A maze representing the challenges of accessing affordable healthcare.

Affordable Care Act: Can It Be Saved?

Nico Varela in Politics & Policy December 2025 • 3 min read.

"Navigating the Future of Healthcare in America"

The Affordable Care Act (ACA), enacted in 2010, is at a crossroads following the 2016 election. The commitment to repeal the act threatened the healthcare landscape for millions of Americans. While some changes were made, the core structure remains, and its future is still debated.

Since its inception, the ACA has faced challenges. Major insurers have withdrawn from exchanges due to profitability concerns, leaving consumers with fewer choices. Rising premiums further complicate the situation, impacting individuals who do not receive subsidies.

Despite these challenges, the ACA has made significant strides in reducing the number of uninsured Americans and controlling healthcare cost growth. The debate now centers on how to address the existing issues while preserving the law's achievements.

Understanding the Rising Costs

A maze representing the challenges of accessing affordable healthcare.

Several factors contribute to the rising costs within the ACA marketplace. One key issue is that the exchanges have attracted a sicker population than anticipated. The hope was that healthy individuals would balance out the costs, but this hasn't fully materialized.

Another factor is the approaching termination of the ACA reinsurance program, which previously helped cover the expenses of very sick enrollees. The general upward trend in healthcare costs also impacts all insurance plans, not just those within the exchanges.

Sicker population in exchanges
Termination of reinsurance program
General increase in healthcare costs

It's crucial to note that many individuals eligible for financial assistance in the marketplace remain unaware of these opportunities. Increased awareness and enrollment could help stabilize the risk pool and lower costs for everyone.

Finding a Path Forward

Critics of the ACA often highlight premium increases as evidence of its failure. However, this perspective overlooks the significant gains in coverage and cost control achieved under the law. The uninsured rate remains at historic lows, and healthcare cost growth has slowed.

Despite its limitations, the ACA's problems are not insurmountable. Solutions include strengthening the risk pool, increasing subsidies, and addressing the underlying drivers of healthcare costs. A 'public option' could enhance competition and affordability.

As advocates for expanding healthcare coverage, it's essential to actively support the ACA and work towards improvements. The goal is to ensure that all Americans have access to quality, affordable healthcare.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1093/hsw/hlw063, Alternate LINK

Title: The Future Of The Patient Protection And Affordable Care Act

Subject: Health (social science)

Journal: Health & Social Work

Publisher: Oxford University Press (OUP)

Authors: Stephen H. Gorin

Published: 2016-12-15

Everything You Need To Know

What's the current status of the Affordable Care Act (ACA) and what major factors contribute to its uncertain future?

The Affordable Care Act (ACA) faces uncertainty due to ongoing debates and challenges since its enactment in 2010. The repeal efforts after the 2016 election created instability. Issues like insurers withdrawing from exchanges and rising premiums contribute to the ACA's precarious position. While the core structure remains, its future depends on addressing these challenges effectively. The commitment to accessible healthcare remains a focal point.

Why are costs rising in the Affordable Care Act (ACA) marketplace, and what's the impact of the termination of the ACA reinsurance program?

The rising costs within the ACA marketplace stem from several factors. The exchanges attracted a sicker population than anticipated, leading to higher expenses. The approaching termination of the ACA reinsurance program, which helped cover costs for very sick enrollees, exacerbates the problem. The general upward trend in healthcare costs also affects ACA plans. A potential solution involves increasing awareness of financial assistance to encourage more enrollment and stabilize the risk pool. The interplay of these issues shapes the financial landscape of the ACA.

How do rising premiums align with ACA's goals, and what has the ACA achieved in terms of coverage and cost control?

While critics point to premium increases, it's crucial to acknowledge the ACA's achievements in expanding coverage and controlling healthcare cost growth. The uninsured rate has decreased significantly, and healthcare cost growth has slowed. This perspective highlights the need for a balanced assessment, considering both the challenges and successes of the Affordable Care Act. These gains underscore the ACA's impact on healthcare accessibility and affordability.

What's the ACA reinsurance program, and what happens when this program ends?

The ACA reinsurance program was designed to help cover the expenses of very sick enrollees, acting as a financial backstop for insurers. Its termination poses a significant challenge because it removes a key mechanism for managing the high costs associated with these individuals. Without this program, insurers may face increased financial strain, potentially leading to higher premiums or further withdrawals from the exchanges. This situation necessitates exploring alternative strategies to support the risk pool and maintain stable coverage.

How does the risk pool relate to health insurance costs within the ACA, and what would happen if more healthy people joined the exchanges?

The ACA aimed to create a balanced risk pool within the exchanges by attracting a mix of healthy and sick individuals. However, the exchanges have disproportionately attracted a sicker population, leading to higher costs. If more healthy individuals enrolled, it would help distribute the financial burden and potentially lower premiums for everyone. Strategies to encourage broader participation include increased outreach, simplified enrollment processes, and addressing concerns about affordability and coverage options. Achieving a more balanced risk pool is crucial for the long-term sustainability of the ACA.