Fifteen years ago, at a White House ceremony, President Barack Obama signed the Affordable Care Act (ACA) into law—a historic moment that Vice President Joe Biden called “a big f-ing deal.” The ACA reshaped America’s healthcare system by increasing access to health insurance, reducing premiums, and covering essential health services. But what did it mean for Black women’s reproductive care?
At Word In Black, we examined how the ACA has influenced reproductive health access for Black women. Experts agree: the law has brought major advancements but also exposed persistent gaps in equity and care.
Expanding Contraceptive Access
Before the ACA, state laws varied on contraceptive coverage. The ACA mandated that most private health insurers cover all FDA-approved prescription contraceptive drugs and devices, eliminating a significant financial barrier for many Black women.
“This means people can get contraceptive care without out-of-pocket costs, which we know is a huge barrier for women of color, specifically Black women,” says Monica Edwards, senior manager of public policy at Power to Decide.
The law also contributed to a significant decline in the uninsured rate among Black Americans. By 2020, a decade after its enactment, the number of uninsured Black Americans had dropped by 10%. Medicaid expansion—one of the ACA’s key provisions—ensured that Black adults in states adopting the expansion were less likely to be uninsured than their counterparts in non-expansion states.
Limitations and Ongoing Disparities
Despite these advancements, the ACA did not address systemic racism in healthcare. Black women remain disproportionately affected by maternal mortality, medical bias, and financial barriers to care. Additionally, abortion access—one of the ACA’s most impactful provisions—has drastically changed since the Supreme Court’s overturning of Roe v. Wade.
“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.
Black women are more likely than white women to live in states that have banned abortion and face financial obstacles in seeking care elsewhere. Even before the fall of Roe, the Hyde Amendment restricted federal funding for abortion services, meaning that states could prohibit abortion coverage in ACA Marketplace plans. Currently, 25 states do so, further limiting access for Black women.
The Future of the ACA and Reproductive Justice
Since its implementation in 2014, the ACA’s Medicaid expansion has significantly improved maternal health outcomes. Today, Medicaid covers over 40% of all U.S. births and 65% of births to Black parents. However, the future of Medicaid is uncertain. A Republican-led Congress is considering major budget cuts, potentially slashing over $880 billion from Medicaid spending.
Jasmine Young, a staff attorney at the National Health Law Program, warns that these cuts could undo years of progress.
“It’s essential that we protect funding and resources that go towards Medicaid and the Affordable Care Act,” Young says. “It would be damaging to so many communities, especially to Black women and femmes who rely on these resources.”
Additionally, Project 2025—a conservative policy proposal—seeks to roll back the ACA’s anti-discrimination protections, which prevent bias based on race, gender, and disability in healthcare settings.
“If these cuts persist and the ACA is eliminated, it would be devastating,” Young adds. “The ACA helped advance reproductive justice by ensuring bodily autonomy, access to contraception, and the ability to parent in safe and sustainable communities.”
As policymakers debate the future of healthcare, Black women’s reproductive rights remain at the center of the conversation. Ensuring equitable access to care is essential—not just for individuals, but for the health of entire communities.