How did the Affordable Care Act aim to expand coverage, and what mechanisms did it use?

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Expanding coverage under the ACA relied on a mix of public program expansion and private-market reforms paired with strong consumer protections. Medicaid expansion opened eligibility to more low‑income individuals in states that chose to participate, broadening public coverage. Health insurance exchanges (marketplaces) were created to offer plans with subsidies for individuals and families with modest incomes, making private coverage more affordable. The individual mandate was designed to encourage enrollment across the risk pool, helping to prevent adverse selection, with penalties tied to tax filings (the federal penalty was repealed in 2019). The law also prohibited denying coverage due to health status by requiring guaranteed issue and using community rating to prevent price discrimination. Finally, it set a floor of covered services by requiring essential health benefits, ensuring that plans provide a baseline of important care. Together, these mechanisms aimed to reduce the uninsured rate by widening access, subsidizing private coverage, and strengthening protections for people with health conditions.