15 Years On: How The ACA Shaped Reproductive Care Access

Fifteen years ago, at a White House ceremony, President Barack Obama signed into law what Vice President Joe Biden, in a hot-mic moment minutes earlier, called “a big f-ing deal”: the Affordable Care Act, a sweeping new law that changed the health care landscape.

In his remarks, Obama touted the ACA’s benefits, including how it would improve access to health insurance, lower premiums, and cover a range of out-of-pocket costs.

“The bill I’m signing will set in motion reforms that generations of Americans have fought for, and marched for, and hungered to see,” the president said.

Obama didn’t mention it that day, but the ACA also quietly promised to usher in a new era for reproductive health for women in general — and for Black women in particular. That’s because the law covered preventive screenings for health issues Black women disproportionately struggle with, like breast cancer, and required insurance companies to make birth control free.

Related: Health Care Prevention is the Gold Standard

At Word In Black, we wanted to know precisely how the ACA has impacted Black women’s access to reproductive health care. Here’s what experts say and what the data shows.

Monica Edwards senior manager of public policy at the nonprofit Power to Decide, says the law nicknamed Obamacare was transformational.

“I do think the ACA is one of the greatest advancements for women’s health in a generation,” Edwards says. “Overall, it has been a good policy to make sure people get access to the health care that they need.”

Expansion of Contraceptive Care

Reproductive health care, in general, includes contraception, obstetrics care, treatment and prevention of sexually transmitted infections, and abortion care. Since the mid-1990s, states have required health insurance plans that cover prescription drugs and devices to also cover contraceptives.

But the ACA took it a step further, according to the Guttmacher Institute, a reproductive health research and policy organization. It now requires most private health insurers to pay for FDA-approved prescription contraceptive drugs and devices.

“This means people can get contraceptive care that they need without having to pay out of pocket, which we know is a huge barrier for women of color, specifically Black women,” Edwards says.

In 2020, the 10^th anniversary of the ACA, The Commonwealth Fund reported that every racial demographic was more likely to be insured because of the law. Notably, it took just 6 years for the rate of uninsured Black Americans to drop 10%. And Black adults living in states that expanded Medicaid — a key provision of Obamacare — are less likely to forego health insurance than white adults in states that didn’t expand Medicaid access.

Downfalls of the ACA

But like any policy, there are limitations.

Although the law brought down the number of uninsured Black people, it did little to address institutional racism in the healthcare system. Compared to white women, Black women are still more likely to die during childbirth, caregivers are less likely to take their complaints of pain seriously, and they are more likely to struggle with medical debt.

And when it comes to reproductive care — one of the most popular aspects of the ACA — the landscape has changed significantly.

Since the Supreme Court overturned the landmark Roe v. Wade decision, access to abortion has varied significantly: some states protect it as a fundamental right, while others have declared it illegal. That’s had a disproportionate effect on Black women, who are more likely than white women to live in a state that bans abortion, and less likely to be able to afford out-of-state travel to terminate a pregnancy.

Read more: 2 Years After Roe, Abortion Access a Patchwork for Black Women

“Since the overturning of Roe v. Wade, barriers to accessing reproductive health care for Black women, girls, and gender-expansive people have grown even more daunting,” says Regina Davis Moss, president and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda. “We know that Roe was never enough on its own to secure full bodily autonomy for our communities.”

Even before Roe v. Wade was overturned, the ACA was hamstrung by the Hyde Amendment — a provision that prevents the federal government from using taxpayer funds on abortion, except under extreme circumstances. As a result, the health care law allows states to ban abortion coverage in plans offered through the ACA Marketplace, and 25 states have done so. That means access to abortion care largely depends on what state someone lives in.

“Just last year we learned the stories of Amber Nicole Thurman, Candi Miller, and so many others who were killed as a result of abortion bans,” Davis Moss says. “Our own polling showed that since Roe was overturned, 40 percent of Black women of reproductive age feel less safe and are less sure about whether to have children because of abortion bans.”

The Future of the ACA

Since 2014, the ACA expanded Medicaid allowing states to cover nearly all low-income adults younger than 65 years old. As of 2025, 41 states and the District of Columbia have adopted the Medicaid expansion and 10 states have not. Medicaid covers more than 40% of U.S. births and 65% of births to Black birthing people.

The Republican-led Congress is considering plans to cut Medicaid, with the House budget resolution targeting $880 billion or more in potential reductions to federal Medicaid spending, according to KFF. On Truth Social, his social media platform, President Donald Trump “We need both Chambers to pass the House Budget to “kickstart” the Reconciliation process, and move all of our priorities to the concept of, “ONE BIG BEAUTIFUL BILL.”

Jasmine Young, staff attorney at the National Health Law Program, an organization working to protect and advance the health rights of underserved communities, says the potential Medicaid cuts are very concerning. The Medicaid expansion provision has lowered maternal mortality rates and narrowed racial maternity health inequities.

“It’s essential that we protect funding and resources that go towards Medicaid and the Affordable Care Act,” she says. “It would be damaging to so many communities, especially to Black women and femmes who rely on these resources.”

Section 1557 of the ACA bans healthcare discrimination based on race, color, national origin, sex, age, and disability. It’s the first federal law that banned health care discrimination, Young explains. Project 2025 aims to roll back these non-discriminatory practices that disproportionately affect Black Americans.

“It would be horrible if these funding cuts were to persist, and the ACA was eliminated,” she says. “I really do think the Affordable Care Act was a way to lean into the principles of reproductive justice, which is the human right to maintain bodily autonomy, the right to not have children, and to parent the children that we have in safe and sustainable communities.”

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