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The Affordable Care Act and Healthcare Reform

The ACA is an important step in shaping the United States' healthcare, following earlier laws to ensure that more people have access to care. The ACA's link to past healthcare reforms becomes clear when you notice that the foundations for federal healthcare were established with the introduction of Medicare and Medicaid in 1965, particularly for those who are elderly or have lower incomes (Sullivan et al., 2024). The unsuccessful Clinton Health Security Act of 1993-1994 made people realize that changing America's healthcare system was a major political challenge and that the government should address healthcare as a fundamental matter. In 2006, the Massachusetts health reform law demonstrated that universal coverage could be achieved by requiring everyone to obtain health insurance and offering them financial assistance for marketplace plans. The ACA, enacted by President Obama in 2010, incorporated numerous small changes, drew on lessons from the past, and became the most significant healthcare reform of the era since Medicare and Medicaid.

Rather than remodel healthcare from scratch, the ACA decided to use and improve the existing insurance models, which was necessary given the limitations of healthcare reform over the past few years. From 2021 to 2023, marketplace enrollment for Black and Latino people in states linked to HealthCare.gov increased significantly more than for any other racial or ethnic group, demonstrating that the law remains active and effective (Sullivan et al., 2024).

The ACA has numerous significant impacts on various populations, aiming to address longstanding inequalities and provide all groups with better opportunities for good health. Low-income people have seen the most benefit from Medicaid under the ACA, as the main reason for the rise in health insurance coverage between 2019 and 2023 was an increase in Medicaid enrollment (Hill et al., 2025). Due to essential health benefits, insurance plans must cover preventive, maternity, and mental health services to redress issues that have earlier affected women and minority groups.

Experts report that with the ACA, there were declines in the insurance coverage gap between blacks and whites by 4.1 points and a fall of 9.4 points between Hispanics and whites (Sullivan et al., 2024). At the same time, the ACA has helped and hurt various groups in different ways, as many significant challenges remain. In 2023, some differences in insurance coverage still exist. The highest rates among young populations are found among American Indian or Alaska Native (AIAN) people (18.7%), closely followed by Hispanics (17.9%) and Native Hawaiians or Pacific Islanders (12.8%); these rates are all higher than the rate of 6.5% for young White people (Hill et al., 2025). Because of this, undocumented immigrants still lack access to the ACA, which points to challenges in providing healthcare for all types of communities in the country.

References

Sullivan, J., Orris, A., & Lukens, G. (2024, March 25). Entering their second decade, the coverage expansions of the Affordable Care Act have helped millions provide the basis for further progress. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/entering-their-second-decade-affordable-care-act-coverage-expansions-have-helpedLinks to an external site.

Harrill, W. C., & Melon, D. E. (2021). A field guide to U.S. healthcare reform: The evolution to valuebased healthcare. Laryngoscope Investigative Otolaryngology, 6, 590-599. https://pmc.ncbi.nlm.nih.gov/articles/PMC8223464/Links to an external site.

Hill, L., Ndugga, N., Artiga, S., & Damico, A. (2025, February 13). Health coverage by race and ethnicity, 2010-2023. Kaiser Family Foundation. https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/Links to an external site.