The ACA expanded Medicare/Medicaid, strengthened employer-based care, and included an individual mandate. Before the ACA there were 32 million uninsured people and “about half, or 16 million, will gain coverage through a Medicaid expansion” (Barr, 2011, p. 292). To improve the cost of health care, the ACA required employers with more than 50 employees to offer plans, and individuals would have to purchase plans from the government. "The ACA does not directly address disparities in access to care based on a patient's race or ethnicity. It places a responsibility on providers to collect data on race or ethnicity, primary language, disability status, and similar demographic characteristics of the patients treated” (Barr, 2011, p. 293). The ACA strives to provide health coverage to all, but the power still rests with the private sector because not everyone is insured and the disparities are still evident. If we want the United States to become a nation state with completely equal citizens, more policy evolution is needed. I believe that health scientists need to do more research The patient's opinion must be included in the system