How the Affordable Care Act has improved health, especially among poor people

Washington D.C. residents participate in an incentive program that makes produce at farmer’s markets more affordable for low-income residents as part of the Affordable Care Act. Joseph Molieri/Bread for the World.

Editor’s note: This post is part of a weekly, year-long series called the Nourishing Effect. It explores how hunger affects health through the lens of the 2016 Hunger Report. The Hunger Report is an annual publication of Bread for the World Institute.

By Derek Schwabe

The Affordable Care Act (ACA), or Obamacare as it’s more commonly known, is in the headlines once again this month, after leading health insurance provider Aetna announced its plans next year to largely pull out of the public insurance marketplaces created by the law. Increasing premiums and a dwindling list of providers, among other setbacks, have raised alarm about the future of the Obamacare system. While experts agree that the still fledgling healthcare exchanges do need improvement, many believe that the bumpy start is mostly unavoidable since providers are still learning how to work in an uncharted healthcare market.

While it’s important for the exchanges to make improvements based on constructive criticism, we must not lose sight of the fact that the ACA is largely functioning as intended and is already improving health, particularly among lower-income people.  

Here are three ways that is happening:

  1. The largest reduction in the number of uninsured people in four decades. According to the Department of Health and Human Services, about 16.4 million uninsured people have gained health coverage since 2010, reducing the uninsured rate to the lowest on record. These gains came primarily from the marketplaces, Medicaid expansions, and enabling young adults to stay on their parents’ insurance plans until they turn 26.
  2. Healthier people. A study recently published in JAMA (Journal of the American Medical Association) Internal Medicine found that low-income people in Arkansas and Kentucky, states that expanded Medicaid insurance, achieved a variety of better health outcomes that their peers in Texas, which did not expand its Medicaid, did not. Those in Arkansas and Kentucky had better access to primary care, fewer medication doses skipped due to cost, a lower likelihood of emergency department visits, and a greater likelihood of reporting that they were in excellent health. Other studies have found additional benefits among Obamacare participants, including reduced medical debt.
  3. A stronger focus on prevention. Historically, hunger and medical care have been seen as two separate and distinct issues in the United States. The ACA is beginning to change that, both by expanding the community benefits that hospitals must provide in order to maintain their nonprofit status, and by requiring hospitals to reduce the readmission rates of Medicare patients. More health systems across the country are coordinating with social services providers to promote healthy lifestyles and ensure that patients get the preventive services they need before they develop complicated and expensive health conditions. Groups like Eskenazi Health in Indiana are using creative solutions like in-hospital food pantries to ensure that families are getting the nutrition they need for good health.

The evidence that the ACA is improving patients’ health is mounting even as the marketplace system confronts growing pains. Perhaps even more important is how the ACA is redefining effective health care—in ways that can help end hunger.  The law encourages nonprofit hospitals to focus more on preventing illnesses, reducing patient readmissions, responding to broader societal influences on health, and developing community partnerships, rather than simply on treating illness by prescribing more medical care. The ACA urges hospitals to pay attention to the community benefits they can provide, including ensuring adequate nutrition. More and more, healthcare providers are looking for ways to deal with food insecurity and poor nutrition up front, encourage better eating habits, and broaden patients’ access to quality food to improve their health.

You can learn more about the impact of the ACA on health and hunger in the 2016 Hunger Report, The Nourishing Effect. Read the full report and get key statistics and stories online at 

Derek Schwabe is a research associate at Bread for the World Institute.

Related Resources