Signed into law 16 years ago on March 23, 2010, the ACA has recently been at the center of a government shutdown, coverage dips and political discourse.
Here are five things to know about where the law currently stands:
- President Donald Trump has not been shy about wanting to deviate from the ACA. He suggested redirecting ACA dollars to consumers, bypassing insurers, but has not articulated a specific plan to do so. In a November Truth Social post, he argued that Americans could purchase their own insurance if given the funds. He called to “terminate, per Dollar spent, the worst Healthcare anywhere in the World, ObamaCare.” President Trump continued his criticisms in his Feb. 24 State of the Union address, referring to the ACA as the “Unaffordable Care Act.”
- Broader Republican scrutiny of the ACA persists, as well. In February, House Republicans subpoenaed Blue Shield of California, Centene, CVS Health, Elevance Health, GuideWell, Health Care Service Corp., Kaiser Permanente and Oscar Health over ACA fraud concerns. The push followed a December Government Accountability Office report that identified billions in unreconciled ACA subsidies.
- This year, CMS pitched sweeping ACA changes for 2027. The proposal would affect plan flexibility, cost-sharing reductions, quality reporting and risk adjustment, among other changes.
- The expiration of enhanced tax credits has been linked to affordability concerns. Some states have attempted to backfill or ease the burden of the lost federal subsidies. A March 19 KFF survey found 80% of returning ACA enrollees reported higher healthcare costs this year, and 9% of 2025 enrollees are now uninsured.
- If not going uninsured, the quality of consumers’ health coverage appears to be declining as enrollees downgrade to bronze plans. Texas health insurance leaders said this pattern has been prevalent in the state, which experienced a boost in ACA enrollment in 2026.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 17–19 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
