When the Affordable Care Act was passed in 2010 after long and brutal political fight in Congress, President Obama and his allies said the law would provide new insurance coverage to more than 30 million Americans. Three years later, as the online health care exchanges that are a centerpiece of the law debuted on Oct. 1, the reality is proving to be far different than the promise. The cumulative effect of political opposition, public confusion and the sheer complexity of launching the largest new entitlement in almost 50 years means many americans who stand to benefit from Obamacare don’t realize it, while millions of others who are uninsured will get no relief at all. and it may be years before anyone can measure success or failure. In the meantime, many Americans are left trying to figure out just what the massive reorganization of the U.S. health care system means for them.
Obamacare: Promise vs. Reality
Justin Clemons for TIME
Nicolette Cooksey, 30
An uninsured single mother of two, Cooksey works part-time at a day-care and earns about $8,000 per year. She would qualify for Medicaid under the Affordable Care Act’s new eligibility guidelines if Texas opted to expand the program. Because the authors of the ACA assumed states would use Medicaid to cover poor working adults like Cooksey, she is not eligible for subsidies to buy private coverage either. Cooksey has about $13,000 in medical debt. “I don’t know my exact credit score, but I’m sure it’s terrible,” she says. “If I want anything in life, I have to pay my medical bills first.”