The Affordable Care Act is still law and, by several measures, bigger than ever. More than 24.3 million people selected marketplace plans during the 2025 open enrollment period, a 13% jump from the year before and an all-time record. But the ACA of 2025 looks different from the version signed in 2010. Some provisions have been strengthened, others have been gutted, and a few are hanging by a thread heading into 2026.
The Individual Mandate Is Gone
The most controversial piece of the original law, the requirement that every American carry health insurance or pay a tax penalty, was effectively eliminated at the end of 2018. Congress didn’t repeal it outright. Instead, the 2017 Tax Cuts and Jobs Act set the penalty to $0, which achieved the same result. You can still go without coverage and face no federal consequence.
Four places kept their own versions: California, Connecticut, the District of Columbia, and Maryland each enforce state-level mandates with their own penalty structures. If you live in one of those areas, going uninsured still costs you at tax time. Everywhere else, the mandate exists on paper but carries no teeth.
Record Enrollment, Driven by Subsidies
Despite losing the mandate, enrollment has surged rather than collapsed. The reason is money. Enhanced premium tax credits, first introduced as a pandemic relief measure in 2021 and extended through the Inflation Reduction Act, have cut premium payments by an estimated 44% for people who qualify. That translates to roughly $705 per year in savings for the average subsidized enrollee.
These boosted subsidies removed the old income cap that had priced middle-income earners out of financial help. Before the enhancement, a 60-year-old making $55,000 might have owed the full sticker price for a plan. Now, no one is expected to pay more than 8.5% of their income toward a benchmark silver plan. The result: enrollment nearly doubled from where it sat in 2020.
The catch is that these enhanced subsidies expire at the end of 2025. If Congress doesn’t act, subsidized enrollees in at least 12 states would see their annual premium payments double or more. The projected increases are steepest in Wyoming (195% increase, about $1,872 more per year), Alaska (125%, or $1,836), and West Virginia (133%, or $1,404). In Texas alone, 3.4 million people receiving tax credits would face an average annual increase of $456. Whether these subsidies get extended is one of the single biggest questions in health policy right now.
What Marketplace Plans Cost Today
The average benchmark silver plan, the mid-tier option that subsidies are pegged to, costs $500 per month in 2025 before any tax credits. That’s up 5.8% from $473 in 2024. Most enrollees never pay that full amount because subsidies cover the difference, but the sticker price matters: it determines how much the federal government spends and how much you’d owe if subsidies disappear.
Competition among insurers has actually improved in the individual market. The average market share of the largest insurer in each state dropped from 58% in 2013 to 53% in 2023. Both insurer participation and enrollment in the ACA marketplaces are at record highs, with companies expanding into new states and new regions within states as the subsidized customer pool has grown. More competition generally means more plan choices and better pricing for consumers.
Medicaid Expansion Reached 41 States
The ACA originally intended every state to expand Medicaid to cover adults earning up to 138% of the federal poverty level, roughly $20,800 for an individual in 2025. The Supreme Court made that optional in 2012, and for years a large block of states refused. That block has slowly shrunk. South Dakota became the most recent state to begin expansion coverage in July 2023, bringing the total to 41 states including D.C.
Ten states still have not expanded, concentrated in the Southeast: Texas, Florida, Georgia, Mississippi, Alabama, Tennessee, South Carolina, Kansas, Wisconsin (which covers adults up to 100% of the poverty level through a separate waiver), and Wyoming. Residents in those states who earn too much for traditional Medicaid but too little for marketplace subsidies fall into what’s known as the coverage gap, with limited options for affordable insurance.
Preventive Care Coverage Survived a Major Legal Challenge
One of the ACA’s most popular provisions requires insurers to cover preventive services like cancer screenings, vaccines, and contraception with no copay or deductible. A lawsuit called Braidwood Management v. Becerra challenged the constitutionality of the task force that decides which preventive services insurers must cover. A federal district court in Texas initially ruled in the plaintiffs’ favor, raising the possibility that millions of Americans would start seeing charges for services that had been free for over a decade.
On June 27, 2025, the Supreme Court ruled that the preventive services requirement is constitutional, finding that the task force members are properly appointed and that the Secretary of Health and Human Services has adequate oversight authority, including the power to remove members and block recommendations. The core requirement for no-cost preventive care remains intact.
The case isn’t entirely finished. The lower court still needs to resolve separate claims about two other advisory bodies that help determine vaccine coverage and women’s health services. But the biggest threat to free preventive care has been resolved in the law’s favor.
Protections That Remain Unchanged
Several foundational ACA provisions have survived every repeal attempt and legal challenge since 2010. Insurers still cannot deny coverage or charge higher premiums based on pre-existing conditions. Children can stay on a parent’s plan until age 26. All marketplace plans must cover a set of essential health benefits including hospitalization, prescription drugs, mental health services, and maternity care. Lifetime and annual dollar limits on coverage are still banned.
These protections apply regardless of what happens to subsidies or the mandate. They are baked into the law itself and would require an act of Congress to change. Multiple repeal efforts, most notably the 2017 “skinny repeal” that failed by a single Senate vote, attempted to undo some or all of these rules. None succeeded.
The Biggest Risk Ahead: The Subsidy Cliff
The ACA’s immediate future hinges almost entirely on what happens to enhanced subsidies before they expire in December 2025. If extended, enrollment will likely continue growing and premiums will remain manageable for most buyers. If they lapse, the Congressional Budget Office has estimated millions of people would drop coverage as costs spike, and the marketplace would return to a smaller, more expensive risk pool resembling its pre-2021 state.
The law itself isn’t going anywhere. After surviving more than a dozen repeal votes, three Supreme Court cases, and an executive branch that tried to dismantle it administratively, the ACA’s structural framework is deeply embedded in the American health insurance system. But the financial scaffolding that made it accessible to record numbers of people is temporary, and its renewal is not guaranteed.