I AM A FAMILY PHYSICIAN in Cleveland. For more than two decades, I have cared for lower-income families whose health struggles were made worse by their inability to afford private health insurance or to qualify for publicly funded health insurance through Medicaid or Medicare. Very few of their employers offer health insurance. This results in unaffordable medications and treatments, poor control of chronic illnesses, and avoidable complications from these illnesses.

The Affordable Care Act (ACA) of 2010 represented a sea change in the lives of my patients. They benefitted from two major health-insurance expansions: individual health-insurance exchanges, with subsidies to help middle-income families buy private insurance, and an expansion of Medicaid.

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