14 Time March 30, 2020
TheView Health
In many ways, the ACA today serves
as a kind of socio political Rorschach
test in the U.S. To many mainstream
Democrats, the law is an imperfect
victory: in 2018, they won the majority
in the House of Representatives in
part by trumpeting a platform of
protecting—and improving—the ACA.
Progressives, meanwhile, see the law
as not going nearly far enough.
To many Republicans, the law is
a bête noire. Congressional Repub-
licans have voted at least 70 times
to dismantle, defund or change the
ACA, and conservatives have brought
three major challenges to the law to
the Supreme Court. Fourteen states,
most with Republican governors, still
refuse to opt in to the law’s Medicaid
expansion, and the Trump Administra-
tion has successfully chipped away at
a handful of the law’s crucial rules. But
in 2017, when Republicans got their
chance to kill the ACA outright, they
balked. Despite having majorities in
the House and Senate, they couldn’tM
aurine STuarT crediTS The affordable
Care Act (ACA) for saving her family. In 2014,
Stuart was diagnosed with HELLP syndrome,
a rare disease that causes heart, liver and lym-
phatic problems. As a result, she was unable to continue work-
ing full time—which meant losing her employer- sponsored
health insurance. But thankfully, she says, that same year, her
home state of West Virginia opted in to the 2010 Affordable
Care Act’s Medicaid-coverage expansion, and she qualified.
Over the next few years, as bad news kept rolling in, ACA
protections continued to keep Stuart’s family afloat. When
Stuart was diagnosed with breast cancer, when her sister was
diagnosed with a brain tumor, and when her daughter Peyton
began having seizures, the ACA consistently offered avenues
of affordable care. Stuart and her sister received coverage
under the Medicaid expansion, while Peyton got it through
the Children’s Health Insurance Program, which had been
strengthened under the ACA.
Stuart says the ACA not only gave her and her family ac-
cess to the treatments they needed, it also changed their men-
tality about when to seek out professional care in the first
place. When she and her siblings were growing up in Cali-
fornia in the 1980s and ’90s, they couldn’t afford health care,
Stuart says. “The criteria for going to the doctor was, ‘Are
you bleeding? Have you lost a limb?’ ” Her father and brother
never shook that idea, Stuart says. Despite the passage of the
ACA, they never got insurance. They thought it would be too
expensive. So in recent years, when both of them began hav-
ing severe health issues, neither regularly went to the doctor.
By 2016, both men were dead: her father from prostate cancer
and her brother, at 19, from a massive pulmonary embolism.
“My dad and my brother died; my sister, my daughter,
me, we all lived,” Stuart says. “The common denominator,”
she says, was health insurance.
It’s been 10 years since President Barack Obama signed
the Affordable Care Act into law—and proudly embraced its
once pejorative nickname, Obamacare. But the law’s legacy
remains at least as layered and complicated as Stuart’s family
medical history. Thanks to the ACA, 20 million people in the
U.S. gained health coverage, and early studies show the law
improved the health of Americans across a range of measures.
It also helped narrow racial, gender and ethnic gaps in cover-
age. Between 2013 and 2018, the uninsured rate dropped 10%
for black adults and by more than a third for Hispanic adults.
Other groups, including women and young people, saw signif-
icant gains in coverage as well.
But the law is also deeply flawed. Despite its framers’ high
hopes, plenty of health outcomes have not improved, market-
place insurance plans have remained too expensive, and while
national health care spending has been lower than predicted,
the ACA’s record on containing costs is a mixed bag.
Ten years in, Obamacare
has wins and losses
By Abigail Abrams
^
Supporters of the
Affordable Care Act
celebrate outside
the Supreme Court
in 2015 after a
favorable ruling