The Affordable Care Act At Fifteen: Policy Surprises And Lessons (HealthAffairs)

On its 15th anniversary, the Affordable Care Act (ACA) has largely fulfilled its original goals of expanding coverage and controlling costs, achieving record-high health insurance rates and moderating healthcare spending. While not all policies worked as intended, the law exceeded expectations in some areas—such as the effectiveness of premium tax credits and the realization that near-universal coverage is possible without the individual mandate. Key lessons include prioritizing improvements to existing programs, extending enhanced subsidies, and simplifying policy design.