Five Obama Alum carrying on the legacy of the Affordable Care Act

My inspiration for working in health care comes from two places: my personal experience growing up in Misaje, a remote village in Cameroon, and the extraordinary dedication of my mother, Roseline Ndansi.

In the early 1980s, my mother worked at a small health center in Dumbo Village. Though she was only a nurse’s aide, to the people of the village, she was their only "Docta." …I grew up watching her work tirelessly, with courage and compassion, in life-and-death situations, all while maintaining the highest infection prevention standards. She taught me that health care is more than medicine—it is service, sacrifice, and love for humanity. Later, I realized she wasn’t a doctor or even a registered nurse, yet she did more to save lives than many trained professionals ever could.

The most fulfilling part of this work is witnessing the direct impact of our efforts—seeing a mother safely deliver her baby in a clinic we helped set up, hearing the laughter of children who have received medical care, or watching homes light up for the first time because they now have electricity. I find joy in the resilience and hope of the communities we serve. I am reminded that this work is not just about health care— it is about preserving human dignity and giving people the opportunity to thrive.

The Affordable Care Act reaffirmed the fundamental belief that health care is a right, not a privilege. It expanded access to millions of people in the United States, just as I strive to do in underserved communities in Africa. I see a shared vision between the ACA and the work I do— both are about breaking barriers to health care access and ensuring that no one is left behind. President Obama’s commitment to equity in health care is an inspiration, and his leadership continues to fuel the mission of those of us working to make health care accessible, no matter where people live.

Besides designing and implementing training for Timor-Leste's primary health care professionals, our teams also run rural mobile clinics, conduct community screening, and embed in Ministry of Health facilities to support existing government initiatives. Our HIV team supports the Timorese National AIDS program to provide good quality care for about 1/4 of the known PLHIV (people living with HIV) community in Timor-Leste, including mothers and babies. "Maluk Timor" means "kin of Timorese," and that embodies the ideals and strategy that we've chosen over the years—committing to working shoulder-to-shoulder with Timor-Leste's government health leaders and helping support a resilient health system.

In primary care, you'll meet some extraordinary human beings. They've been quietly serving their communities through war, scarcity, and personal tragedy for years before you showed up and they will continue serving long after you're gone. Knowing that I have contributed to their work is what gives me joy.

Working in a resource-constrained context where universal health coverage is still a work in progress, I recognize the challenges faced by those who implemented and continue to carry out the Affordable Care Act. From where I stand, it aims to do exactly the kind of thing that I do in my corner: make quality health care accessible and affordable.

My first job out of college was working for my home state's Senator, Tom Daschle. He encouraged my interest in health policy because it's "really important, really hard, and really important because it's hard." Everyone has had a frustrating encounter with accessing health care and I've been passionate about helping solve these problems. After law school I was able to work on the Senate HELP Committee during the floor debate on the ACA— including attending the momentous floor vote on December 24, 2009— and it's where I first really appreciated the importance of public health in improving health outcomes.

The thing that I love about health policy is using quality information to seek consensus for solutions. Health care is so personal to everyone, but I feel like if I'm doing my job well, no one is thinking about my work. I take a lot of joy in the customer service aspects of my job and solving problems for Minnesotans. I believe so deeply in the ability of government to help people, so it's always satisfying when we get to help someone resolve an issue.

The ACA changed our country for the better. Reflecting on implementation, it was such an exciting time and there was such a sense of teamwork. There was a lot of hard work to complete the rulemaking and draft all of the guidance documents, but it was so rewarding. We were getting feedback in real time about what was working and what needed clarity. 

As an “elder millennial,” it's thrilling when I meet young people who can't remember a time before the ACA. They don't know about lifetime limits or riders or not being able to stay on their parents' insurance. The ACA set a new baseline for health care coverage and what people expect. It's also personally satisfying how popular the law is now, and it feels really good to have fought for something that's so important.

In my early childhood, I was acutely aware of how the HIV/AIDS pandemic was affecting not just the health, but the development of my country and region. Early in my career, I saw how the health system in Mozambique lacked investment and was motivated to pursue public health and work on solving problems in the health sector.

My research is about planning for a future where changes are expected due to the climate crisis, specifically around estimating the burden of enteric pathogen exposure and diarrheal disease in Mozambique due to climate change, with a view on what can be done to prepare for it. Mozambique is both highly affected by diarrheal disease and climate events; getting in front of the issue could potentially save lives, reduce sickness, and reduce the burden on the health system.

I keep active with yoga and walks. Whenever possible I connect with friends and family. I'm fortunate to be able to pursue many hobbies and interests outside of my professional endeavors to keep me sane. It's a really challenging time for so many reasons. I hold on to hope and feel immense gratitude for my loved ones and the life I live.

At United States of Care, we know people across the country want the same thing out of health care and their health care experiences, regardless of race, ethnicity, political party, income, geography: they just want to be healthy and not go into medical debt to get there.

We've listened to over 30,000 people, for over 5,000 hours. We have a data warehouse that has over 100 unique data sets that maps the human experience in the American health care system. What is clear is that there are four shared values that people want from the health care system: One, they want the certainty that they can afford their health care. Two, they want dependable coverage as their life changes. Three, they want personalized health care, and four, they want a health care system that's easy to understand and navigate. 

That is what the Affordable Care Act aimed to do. The policy aimed to give people more affordable and dependable coverage and personalized, accessible care. And these goals are our North Star for the change we drive at United States of Care.

Something that brings me joy is knowing that our organization can connect shared experiences and stories together to show that people are not failing at health care, instead that the system is failing them. There are things that we can do to fix it. We get up every day to not only find those common stories that make people feel less alone, we take those insights to change policy at the state and federal level. 

So I take a lot of joy in our work of building people-centered policy by listening to communities all over the country and carrying those needs forward to pass influential policy.

Making the Affordable Care Act was a huge part of my life - professionally and personally. I was six months pregnant when I started at CMS. A few months later I went into pre-term labor under my desk while on the phone with the NAIC (National Association of Insurance Commissioners) talking about Standard Benefits Coverage, which is a policy that was a part of the Affordable Care Act. I had my second and third kids while working at CMS - though thankfully none of them under my desk! The ACA ensured that my son’s premature birth was not a lifelong sentence of a preexisting condition. 

Now 15 years later, my son started high school and the ACA is a lasting, impactful part  of our health care system. It is enrolling millions of people. It is providing coverage for life saving preventive services to millions of people. It is reinventing how we pay for and deliver care. It has brought a new way of thinking about how to help people enroll in something as complicated as health insurance. There have been new innovations that have happened because of the Affordable Care Act that our entire country benefits from.

And, clearly, there's so much more to do to make our health care system better. But there is no doubt that these advances have allowed us to move closer to a system that works as effectively as possible for everyone.