On March 23, 2010, the Affordable Care Act (ACA) was signed into law, reshaping the U.S. healthcare system and expanding access to coverage across commercial, Medicare and Medicaid markets. Sixteen years later, its core consumer protections remain foundational to how people experience healthcare today.
To reflect on the ACA’s impact and examine what lies ahead, CareFirst BlueCross BlueShield (CareFirst) hosted a webinar on March 18 featuring experts with firsthand experience shaping and implementing the law. The discussion explored how the ACA transformed coverage, where progress has been made and how recent policy changes may affect affordability and access in the years to come.
Expert Perspectives on the ACA
The webinar opened with remarks from David Schwartz, Vice President of Public Policy & Federal Affairs at CareFirst. Mike Rapach, Senior Vice President of Government Programs, moderated the discussion with a panel of policy leaders:
- Ellen Montz, Managing Director, Manatt Health
- Randy Pate, Founder, Randolph Pate Advisors LLC
- Andy Chasin, Vice President of Federal Policy & Advocacy, Blue Shield of California
Ellen Montz and Randy Pate both previously served as Deputy Administrators of the Centers for Medicare & Medicaid Services and Directors of the Center for Consumer Information and Insurance Oversight (CCIIO) during different administrations, offering unique insight into the ACA’s design and evolution.
How the ACA Transformed Healthcare
Panelists highlighted how the ACA introduced consumer protections that are now considered essential features of commercial insurance. These include protections for people with preexisting conditions, coverage of preventive services without cost sharing and the ability for young adults to remain on a parent’s health plan through age 26.
The ACA also established the Health Insurance Marketplace, which opened for enrollment in October 2013 for coverage beginning in 2014. The Marketplace created a “one-stop shop” for individuals who do not qualify for Medicaid and do not have access to affordable employer-sponsored coverage. Panelists discussed how tools such as Section 1332 waivers allow states to develop innovative approaches tailored to their populations while maintaining coverage standards.
Medicaid expansion emerged as another key driver of coverage gains. To date, 41 states and Washington, D.C. have adopted the ACA’s Medicaid expansion, extending coverage to adults with incomes up to 138% of the federal poverty level. This policy contributed to a historic decline in the uninsured rate—from 15% before the ACA to 7.7% in 2023.
Panelists also reflected on pandemic-era policies, including temporary continuous Medicaid enrollment and enhanced advance premium tax credits (eAPTCs), which helped individuals maintain coverage during times of economic uncertainty.
Impact of Recent Policy Changes
The discussion also addressed recent legislative and regulatory changes that may affect enrollment and access to care. Panelists highlighted how increased administrative requirements for Medicaid enrollees and added financial pressure on states could lead to coverage loss, particularly among vulnerable populations.
While panelists agreed on the importance of addressing fraud, waste and abuse, they emphasized that new requirements must be communicated clearly and designed to avoid unnecessary barriers that could disrupt coverage for eligible individuals.
Affordability and the Road Ahead
Although the ACA significantly expanded access to coverage, panelists underscored the continued challenge of healthcare affordability. The expiration of eAPTCs is already increasing premiums for many enrollees, with estimates suggesting millions could lose coverage over the next decade if affordability challenges persist.
Panelists also discussed the role of price transparency initiatives, including the Transparency in Coverage rule, as one tool to help consumers better understand healthcare costs in both employer and individual markets.
So, What Comes Next?
The webinar concluded with a forward‑looking conversation about policy opportunities to strengthen affordability, coverage stability and consumer experience. Panelists shared ideas for improving the system if they could “wave a magic wand”—insights best experienced by watching the full recording.
CareFirst remains committed to thoughtful partnership, innovation and proactive policy engagement to improve care for the members we are honored to serve. Reflecting on the ACA’s legacy helps inform how we continue advancing solutions that support access, affordability and consumer protections in a changing healthcare landscape.