Barack Obama

Barack Obama (born August 4, 1961, in Honolulu, Hawaii) is an American politician who served as the 44th president of the United States from 2009 to 2017. He was the first African American to hold the office and is widely noted for his historic 2008 election and subsequent reelection in 2012. ^[1][2]

Before becoming president, Obama represented Illinois in the U.S. Senate (2005–2008) and built a national profile through his 2004 Democratic National Convention keynote address and his 2008 presidential campaign. ^[1][2]

Obama's early life includes growing up in Hawaii after being born to a Kenyan father and a mother from Kansas, and he later worked as a community organizer in Chicago before attending Harvard Law School. In 2009, he was awarded the Nobel Peace Prize for what the Nobel committee described as efforts to strengthen international diplomacy and cooperation between peoples. ^[1][3]

Context

Obama rose to national office during a period marked by the Great Recession, which the NBER dates from December 2007 to June 2009. ^[4] The unemployment rate rose sharply during this period and remained elevated into the early years of his presidency. ^[5] Public trust in the federal government had been historically low since 2007, according to long-running survey series summarized by Pew Research Center. ^[6] In February 2008, Gallup reported that the economy became the most frequently named national problem, overtaking the Iraq war, with healthcare and immigration also among prominent mentions. ^[7] Pew found that by August 2008 the economy was the top issue for voters, followed by energy and a cluster of issues including health care, education, the war in Iraq, and terrorism. ^[8]

Healthcare Reform

The Patient Protection and Affordable Care Act, signed into law in March 2010, represented the largest expansion of health insurance coverage in the United States since the creation of Medicare and Medicaid in 1965. ^[9] The law's major coverage provisions included expansion of Medicaid eligibility to adults with incomes up to 138 percent of the federal poverty level and creation of health insurance marketplaces where individuals could purchase subsidized coverage. ^[10]

The uninsured rate among nonelderly Americans fell from 48.2 million in 2010 to 27.3 million by 2016, a reduction of approximately 21 million people. ^[11] Among adults aged 18 to 64, the uninsured rate declined from 22.3 percent in 2010 to approximately 12.4 percent in 2016. ^[12][10] The decline in uninsured rates continued after Obama left office, reaching a record low of 7.9 percent of the overall population by 2023. ^[13]

Coverage gains varied substantially by state depending on whether states chose to expand Medicaid under the ACA's optional expansion provision. In states that expanded Medicaid, the uninsured rate among adults aged 18 to 64 fell from 18.4 percent in 2013 to 9.1 percent by 2019. In non-expansion states, the uninsured rate declined more modestly from 22.7 percent to 17.1 percent over the same period, remaining nearly twice as high. ^[11] As of 2024, ten states had still not expanded Medicaid, leaving approximately 1.6 million people in what policy analysts term the "coverage gap"—with incomes too high to qualify for traditional Medicaid in their states but below the poverty level that would make them eligible for marketplace subsidies. ^[14]

The law's implementation encountered significant challenges. The federally operated Healthcare.gov website, which launched on October 1, 2013, to serve residents of 36 states, experienced severe technical failures that prevented most users from enrolling. According to a case study by the HHS Office of Inspector General, only six users successfully enrolled on the first day due to capacity issues, incomplete design, and management problems including the absence of clear leadership. ^[15] The website became functional after approximately two months of intensive repair work, ultimately facilitating enrollment for millions of individuals.

Research on the ACA's effects found that the law was associated with increased healthcare access, improved affordability, and greater use of preventive and outpatient services among low-income populations, though impacts on inpatient utilization and health outcomes were less conclusive in early studies. ^[10] By early 2024, more than 45 million people had enrolled in ACA-related insurance plans through the marketplaces, Medicaid expansion, and the Basic Health Program. ^[16]