FUSION/Omar Bustamante

This is the last of a three-part series examining Obama’s legacy on his cornerstone policy achievements.

It's been almost seven years since President Obama signed the Affordable Care Act, a landmark piece of legislation that would prove to be among the most significant—and most contentious—accomplishments of his presidency. In the years since, around 20 million people have gained access to insurance. Pre-existing conditions were no longer a pretext for insurers to deny coverage, a new baseline for mandatory care was established across plans, and health care as we knew it changed.

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But there were significant gaps in the law, wide enough to let millions fall through them. While the uninsured rate has dropped to a historic low, around 30 million people remain without coverage. And for people living in states that did not accept the Medicaid expansion, the coverage gap—a population that earns too much for Medicaid and too little for a subsidy—has meant living without insurance at a moment of unprecedented coverage.

These are the stories of two people living on both sides of that divide, as told to Fusion.

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Carrie Denny, 41, grew up in a small town in Tennessee. One month after taking a full-time position in nursing, she was diagnosed with thyroid cancer. 

My journey started back in 2012. I already had bachelor's and master's degrees, but I had gone through a layoff and decided to pursue my lifelong dream of becoming a nurse.

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I graduated in December 2013 and started my new job as a nurse in an orthopedic surgery wing. But I was out of work the next month with bilateral knee injuries. In the middle of all that, they figured out there was an issue with my thyroid. So on April 16th, 2014, I had surgery to remove the half of my thyroid that had a tumor on it.

On April 18th, I went for my follow-up to the surgery and they said, “You have cancer.” My life changed forever. I had known all along that the end date of my COBRA [which I went on during nursing school] was coming, but now it’s, “Oh my god, I can’t go back to work, I am going to be out of insurance and I have cancer." I ended up having the second surgery literally six days later. They even went in through the same incision—that’s how advanced it was and how quickly things happened.

Sometime between finding out I had cancer and preparing for the surgery, I got on HealthCare.gov to research plans. I found one. There was no such thing as a pre-existing condition.

I went from thinking I was going to go bankrupt, or die, or both, to thinking, “I’m going to be OK.” After I added it all up, my cancer costs were upwards of $750,000. There was no way I could have paid for that.

My fear going forward is if I lose my coverage or anything happens with pre-existing conditions, I won’t be insurable. And that is terrifying because I am only 41 years old. It's been only a year-and-a-half since my no-evidence-of disease report.

Before this happened to me, I was a card-carrying member of the NRA, a card-carrying Republican. I thought universal health care was the wrong idea.

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I was out of work for almost three years. I couldn’t even get out of bed, I was so weak. I ended up having to go on disability, on food stamps. It made me realize these programs assist people, and we need to de-stigmatize them. It changed me, and I’m grateful for that. I feel like I’m much more human.

Sitting in my seat, it is scary to not know what my future looks like; if I’ll even have a future based on what Washington decides to do.

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Ima Oduok, 27, is an English teacher from Texas, a state that rejected the Medicaid expansion. This is the second year in a row she has found herself in the Affordable Care Act's "coverage gap." 

I tried to sign up for health care on the marketplace, and they ask for your income information and all that. I put in what I expected to make for 2017, which is really little. But I still didn't qualify for Medicaid. At the same time, I also didn't qualify for the subsidies.

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I had insurance last year, even though I also didn't qualify for the subsidies then. I was paying for my health insurance out of my savings that I had from before. Between bills and home and paying rent here [in the French Caribbean, where she is teaching until April]—it was just too much. Then my premiums went up and there was no way.

Without Medicaid and without a subsidy, it was just too expensive. So I didn't sign up and took the hardship exemption. I'll be putting that code in on my tax returns.

But before the Affordable Care Act, I couldn't get health insurance at all outside of work. I have chronic depression, and when I tried to get my own individual health insurance right after I graduated–which was before the ACA–the company basically told me, "We can't cover you because of your pre-existing condition." So when the ACA was passed I was like, "I can get meds!" It was really upsetting for me to not be able to get health care again, and it's causing me a lot trouble, actually, trying to get off of my meds so I don't have to worry that much [about not being able to afford them later.]

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My plan now is that if I need to go to the doctor, I'll go to low-income health care clinics. And try not to get sick.