The ACA Lives, but Healthcare Gaps Remain


A couple weeks ago, the Supreme Court upheld the Affordable Care Act. The vote was 6-3, which makes me think that even the conservative judges realized that eliminating the current way the Exchange works would create chaos for millions of people and our healthcare system in general.

Don’t get me wrong; I believe that the Supreme Court’s decision is good and wise. The truth, however, is that nothing has really changed. The flaws in the healthcare system are still there whether or not the Supreme Court gives it its stamp of approval. I know this firsthand because at the Church Health Center, more than 90% of our patients are ineligible for a subsidy from the Exchange.

Our patients – all of whom are employed – will continue coming to us when they are sick.

Many of our patients and countless others all over the United States continue to struggle in this post-ACA landscape. If they go to the ACA website and enter their income information, they will be referred to their state’s Medicaid program for help. But in Tennessee and every state in the South except Arkansas, the state legislatures have refused to expand Medicaid. That means that anyone whose income is below 138% of the poverty level receives no benefit from the ACA.

Yes, that is right: the poorest people get nothing.

If a single person makes less than $16,000 or a family of four makes less than $32,000, they receive no help with purchasing health insurance. They are on their own. Even those who are eligible for subsidies through the Exchange sometimes face difficult decisions. If a single mother works three jobs and has three children and makes $33,000, she will be able to buy a policy for $150 a month for herself, but that is $150 she might not have budgeted. The policy will have a $5,000 deductible. Not a day goes by that one of my female patients doesn’t ask me what I would do if I were in her position. I cannot honestly say that I would purchase the policy, but she knows that if she does not, she is breaking the law.

It is hard to believe, but these are the facts.

The gaps are real.

The system is broken.

People are dying.

It is clear that the Supreme Court did not solve our healthcare issues. Our system is not designed to provide affordable care to our most vulnerable populations, but I am confident that America can do better than that.

In the wake of Independence Day, surely we will remember that a great country is judged on how it treats those whom the Bible calls “the least among us.”


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