There’s nothing like a global pandemic and an ensuing economic crisis to drive home the point that health care is not a luxury. 

Today, on the tenth anniversary of the Patient Protection and Affordable Care Act (ACA), we take stock of what we’ve gained – and how urgent it is to continue our fight for health equity for all. 

The ACA, or Obamacare, created federal and state marketplaces to buy insurance, provided tax credits that made coverage more affordable for millions, and allowed states to expand Medicaid. It required insurance companies to cover certain essential benefits, prohibited them from denying coverage based on pre-existing conditions, and ensured young adults could stay on their parents’ plans to age 26. 

While some states refused to take full advantage of the ACA, here in Washington, we expanded Medicaid to cover many more people and opened the Health Benefit Exchange so consumers can compare and buy health insurance plans and qualify for federal tax credits. 

The benefits of the ACA to Americans are undeniable. Over 20 million people nationwide have gained health care coverage. Insurance rates improved for people in every demographic. Disparities by race and ethnicity have decreased. Black, Latinx and low-income people experienced the most significant improvements, particularly in states that expanded Medicaid. In Washington State, the overall rate of people without insurance decreased from 14 percent in 2010 to a record low of 5.4 percent in 2016. 

But our gains have begun to stall. The Trump administration has launched attack after attack on the crucial law, rolling back some of the advancements we’ve made towards health equity. Trump eliminated the individual mandate, which was designed to improve the risk pool for everyone by assessing a tax penalty on people who did not have health insurance. Trump also terminated federal subsidies to insurance companies for cost sharing reductions (CSR), which enabled discounts to people with low- and moderate-level incomes purchasing certain plans. Trump also slashed the marketing budget for the ACA from $100 million in 2016 to just $10 million just two years later. 

We’re feeling these attacks in Washington State. For the first time since 2014, the insurance rate in Washington has actually decreased. Gains we’ve made towards reducing racial disparities have slowed. Costs are on the rise as executives and shareholders in the medical industry rake in the big bucks, and families fear a catastrophic event that would drive them into bankruptcy. More than a third of consumers who drop coverage on the Health Benefit Exchange report the high cost as the main reason for dropping coverage. 

And though the benefits to the ACA have been widespread for many, we still have a long way to go to ensure access to medical care for all. Undocumented people continue to face extremely high rates of uninsurance due to federal eligibility restrictions. In Washington, undocumented immigrants are 11 times more likely to be uninsured than someone born in the U.S. 

Leaders both in D.C. and Washington State need to act urgently to protect the gains we’ve made and build on our progress – and fast. The current global public health crisis underscores the urgency of ensuring every person who lives in the United States has access to affordable, high-quality health care. 

In particular, we need to expand Medicaid and subsidies on the Exchange to ensure access for people who will lose their job and their health insurance along with it. We need to ensure the people on the front lines of providing health care have decent pay and benefits, along with ample supplies for treatment and personal protection. And we need both our federal and state governments to do far more to stop profiteering throughout the health care system and control costs.

Read our latest report, “Health Coverage in Washington State,” to learn more about our state’s health care system – the gaps, the disparities, and the solutions – which can guide our road map towards health equity. 

Today, as we honor the most sweeping health care reform in the history of the United States, access to health care has never been more vital. Can we afford it, some may ask? With a global pandemic on our hands, we can’t afford not to.