The Seven Biggest Threats to the ACA as it Turns 15

Despite Its Popularity, the ACA Remains Under Attack and Faces an Uncertain Future

On Sunday, March 23, the Affordable Care Act (ACA) will celebrate 15 years of giving hundreds of millions of Americans access to affordable and quality health coverage. Yet, despite its popularity with people across the political spectrum, it remains under attack. Congress and the Trump administration have proposed changes to undermine the law and significantly upend health insurance for millions, reverse the coverage gains achieved over the last few years and cause premiums to skyrocket. Here are the seven biggest threats:

1. Failing to Extend Enhanced Tax Credits Will Cause Premiums to Skyrocket
   Twenty million people now get premium assistance to buy coverage for themselves and their families. In 2021, Congress increased the assistance amount to further help people afford coverage. If Congress doesn’t extend these tax credits this year, four million people will become uninsured. People’s premium costs will increase by 44% on average, and more for some age and income groups.
2. Deep Cuts to Federal Funding Threaten Medicaid Expansion
   The ACA brought Medicaid expansion, which made it possible for states to provide health care to millions more low-income adults. The proposed cuts to Medicaid threaten the future of Medicaid expansion in those states, who will face severe budget shortfalls that force them to roll back access to care, cut benefits for people and leave millions of people without health care coverage entirely.
3. Eliminating Key Health Benefits
   The Supreme Court case Braidwood vs Becerra is threatening access to the preventive health benefits that are currently required to be covered by health plans as part of the ACA. One of the law’s most popular provisions, all health plans are required under the ACA to cover preventive services such as cancer screenings, contraception, wellness check-ups, vaccines and immunizations, and HIV prevention, to name a few. If the Supreme Court does not uphold these important ACA provisions, the Trump administration could take steps to roll back covered health services, sending us back to the days when insurance plans didn’t have to cover proven, evidence-based treatments and simple preventive health care services.
4. Promoting Junk Plans that Empower Insurers to Provide Lower Quality Health Care Coverage to Consumers
   In his first term, President Trump took steps to allow and promote broader sale of junk health insurance plans that don’t have to provide comprehensive health care coverage and undermine people’s access to quality care. This administration is continuing that effort in this second term and most egregiously, they could also eliminate the consumer warnings about these plans so more people unknowingly purchase a junk plan that doesn’t cover their basic needs, and then get stuck with a huge bill. Congress could also alter laws to increase the sale of Association Health Plans and Level-Funded plans, which do not adequately protect employees and small businesses. Federal workforce cuts already undermine federal oversight of insurance frauds that harm consumers and target primarily older and low-income individuals — leaving people even more vulnerable to the abusive practices of these junk plans.
5. Cuts to Navigator Programs that Help People Enroll in Affordable Health Care Plans
   The administration recently cut 90% of funding for the federal marketplace’s navigator funding program, devastating an essential resource for people enrolling in marketplace plans, Medicaid and CHIP. Navigators help people with some of the most complex situations understand their health plan options and assist them in getting needed care. In 2024 alone, navigators helped more than 384,000 families choose affordable health coverage through Medicaid or the marketplace that best suited their circumstances. This will make it harder for Americans to enroll in health care and to make sure they are getting the full financial assistance they are due.
6. Taking Health Care Away from Immigrant Communities
   The Trump administration recently proposed a new rule to pull back access to health care across the board for DACA recipients, also known as Dreamers — people who have lived in the U.S. since childhood, only know the U.S. as home, work in our communities and pay state and federal taxes, much like American citizens. The proposed rule is cruel and would rip health care away from 100,000 Dreamers who need it to continue working in America and building their American dream.
7. Using Valuable Federal Resources to Expand Tax Breaks for the Rich
   Republicans in Congress and the Trump administration have proposed expanding Health Savings Accounts (HSAs) which overwhelmingly benefit wealthier individuals. The HSA model encourages the growth of plans that have very high deductibles and cost sharing, making medical care unaffordable for millions of families. Two out of 5 adults in America say they would need to borrow or sell something to cover an unanticipated $400 expense —they can barely afford their current expenses, let alone stash money in an HSA for the future.

The Affordable Care Act allowed 44 million people to get health insurance coverage through the marketplaces and Medicaid, and provided many new protections to people with employer-based coverage. As we celebrate its 15th anniversary, let’s remember that the Affordable Care Act has faced threats before and survived because an overwhelming majority of Americans made it clear that they will not tolerate threats to the health care they want and need. Now is the time to once again make our voices heard and demand that Congress and the Trump administration protect access to health care and stop efforts to rip health care away from millions of Americans.