Nora O’Brien-Suric, PhD, is president, Health Foundation for Western & Central New York., May 5, 2024

Is health care a right or a privilege? At the Health Foundation for Western & Central New York, we believe access to quality, affordable health care is a basic human right. Fourteen years after the passage of the Affordable Care Act, we’re reflecting on how it has pushed our health care system to be more equitable.

It’s easy to take landmark legislation for granted, especially when the impact has been widespread.  It’s important to take stock of the benefits and protections we’ve gained under the ACA — and what’s at stake if we lose it.

Before the Affordable Care Act, insurers could remove older children from their parents’ family health plan. Thanks to the ACA, young adults are able to keep the coverage until they turn 26. Before the ACA, insurers were free to set much more expensive premiums based on age. An older adult a few years away from Medicare eligibility was often charged more than 5 times the amount a younger person would pay. Today, because of the ACA’s 3-to-1 limit on age rating, an older adult’s premium can’t be more than 3 times the amount a 21-year-old would pay.

Once, insurers could simply stop paying for your health care once costs reached a certain amount. Under the ACA, private insurance plans can’t place annual or lifetime limits on health coverage. Before the ACA, insurers could charge higher premiums to cover pre-existing conditions — or deny coverage altogether. Thanks to the ACA, if you have a pre-existing condition, like diabetes, asthma, hypertension, depression, cancer, or pregnancy, you can’t be denied coverage or charged a higher premium.

Services such as cancer screenings used to be costly. With the ACA, preventive care covers — at no cost — vaccines and screenings for cancer, diabetes, hypertension, autism, and other conditions.

Today, roughly 45 million people have health care coverage in the United States, thanks to the ACA. The uninsured rate remains at an all-time low — just over 7%.

The Inflation Reduction Act is designed to build on the ACA by tackling the soaring prices of prescription medications. Under the IRA, Medicare can negotiate prices with pharmaceutical manufacturers to keep consumer costs down and drug companies competitive. The IRA includes inflation rebates and a $2,000 out-of-pocket cap for drug costs beyond Medicare. The IRA also extends the ACA’s premium tax credit benefit, saving millions of Americans an average of $800 each year.

Although nationwide health coverage has significantly improved since 2010, we still have a long way to go before our system is truly equitable. Let’s keep building on the promise of both the ACA and the IRA. Let’s not go back to the way it used to be.

Nora O’Brien-Suric, PhD, is president, Health Foundation for Western & Central New York.  May 5, 2024

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