since the Affordable Care Act (ACA) became effective in 2014, and the percentage of African Americans who have no health insurance dropped sharply since then, according to reporting in The Washington Post from Akilah Johnson. But that progress depends largely on where people live, she added. Nearly one million African American adults would become eligible for medical insurance if 12 holdout states expanded Medicaid eligibility under the ACA, according to a report from the federal Department of Health and Human Services on Feb. 22, she noted.