Signed into law in March 2010, the Patient Protection and Affordable Care Act (ACA) aimed to bring the uninsured more fully into the health care delivery system, improve access to health care providers, spur new approaches to patient well-being and disease prevention, attack racial disparities in health care and outcomes in communities of color, and hold providers accountable with respect to costs. By February 2015, 11.4 million Americans had signed up for private health insurance coverage through marketplace exchanges. An additional 8.7 million people gained coverage through Medicaid and the Children’s Health Insurance Program (CHIP). The percentage of uninsured Americans dropped from 18 percent in 2013 to 12.9 percent at the end of 2014. By any standard, these numbers are impressive. But experience of the ACA at the ground level has been uneven across states and across communities. Reaching the ACA’s goals for enrollment and health care delivery reform will require learning from efforts to date and refining approaches to better meet the needs of all communities.
With support from the W.K. Kellogg Foundation, the Alliance for a Just Society conducted field research in 10 states (California, Florida, Idaho, Louisiana, Michigan, Mississippi, Montana, New Mexico, Oregon, and Texas) to explore how those who need health care the most – low-income people, immigrants, and people of color – are experiencing implementation of the Affordable Care Act. The methodology includes an examination of public data, interviews with state-based navigators, policy and health care professionals, and advocates, and 1,200 surveys in Spanish, Cantonese, and English with low- to moderate-income health care consumers at food pantries, health clinics, and homeless service centers. This report examines the following questions: Who was able to sign up for health insurance? How effective was outreach to underserved communities? How accessible are health care services to newly enrolled patients? And finally, what changes might make the current health care delivery system more effective in serving low-income communities, immigrant communities, and communities of color?