Dear Affordable Care Act, or ACA as they call you,

On a chilly March Tuesday in Washington, DC, with the stroke of just 22 pens, health care as we know it in the United States was changed, and you were officially signed into law. Nine years later, and not without certain strife, you are still law, and continue to provide greater access to health insurance and health care to Americans across the country.

For your ninth birthday, we want to give thanks for the gifts you’ve given us over the years.

You make us feel essential

You have a list of benefits, or Essential Health Benefits (EHBs) that are required to be covered by every major medical insurer in order to be considered a qualified health plan. Before you, many insurance plans left out important and costly health services like mental health treatment, maternity care, and prescription drug coverage. This left consumers on the hook for high medical bills for health care services that are often unavoidable.

You don’t discriminate

You’ve stopped major medical insurance plans from charging higher premiums or denying applications based on pre-existing medical conditions like pregnancy or unavoidable chronic conditions. Can you believe we used to buy major medical insurance that could deny cancer care due to a tumor you did not know you had? 

You don’t mind if we depend on our parents a little while longer

Young adults had an uninsured rate of 29 percent in 2010, the year that you gave children the right to stay on their parents’ plan until they were 26 years old. This, coupled with other provisions, dropped the young adult uninsured rate from 29 percent to 16.4 percent in 2015, a 45 percent decrease. If that’s not love, I don’t know what is.

You give us some extra cash when we need it

You introduced income-based tax credits and out of pocket cost assistance, helping to alleviate the financial burden of maintaining health insurance on individuals and families. With 84 percent of all exchange enrollees receiving a tax credit, there’s no question that premium tax credits (PTCs) and cost-sharing reductions (CSRs) are critical for consumers, many of whom could not afford insurance before.

Additionally, you implemented caps on out-of-pocket costs for those of us with employer-sponsored insurance (ESI) as well. Now, if we have a serious medical event or a high-cost condition, we have peace of mind we won’t be bankrupted in the process. Thanks for watching out for us.

Your love has no (annual) limit

Before you, consumers used to run out of insurance. Yes. Before 2010, plans could set a lifetime or annual limit on benefits. That meant, even though someone paid their premiums for the whole year, an insurance plan could stop paying out at the exact time people needed coverage the most: during a traumatic medical event, management of an expensive chronic illness, or a problematic birth. At the time the ACA passed, between 20,000-25,000 Americans covered under ESI had reached their annual limits, on the hook for financially ruinous medical bills. A small provision, but a huge protection. Our pockets are fuller, and so are our hearts.

Your love expands like Medicaid

Medicaid expansion changed the lives of many people who, at one point, may have thought health insurance was something unattainable. The federal government offered to assist states in expanding their Medicaid program to all individuals under 138 percent of the federal poverty line, closing a gap between traditional Medicaid programs and the baseline for premium subsidies (the federal poverty line). So far, 37 states and Washington, DC have opted to expand their programs in some way, extending health coverage to 12 million Americans. If the remaining states opted to expand Medicaid, 45 percent of the remaining uninsured could gain comprehensive health coverage.

In conclusion, ACA, you make us warm and fuzzy inside (in a healthy way). We appreciate you and everything you’ve done for us since March 23, 2010! Happy Birthday!