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Ten years after its passing, and still relatively intact despite numerous Republican attempts to repeal it in whole or in part, Obamacare has slowed the growth of health care spending and significantly improved access to care for the US population. It has enabled nearly twenty million people who did not previously have health insurance to obtain it. However, thirty million people remain uninsured, a far cry from the promises of “near” universal health coverage heard in Democrat speeches in 2010. Months before the November 2020 presidential elections and in the midst of the COVID-19 pandemic, these limitations call for reform. This article looks back at the advances and limitations of Obamacare ten years after its passing, as well as the changes made under the Republicans.