The ACA@15 - Tracking Prior and Emerging Results since its Inception

March 2025

Authors

Sam Bertoch, FSA, MAAA
Consulting Actuary
Milliman

Fritz Busch, FSA, MAAA
Principal and Consulting Actuary
Milliman

Jason Karcher, FSA, MAAA
Consulting Actuary
Milliman

Lindsy Kotecki, FSA, MAAA
Principal and Consulting Actuary
Milliman

Jeff Milton-Hall, FSA, MAAA
Principal and Consulting Actuary
Milliman

Executive Summary

This report builds on the original headline market indicators from the previous ACA@10 research to evaluate the full history of the ACA’s effectiveness relative to its stated goals. This report analyzes the three goals of the ACA and evaluates the successes and failures of the ACA during different time periods that reflected changes in the legislative, regulatory, and marketplace environments. The goals of the ACA as represented in the report are listed below.:

  • Reduce the Uninsured Rate. This ACA goal focused on decreasing the proportion of the population that was not enrolled in comprehensive health insurance coverage. The report helps to identify the main causes of change in the uninsured population.
  • Increase Insurer Competition. This ACA goal focused on ensuring adequate choice of insurance companies offering comprehensive, ACA-compliant coverage in the individual exchange markets to provide flexibility to consumers in search of health insurance.
  • Affordable Coverage. Provide premium stability in the form of low or moderate premiums, annual premium changes and out of pocket medical costs to consumers in the individual market.

The research into these measures creates a time series of data that provides insights into the factors driving these market indicators and examines the successes and shortfalls of the ACA from an actuarial perspective.

Materials

The ACA@15

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