Bill from Colorado, after reading last week’s Tip which noted the anniversary of the Affordable Care Act, asked if I’d share my “perspective on the ACA, now that it’s been in effect for several years.”

A few thoughts.

Has the employer mandate changed the percentage of businesses offering coverage?

No.

In 2024, as in years past, 54% of all employers offered some health benefits. Large firms (200 or more workers) are much more likely than small firms to offer coverage; 98% vs 53%.

Arguably, the ACA’s biggest impact has been in reducing the number of uninsured, from about 15% of Americans in 2010 to 8% today.

Credit the Health Insurance Marketplace – offering coverage to individuals under age 65, not covered by an employer sponsored plan – for this result.

Of the 21 million people enrolled, 91% have received a substantial advance premium tax credit, resulting in an average net monthly premium of just $124.

Then, there’s this.

As reported by the Centers for Medicare and Medicaid Services (CMS); national health spending totaled $74.1 billion in 1970, $1.3 trillion in 2000 (12.6% of GDP) and had tripled to $4.5 trillion in 2022 (17.5% of GDP).

Back at you, Bill.