In this video Achilles Natsis discusses The ACA@15 report from the Society of Actuaries Research Institute which evaluates the Affordable Care Act’s 15-year performance against three core goals: reducing the uninsured rate, increasing insurer competition, and providing affordable coverage. It finds that the uninsured rate declined significantly from 17% in 2013 to about 10% in 2024, driven primarily by Medicaid expansion, enhanced exchange subsidies, and pandemic-era policies, though recent Medicaid disenrollments led to a slight uptick. Insurer participation initially surged, then dropped sharply due to financial losses and policy uncertainty, before rebounding after 2018 as market conditions stabilized and enrollment grew. Affordability worsened during periods of sharp premium increases but improved over time through reinsurance programs and enhanced federal subsidies, resulting in relatively stable premiums below inflation from 2018 to 2024. Overall, the ACA shows its strongest success in reducing the uninsured rate, with marketplace stability and affordability often dependent on subsequent policy interventions.
Contributors: Achilles Natsis, FSA, MAAA, FLMI; Rose Northon, Eric Miller, FSA, MAAA; Jon Forster, ASA, MAAA
