Even after about a decade of becoming law, the Affordable Care Act remains a rather hotly debated law. This debate has been ongoing between Democrats and Republicans. However, a debate has also been brewing during the decade since the ACA became law within the Democratic Party itself. Specifically, many progressives within the Democratic Party don’t believe that the ACA has been as successful as was possible.
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ACA as a Step Towards a Single Payer System
A notable cohort of progressives or liberals had reservations about supporting the enactment of the ACA in 2009 when the legislation was being debated in Congress. This specific cohort ultimately “got on board” and supported ACA because they believed that the legislation would prove to be a stepping stone or intermediate step to a single-payer system. Single-payer is also commonly called “Medicare for all.”
Medicare for all has not come to pass. Many progressives or liberals who ended up initially supporting ACA believed that a single-payer system would be in place by this juncture in time. Because this hasn’t come to pass, this segment of people on the progressive or liberal side of the political spectrum does not believe ACA has been as successful as they hoped.
ACA as a Step Towards a Public Option
Another notable cohort of progressives of liberals fought hard from the ACA to include a public option. A public option would have allowed a consumer to select what essentially would be a government option for his or her health insurance coverage.
A public option was a part of the ACA debate in 2009. With that said, President Barack Obama ultimately declined to support or push a public option in his healthcare and health insurance reform legislation. This reality left a good number of progressives or liberals believing from day one that the ACA was not as helpful of a healthcare and health insurance reform than it could have been with a public option.
Gaps in ACA as a Result of Failure of Some States to Expand Medicaid
Another reason why some progressives or liberals believe that the ACA isn’t as successful as was possible is because individual states that the legal ability to forgo expanding Medicaid. The reality is that for the ACA to be fully effective, individual states needed to get on board and expand Medicaid availability.
As of the fall of 2019, 14 states have not expanded Medicaid, according to the Kaiser Family Foundation. As a consequence, a notable segment of the U.S. population is not able to enjoy the benefits provided by the ACA.
Progressives and liberals continue to push for an expansion of ACA or a movement from the ACA to an alternative that includes a public option or to a single-payer system. At the same time, conservatives continue to attempt to limit the application of the ACA or even eliminate the law completely. Political insiders and experts that monitor healthcare and health insurance in the United States tend to think movement away the current ACA status quo is most likely to occur when both Houses of Congress and the presidency are controlled by the same party.