Ten years ago today, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. This ACA anniversary arrives in the middle of a global pandemic, with the number of people infected by COVID-19 continuing to soar. The spread of the virus across the United States is testing an already strained healthcare infrastructure, with many worrying about the cost of care arising from testing and treatment.

A December 2019 report from Kaiser Health News found that the number of uninsured people decreased between 2010 and 2016, after which the number began rising again. Those who are uninsured are likely to be “in low-income families and have at least one worker in the family,” according to the report. Uninsured individuals are also disproportionately people of color.

In recent days, nine states reopened ACA enrollment to provide residents an opportunity to sign up for health care amid concerns about the spread of the coronavirus. On Sunday, Michigan Gov. Gretchen Whitmer urged the Trump administration to reopen enrollment. Generally, special enrollment periods are triggered by qualifying events such as unemployment, birth, adoption of a child, or change in marital status. It is still unclear whether states without Medicaid expansion will struggle as COVID-19 cases rise.

Over the past decade, the ACA has been challenged by Republicans every step of the way through its passage and numerous legal maneuvers. Previously, the ACA withstood a legal challenge when the Supreme Court identified the individual mandate as a tax within the federal government’s recognized powers. In 2017, the Trump administration’s tax plan reduced the individual mandate to $0. Now, opponents who seek to overturn the ACA say that it is no longer a valid tax and is therefore unconstitutional.

Many Americans favor the individual component reforms within the ACA and directly benefit from them. Despite her staunch opposition to the ACA, conservative commentator Tomi Lahren acknowledged in 2017 she was still on her parents’ health insurance. At the time, Lahren’s age allowed her to remain on the plan due to the ACA expanding dependent coverage until age 26.

Today, the ACA continues to represent a crisis in narrative control for its proponents. The term “Obamacare,” which was coined in 2007 and made popular by Mitt Romney, is still used today. As a candidate for Kentucky governor, Matt Bevin railed against the ACA, favoring shutting down the state health care exchange and rolling back Medicaid expansion. Kentucky was often touted as an ACA “success story,” with many of the people who supported Bevin greatly benefiting from the plan. Many were unaware that Bevin’s positions would undo their health care down the line.

This term, the United States Supreme Court will hearCalifornia v. Texas/United States House of Representative v. Texas, two consolidated cases that could have broad implications on many crucial reforms to the healthcare system such as:  

• Protections for pre-existing conditions

• Dependent coverage until age 26

• Gender parity in insurance coverage

• Medicaid expansion

The cases have SCOTUS once again reviewing the constitutionality of the ACA. A federal judge in Texas invalidated the individual mandate and determined the mandate was not severable from the remainder of the law, thus invalidating the entire law. However, in 10 years of actively opposing and trying to overturn the ACA, opponents have failed to provide viable alternatives that would improve health care access and not worsen it.

The current public health crisis could bring Medicare for All closer to reality, with 41% of American adults recently polled indicating they were more likely to support universal healthcare as a result of the coronavirus pandemic. While health care advocates have differing opinions on what mechanism should be employed to provide coverage to individuals and their families, there is a clear difference between those who are determined to undo the ACA with no clear recourse for people, and those who seek to improve the continued gaps in coverage and access.