Checking in on 14 Years of Obamacare; Part 1

Health and Gender Policy Brief #170 | By: Geoffrey Small | March 05, 2024

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March 2024 highlights fourteen years since the The ACA (Affordable Care Act) has been enacted. When it was passed more than a decade ago, there were three primary goals of the ACA, or more popularly referred to as Obamacare. According to, the first was to make affordable health insurance more available for the American public. The second goal was to encourage states to expand their Medicaid coverage to all individuals whose income is significantly below the federal poverty level. Finally, the ACA would provide federal support to “innovative medical care delivery methods designed to lower the costs of health care generally.” Considering the fact that this landmark legislation, the most significant policy change since the introduction of Medicare in 1965, is categorized into three broad regulatory goals, this policy analysis series will break down each goal to understand the progress of this healthcare reform. The first in this series will expand on the data that indicates how the ACA has made healthcare more affordable and available overall.

Policy Analysis

To measure ACA affordability, factors such as inflation, the COVID-19 pandemic, fluctuating state Medicaid coverage, and the growing rate of insured individuals play a major role when strictly looking at premiums. According to the Peterson Center on Healthcare and the Kaiser Family Foundation, there will be a projected 2-10% increase in 2024 ACA premiums. One can only imagine the increases in cost if Obamacare wasn’t enacted, but premiums are a significant variable that directly impacts an insured individual’s ability to afford coverage. However, this metric alone is reductive when viewed through the comprehensive lens of affordable healthcare overall.

Accessibility also provides insight into affordability. And according to multiple HHS (Health and Human Services) studies, accessibility to healthcare coverage is improving because of the ACA. In 2022, HHS stated that the national uninsured rate is at an all time low, due to ACA policy changes. The Office of Health Policy stated  “Changes in uninsured rates from 2020 to 2022 were largest among individuals with incomes below 100% of the Federal Poverty Level (FPL) and incomes between 200% and 400% FPL.”

Checking in on 14 Years of Obamacare; Part 1

Accessibility across racial and ethnic backgrounds has also improved because of Obamacare. Despite these positive trends, minorities still have significantly higher uninsured rates than whites.

A separate HHS study concluded that before the ACA was administered, “individuals who identified as Hispanic or Latino had the second highest rate of uninsured individuals, with 32 percent in 2010. From 2010 to 2019, the rate of uninsured Hispanic individuals decreased by nearly one third, but at 22 percent in 2019 it is still almost 2.5 times the rate for white individuals (whose uninsured percentage dropped from 14 to 9).” Native Americans also experienced the most dramatic decrease in uninsured adults.

Checking in on 14 Years of Obamacare; Part 1

A Health Affairs research article has also stated that the LGBTQ community has seen improvement in overall accessibility thanks to the ACA. The research indicated that adult LGBT coverage increased from 75.9% in 2013 to 91% in 2019.

The Affordable Care Act is considered a massive overhaul of our healthcare system. A 14-year debate has since ensued between scholars, policymakers, and the mainstream media related to the three primary goals. Within each goal lies nuanced data detailing the progress our society has made since the law was passed. One simply can’t determine that a rise in healthcare premiums dictates affordability. Progress is being made in overall accessibility, but inequalities among the uninsured still remain.

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