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The Affordable Care Act (ACA) was signed into law in 2010 by then-President Obama (Singh, 2024). The ACA legislation was fully implemented by 2014 (Singh, 2024). The ACA was initiated in the United States (U.S.) as a result of millions of Americans being uninsured or underinsured. The Biden administration supported a temporary expansion of eligibility for ACA health insurance subsidies as part of the COVID-19 relief legislation. Financial assistance was also increased for persons who were already eligible for health insurance under the ACA (Singh, 2024). Those temporary measures to increase financial assistance as part of the COVID-19 relief legislation were supposed to be permanently extended as part of the Inflation Reduction Act (IRA) (Singh, 2024).

Following the Obama administration, the Trump administration undertook several actions that impacted the ACA. During the first term of President Trump in 2017, Congress was controlled by the Republicans. The Republican-controlled Congress unsuccessfully attempted to repeal and replace the ACA legislation (Singh, 2024).  

Components of the ACA I Think Will Have a Positive Effect On Improving Health Care Outcomes And Decreasing Costs? 

I believe the components of the ACA will have a positive effect on improving health care outcomes and decreasing costs, including but not limited to:

· Making healthcare insurance in the U.S. more affordable,

· Expanding the Medicaid program to cover adults with an income less than 138% of the federal poverty level (FPL),

· Supporting innovative medical care delivery methods designed to decrease health care costs

Prior to the ACA, many people in the U.S. were uninsured or underinsured. Underinsured referred to the percentage of persons living below the Federal Poverty Level (FPL) in the U.S. (Lukens & Zhang, 2025). The FPL is defined and referred to as those persons in households with incomes between 100% and 400% of the FPL (United States Department of Health & Human Services, 2022).

Key Considerations with the ACA in 2025 and Health Policy Shifts

While the ACA has many technical issues and terms associated with it, the changes proposed to the ACA would mean an increase in the cost of health coverage by hundreds of dollars for most people covered by the ACA . There are approximately 20 million people who get coverage through the ACA marketplace (Lukens & Zhang, 2024). Efforts to reduce the costs of the ACA to provide insurance to the approximate 20 million people would consist of initiatives like reducing premium tax credits and letting insurers raise out-of-pocket charges. Many marketplace enrollees will be unable to afford essential medical care for acute and chronic health care conditions (Lukens & Zhang, 2024). Another key consideration would be accumulating additional medical bills from medical care that they can’t or won’t be able to afford to pay. Others currently covered by the ACA will lose health care coverage altogether. (Lukens & Zhang, 2024). The impacts of losing the ACA or having changes or increases in premiums will result in challenging and harsh conditions and circumstances for people with chronic conditions or other costly illnesses or injuries (Lukens & Zhang, 2024). There will be significant changes and issues associated with the persons covered by the ACA. For example, there will be increases in monthly premiums as well as higher out-of-pocket costs due to proposed increases in the ACA plan. There will also be limits on how much each enrollee may be required to pay in deductibles, co-payments, and coinsurance each year (Lukens & Zhang, 2024).

Conclusion

The ACA was put into place to help provide affordable health insurance coverage for millions of Americans who were either uninsured or underinsured. The ACA was signed into law by President Obama in 2010 and fully enacted in 2014. The ACA has brought affordable health care to many Americans who otherwise would not have insurance coverage for acute and chronic conditions. As far as the future of the ACA with this new presidential initiative, health policy shifts, and federal budget changes and initiatives, the future and outcome of the ACA remain to be seen.

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