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President Obama Signs Health Care Reform Bill
Barack Obama signs the Affordable Health Care for America Act during a ceremony with fellow Democrats in the East Room of the White House on March 23, 2010 in Washington, DC.Win McNamee / Getty Images, file

Twelve years later, the ACA is getting the last laugh

Twelve years after Joe Biden whispered to Barack Obama that the Affordable Care Act was a big bleeping deal, there’s little doubt that he was right.


After the Affordable Care Act became law, there were points at which its future appeared to be in doubt. The website didn’t work. Polls suggested the law was unpopular. Legal challenges put the ACA in jeopardy — including three separate Supreme Court cases. After Donald Trump’s 2016 election, the fate of “Obamacare” appeared sealed.

And yet, on the 12th anniversary of Barack Obama putting his signature on the Affordable Care Act, it’s the law’s proponents who are getting the last laugh. CNN’s John Harwood summarized this week:

Today, more Americans than ever have health care coverage under the ACA. That includes 14.5 million people purchasing plans for 2022 coverage from Obamacare insurance exchanges, well over the peak during President Barack Obama’s last year in office. A comparable number gained coverage from provisions of the ACA that expanded the Medicaid program to low-income adults. The proportion of Americans without health insurance has fallen by about half, to below 10%.

Neera Tanden, an Obama administration health policy aide who now works in the Biden White House, added, “It’s not just that it has survived. It’s thriving.”

There’s ample evidence to bolster the point. Circling back to our earlier coverage, the reform law continues to break its own record for extending health care coverage in part because the Biden administration launched an initiative to get people signed up — complete with a renewal of the navigator program — and in part because officials extended the length of the enrollment period.

But perhaps most important of all is the fact that insurance has never been more affordable than it is now: Democrats included generous new ACA subsidies in the party’s American Rescue Plan last year, with some consumers seeing their premiums fall to nearly or literally zero, thanks entirely to the investments in the Democrats’ Covid relief package from early last year.

It caps a period that also saw the U.S. Supreme Court shield the ACA from its latest Republican attack, coinciding with Republicans quietly dropping ACA repeal from its to-do list.

Indeed, when Florida Sen. Rick Scott unveiled a new policy blueprint, the Republican leader’s 31-page document was chock full of right-wing elements — but he didn’t bother to say anything about repealing “Obamacare.” Soon after, when Sen. Ron Johnson briefly suggested he wanted to put ACA repeal back on the table, even the Wisconsin Republican scrambled to walk it back.

For those of us who covered the political fight over the Affordable Care Act, this day seemed implausible. Before Obama signed the reform package into law, Republicans condemned it as an economy destroying attack on free enterprise and the American way of life. After the ACA became law, Republicans spent years, not only denouncing the reforms, but voting several dozen times to repeal it.

Now, even many of Capitol Hill’s most conservative Republicans have moved on.

It’s worth emphasizing that there are some clouds on the horizon. As regular readers know, the ACA-related benefits included in the American Rescue Plan are, at least for now, temporary. The White House and Democratic leaders want to make the current benefits permanent, and it’s a central pillar of the Build Back Better package, but it’s an open question as to whether some conservative Democrats will allow the new status quo to continue.

For now, however, proponents of the law still have reason to celebrate. Twelve years after then-Vice President Joe Biden whispered to Obama that the reform measure was a big bleeping deal, there’s little doubt that he was right.

The ACA is working; it’s popular; it’s affordable; it’s withstood far too many legal challenges; and it no longer has a Republican-imposed target on its back. Twelve years ago today, this dynamic was hard to predict, but to the benefit of millions of American families, it’s the truth.