In June 2014, Mary Gass, a 55-year-old employee at a nursing home in Inman, South Carolina, was lifting an elderly resident out of his bed when she felt a sudden, sharp pain in her neck followed by what she described as a burning numbness. For weeks, the pain worsened, leaving Gass unable to perform many of the everyday tasks for the elderly and infirm people she cared for. After several months, her doctor advised her to take leave from her job in order to treat a bulging disk in her neck that was impinging on the nerves in her upper spinal cord. She would need surgery to repair the disc, but the operation was standard enough to be done at the local Hospital in nearby Spartanburg.

Yet just weeks before her planned surgery, Gass—whose income was dedicated primarily to basics, like food and rent, and who also played a crucial role in supporting her disabled daughter—says she was stunned to learn that her employer-sponsored healthcare plan provided by an Indianapolis-based company called Key Benefit Administrators would only contribute several hundred to the surgery, which would potentially cost up to $20,000. For years, Gass had been accustomed to being fully protected against such large bills. “I had been covered for all these years before,” Gass said. “But this stopped the ball in middle of the road—it wouldn’t cover crap.”

Earlier that year when the Affordable Care Act (ACA) began requiring that large employers provide health insurance to their employees, the nursing home where Gass worked had began pushing a new insurance plan called KeySolution, which was being offered by Key Benefit Administrators. The company offers what is known as a “skinny plan,” which exploits what many consider to be a loophole in the language of the ACA that allows employers to offer employees insurance that covers strikingly little.

One of the central promises of Obama’s signature healthcare law was to prevent Americans from going broke paying for essential healthcare procedures. But some of the country’s largest health insurance companies—including healthcare behemoth UnitedHealthcare—have developed and marketed a variety of plans similar to Gass’s that allow employers to avoid the expense of doing just that. The plans exist in a legal gap area that only applies to large employers and often cover only preventative care options such as check-ups but not things like hospitalization and surgical operations—the very items that carry the bank-breaking costs from which Obamacare was intended to shield low-income Americans. Employees like Gass are exposed to bankruptcy-causing medical bills as if they had no insurance at all.

A Key Benefit Administrators document—which was posted online by an Oklahoma-based temporary staffing agency—shows in explicit detail just how little the plan covers. Some examples of healthcare items not covered by the KeySolutions plan, according to the document, are a primary care “visit to treat an injury or illness,” diagnostic tests, hospital stays, emergency care, and both generic and brand drugs. The plan does cover preventative care, screenings, immunizations and prenatal exams.