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To the editor:

Fifteen years ago, the Affordable Care Act (ACA) was signed into law by President Barack Obama. Since then, millions of Americans have benefited from the law’s provisions that make healthcare coverage in this country more accessible and affordable. The anniversary of this groundbreaking bill provides an opportunity to both celebrate the ACA’s successes as well as assess what challenges may lie ahead for the most important piece of legislation since the creation of Medicare and Medicaid.

The ACA has given a record 44 million Americans access to health care through the Affordable Care Act’s Marketplaces and its expansion of the Medicaid program in 2024, according to data from the Kaiser Family Foundation (KFF). In North Carolina alone over 987,000 residents enrolled in a plan through the ACA’s healthcare marketplaces last year. Enrollment in the state has increased by 118% since 2020.

Enrollment in North Carolina’s Medicaid program has soared. As of March 7, 2025, there are 640,297 people enrolled in Medicaid expansion in North Carolina, according to state figures. The expansion has provided access to healthcare for individuals and families who were previously uninsured.

Other popular provisions of the ACA protect those with pre-existing conditions such as cancer, asthma or diabetes from being denied coverage or charged higher premiums; allow young people to remain on their parents’ health plan until the age of 26; and require private health insurance plans to cover recommended preventive services without any patient cost sharing.

Recent policy debates in Congress signal potential threats to the substantial progress that has been made to improve healthcare access and coverage under the ACA. On assuming the majority, Republicans wasted no time in introducing legislation to repeal the law. H.R. 114, the so-called Responsible Path to Full Obamacare Repeal Act, was introduced in January by Rep. Andy Biggs (R-AZ-5).  Past efforts by Republicans in Congress to repeal the ACA have failed, fortunately, but President Trump is seeking ways to undermine the program through changes in regulations and other means.

Regarding Medicaid expansion, the Republican-dominated House of Representatives last month approved a sweeping budget resolution that could lead to some $880 billion in reductions to the Medicaid program in order to pay for the extension of trillions of dollars in tax cuts for wealthy Americans. The Center for American Progress (CAP) projects that in the 3^rd Congressional District alone, of which Dare County is a part, these cuts could result in a $2.13 billion funding loss and a reduction in enrollment of 60,000 people.

Congress must act this year to continue the enhanced subsidies for ACA Marketplace plans that are set to expire at the end of 2025. Since 2021, these enhanced subsidies have lowered monthly premium payments for most Marketplace enrollees. Should Congress let them expire, almost all ACA Marketplace enrollees will experience steep increases in premium payments in 2026, according to the Kaiser Family Foundation.

What can you do to fight against changes to the ACA, including possible Medicaid cuts? If you care about the future of health care in this country and North Carolina, contact your members of Congress and hold them accountable. You can make a difference! Republicans representing red counties such as Dare are hearing from constituents concerned about the impact of Medicaid cuts and other issues. Thousands of outraged citizens across the State of North Carolina are demanding their congressional representatives hold in-person town halls to explain their actions and those of the Trump/Musk Administration. You can do the same.

To reach your members of Congress, Senators Thom Tillis and Ted Budd, and Representative Greg Murphy, call the U.S. Capitol Switchboard at 202-224-3121.

There is no time to waste.

Laura Allendorf

Manteo

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