Insurance

Falling Through the Gaps in Obamacare

There was a time when health insurance was only available to people with money and/or with jobs that offered affordable insurance coverage. Today, thanks to the Affordable Care Act, aka Obamacare, more people are able to afford the coverage they need.

Furthermore, many of those people are also getting coverage for things that had previously been left out of insurance policies, such as drug and alcohol treatment services.

In fact, according the ACA, substance abuse and mental health services are considered essential care for which insurance companies are required to provide coverage. There are also rehab centers that are aware of this, and can help people navigate the new insurance rules to get the help they need. (1)

However, although the Affordable Care Act has made it possible for millions of the poor and self-employed to get affordable health insurance, there are still those who fall through the cracks.

Falling Through the Cracks

When the Affordable Care Act was first introduced, there were provisions to expand Medicaid coverage to individuals who would be too poor to qualify for the subsidy, but not poor enough to normally qualify for Medicaid. The Supreme Court ruled that requiring states to expand Medicaid was unconstitutional, and the states were given the option to opt out – several states took that option.

As of this writing (2), 28 states and the District of Columbia have expanded their Medicaid coverage, three states are considering expansion, and 19 states have no plans to expand. This means that the millions of poor living in the states without Medicaid expansion will continue to fall through the cracks.

What the Obamacare Medicaid Provision Means

Prior to the Affordable Care Act, there were millions of working poor: people who had jobs – sometimes multiple jobs – that paid a subsistence wage. Additionally, many of these jobs did not provide health insurance. However, although they could be classified as poor, their jobs paid just enough they there were above the poverty line. (3)

With the Medicaid expansion in the Affordable Care Act, the working poor under age 65 could qualify for Medicaid if they are at or below 138 percent of the poverty line. That means a single person, without kids, could make up to $15,857 per year, and a family of four cold make $29,700 per year. Those who make more than that would qualify for a subsidy if they apply for insurance through the marketplace.

The Federal government would have funded the expansion 100 percent the first year, meaning the funds would not have come out of the State’s coffers. Additionally, the federal government would have continue to fund 90 percent for the remaining years, meaning the expansion still would have been of very little cost to the states that participated.

Yet, 22 states refused to expand and, as a result, those millions of working poor fell through that gap that would have been closed by the expansion.

What the Gap Means

That gap means that individuals who are too poor for the subsidy, but not poor enough for Medicaid will get no coverage at all. Not only will they not have coverage for preventative care that could keep them healthy, such as yearly physicals, mammograms, and pap smears, but they will also not have coverage for the care they need when they are sick.

It also means that individuals with existing conditions, such as chronic diseases or drug and alcohol issues won’t, be able to afford the care they need to get sober.

Options for Care Without Insurance

Community health centers are often the only care option for people who don’t have insurance coverage. Some of these community centers offer everything from vaccinations and other preventative care to care for acute injuries and illnesses. In many cases, they can offer a sliding scale for fees and payment plans.

However, not every community has these types of clinics, and the few clinics that do exist are overcrowded.

For many, emergency rooms are still the first option for people with acute injuries and illnesses, because emergency rooms can’t turn people away. However, when it comes to treating and managing chronic conditions, or mental health issues like drug and alcohol addiction, there are still very few options.

The good news is that more states are looking to expand Medicaid, which means we could get closer to closing that gap and providing affordable coverage for all.

Resources:

1.  The Recovery Village: Insurance

2.  The Advisory Board Company: Where the States Stand on Medicaid Expansion

3.  Healthline: Healthcare Reform: How the Poor Continue to Fall Through the Cracks

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