# Affordable Care Act

> Signed the most consequential health law in decades, creating insurance marketplaces, expanding Medicaid, subsidizing coverage.

Barack Obama · Healthcare · Legislation · Mar 23, 2010
Official record: https://www.cbpp.org/blog/affordable-care-act-improvements-push-uninsured-rate-to-another-all-time-low-though-share-of

## What happened

Signed the most consequential health law in decades, creating insurance marketplaces, expanding Medicaid, subsidizing coverage, and barring denial for pre-existing conditions.

## How it happened

Passed Congress on party-line votes via reconciliation; signed March 23, 2010. Survived multiple Supreme Court challenges.

## Documented impact

- [positive / substantiated] Drove the uninsured rate to record lows. — The uninsured rate fell from 15.5% (2010) to a record-low 7.9% (2023); marketplace enrollment reached ~20+ million.
- [negative / contested] Premiums, costs and the individual mandate drew sustained opposition. — Critics cited rising premiums in some markets and the (later-repealed) mandate penalty; the law was politically divisive for years.

## Public opinion

The Affordable Care Act

Favorable: 55% · Unfavorable: 39%

Underwater at passage (~40% favorable); favorability later climbed to a record ~57% by the 2020s.

Source: KFF / Gallup, 2020s

## Sources

- [CBPP: uninsured rate](https://www.cbpp.org/blog/affordable-care-act-improvements-push-uninsured-rate-to-another-all-time-low-though-share-of)
- [KFF: public opinion on the ACA](https://www.kff.org/affordable-care-act/5-charts-about-public-opinion-on-the-affordable-care-act/)

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Canonical: https://eo.alanwizemann.com/eo/obama/affordable-care-act