Health Care Reform at Five Years States that implemented the law more fully see the biggest reductions in uninsured.


arch 23 marked the fiveyear anniversary of the signing of the Affordable Care Act (ACA). Although it will take years to know the full impact of the ACA, a law that remains controversial, a recent survey shows a drop in uninsured adults throughout the states. The Gallup–Healthways WellBeing Index, a nationwide, annual telephone survey (read about it at, shows that the overall rate of uninsured Americans fell from 17.3% to 13.8% from 2013 through 2014, when the individual requirement to obtain health insurance took effect. The survey was conducted from January 2013 to December 2014. Arkansas and Kentucky saw the largest reduction in uninsured residents. Both states reduced their rate of uninsured by more than 10 percentage points. At

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4.6%, Massachusetts had the lowest percentage of uninsured residents in the nation and Texas— for the seventh year in a row—had the highest, at 24.4%. The states that saw the biggest drops were states that chose to implement two features of the law: expansion of Medicaid, covering more low-income adults, and state-based insurance marketplace exchanges or state–federal partnerships. Despite the effective reduction in the nation’s uninsured population, there is still some strong opposition to the ideology of the law and concern over long-term economic outcomes and the cost of expanded coverage. Although insurance premiums have gone up for some, reports by the U.S. Department of Health and Human Services cite economic benefits for states and estimate that with more Americans insured, hospitals will face

less uncompensated care, which accounted for billions of dollars in 2013. The American Nurses Asso­ ciation outlined the pivotal role nurses can play in a report on the impact of the ACA on nurses ( In nursemanaged health centers, for example, nurses provide care to the newly insured, encourage preventative care, and coordinate care with accountable care organizations to reduce costs, improve the quality of care, and ensure favorable outcomes.—Maria Nix, MSN, RN

AJN ▼ June 2015

Vol. 115, No. 6


Health care reform at five years.

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