Since the passage of the Affordable Care Act, the country has made amazing progress toward reducing the number of uninsured people, aided most recently by the Inflation Reduction Act’s continuation of enhanced premium subsidies. Census data show that 9.2% of U.S. residents were uninsured in 2019, compared to 15.5% in 2010 when the ACA passed. However, 30 million people still lack coverage.

The reasons for the high number of uninsured individuals include the Medicaid Gap, the family glitch and other barriers that prevent eligible individuals from signing up for coverage.Yet policy debates often exclude a population that is systematically and often statutorily excluded from coverage: immigrants.


During the early days of the Affordable Care Act (and again during the insane "Repeal/Replace" saga of 2017), one of the dumbest and most disingenuous talking points of Republicans was to attack the ACA for being "too long."

I'm quite serious...many Very Serious Conservatives stroked their beards and wrung their hands over the sheer length of the ACA's legislative text (officially around 2,700 pages, though if you includ the mountain of regulations which are included with any major bill impacting hundreds of millions of people it could theoretically be tracked at 20,000 pages or so).

This silliness was most clearly expressed by Donald "Who?" Trump's first press secretary, Sean Spicer, who infamously put a copy of the House Republican's "replacement plan" (the AHCA) next to a copy of the ACA itself and cited the difference in pages between the two as some sort of "proof" that the AHCA was "better" for reasons unknown.

Anyway, the AHCA, Sean Spicer and Donald Trump are now gone, good riddance.