Whether you support the Affordable Care Act, commonly known as Obamacare, or not, there is no doubt the 2010 law has drastically changed health care in the U.S.  Since its passage under President Barack Obama, the ACA has helped insure 20 million more Americans, providing a financial safety net in the case of a medical emergency, broadening access to preventive care, and granting greater access to prescription medications.

The Affordable Care Act accomplished this by using a dual approach. On the one hand, the federal government offered to pay for all or some of the costs of new enrollees in Medicaid if state government loosened eligibility rules including raising maximum income from 100 percent to 133 percent of the federal poverty level. This expansion of Medicaid helped insure 15 million lower income Americans who had previously gone without coverage.

The other component of the Affordable Care Act is the establishment of the private insurance exchanges in every jurisdiction in the country. Private citizens and businesses could purchase health coverage from private insurers on the exchanges. For the first time, the federal government was also offering tax credits to eligible applicants that could cut monthly premiums by hundreds of dollars a month.

How States Benefited from the Affordable Care Act

There are many obvious reasons why state governments overtly or surreptitiously support the Affordable Care Act.  The most blatant reason is that it relieves some of the financial burden off of state budgets.  In the first year of Medicaid expansion, the federal government pays 100 percent of benefits of new enrollees, gradually lowering this over time.

States are financially benefitted in other ways as well.  By enrolling more people in a health plan, fewer people who visit a hospital or doctor are uninsured.  This helps keep medical businesses financially solvent which in turn allows them to hire more workers that pay local taxes, a key revenue stream for states.

Health insurance also maintains the financial wellbeing of families. Millions more who might have gone without insurance can now face a serious medical issue without losing their home, savings or source of income. Without the Affordable Care Act, there could be thousands more cases of bankruptcy in communities across the nation, disrupting local economies and sparking recessions.

Another important benefit for states is a healthier population.  With accessible health care, more people can avoid serious health complications that drain personal and community resources. This enables more people to stay healthy, remain in the workforce, and contribute to the state economy.

Finally, the Affordable Care Act also provides some relief from the opioid epidemic.  The ACA requires that substance abuse treatment be included in all health plans, granting more people access to reasonably priced addiction treatment. Treatment for opioid addiction can head off much more costly emergency services, HIV treatment, and overdose fatalities. Although only one in ten opioid-addicted Americans is getting addiction treatment, many who do are only able to do so due to the financial protection afforded by the Affordable Care Act.

State Initiatives to Bolster ACA Enrollment

Given the many benefits of the Affordable Care Act for states, it is hardly surprising that states are often leading the effort to sign up people.  Whether this involves targeted marketing, pumping up premium subsidies or providing shopping tools, many states are eager to enlist more people on Obamacare.

In an age where most people get information through their PC or smart phone, it is not surprising that many state programs use digital marketing and social media to encourage ACA enrollment.  These marketing campaigns usually offer information about when to sign up and what plan options are ideal for shoppers. Last year, New York invested 7 million dollars in ads for Obamacare and boosted enrollment by 4.2 percent—a huge increase at a time when the federal government was slashing advertising and enrollment was falling nationally.

New York, Washington and Rhode Island were able to boost enrollment last year by using personalized emails, billboards, TV ads, and community outreach to raise awareness and help potential enrollees navigate the complex enrollment system.  Facebook and Twitter played key roles in reaching the public. Washington state even went so far as to open six brick-and-mortar facilities that provided personal assistance to shoppers.

These promotional campaigns can produce substantial jumps in enrollment if they focus on educating the public and directing consumers to intuitive shopping tools that make enrollment a simpler process.  The key barrier to enrollment appears to be a general misunderstanding about the Affordable Care Act programs and difficulty navigating an involved system.

Washington has innovated new programs that marry promotional campaigns with navigation and shopping tools that have helped boost Obamacare enrollment by 7.8 percent in the past year. One of the most powerful tools they have implemented is Smart PlanFind which guides applicants to the ideal plan based on their prescriptions, personal physicians and number of annual doctor visits.

The Future of the Affordable Care Act

Obamacare has endured numerous political and legal attacks in the past few years, but it remains the law of the land. Although components like the individual mandate (the penalty for not being insured) and cost-sharing subsidies have been repealed or undercut, the Affordable Care Act is likely to remain a part of U.S. health care for the foreseeable future.

The current administration and possibly others that follow could renew attempts to repeal the law, but with a majority of Americans now in favor of it, it would likely take an all-out effort on the part of the government that would likely come with an enormous political cost.

Even if the federal government repealed the Affordable Care Act, there is no guarantee that states wouldn’t create their own versions. In the wake of certain actions that undercut the viability of the ACA, some states took action to prop up the program.

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