Most significant ways obamacare changed healthcare

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Ten years ago on Christmas Eve, the Senate passed its version of Obamacare. The s began with the United States taking its most significant steps toward universal health coverage in a generation. It ends with the country having moved closer to that goal than ever, but still falling short.

There have been plenty of bumps along the way. Still, the law passed, thanks to the legislative chicanery by then-Senate Majority Leader Harry Reid and once and future Speaker of the House Nancy Pelosi, and was signed by President Obama in early The midterms were disastrous for Democrats, but the law would persist. In , it overcame its first existential threat at the Supreme Court, when Chief Justice John Roberts found a rationale for upholding the individual mandate and with it the rest of the law.

The botched rollout of HealthCare. Then came the election of Donald Trump. Republicans finally had a chance to deliver on their promise to repeal and replace the health care law they hated so much. Obamacare has been hobbled along the way. Medicaid expansion was undercut by the Supreme Court by making it optional for states, a decision that has left more than 2 million people in poverty without coverage. And today, right now, the Trump administration and Republican-led states are still trying to get Obamacare overturned by the courts.

But at the end of the decade, millions more Americans have health insurance now than they did at the beginning of it. The uninsured rate is near its historic low. Early evidence indicates people are living longer and they are less at risk of going bankrupt over medical bills because of coverage expansion.

And yet, the project remains unfinished. Tens of millions of Americans still lack insurance and many millions more have an insurance card but not benefits that would actually provide financial security in the event of a dire diagnosis or emergency.

Premiums and out-of-pocket costs for the million Americans who get insurance through work continue to rise. US health spending still leads the world by far, driven by the highest prices anywhere on the globe.

In the wealthiest country in the world, one in four people say they have delayed treatment for a serious medical condition because of the cost. So Democrats are still today debating how much to expand government programs to cover people and how aggressively to regulate health care prices. The extraordinary influence of the health care industry, dented but holding firm heading in the s, makes the road to any new reforms extremely challenging. It could be a very dark harbinger for the decade to come that Congress has failed to pass a fix for surprise medical bills here at the end of the s, overwhelmed by industry lobbying and political in-fighting.

The next 10 years promise a continued, prolonged debate about how to fix US health care — without any guarantee the dream will be realized. Sign up to get VoxCare in your inbox along with more health care stats and news. Are you interested in more discussions around health care policy? Join our Facebook community for conversation and updates. Financial contributions from our readers are a critical part of supporting our resource-intensive work and help us keep our journalism free for all.

Please consider making a one-time contribution to Vox today. The Affordable Care Act established health insurance marketplaces, including Healthcare. Despite initial spikes in prices on the marketplace, premiums have grown more affordable over the last couple of years. More than 20 million Americans gained health insurance under the ACA. Black Americans , children and small-business owners have especially benefited. As a result of the increased access to health care, it's estimated that more than 19, lives have been saved.

The Medicaid expansion is popular with voters. After Louisiana Gov. John Bel Edwards, a Democrat, won reelection in November, his lead pollster told The Washington Post that "no single issue was more important than the Medicaid expansion. That math has led even red states that criticized the Affordable Care Act to eventually adopt it, Stevens said. There are other parts of the ACA with bipartisan support, including prohibiting insurers from denying coverage or charging more to people with preexisting conditions.

More than 1 in 4 Americans report having a preexisting condition such as asthma or high blood pressure. The law prohibited health insurers from including lifetime and annual caps in their plans. In the past, the government estimates that more than 20, people hit those limits each year. The Affordable Care Act also banned insurers from charging rates based on gender. Under the ACA, Medicare stopped reimbursing hospitals for the treatment of hospital-acquired infections.

As a result, the number of such infections have plummeted and , fewer deaths have occurred. Health-care spending still makes up nearly a fifth of the country's gross domestic product. Many Americans can't afford to take care of themselves. The Trump administration has been hostile toward the Affordable Care Act. The overhaul of the tax code in repealed the individual mandate penalty. That central provision of the Affordable Care Act required every American to sign up for health insurance or face a tax penalty.

Advocates say it's now harder for people to learn about their health insurance options. These changes are likely among the reasons , fewer people signed up for health insurance on the marketplace in than in Between and , the number of uninsured children swelled by , Since more than a dozen states continue to refuse to adopt the Affordable Care Act's Medicaid expansion, 2. In Texas, one of the states that hasn't expanded Medicaid, nearly 1 in 5 people live without health insurance.

Some 10 states are in the process of trying to impose work requirements for their Medicaid benefits. The new qualifications could lead to , Americans losing their health coverage. Starting in January, many Medicaid recipients in Michigan will have to show at least 80 hours a month of workforce engagement to maintain their coverage.

Other states, meanwhile, have fully adopted the Affordable Care Act — and gone further to cover their residents.