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How the Affordable Care Act (ACA) Impacts LGBTQ+ Folks

Understanding the Affordable Care Act (ACA)

How the Affordable Care Act (ACA) Impacts LGBTQ+ Folks

The healthcare landscape in the United States has undergone significant transformations over the years, with the implementation of various healthcare reform measures. One such reform is the Affordable Care Act (ACA), also known as Obamacare.

The ACA also includes provisions that address mental health, such as the expansion of mental health and substance use disorder benefits and parity protections for mental health and substance use disorder benefits in health plans.

The ACA protects LGBTQ+ individuals as well, by prohibiting discrimination against them in the healthcare marketplace and providing them with access to the same health care services as everyone else. In this blog post, we will delve into what the ACA is, its key provisions, and its impact on LGBTQ+ individuals and the healthcare industry as a whole.

What is the Affordable Care Act (ACA)?

In March 2010, then-President Barack Obama signed into law the Affordable Care Act (ACA). It includes several healthcare policies designed to expand access to health insurance for millions of uninsured Americans.

Health insurance exchanges were created under the law, Medicaid eligibility was expanded, and pre-existing conditions could not be denied coverage.

Understanding the Affordable Care Act (ACA)

The Affordable Care Act aimed to expand access to quality healthcare while controlling costs. Its main objectives were to provide affordable health insurance coverage for all Americans, enhance the quality and affordability of healthcare, and reduce the overall growth of healthcare spending. It allowed states to expand Medicaid eligibility, create health insurance exchanges, and provide subsidies to help people purchase insurance. It also required insurance companies to cover pre-existing conditions and set minimum coverage standards. For instance, the ACA prohibited insurance companies from denying coverage to individuals with pre-existing conditions, allowing more people to access the necessary healthcare.

Key Provisions of the ACA

1. Individual Mandate: One of the central provisions of the ACA was the individual mandate, which required most Americans to have health insurance coverage or face a penalty. This provision aimed to increase the number of insured individuals, ensuring that everyone had access to necessary healthcare services. The individual mandate was intended to incentivize people to purchase health insurance by requiring them to pay a penalty if they failed to do so. As a result, it would help to spread out the cost of healthcare among more people, making it more affordable for those who need it.

2. Health Insurance Marketplaces: The ACA established state-based health insurance marketplaces, aka, exchanges, where individuals and small businesses could compare and buy health insurance plans. These marketplaces offered various coverage options, giving individuals choices that best suited their needs and budgets.

3. Medicaid Expansion: The ACA expanded Medicaid eligibility to cover more low-income individuals and families. This provision aimed to bridge the gap in healthcare coverage for those who couldn’t afford private insurance but didn’t qualify for Medicaid under previous criteria.

4. Essential Health Benefits: Under the ACA, health insurance plans were required to cover ten essential health benefits, including preventive services, prescription drugs, maternity care, mental health and substance abuse treatment, and more. As a result, it ensured that individuals had access to comprehensive coverage.

5. Pre-existing Condition Coverage: Before the ACA, individuals with pre-existing conditions often faced difficulties obtaining health insurance or were charged significantly higher premiums. The ACA prohibited insurance companies from denying coverage or charging higher rates based on pre-existing conditions, providing greater access to insurance for those who needed it most.

Impact of the ACA

The Affordable Care Act has profoundly impacted the healthcare landscape since its implementation. Some of its notable effects include:

1. Increased Insurance Coverage: The ACA significantly reduced the uninsured rate across the country. Millions of previously uninsured individuals gained access to affordable health insurance through the marketplaces and Medicaid expansion. As a result, more individuals have been accessing health services and receiving preventive care and treatments that they may not have been able to afford before. The ACA also ensured that individuals could not be denied coverage based on pre-existing conditions, allowing more individuals access to the care they need.
2. Improved Access to Preventive Care: The ACA emphasized preventive care, ensuring that health insurance plans covered preventive services, such as vaccinations, screenings, and wellness visits, without cost-sharing. This focus on prevention aimed to improve overall population health and reduce healthcare costs in the long run.
3. Cost Containment Efforts: The ACA introduced various measures to control healthcare costs, such as promoting value-based care, encouraging electronic health records, and implementing payment reforms. While the long-term impact of these cost-containment efforts is still being evaluated, some studies suggest that healthcare spending growth has slowed since the ACA’s implementation.

Updates to the Affordable Care Act

In 2016, Donald Trump launched efforts to repeal and replace the Affordable Care Act following his election, stating that “any provision or requirement of the [Patient Protection and Affordable Care] Act that would impose a fiscal burden on any State should not be implemented.” 10
Due to the Tax Cuts and Jobs Act (TCJA), individuals will no longer have to pay a penalty for not having health insurance, and the outreach program will be substantially scaled back, cutting the enrollment period in half. A Kaiser Family Foundation report found that by 2018, Americans covered under the ACA had dropped from 17.4 million to 13.8 million.

In 2021, President Biden signed an executive order about the “rules and other policies that limit Americans’ access to health care,” requiring federal agencies to examine five areas, including pre-existing conditions, policies undermining the Health Insurance Marketplace, enrollment roadblocks, and affordability. ACA subsidies were extended to those purchasing health coverage on the Marketplace with incomes exceeding 400% of poverty after COVID-19 relief legislation.

After Biden signed the Inflation Reduction Act into law on Aug. 16, 2022, financial assistance for people enrolled in the ACA will be extended through 2025 rather than 2022. It also expands eligibility for premium assistance, making it available to more middle-class Americans. In both the House and Senate, the legislation passed.

The ACA and LGBTQ+ People

The ACA has had a significant impact on the LGBTQ+ community, providing access to a wide range of health insurance options and protections. These include the prohibition of discrimination on the basis of sexual orientation or gender identity, coverage of preventive services without cost-sharing, and the ban on pre-existing condition exclusions.

These protections have allowed for better access to health care for LGBTQ+ individuals, and have increased their ability to receive necessary medical care. The ACA has enabled millions of Americans to gain health care coverage and improved their quality of life.


The Affordable Care Act represents a significant milestone in healthcare reform, aiming to increase access to affordable health insurance coverage and improve the quality and affordability of healthcare services. While it has faced both praise and criticism, the ACA has undeniably played a crucial role in reshaping the healthcare landscape in the United States. As we navigate the complexities of our healthcare system, understanding the ACA and its provisions is essential for individuals and policymakers alike.

For more information about insurance and other medical coverage, follow our Lifestyle Guide at LGBTQ and ALL.

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