Twenty million Americans are estimated to have gained coverage or enrolled in a new plan under the Affordable Care Act through the end of April 2014, according to a new report in the New England Journal of Medicine. The analysis, by Commonwealth Fund President David Blumenthal, M.D, and Vice President Sara Collins, Ph.D., looks at the gains in enrollment under different provisions of the law, including the health insurance marketplaces and premium subsidies, the expansion of dependent coverage, and the broadening of Medicaid eligibility. Their estimate of total coverage gains also takes into account the ability of people with preexisting conditions and older adults to purchase affordable coverage directly from insurers.