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Fell Through Affordable Care Act Crack in 2015

Theresa BrownGold's painting "Affordable Care Act Crack" for her art project, Art As Social Inquiry.

(Interview 5/2015. Oil on linen, 40 ins. x 30 ins.)

Update 2021

This subject received an exemption from the Affordable Care Act's federal mandate to carry health insurance in 2015 when I interviewed her. The shared responsibility payment required most Americans to carry health insurance or pay a penalty.

The Tax Cuts and Jobs Act of 2017 eliminated the federal penalty for those not carrying health insurance. The ACA's federal mandate is still on the books but the penalty is $0 making the mandate toothless. Some states are keeping the insurance mandate and the penalties that go with it. Residents of those states will have to pay a penalty if they do not carry health insurance.

While the subject escaped having to pay a penalty in 2015 for being uninsured under ACA regulations, she still found herself needing healthcare and not having the means to pay for it.

On the one hand she made too much money as a server to get financial help on the Obamacare online marketplace to buy an individual policy. On the other hand she was not penalized for not buying health insurance because paying full price for a single policy would eat up more than 8% of her income. She qualified for an exemption.

This was not a good thing. The subject did not want an exemption. She wanted health insurance.

The subject let a suspicious bug bite go untreated. An infection caused her leg to swell. “I’ll get better. I’m young and healthy.” She had trouble walking. Her boss told her to get help. She went to the emergency room even though she was uninsured. The hospital billed her a few thousand dollars to treat her leg. She had neither insurance nor money.

Artist Note (from 2015)

It takes courage to share the intimate details of a life. This subject does so that we might grasp how health insurance – or lack of it – hums like a generator in the background of so many of our life decisions.

This subject shares one typical incident, and then another, and another until the path leads us straight back to ourselves. “That could have happened to me.” We know it. Will we only admit it to ourselves? And if we admit that what happens to others could happen to us, would we expect the greatest country in the world to devise a system where everyone has access to good, affordable health insurance?

Thank you to this brave young woman for telling us things only girlfriends whisper to one another by the kitchen sink. Why would she share so much? I never asked. I am just grateful. Her story teaches us that we NEED real access to good, affordable care in our everyday ordinary living. Courage. She’s it.


The Affordable Care Act, Obamacare, mandates that everyone in the US have health insurance by 2014 or pay a penalty. (Not anymore. See 2021 update above.) But some people are exempt from that requirement like the subject of this painting. Please note that she would rather be insured than exempt.

This subject was not required to purchase insurance because doing so would have cost more than 8% of her income. The healthcare law has about 20 exemptions from the individual mandate.

While the subject escaped having to pay a penalty for being uninsured under ACA regulations, she still found herself needing healthcare and not having the means to pay for it.

Eventually, pain from an untreated injury forced her to quit her job as a server.

The subject said, “I thought having more money to buy quality food was more important than carrying health insurance. Then I got injured. I wonder why one should have to choose?”

While I fully support the healthcare law, I recognize that the ACA is a compromise. Moneyed interests -- health insurance, pharmaceuticals, hospitals, medical device companies, investor-owned for-profit companies -- worked to kill reform with well-financed lobbying and disinformation campaigns if their interests were not protected. Wendell Potter, former head of communications at Cigna testified before the Senate panel on healthcare reform. His book Deadly Spin takes us behind-the scenes of a for-profit insurer where millions are spent financing propaganda campaigns to protect profits.

A Center for Public Integrity analysis of Senate lobbying disclosure forms shows that more than 1,750 companies and organizations hired about 4,525 lobbyists — eight for each member of Congress — to influence health reform bills in 2009.

The healthcare law we have today, while so needed, delivers millions of new customers to private insurance companies while leaving some people still falling through the cracks like this painting’s subject.

Although the family got health insurance through her dad’s job, this subject still remembers her mom borrowing her birthday and Christmas money to pay doctors’ co-pays.

By looking at the healthcare law’s potholes, I hope to add a voice to those calling to strengthen the law. After 7 years of story-listening, I have observed that the need for health insurance is a sad, unanswered refrain in so many lives. I dream of a day in this country when we have a system where, on the day people are born, they are issued insurance cards they have for life. This subject’s story deepens that wish.


(Studies. They're all misses. They could be the subject's sisters.)

Former Server, Worker at a Community Pharmacy, Age 29, Uninsured

The ubject is newly employed at a worker’s cooperative. “We all share the responsibilities of running our store. My title is Worker. I utilize my background in herbal medicine on the sales floor by talking about alternative healthcare options. I am also a member of our personnel team.”

The subject describes her young family life as lower middle class. Her mom was a stay-at-home mom. Father was a teacher.

Although the family got health insurance through her dad’s job, this subject still remembers her mom borrowing her birthday and Christmas money to pay doctors’ co-pays.

Eventually her mom went back to work as a part-time teacher. And her dad ended up working 3 jobs to support the family.

As an adult, the subject admits to feeling class rage. “Why are we judging poor people like it’s their fault?” She observes that a lot of young risk-takers have safety nets, a family they can rely on. “I never had a safety net. I found it harder to take risks.”

When the subject was six, her mother had a traumatic brain injury that led to anger control issues. By her junior year in high school tensions at home peaked. At 17, the subject ran away to a shelter. Her grades dropped. She was a volatile, angry teenager mandated to see a therapist. Her father mustered up the cash for the therapist. The subject almost did not finish high school. “A couple of awesome teachers” intervened and "saved her." The subject said

At 18, the subject rented her own place while still in high school. She was going to school, waiting tables and supporting herself. She was still listed as a dependent on her father’s health insurance plan. She graduated from high school, accepted two scholarships to a state college, and majored in education.

The subject was 19 and in college when she was raped. She did not tell anybody. She did not seek medical care although she was still on her father’s policy as a dependent. She coped by going into denial. She was living in a dorm. She still had to get up and go to work and school. There was a big problem. She had to work with her rapist. She thinks her roommate suspected something. The subject describes herself as “detached.” She quit her job a week after being raped. But she still had to endure the two-week notice working with her rapist.

The subject spent the next 9 years of her life “numbing myself with pot and alcohol.” She managed to get good grades in college for a while. But she was drinking and partying, and eventually stopped going to class. Her parents separated. She withdrew from college, saying the separation was too hard to deal with. But deep inside herself she knew that wasn’t true.

“I knew that I needed time away from school to process because I was floundering due to the constant desire to numb myself. If I didn’t withdraw, I would flunk that semester.”

No longer at college, the subject could not remain as a dependent on her fathers insurance. The Affordable Care Act now mandates that adult children can stay on their parents’ plans until age 26. But the subject did not have that option when she was in college

The subject's mom convinced her to go to a therapist after quitting college even though she was uninsured. Her father offered to pay. She went but missed appointments. She did not share her rape history with the therapist. Her father was paying $100 a session, and sometimes she would not show up. After 3 months she stopped going.

The subject let a suspicious bug bite go untreated. An infection caused her leg to swell. “I’ll get better. I’m young and healthy.” She had trouble walking. Her boss told her to get help. She went to the emergency room even though she was uninsured. The hospital billed her a few thousand dollars to treat her leg. She had neither insurance nor money.

Her income qualified her for financial assistance, the hospital's charity care. She still owed the doctor $700 which she could not pay. She also had student debt.

Before the 2008 Great Recession “I was making good money” in the restaurant business. On top of $13,000 in school loans, the subject had to repay scholarship money at 10% interest because she did not fulfill the terms of the school contract when she dropped out. “I put all the money I was no longer spending on booze and pot toward paying down debt.”

The subject started studying herbal medicine. She was learning about the plants in Appalachia. But she admits she was still acting out. “I once got fired for being a sassy bitch.

The great financial crisis of 2008 happened, and subject’s income dropped. She started living on credit cards racking up an additional $20,000 debt. “I paid the school debt until I could no longer support myself. It’s now outstanding debt.” She got a job serving at a brewery, and was just getting by.

She tried to dig herself out psychologically by biking, journaling, and doing yoga. She was still uninsured.

When her grandmother died, “my sole provider of unconditional love,” she felt it was time to honor her grandmother by finding the best in herself. She went back to school to study nursing and Spanish. She spent a summer in Ecuador studying Spanish and environmental biology. She carried a 4.0 average, and then it happened.

She fell in love. She followed her boyfriend to Wisconsin. The plan was that she would work for a year to establish residency (for better tuition rates), and he would help her get her nursing degree. But they split before the plan materialized. Transplanted to a new state and no boyfriend, the subject still found herself feeling relieved to leave her past behind. Her hometown had seen her spiral out of control. She was tired of the past all around her. Moving to a new state offered a new beginning.

Getting distance from her past gave her room to reflect and face her depression. In a job with insurance now, subject went to a therapist.

The subject finally acknowledged her own childhood sexual trauma (confirmed by her mother) in addition to the rape in college -- something she was not able to do with the therapist she saw when she left college.

By 2012 (before full implementation of the ACA) the subject had a job with insurance. She was practicing yoga and meditating. She went to yoga teacher training. “I wanted to be in my body, a safe place, by peeling off layers, being honest, going through emotions, and forgiving self and others.” And she started seeing a therapist paid for by her health insurance. *My co-pay was $50 a session"

The subject's job required her to work a 30 hour work week to qualify for health insurance benefits. She worked 35-40 plus hours/week waiting tables. After the 6-month waiting period, she got health insurance.

She was required to pay half the premium. The premiums, however, kept rising but the employer contribution stayed the same.

By 2013 subject was paying $280/month, her portion of the premium. Insured, she was able to complete her therapy. She felt she had successfully finished. She took a month to go to yoga teacher training. When she returned, she made the decision to buy high quality food to stay healthy. The budget strained, she decided to drop health insurance to save money.

The subject injured her shoulder shortly after dropping her health insurance. She did not get checked out. She was not insured. The subject was running half marathons, hula-hooping, cycling, and waiting tables. She was in chronic pain and still is today (spring 2015). She had to quit her job. She asked herself, “What skills do I have?” Herbal medicine.

In Spring 2015 she got a job at a community pharmacy, a workers’ cooperative. She will qualify for full health benefits in 3 months. “I’m very excited.”


The healthcare law was fully implemented in 2014. Subject could never work full time at her restaurant job after her shoulder injury. She was in too much pain. As a part time worker, she was eligible to receive financial assistance, a subsidy, on the online marketplace.

Even as a part time worker, subject made too much money to qualify for financial help. But she also could not afford to pay full price for the premiums. She qualified for an exemption to the healthcare law’s mandate requiring everyone to have health insurance -- paying full price for insurance would have cost more than 8% of her income.


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