Barb Emerson lives in a big, Victorian house with mauve-colored wood siding. It's in Gorham, New York, between Seneca and Canandaigua Lakes. And this week, she's taking care of her husband, Louis. He just had knee surgery.
"We gotta keep that leg straight, so I have to hold on to that leg for him all the time," she said as she walked onto her porch.
The Emersons have been married for 34 years. "I got a good one," Louis said.
He works a seasonal job driving a truck for a local construction company, but even before he hurt his knee at home, the work was sporadic -- two days here, three days there.
Barb recently left her job doing electronics parts assembly to go on Social Security disability. She has ovarian cancer, and was worn out.
"It is something where, I am going to die from it," she said. "It's not going to go away. So they're trying to prolong my life right now."
Because of their low incomes, both Barb and Louis now qualify for Medicaid under the Affordable Care Act's expansion of the program. They just got approved this past spring. The program provides health insurance for low income adults and children, the elderly and people with disabilities.
"So far, so good," Barb said. "It means a lot to me. And I really hope that they ... can get this Obama, Trump stuff....I hope they can work it out."
How Congress Would Change Medicaid
Here's how the House and Senate have worked it out so far. The bills in Congress to change the Affordable Care Act eventually end that law's expansion of Medicaid for people just above the federal poverty line.They'd have to return to the individual market, if they can't get insurance through a job.
Louis Emerson doesn't see how he could afford the health insurance premiums.
"What do you do? Move in a box?" he asked, rhetorically.
Louis and Barb's representative in Congress is Republican Tom Reed. He voted for the House bill. He says the changes to the Affordable Care Act include tax credits for people to buy insurance on the private market.
"So that they get assistance," he told reporters recently. "Not being penalized, not having to go to Medicaid, but [having] access to a private provider, private health insurance."
According to analysis from the non-partisan Congressional Budget Office, even with tax credits, the annual premiums for low income, older people would cost more for insurance that could cover less care.
What New York can do
New York state could take on more of the cost Medicaid and continue to cover people under the expansion. But that would mean billions more state dollars. That kind of fiscal pressure could lead to fewer benefits, fewer people qualifying, or higher taxes.
New York does have more a more generous Medicaid program than most of the country. At the moment, the program covers about one in three New Yorkers.
The Safety Net
Barb Emerson has heard the stories about Congress considering steep cuts to Medicaid.
"And if they do cut Medicaid, is that me? I'm not a welfare person I've never been on welfare," she said. "I'm a person that has cancer and I'm out of work for a reason. And this means a lot to me. It means survival."
After a lifetime of getting health insurance at the workplace, Barb and Louis Emerson are now using Medicaid as a safety net.
The Emersons will likely maintain health insurance coverage no matter what happens, because they're both about a couple of years away from qualifying for Medicare, the government-run insurance program. If passed, the steepest Medicaid changes wouldn't happen before then.
But there are surely others like Barb and Louis who wouldn't have that option