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The Affordable Care Act has been advertised as providing "healthcare for all." But this huge patch on a dysfunctional healthcare system will allow at least 5.2 million Americans to fall through the cracks.

In the United States, for the last 50 years healthcare has been insured by private insurance plans, Medicare, and Medicaid. As many as 48 million Americans have not been covered by either of the two major government plans or private insurance, and as many as 42 million will be able to get insurance, assuming the healthcare exchanges work out their enrollment issues, under provisions of the Affordable Care Act.

But between 5 and 6 million Americans will continue to be unable to get medical care except on an emergency basis, their chronic health problems left untreated until expensive ER visits and hospitalizations are their only option.

Who Isn't Going to Be Covered by Obamacare?

The people who aren't going to get insurance under the Affordable Care Act are the working poor. These are people who aren't old enough to get Medicare, who aren't poor enough (earning as little as $2,200 per year under some state rules) to get Medicaid, and who don't earn enough to pay the $6500 per year deductible plus the $120 to $1200 monthly premiums for Obamacare policies without federal subsidies.

Who Is Getting Help with Their Health Insurance?

Rather than creating a single-payer system like the more successful healtcare programs in Canada and the United Kingdom, the United States chose to expand existing healthcare coverage to more people. 

The federal health insurance exchanges don't sell "government plans." They match individuals to health insurance offered by private companies.

Although there was considerable discussion of "Medicare for all," eliminating the age requirement for enrollment in this popular and generally successful healthcare program for Americans over the age of 65, it was the Medicaid program, the healthcare program for the poor that actually was targeted for expansion, along with a system of premium subsidies for people in the middle class.

Individuals who earn at least about $15,000 per year up to about $45,000 per year get help paying their premiums, as do families earning up to about $94,000 per year (for a family of four). 

Who Isn't Getting Help with Their Health Insurance?

However, if you are a single person earning less than $15,000 per year, or a family earning less than about $45,000 per year, certainly not enough to pay for health insurance on your own, you may or may not be eligible for any insurance at all depending on the state in which you live.

Some states accepted the hundreds of billions of federal dollars provided under the new law to make health insurance available to all their citizens without having to spend any state tax revenues at all for at three years, and other states, led by Republican governors or governed by Republican legislatures, turned down the federal tax dollars for which their citizens will still pay taxes and barred the working poor from any kind of new health insurance.

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