When the Affordable Care Act (ACA) was signed into law fourteen years ago, it transformed health care in America by making quality, affordable care a reality for millions of people. Despite the ACA’s progress, longstanding inequities within the U.S. health system persist, and the cost of care continues to increase, especially for systemically excluded communities dealing with significantly worse health outcomes and experiences in care.

The ACA has had a profound impact on Black and Latinx communities who, for generations, were denied access to care due to structural barriers rooted in racism and economic inequality. It stands as one of the most significant health policies in a generation, prioritizing people over profit, investing in preventive care, and reducing racial and economic disparities in access to care.

Yet despite its broad popularity and the substantial improvements it delivered, Republicans have attempted to repeal the ACA more than 50 times, coming closest in 2017 during the first Trump administration with a Republican-controlled Congress.

A Shift in Tactics: From Repeal to Dismantling

With Donald Trump re-elected and Republicans once again controlling Congress, we are facing a renewed threat to the ACA and the health justice gains it represents. Extremist politicians who oppose health justice are now empowered to put our access to health care at significant risk.

While Community Catalyst and a broad movement of partners successfully mobilized to defend the ACA previously, our opponents have adapted. Instead of outright repeal, they are now pursuing a piecemeal approach that is just as harmful. Their Project 2025 plan outlines a radical vision to dismantle nearly every element of our health care system and prioritizes profits over people. The result? Higher costs, deeper medical debt, and restricted access to essential care.

The plan threatens to gut the Medicaid program, impose burdensome work requirements for those with Medicaid, eliminate tax credits that make marketplace plans affordable for so many, and strip access to gender-affirming care for LGBTQ+ people and sexual, reproductive, and maternal health care. The impact will be devastating—especially for communities of color, working-class families, and those who are already marginalized by systems that discriminate based on race, income, immigration status, gender identity, age, or disability.

In particular, not extending enhanced premium tax credits will lead to massive tax increases for families with low- and middle-incomes. And it is clear that these devastating increases will happen while Republicans focus on tax breaks for the wealthy and corporations.

Whether through a strategy of outright repeal or “death by a thousand cuts,” we know they will try again. And that makes this ACA open enrollment period unlike any we’ve seen before.

The ACA has expanded coverage to 20 million people, driven the uninsurance rate to an all-time low, and set a new standard for protections—like ensuring people with pre-existing conditions can’t be denied coverage and providing preventive care without copays or deductibles. This year, for the first time ever, DACA recipients can enroll in marketplace plans, a long overdue step toward health equity.

For people like Jason, who used his ACA coverage to afford cancer treatment and continues to use the affordable coverage he gets from enhanced premium tax credits for ongoing screening and care, the ACA has been a lifesaver.

Video still of Jason answering the question "how has having affordable health insurance helped you? Jason is wearing in
Meet Jason, a Philadelphia-based freelance illustrator whose life changed dramatically when he was diagnosed with thyroid cancer at age 33. Thanks to premium tax credits, he was able to upgrade from a basic bronze plan to silver coverage – a decision that proved life-saving. Now he advocates for extending these credits to ensure others don’t face the impossible choice between life-saving care and financial ruin.

We must not forget that before the ACA, being a victim of domestic violence was considered a pre-existing condition in eight states—a reason to deny coverage. Weakening or dismantling the ACA would turn back the clock, exacerbating racial and economic inequities, worsening health outcomes, and leaving millions—particularly women, communities of color, and families with low incomes—facing higher costs and fewer options.

United on the Frontlines: Protecting Health as a Right

We believe in a vision for health where everyone—regardless of race, gender, zip code, or income—can access the care they want and deserve. That’s why we are doubling down on protecting the ACA and Medicaid, and why we’re committed to expanding Essential Health Benefits, lowering costs by making enhanced Premium Tax Credits permanent, protecting access to reproductive care, and pushing for Medicaid expansion in the 10 holdout states.

We are not naive about the challenges ahead. The incoming administration has made clear its intention to strip away critical protections, which will only worsen the medical debt crisis—a crisis that already impacts 4 in 10 adults. But we also know that stripping away life-saving protections will only accelerate the suffering of those already facing health disparities.

As we enter this pivotal open enrollment period, we must be vigilant in defending the gains made by the ACA. But we cannot stop there. We must move forward, expanding access and lowering costs so that every person can access the care they need. We’re not just playing defense; we’re building power for a health system that puts people over profits and fights the growing and harmful influence of private equity in health care.

Health care is not a luxury—it’s a right. And we cannot allow extremist politicians and special interest groups to take us back to a time when only the wealthiest could afford it. When health care is comprehensive, accessible, and affordable for all, we all benefit as a society.

The fight for the ACA is about more than just policy—it’s about people. We must unite across race and class to challenge those who seek to divide us and weaken our health care system. The efforts to dismantle the ACA are part of a broader strategy to concentrate power among the wealthy few, at the expense of everyday people. But when we stand together, we can build a future where health is a right for all.

As the leaders of Community Catalyst declared immediately after the 2024 election:

“We remain unwavering in our commitment to defending the progress made in advancing race equity and health justice. Together with our partners, we will harness the power within our communities to unite towards a future where health is a right for all. This is not a sprint, but a marathon, and it requires a broader movement to fight against harm while setting the stage for future progress.”

Our resolve for a health system rooted in race equity and health justice has never been stronger. We are here to ensure that this ACA enrollment period is not the last.

Your Role in This Movement

As we collectively support and uplift open enrollment, let’s not lose sight of what’s at stake. Together, we will defend the progress made, resist efforts to roll back protections, and push forward toward a system that serves all of us. Because health care is not just a policy—it’s a right.

The movement for health justice needs you now more than ever. What is motivating you in this very moment?