to lose coverage. One method to accomplish this could be through imposing work reporting requirements. The vast majority Medicaid enrollees either already work, or cannot work due to disability, caregiving responsibilities, or being a student. We know work requirements don’t increase employment, and onerous paperwork standards mean qualified individuals will lose access to care.
2. The Braidwood Case
A current legal challenge, Kennedy v. Braidwood, questions the ACA’s mandate requiring insurers to cover preventive services at no cost to patients. The case will be argued at the Supreme Court in April. If the ruling limits these protections, millions could lose access to critical screenings and preventive care.
3. End of Enhanced Premium Tax Credits
The enhanced premium tax credits, introduced as part of pandemic relief efforts, has made ACA marketplace plans more affordable for more Americans. So much so that last year saw a record number of people getting covered. If these tax credits are allowed to expire at the end of this year, most could see higher insurance premiums, making coverage unaffordable for millions of low and middle income individuals and families.
What Can You Do?
While we have a lot of work to do to improve equity, affordability, and accessibility in health care in our country, now is the time to tell lawmakers that we won’t allow them to strip away the gains we have made over the last 15 years. Sharing personal experiences with your members of Congress shows them how their own constituents will be affected by the decisions they make regarding our health care. If you or a loved one has benefitted from Medicaid, taken advantage of free preventive care, or worry about increasing insurance premiums, you can reach your Representative and Senators by calling the Capitol switchboard at 202-224-3121. No personal experience to share? No problem! You can still provide data points on these issues. Check out this interactive map from KFF that provides district-level information on the enhanced premium tax credits, or this search tool from the Center for American Progress for the district-level impacts of cutting Medicaid.
Mina Schultz is YI’s Health Policy and Advocacy Manager. If you’re interested in getting involved further in Young Invincibles’ health care advocacy work, please reach out to Mina.Schultz@younginvincibles.org.