The ACA Coverage Gap and Its Deadly Implications

As the December 15th deadline approaches to sign up for 2017 market exchange plans, affordable health insurance remains out of reach or at-risk for too many Americans.

Since Donald Trump was elected, progressives have been preparing to fight tooth and nail to protect what they see as hard-won gains in increasing access to healthcare for Americans. Obamacare has considerably reduced the number of people who are uninsured and had major benefits for women. If Trump does eliminate the program as he’s committed to do, marginalized people across the country will undoubtedly suffer.

But even under President Obama, far too many people already face insurmountable barriers to healthcare, particularly low-income people of color and women. This coverage gap is made up of people who make incomes that exceed the threshold for Medicaid programs, yet don’t make enough money to qualify for subsidies on the federal healthcare exchange.


Although most of us remember the 2012 Supreme Court ruling that upheld the Affordable Care Act as an overall victory, this decision also mandated that states had the option to decide if they would expand their Medicaid programs. As a result, 19 states refused to extend eligibility requirements for their programs, thus creating the gap or the “deadzone” as described by Janet Foy for the New York Times.

We spend a lot of time focusing on the physical implications for people living without health insurance, however we must also consider their mental wellbeing – or lack thereof. As Genevieve Kenney, co-director of the Health Policy Center at the Urban Institute, notes in an interview with the New York Times:

A study in Oregon found that offering Medicaid to the uninsured reduced bad medical debts, decreased the likelihood of choosing to cover medical expenses over other bills, buffered them from catastrophic out-of-pocket payments and significantly reduced depression.

The coverage gap may seem like numbers on a chart to some people, but it is a clear denial of humanity for low-income people, especially people of color and women–and in all likelihood it’s about to increase if the GOP manages to eliminate Obamacare. People’s access to health insurance greatly impacts their overall health outcomes. In our nation’s continuing refusal to create equitable healthcare access for all, we are creating death sentences for the most marginalized.

Photo courtesy of New York Times.

Quita Tinsley is a fat, Black, queer femme that writes, organizes, and overall is working to build sustainable change in the South. She holds a B.A. in Journalism with a minor in Sociology from Georgia State University, and is currently pursuing an M.A. in Women’s, Gender, and Sexuality Studies from her alma mater. She is a member on the board of directors of Access Reproductive Care – Southeast, and is a former content creator for the The Body Is Not An Apology. As a femme, feminist, and queer Black woman, it is through her lived experiences and complex identities that Quita has come to believe in the power of storytelling and the validation of lived experiences.

Quita Tinsley is a fat, Black, queer femme that writes, organizes, and overall is working to build sustainable change in the South.

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