What did the ACA originally intend to do?

• A. Expand Coverage for All Residents Through Federal Subsidies
• B. Create State Health Exchanges
• C. Increase Public Healthcare Funding
• D. Expand Medicaid

Answer: (D)

The ACA’s strategy to broaden health insurance coverage centers on expanding access for those most without it, and a major lever for that goal was extending Medicaid to more low-income adults. By widening eligibility and funding most of the costs, the law aimed to pull a large segment of uninsured people into a publicly supported program, which would dramatically increase coverage. The creation of state health exchanges and the subsidies they offer are important mechanisms to help people afford private insurance, but they serve as pathways to coverage rather than the primary expansion of public coverage itself. The broader aim isn’t just to fund care, but to get more people enrolled in insurance, with Medicaid expansion being a cornerstone of that effort. It’s also worth noting that Medicaid expansion was made optional for states by a Supreme Court ruling, so how it unfolded varied by state, including in North Carolina.