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To the Editor:

Last month marked the 14-year anniversary of the signing of landmark federal legislation designed to make health coverage in this country more accessible and affordable. Thanks to the Affordable Care Act (ACA), or Obamacare, millions of Americans, including North Carolinians, are benefiting from expanded access to health insurance; coverage of essential health benefits, including preventive care; and protections for those people with preexisting conditions. The ACA reached record enrollment of 21.3 million people for the 2024 coverage year, exceeding last year’s record by another 5 million people. Perhaps not surprisingly given such high enrollment numbers, polling from the Kaiser Family Foundation shows that Americans broadly support the law. Then, when so many of us benefit from the ACA, why do Republicans in Congress, Republican governors, and former President Trump, inexplicably continue to push for its repeal?

Let’s review the provisions of the ACA to see more directly what accounts for its popularity and what’s at stake should Republicans repeal it. The law aims to make healthcare coverage more accessible and affordable in several ways. Specifically, the ACA:

• Gives states the option of expanding their Medicaid programs. The ACA allowed states to expand Medicaid eligibility up to 138% of the Federal Poverty Level and provided significant financial incentives for them to do so. The North Carolina Republican-controlled General Assembly finally took the federal government up on its offer last year, and enrollment in the Medicaid program soared to over 400,000 in the first four months of its inception. This number represents more than two-thirds of the 600,000 people North Carolina expects to enroll over the next two years.  Many people who have enrolled through Medicare expansions are young adults between the ages of 19 and 29 and work part-time or full-time. New enrollees also disproportionately live in rural communities. Clearly, Medicaid expansion in North Carolina is popular and providing affordable coverage to those who desperately need it.
• Provides a safety net for those who do not have job-based health insurance coverage or government insurance, such as Medicare or Medicaid. Households with incomes from 100% to 400% of the federal poverty level receive subsidies that reduce the cost of their health insurance premiums. Record numbers of Americans now receive health insurance coverage through the ACA.
• Protects those with pre-existing conditions such as cancer, asthma, or diabetes from being denied coverage or charged higher premiums. This is one of the more popular provisions of the ACA. An analysis by the Kaiser Family Foundation estimates that 27% of adults ages 18-64 have a pre-existing condition that would have led to denial of insurance in the individual market prior to implementation of the ACA.
• Requires private health insurance plans to cover recommended preventive services without any patient-cost sharing. These services include routine immunizations, evidence-based screenings and counseling, and preventive services for women, including mammography and cervical cancer screenings, birth control, and breast feeding support and supplies. The federal Department of Health and Human Services found an estimated 58 million women with private insurance currently benefit from these preventive services provisions.
• Allows young people to remain on their parents’ health plan until the age of 26.
• Mandates that most insurers cover 10 essential benefits and eliminates lifetime dollar caps on essential health benefits.

• Closes the Part D prescription drug “donut hole” to make drugs more affordable for older adults. 

More than 21 million Americans have signed up for affordable health care under the ACA, a number that continues to increase year after year. The ACA provisions also provide protections to those enrolled in private health insurance plans and Medicare and Medicaid. Let’s not put the ACA in jeopardy by supporting candidates who favor repeal of this groundbreaking legislation.

Laura Allendorf, Manteo

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