Problems With The Affordable Care Act

The Affordable Care Act (ACA), also known as Obamacare, was signed into law by President Barack Obama in 2010. It represented a significant overhaul of the U.S. healthcare system, aimed at reducing the amount of uncompensated care that the average family paid. Initially, the ACA required everyone to have health insurance and provided cost assistance to those who could not afford a plan on their own.

The original coverage requirement in Obamacare included a tax penalty, known as the individual mandate, for those who did not purchase health insurance. The penalties were designed to offset the cost of providing healthcare to people without insurance due to hardship situations or other exemptions.

However, in December 2017, the Trump administration passed a tax bill that repealed the individual mandate. This repeal is still in effect in 2023, eliminating the fine for those without health insurance plans in most states. Some states, such as California, Connecticut, Hawaii, Maryland, Minnesota, Rhode Island, and Washington, still have their individual mandates.

In December 2017, the Tax Cuts and Jobs Act was passed, which included a provision to repeal the individual mandate of the Affordable Care Act. The repeal of the individual mandate penalty went into effect on January 1, 2019. This means that there is no longer a federal penalty for not having health insurance, regardless of the state. However, some states have implemented their own individual mandates, which require residents to have health insurance or pay a penalty. As of 2023, California, Massachusetts, New Jersey, Rhode Island, and Vermont have their own individual mandates.

Challenges Of the Affordable Care Act

On January 20, 2017, the same day President Trump was sworn in, he signed an executive order directing administration officials to postpone certain parts of the Affordable Care Act. However, the repeal and replacement of President Obama's healthcare law failed in Congress, culminating in the late Sen. John McCain's dramatic vote against it. Following the setback, President Trump and his administration took a piece-by-piece approach to dismantling the ACA. In the fall of 2017, the President tweeted that "Obamacare is a broken mess" and vowed to give America the "great healthcare it deserves" by dismantling the ACA.

Since then, the Trump administration has implemented several changes to the federal health law, affecting many Americans. Here are the five most significant changes:

  1. The individual mandate, which required all US residents to have health insurance or face a penalty, has been eliminated.
  2. Some states have been allowed to implement "work requirements" for Medicaid.
  3. The cost-sharing reduction subsidies that went to insurers have ended.
  4. The access to short-term, "skinny" healthcare plans has been expanded.
  5. The funds that facilitate sign-ups have been reduced.

The Affordable Care Act (ACA) has been a topic of ongoing debate, with both pros and cons to consider. Here are some of the most often-debated points:


  • Subsidies: The ACA provides financial help to make purchasing health insurance more affordable for those who qualify. The 80/20 rule also ensures that 80% of premium dollars are spent on healthcare instead of administrative costs.
  • Preventive care: Qualified health insurance plans are required to provide essential health benefits, including preventive care and wellness visits with no copay, deductible, or coinsurance.
  • No pre-existing condition denials: Insurance companies cannot deny coverage for pre-existing conditions (unless the plan is grandfathered).
  • Medicaid expansion: For states that have chosen to expand their program, Medicaid coverage now includes uninsured Americans under 138% of the federal poverty level.
  • Dependents can stay under their parents’ plan longer: Children can be insured under their parents' health plan until they are 26 years old.
  • No more limits: Limits on lifetime benefits have been completely banned, and annual limits phased out (excluding grandfathered plans).


  • Higher premiums: Some argue that the ACA has resulted in higher premiums, particularly for those who do not qualify for subsidies.
  • Reduced choice of doctors and hospitals: Some plans available on the ACA marketplace have limited provider networks, which can limit patients' choices of doctors and hospitals.
  • Individual mandate: The individual mandate, which required individuals to have health insurance or face a penalty, was repealed in 2017. While some argue that this gave individuals more freedom, others believe it weakened the ACA's ability to provide affordable coverage for all.

Effects Of The Affordable Care Act

The Patient Protection and Affordable Care Act, commonly referred to as the Affordable Care Act or Obamacare, is a comprehensive piece of legislation passed by the 111th Congress and signed into law by President Barack Obama in 2010. Its primary goal was to improve the affordability and quality of health insurance in the United States.

With over 1,000 pages of provisions, the law aimed to make coverage more affordable and accessible to millions of Americans who struggled to pay for individual coverage, including those with pre-existing medical conditions who were often unable to obtain coverage at any price. The law was successful in significantly reducing the number of uninsured Americans, but the uninsured rate has started to increase under the Trump administration's watch.

Affordable Care Act Problems And Solutions

The recently passed spending deal includes the full repeal of three significant taxes of the ACA - the Health Insurance Tax, the Cadillac Tax, and the Medical Device Tax. However, the repeal of the Health Insurance Tax won't take effect until 2021, which means that the tax, already incorporated into many premiums for the 2020 plan year, will still apply for 2020. Meanwhile, the Cadillac Tax and Medical Device Tax will be repealed starting in 2020.