ACA vs Single Health Insurance_ A Complete Comparison by policyian
                     ACA vs Single Health Insurance
A Complete Comparison
Single-Payer 
Affordable Care Act
System
Incremental Reform
Universal Coverage
 November 20, 2025 www.policyian.com

Introduction to Healthcare Models
The United States employs two distinct approaches to healthcare provision, each with unique principles and 
implementations.
Affordable Care Act (ACA) Single health insurance
Market-based reform building upon existing insurance Universal coverage model financed by government
system
Single public authority pays for all healthcare services
Expands coverage through subsidies and Medicaid 
Eliminates private health insurance for essential benefits
expansion
Typically covers all medically necessary services
Maintains multi-payer structure with private insurance
Individual and employer mandates to increase coverage
Core Distinction
The fundamental difference lies in approach: ACA reforms the existing system while a single-payer model replaces the multi-payer 
structure with universal coverage.
2/10
The Affordable Care Act (ACA) - Core Principles
Enacted in March 2010, the ACA was designed with three primary goals to reform the U.S. healthcare system:
Making Insurance Expanding Medicaid Supporting Innovation
Affordable
The law aimed to expand Medicaid The ACA seeks to foster new 
The ACA provides subsidies, specifically eligibility to cover all adults with approaches to healthcare delivery that 
premium tax credits, to individuals and incomes below 138% of the federal are designed to reduce overall 
households with incomes between poverty level. However, not all states healthcare costs while improving 
100% and 400% of the federal poverty have adopted this expansion. quality and coordination of care.
level to help lower the cost of health 
insurance premiums.  Key feature: Medicaid expansion varies  Key feature: Incentives for Accountable 
by state, creating uneven coverage Care Organizations and value-based care 
access across the U.S. models.
 Key feature: Income-based premium tax 
credits make coverage more affordable 
for middle-class families.
These three principles work together to increase access to affordable healthcare coverage and improve the efficiency of the healthcare system. 3/10
How the ACA Works - Marketplace and Financial 
Assistance
Health Insurance Marketplace Metal Tiers
An organized platform for individuals and families to shop for Plans are categorized into "metal tiers" based on the percentage 
health insurance plans. of healthcare costs they cover:
Offers certified health plans from private insurers Plan Tier Monthly Out-of-Pocket Covered 
Provides tools for comparison shopping Premiums Costs Costs
Assists consumers in understanding options
Can be operated by states or the federal government Bronze Lowest Highest 60%
Silver Moderate Moderate 70%
Gold Higher Lower 80%
Financial Assistance
Platinum Highest Lowest 90%
Premium Tax Credits
Subsidies to lower monthly premium costs for households with incomes 
between 100% and 400% of the FPL.  Catastrophic plans are available for individuals under 30 or those with 
hardship exemptions.
Cost-Sharing Reductions
Reduces out-of-pocket expenses for households with incomes between 
100% and 250% of the FPL who enroll in Silver plans.
4/10
ACA Impact and Performance
 Coverage Expansion Achievements
Uninsured Rate Reduction
The ACA has significantly expanded health insurance coverage since 
its implementation in 2010.
Uninsured Rate Total Enrollment
Decreased from
7.7% 45+ million16% ACA-related insurance plans 
Rate in late 2023 In 2010 (early 2024)
Marketplace Medicaid Expansion
Coverage Gains by Demographics
20.5 million 18.6 million
Largest gains among poor and near-poor individuals, 
Consumers enrolled (February Newly eligible adults enrolled 
particularly adults
2024) (Sept 2023)
People of color experienced larger reductions in uninsured 
rates compared to White individuals (2013-2016)
Medicaid expansion showed the greatest coverage gains 
among newly eligible adults
5/10
Single-Payer System - Core Principles
A single-payer healthcare system features a universal model where a single public authority finances healthcare 
services for all residents.
Universal Coverage Single Financing Source Comprehensive Benefits
Guarantees health coverage for all Government collects all healthcare funds Provides a broad range of medically 
residents, irrespective of income, through taxes and acts as the sole payer necessary services, including preventive 
employment status, or health conditions. for services. care, hospitalizations, and prescription 
drugs.
Elimination of Cost- Price Regulation Administrative Efficiency
Sharing
Leveraging market power to negotiate Reduces administrative overhead by 
Removes deductibles, copayments, and and set prices for healthcare services, simplifying billing and claims processes 
coinsurance for covered services, equipment, and prescription drugs. associated with multiple insurers.
reducing financial barriers to care.
6/10
How Single-Payer Works - Funding and International 
Examples
Tax-Based Financing International Examples
Healthcare funded through general tax revenues
Canada United Kingdom
Eliminates private insurance premiums
• Structure: Public financing, private • Structure: Government-owned, 
Administrative Efficiency delivery public service
• Funding: Provincial taxes (70% • Funding: General tax revenue
Current System Single-Payer government-funded) • Healthcare: 9.7% of GDP
•
15-20% 2-5% Healthcare: 10.0% of GDP • Life Expectancy: 81.7 years
Administrative Costs Administrative Costs • Life Expectancy: 82.3 years
Healthcare Spending (% GDP)
7/10
Coverage and Access Comparison
ACA Coverage Single-Payer Coverage
Targeted Expansion Universal Coverage
Aims to expand coverage to more people through subsidies Guarantees health coverage for all residents, eliminating 
and Medicaid expansion. coverage gaps.
Pre-existing Conditions Pre-existing Conditions
Protections against denial of coverage based on health status. Comprehensive protections ensuring access regardless of 
health status.
Coverage Gaps Comprehensive Benefits
Approximately 7.7% remain uninsured .5 mr-2" style="color: Coverage for dental, vision, and long-
#FF7F50;">
Medicaid expansion gap in non-participating states term care
Elimination of cost-sharing for essential services
Key Difference
While ACA seeks to expand coverage through subsidies and Medicaid expansion, a single-payer system would provide universal coverage, 
ensuring access to healthcare for all residents.
8/10
Cost Analysis and Administrative Efficiency
 Administrative Efficiency  Individual Cost Differences
ACA Individual Single-Payer 
Costs Individual Costs
Monthly premiums No premiums (tax-
subsidies for eligible based financing)
individuals
Eliminated deductibles 
Deductibles (Bronze for covered services
plans ~$5,300 average)
Minimal or no 
Administrative costs as percentage of total healthcare costs Copayments & copayments for most 
coinsurance for services services
Key Efficiency Factors
ACA: Multiple insurance plans lead to complex billing and Cost-Shifting Implications
management Single-payer systems shift from direct patient payments to tax 
Single-payer: Simplified billing and elimination of private financing, simplifying costs at the point of care while potentially 
insurance overhead increasing overall tax contributions based on income.
9/10
Key Takeaways and Future Considerations
Fundamental Distinction
The ACA represents an incremental reform building upon the existing mixed public-private insurance market, while a 
single-payer system advocates for a complete overhaul, replacing the multi-payer structure with universal coverage.
ACA Reform Approach Single-Payer Transformation
Expanded coverage through subsidies and Medicaid Universal coverage for all residents regardless of status
expansion Single government payer replaces private insurance
Maintained private insurance as primary provider Streamlined administration (2-5% overhead)
Multi-payer administrative complexity (15-20% overhead) Requires significant upfront funding mechanism
Remained vulnerable to market fluctuations
Future Considerations
 The choice between these approaches reflects broader questions  Success depends on political feasibility, economic factors, and 
about the role of government, market forces, and individual evolving healthcare needs of the population.
responsibility in healthcare provision.
10/10