Affordable Care Act (ACA)
The ACA requires insurers to cover people with pre-existing conditions at the same price, sets minimum required benefits for individual and small-group plans, subsidizes marketplace coverage, lets states expand Medicaid and requires employers with 50 or more full-time employees to offer coverage. The individual mandate penalty has been $0 since 2019. It is funded in part by new taxes, including a 3.8% tax on investment income for higher earners.
- Individual choice8/20
- Economic opportunity5/20
- Limited, accountable government1/20
- Equal treatment under law5/20
- Property and privacy2/20
Adds freedom
Coverage no longer depends on staying with one employer, which frees people to change jobs, start businesses or retire early. Pre-existing condition protections apply to everyone.
Limits freedom
Mandated coverage eliminated low-cost, high-deductible catastrophic plans, and the rules pushed insurers and providers to consolidate, reducing competition. It widens the gap between haves and have-nots: many people get narrower care while those who can afford it go outside insurance to concierge doctors. It makes the young subsidize the old and the healthy subsidize the unhealthy, reversing the incentive to live healthy. It is a sweeping expansion of the federal government: new federal exchanges, open-ended subsidies, a Medicaid expansion and broad new rule-writing power over every health plan. It also discourages hiring past 50 employees and adds taxes on investment income.
Status as of 2026: the temporary enhanced premium subsidies expired at the end of 2025; the underlying law remains in effect.