The Affordable Care Act expanded coverage to about 20 million Americans by requiring people to buy private insurance policies (partially subsidizing those policies with government payments to private insurers) and by expanding Medicaid. It roughly halved the number of uninsured and curbed some of the private insurance industry’s worst practices.
Even so, as of 2017, about 28 million people remain uninsured, and an estimated 31 million would still be uninsured in 2027 if the ACA remained in place, according to the Congressional Budget Office. Tens of millions more are underinsured (an estimated 41 million in 2016), with skimpy policies and high deductibles, and would face financial disaster should they fall seriously ill. Even those with “good coverage” are vulnerable to financial stress and medical bankruptcy.
The ACA preserves our fragmented financing system, and has actually increased the administrative bloat in the system, diverting dollars from needed medical care.
Meanwhile, the private insurers continue to strip down policies, maintain restrictive networks, and deny care. They also continue their efforts to privatize and wring profits out of the historically public Medicare and Medicaid programs.
In short, the ACA tinkered around the edges of our existing dysfunctional arrangements, but it hasn’t fundamentally fixed the problem.