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The Affordable Care Act has been a divisive political issue since it was proposed.
The Supreme Court largely upheld the law in 2012 when it ruled the individual mandate to buy healthcare was within Congress' ability.
Before the law's rollout, Nevada ranked 49th in the country for uninsured people. Now, as of December 2014 data, Nevada ranks 36th.
Bruce Gilbert is the executive director of the Silver State Health Insurance Exchange, the government agency managing Nevada HealthLink. He told KNPR’s State of Nevada they have been able to reduce the overall number of people in Nevada without insurance by almost half in the 18 months since the exchange started.
“The idea, I think, is to make sure every individual who requires insurance has the opportunity to enroll and gain health insurance,” Gilbert said.
Gilbert admits there is more to be done to get more people enrolled in health insurance. Currently, 12 percent of Clark County residents still lack health insurance.
He said the agency’s next aim will be people who don’t qualify for expanded Medicaid but need help paying for health insurance.
Andres Ramirez agrees. He is the president of the Ramirez Group and has been organizing navigators for the Silver State Health Insurance Exchange. He said they’ve done a good job targeting people who can sign up and clearing up some of the confusion, but there is more to be done.
“We’re focusing on how to increase those efforts better adapt our messaging to reach those we haven’t got to yet,” Ramirez said.
Ramirez has worked to convince people in the Hispanic community and the so-called ‘young invincibles’ that they need health insurance.
“We’ve done a pretty remarkable job of getting to those who can enroll,” Ramirez said.
Even as more people get health insurance through the Affordable Care Act, the political fight over the law has not stopped.
Currently, the high court is hearing a case challenging the ACA's use of subsidies in state-run healthcare exchanges, with a decision expected this summer.
Gilbert said because Nevada’s exchange is separate from the federal exchange and only uses the Internet portal run by the federal government, any ruling from the Supreme Court won’t impact Nevada.
“We are an exchange established by the state,“ Gilbert said. “Subsidies are not at risk.”
Five years into ACA, the country still seems split on support for the law.
In a poll by the Kaiser Family Foundation, 41 percent of Americans support it, 43 are opposed to it, 19 percent said it helped them and 22 percent said they were hurt by it.
Despite that divide, Ramirez and Gilbert said their organizations work to stay above the fray.
“From our perspective this is not a political operation or enterprise," Gilbert said. "Our job at the exchange is to make sure that we provide an operational model that allows people to come and enroll, apply and sign up."
Ramirez said they have had the whole gambit of people ask for help. Some people who dislike President Obama and hate Obamacare still turn up because they want to follow the law. He also works with people who are thrilled to be able to purchase health insurance.
“Whether they like the plan or they don’t like the plan -- that’s not what we’re focused on,” Ramirez.
Bruce Gilbert, executive director, Silver State Health Insurance Exchange; Andres Ramirez, president, Ramirez Group