At 5 Years Old, the ACA Is Succeeding at What It’s Meant to Do: Lower the Uninsured Rate for All

Charles D. Ellison
President Barack Obama speaks at an event marking the fifth anniversary of the Affordable Care Act March 25, 2015, in Washington, D.C.
Jim Watson/AFP/Getty Images

Ready to have that other-than-March Madness, watercooler conversation on the fifth anniversary of the Affordable Care Act? Get your pen and pad ready, because the results are in: What you probably know better by the name “Obamacare” is actually working.

It’s not perfect; nor is its implementation near complete. But as President Barack Obama’s grandest legislative achievement—aside from, you know, preventing an economic apocalypse—hits a symbolic milestone, all signs point to a relative policymaking success.


At least that’s the message from the administration while it takes a victory lap marking passage of the health care law that changed everything from how we make a doctor’s visit to how medical records are stored. And say what you will about the ugly political divide from five years of sour partisan grapes, but the data suggest the ACA was probably worth all the hurt feelings.

Of course, we all remember the embarrassing rollout. But, real talk, did we expect every aspect of the overhaul of the world’s most advanced health care system to go completely smoothly?

Since then—barring the base-appeasing political noise from Republicans—the evidence shows the ACA pretty much, as the folks around the way tell it, doing what it do. According to the Department of Health and Human Services, uninsured rates (pdf) have dropped by 35 percent nationwide, with more than 16 million Americans gaining health coverage since open enrollment took effect. 

Not only are we seeing a dramatic dip in the uninsured rate, but federal analysts (pdf) show we’re spending less on health care: National health expenditures rose only 1.4 percent in 2013. Mandated efficiencies in the system have also led to 50,000 fewer patient deaths from preventable issues such as infection and medication error, according to the Centers for Medicare and Medicaid Studies, with the overall patient harm index down by 17 percent.


Independent studies from think tanks like the Brookings Institution give the ACA passing grades as well. “Behind the noise and confusion, there are some major forces at work that are driving new models of care and changing the way we practice, pay for and evaluate health care,” writes Kavita Patel, Brookings’ managing director of clinical transformation. In a recent evaluation, Patel outlines five ways the ACA may have radically changed a visit to the doctor’s office.

But what’s all the ACA good news doing for people of color and other groups who need it the most?


The uninsured rate for African Americans (pdf) has dropped 41 percent since the first open enrollment period in 2013, with more than 2 million gaining coverage. For Latinos, the uninsured rate dropped 29 percent; for young adults, it’s a 40 percent drop; and for women, the uninsured rate drop was nearly 30 percentage points larger than for men. Nearly 8 million privately insured black Americans now have expanded access (pdf) to no-cost-sharing services such as Pap smears, mammograms, colon-cancer screenings, well-child visits and flu shots for all ages. More than 10 million African Americans are also no longer held back by lifetime dollar limits on their health benefits (including nearly 4 million black women) since ACA protections put a stop to that.

Assessing ACA’s impact on underserved populations is crucial in terms of further expanding their access to both affordable and quality health care, as well as improving the larger health care system for the long term. It’s no secret: Americans of color will outnumber the current majority of white Americans by 2050 or earlier. Minority births already outnumber white births, based on Pew Research figures; public school enrollment, according to the National Center for Education Statistics, is dominated by black, Latino and Asian Americans.


That partly explains, in a big way, the sense of urgency around preparing the nation’s health care system for impending demographic shifts. Even as the U.S. economy recovers and grows, populations of color are still grievously underserved. According to the Kaiser Family Foundation, the national black nonelderly uninsured rate was 17 percent in 2013—2 percentage points higher than the national average. In places like Florida, Nevada, Ohio and Texas, the black uninsured rates are 20 percent or more—and Deep South politically red states (which house more than half of the U.S. black population) like Louisiana and Texas just won’t allow sorely needed federal Medicaid expansion that would offer coverage for many uninsured African Americans.

The Urban Institute’s Lisa Clemans-Cope told The Root several months ago that “rates are going … down, especially for blacks.” But according to her December 2014 study (pdf) on the issue, “The gains are trending differentially. There is a disproportionate share of blacks that are in the eligibility gap” since 55 percent of African Americans live in states that won’t do Medicaid for one anti-Obama reason or the other.


Those snags are compounded by a two-pronged assault on the Affordable Care Act: In Congress, Republicans are attempting to bum-rush it through the budget process, while the law faces uncertainty in the Supreme Court. Worries mount over either scenario suddenly reversing positive trends. And with 2016 on the horizon, the president has less than two years to convince a politically skittish public that despite ideologically driven doubts over Obamacare, this is something perhaps too big to fail—and, as the numbers show, too good a thing to let go.

Charles D. Ellison is a veteran political strategist and a contributing editor at The Root. He is also Washington correspondent for the Philadelphia Tribune, a frequent contributor to The Hill, the weekly Washington insider for WDAS-FM in Philadelphia and host of The Ellison Report, a weekly public-affairs magazine broadcast and podcast on WEAA 88.9 FM Baltimore. Follow him on Twitter.

Share This Story

Get our newsletter