Remember in 2010 when President Obama signed the Affordable Care Act (ACA) into law? Afterwards, discussions about the legislation monopolized our political discourse; people had strong opinions on both sides of the debate. Those conversations continued in earnest until the summer of 2017 when Congress’ effort failed to repeal and replace the ACA. While the debate has continued, the fervor surrounding the ACA has subsided.

To the surprise of some, the ACA turned 14 in March—not bad for legislation that people weren’t sure would make it past five years. Now in 2024, it’s worth reflecting on how this law has impacted older adults. First, the law ensures basic guarantees that have benefited older Americans. The legislation protects people with preexisting conditions, caps older adult’s premiums compared to their younger counterparts, prevents lifetime or annual limits on coverage, and provides essential health benefits and access to preventive services.

While these are all important provisions of the ACA, it won’t make a difference if people don’t have coverage. Fortunately, the ACA has helped reduce the uninsured rate for older Americans. According to the American Association of Retired Persons (AARP), the uninsured rate for people aged 50 to 64 decreased from 14.5% to 7.9% between 2012 and 2022.

Originally, the ACA included tax credits to help qualifying people afford insurance in the marketplace. Then in 2021, Congress passed the American Rescue Plan Act, which temporarily increased the tax credits for people and expanded the number of people who qualified. The following year, Congress extended the tax credit expansion through 2025. The expanded tax credits have been critical in making insurance more affordable. The Center for Medicare and Medicaid Services (CMS) reported that in 2024, 92% of marketplace enrollees (19.7 million people) are eligible for premium tax credits.

With the premium tax credits being vital, it begs the question: what happens when the expanded tax credits expire in 2026? First, I hope Congress and the White House will work together to continue the current version of these credits. Not extending the enhanced tax credits could have devasting consequences for older adults. For example, a report from the Center on Budget and Policy Priorities (CBPP) found that if the credit expires, a 60-year-old with an income of $45,000 a year could see yearly premiums go up by about $2,000. A 60-year-old couple making $80,000 a year could see yearly premiums increase by a whopping $17,511 a year. For a couple making $80,000 a year, absorbing an additional $17,511 increase in premiums would be crippling.

I would also be remis if I didn’t address Medicaid expansion, which has helped decrease the uninsured rate. Under the ACA, states have the option to expand their base of people (ages 19 to 64) who qualify for Medicaid.  That has led to 41 states (including D.C.) to expand Medicaid to their residents, which has resulted in uninsured rates going down. Generally, people with insurance have healthier outcomes.

One analysis can’t possibly examine all the ways the ACA has benefited older adults.  Fourteen years is a significant measure of a law’s effectiveness. Clearly, increasing the insurance rate for older adults has led to positive outcomes. Hopefully, we will continue to move forward and ensure the ACA’s expansion continues its progress in insuring older adults.

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Evan Carmen, Esq. is the Legislative Director for Aging Policy at the B’nai B’rith International Center for Senior Services. Click here to read more from Evan Carmen.