One of Obamacare’s main goals is to make healthcare affordable — that’s why the official name is the Affordable Care Act. The ACA does this in a bunch of ways, and three especially stand out:

•  The ACA enables states to expand Medicaid to cover people earning up to 138 percent more than the federal poverty level.

•  It also established cost-reducing insurance marketplaces where insurance plans would compete and keep prices low.

•  Finally, the ACA provides direct subsidies to lower-income people enrolling in healthcare to help with the cost of monthly premiums.

These three pillars of the ACA have expanded coverage to millions of Americans. And because people with disabilities tend to have lower income, these pillars have been a game-changer for our community and our health. Here is how each of them work, and especially how they work for our community:

Medicaid Expansion

The ACA gave states the opportunity to expand Medicaid coverage to individuals and families earning up to 138 percent of federal poverty level, which is a huge jump from previous income limits. This has provided coverage to millions of Americans who earned too much for Medicaid but couldn’t afford insurance on their own. However, it has been limited, as states can choose not to participate. As of January 2017, 32 states (including Washington, D.C.) have expanded Medicaid, but 19 states have not.

States with expanded Medicaid provide healthcare options for people earning all the way up to 138 percent of the poverty level, and when they hit 139 percent they can find affordable options using the subsidies.

When states don’t expand Medicaid, it creates a coverage gap — people with income between the Medicaid limit and 100 percent of the poverty level simply can’t get insurance anywhere. Advocates are pushing for Medicaid to be expanded across all states – but if the ACA is repealed, millions in the middle will lose insurance altogether. Instead of taking steps back, we should be moving forward for more healthcare nationwide.

Affordable Care Act Marketplaces

Obamacare has set up insurance “marketplaces” around the country as a one-stop shop for assorted healthcare options available to the public. There is a federal website, www.healthcare.gov, which provides a nationwide marketplace, and several states have set up their own — for example, my state has www.coveredca.com.

The plans are broken up into three easy-to-understand categories with different premiums and co-pays: Bronze, Silver, and Platinum. Before the ACA, people would have to scour the Internet for the best plan or go through an expensive insurance broker to figure things out. This open website of options makes it easy to choose the best option available, right from a home computer.

Now, the marketplaces are open for people purchasing insurance on their own — and because most Americans already have existing coverage or coverage through an employer, Medicare or Medicaid, the marketplaces don’t quite affect everybody. Still, these provide an open area where people looking for insurance can compare plans easily side-by-side. The main idea is that this will create competition between plans and lead to more improved healthcare options overall.


Obamacare provides tax credits, or “subsidies,” to some people purchasing insurance through marketplaces in order to help them afford monthly insurance premiums.

These subsidies are offered to people with incomes up to 100 percent of the federal poverty level ($11,880 for an individual and $24,300 for a family of four) and under 400 percent of the federal poverty level ($47,550 for an individual, and $97,200 for a family of four), and run on a sliding scale. The math can be a little bit tricky and there are a lot of other details to track, but they are all available on the “Obamacare Facts” website.

As an example of how it works, people earning up to 133 percent more than the poverty level can pay under $40 per month for a quality silver plan, or simply get a $260 credit for another coverage option. Somebody else who earns more than 400 percent of the poverty level will pay more for that silver plan – but it will still save them money and often make insurance a possibility.

According to Obamacarefacts.com, a full “87 percent of people who selected Marketplace plans for 2015 got financial assistance,” and “one in six Americans got a Marketplace plan for $100 or less in 2015.” People with disabilities have lower income on average than people without disabilities, so it especially helps our community. And because we have higher health care costs, access to those silver and platinum plans is that much more important.

What if the Pillars are Pulled Down?

Medicaid expansion, insurance marketplaces, and healthcare subsidies are the three cornerstones of the ACA that have allowed millions of people to obtain affordable, quality health insurance. They also work together: The marketplaces allow people to understand their options and subsidies, while the subsidies help the marketplaces flow. Meanwhile, Medicaid plans are available on the marketplaces in states that expanded Medicaid up to 138 percent of the federal poverty level. And finally, that expanded Medicaid is vital to covering people whose incomes are under the poverty limit but above what’s required to meet conventional Medicaid. Each are important on their own, and they work together for Americans nationwide.

You may have heard that 20 to 30 million people may lose their health insurance if Obamacare is repealed — most of these people rely on Medicaid, marketplaces and subsidies to afford their healthcare. People with disabilities fill a huge chunk of those that might lose their coverage, so an ACA repeal will endanger our access to life-saving insurance.