President Biden joined past and present leaders in Congress and health care advocates throughout the country this week in marking the 13th anniversary of the Affordable Care Act (ACA). 

The White House’s celebration of the ACA’s birthday on Thursday was a two-pronged effort that focused both on the law’s success – more Americans have access to health care than ever before – and on threats to its well-being. Although Republicans in Congress have yet to release a formal budget and probably won’t do so for at least another month, one proposal backed by some members of the House Freedom Caucus would repeal and ACA and cripple Medicaid. 

Meanwhile, on Thursday, North Carolina legislators gave final passage to a Medicaid expansion effort, and North Carolina’s governor plans to sign the measure. Forty states have now opted for Medicaid expansion. (Thirty-eight states have implemented expansion; South Dakota will do so on July 1, and the North Carolina law is expected to take effect after lawmakers agree on a state budget, which could happen as early as this summer.) The expanded Medicaid program now reaches about 20 million people who would otherwise almost certainly be uninsured. 

Thursday began with the White House extolling the virtues of the ACA, with a particular focus on the two years that President Biden has been in office. 

Twice during Biden’s tenure, Congress has acted to significantly lower health care costs for Americans and increase coverage. The first time was with passage of the American Rescue Plan in March 2021. The second time was last fall, with passage of the Inflation Reduction Act. 

Since 2014, when HealthCare.gov was launched, enrollment has doubled from 8 million to more than 16 million, Biden Administration officials say. Nearly 16.4 million consumers chose or were automatically re-enrolled in health insurance coverage through ACA marketplaces this year – an all-time record. Indeed, enrollment consistently has increased during the Biden era, with 1.8 million more consumers signing up for coverage during the 2023 open enrollment compared to the previous year, a 13 percent increase, and nearly 4.4 million more consumers signing up in 2023 compared to the 2021 open enrollment, a 36 percent increase. 

It did not happen by accident. 

The Biden Administration invested $98.9 million in “navigators,” basically messengers who could help consumers navigate the ACA marketplaces during 2023 open enrollment. These navigators particularly were tasked with reaching audiences that experience lower access to health care. For example, the Administration partnered with cultural marketing experts to connect more people to resources, including Blacks, Spanish and English-speaking Latinos, and Asian American and Pacific Islander communities in multiple languages. In addition, the Biden Administration’s commitment to expanding the number of people with health insurance led them to hold more and longer open enrollment periods, and to advertise them. 

More people wanted to enroll because the ACA insurance was increasingly a very good deal. Due to passage of subsidies included in the American Rescue Plan, marketplace participants are saving an average of nearly $800 annually on their premiums – meaning more people can afford marketplace coverage in the first place. The Administration estimates that 4.6 million people are receiving this type of financial assistance in 2023 than were in 2021. Indeed, 90 percent of people selecting plans through the marketplace are receiving help to pay for premiums. 

In another event held at the Washington headquarters of the Department of Health and Human Services, Secretary Becerra and other staff administering the ACA spoke of continuing improvements to coverage, with more treatments available with no out of pocket payments required, such as vaccines, mammograms or at-home colon cancer screening tests. They also emphasized the importance of improving access to care for the people covered by expanded Medicaid. One means of doing this is the significant expansion of community health centers, now serving 30 million people (and which the new Biden budget proposes to expand further to 33 million). 

During remarks at the White House Thursday, Biden called the ACA the “most consequential piece of health care legislation since the creation of Medicare and Medicaid in 1965.” 

At the same time that White House officials were touting the ACA’s accomplishments, they also were mounting an aggressive offensive against efforts by some in Congress who would like to see the law vanish. Officials Thursday morning released 51 fact sheets (for all 50 states plus D.C.) warning of the consequences of ACA repeal and gutting Medicaid. 

“The fact sheets demonstrate how Congressional Republicans’ reported proposals will raise premiums and health care costs, threaten health care for Americans with pre-existing health conditions, slash protections against catastrophic medical bills, and will balloon waitlists for quality care for seniors and people with disabilities,” the White House stated in a news release. 

The White House said that since becoming law in 2010, the ACA helped a total of 40.2 million Americans gain quality, affordable health care, lowered health care costs for families, and provided critical coverage of services such as cancer detection and mental health treatment. 

In his remarks, Biden joined in the criticism. He said that Russell Vought, former president Donald Trump’s budget director, is advising “MAGA” Republicans in Congress on a plan to “slash $2 trillion from Medicare.” 

“He wants to end Medicaid expansion under the Affordable Care Act and make additional deep cuts that could lead to nearly 70 million people losing critical services,” Biden said. “Most of them are seniors, people with disabilities and with children.” 

Even as the ACA’s birthday was celebrated in Washington, D.C., health care advocates were fanning out across the country to celebrate the law’s success. Protect Our Care organized events with local elected officials, members of Congress, and consumers who have benefited from the ACA in Arizona, California, Michigan, and Wisconsin, where they were joined by Gov. Tony Evers. 

“The ACA is a pillar of our health care system,” said Leslie Dach, Founder and Chair of Protect Our Care and former Senior Counselor to the Secretary of the Department of Health and Human Services in the Obama Administration. “Thanks to the ACA, millions of people with pre-existing conditions like diabetes or asthma are protected, people who buy insurance on their own can afford their premiums, more than 21 million people are covered through Medicaid expansion, and over 150 million patients have access to free cancer screenings and other preventive care. Thirteen years in, the law is now built into the fabric of America and is only getting stronger.”