The Affordable Care Act (ACA), commonly known as Obamacare, is an American health-care law signed in 2010. It created insurance marketplaces where people can compare and buy health insurance, and expanded Medicaid to cover more low-income Americans.
Since the introduction of enhanced tax credits during the covid pandemic, enrolment in the ACA marketplaces has doubled, with more than 24m people buying insurance through them. Three-quarters live in states Donald Trump won in 2024.
The enhanced subsidies are expensive. Extending them until 2035 would cost $350bn, according to the Congressional Budget Office, which estimated that letting them expire would cause 3.5m people to become uninsured by 2027. The Democratic architects made them temporary; Republicans have been divided over extension.
With the end of the pandemic-era subsidies, the average premium rose by 114%, according to KFF, a health-research outfit. The number of uninsured is expected to rise as auto-enrollees notice bigger bills and healthier people opt out, worsening the risk pool.
The ACA has always blocked federal subsidies from paying for abortion. Some states require marketplace plans to cover the procedure, leading to complicated accounting in which abortion care is paid for by a fund kept separate from federal money.
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