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Affordable Care Act Turns 10 Amid Coronavirus Outbreak


Exactly 10 years ago today, President Obama delivered this speech at the White House after the Affordable Care Act passed.


BARACK OBAMA: Today, after almost a century of trying - today, after over a year of debate - today, after all the votes have been tallied, health insurance reform becomes law in the United States of America.


KING: That was the biggest overhaul of the health care system in this country in decades. Now, 10 years later, this country is in the middle of a pandemic. So what does coronavirus mean for the Affordable Care Act and vice versa?

Larry Levitt is on the line. He's an executive vice president for health policy at the Kaiser Family Foundation. Good morning, Mr. Levitt.

LARRY LEVITT: Good morning.

KING: Let's start with the context - the short arc of history - before we focus on what's happening today. What did the Affordable Care Act accomplish?

LEVITT: Well, I'd say the biggest thing the Affordable Care Act accomplished was getting almost 20 million more people insured. And that's crucially important as we're dealing with a double whammy right now of both a public health crisis and an economic crisis.

KING: What does 20 more million people insured mean for what's going on right now with COVID-19 - with the pandemic?

LEVITT: Yeah. So you know, we're dealing with, obviously, people getting sick - an increasingly number of people getting sick, needing expensive hospital care. And having insurance means you have the peace of mind of knowing that you can get covered, that you have the economic security of knowing that you're not going to run up large medical bills. And it's really important in a public health crisis because we want to make sure that people who are feeling sick can get tested, assuming tests are available, and get care. And that protects not only them, but it protects all of us.

KING: But let's look at the flip side. I wonder, what didn't the Affordable Care Act do? What aspects of it are making it harder to deal with the coronavirus outbreak?

LEVITT: Yeah. I mean, the ACA is certainly not perfect. Many people who got insurance have big deductibles, so health care is still unaffordable. Most people get insurance through their jobs. And often, that coverage is unaffordable - either high premiums or big deductibles, as well. And the ACA really didn't help people who get insurance through their employers.

And you know, the biggest way in which the ACA got people insured was through expanding Medicaid, but the Supreme Court made the Medicaid expansion optional. And 14 states, particularly those in the South, have chosen not to expand Medicaid so far.

KING: A - high health care costs are still a big problem. The law didn't fix that, right?

LEVITT: That's right. I mean, the ACA was really centered on getting more people insured, but it largely left in place our - the health care system that existed. So that health care system is in many ways fragmented with multiple private insurance companies, with high overhead and didn't really do a lot to address the underlying cost of health care. I mean, we pay double what other countries pay. Many of those other countries are dealing with this pandemic as well, and they pay less because they pay lower prices for health care. And the ACA didn't address that.

KING: Have you heard of people who are - who would like to be tested for coronavirus but who won't because they're afraid they won't be able to pay for treatment, even if they have insurance?

LEVITT: I haven't, though that is certainly the concern. You know, once we have tests widely available, we want to make sure people get tested if they need to. The bill passed already by Congress does provide free testing for people with insurance or even if they don't have insurance. So testing is largely taken care of, the cost of testing. I think what the big concern now would be someone who's uninsured and gets sick. The treatment costs could run $20,000 or more in a hospital.

KING: Just quickly - even before the outbreak, we knew that health care was going to be a big issue going into this election. Do you think this pandemic could change the politics of health care even more as we head into the 2020 election?

LEVITT: I do. I mean, we've talked about health care a lot in the primaries. And it was going to be a big issue in the general election, as well, with President Trump supporting a lawsuit to overturn the ACA entirely. But what the coronavirus does is put health care top of mind for people. It's now a very personal issue.

KING: Larry Levitt of the Kaiser Family Foundation, thanks so much.

LEVITT: Thank you. Transcript provided by NPR, Copyright NPR.