Entering Their Second Decade, Affordable Care Act Coverage Expansions Have Helped Millions, Provide the Basis for Further Progress

The number of people who are uninsured has dropped from 45.2 million in 2013 to 26.4 million in 2022, a historic decline.2 In addition to reducing the number of people without any coverage, the ACA marketplace plans and Medicaid provide far lower-cost coverage to millions more people. [...] More People Have Affordable Health Coverage Because of the ACA Today, roughly 40 million people are enrolled in coverage under the ACA marketplaces and Medicaid expansion.3 The ACA’s coverage expansions drove a precipitous decline in the uninsured rate, which fell and eliminating prior barriers in the private insurance market for people with pre- 1 Several states and jurisdictions began implementi. [...] 8 The marketplace uses the poverty guidelines, commonly known as the federal poverty level (FPL), in effect at the start of the open enrollment period to determine premium tax credits for the subsequent plan year. [...] Because the ACA presumed that all people under 138 percent of the poverty level would be covered by Medicaid and thus made people under the poverty level ineligible for PTCs, the court’s decision led to a “coverage gap” for people with incomes under the poverty level in states that opted not to expand Medicaid. [...] (See Figure 3 for a family of four at different income levels; Appendix Table 1 for the costs facing people of various family sizes, ages, and incomes; and Appendix Table 2 for the costs facing people of various family sizes, ages, and incomes by state.) As a result of the enhancements, people with incomes above 400 percent of the federal poverty level became newly eligible for PTCs if their marke.