Day four of a five-day series
THURSDAY, Sept. 26 (HealthDay News) -- Millions of Americans
struggle to make ends meet but they don't qualify for Medicaid, the
government-sponsored health program for the poor. Yet they don't
make enough money to afford private health insurance.
The Affordable Care Act, President Barack Obama's historic and
controversial health reform law, seeks to narrow that insurance gap
Those two parts of the health reform law are scheduled to take
effect on Jan. 1, 2014.
Few people realize that Medicaid leaves so many unemployed,
homeless or working uninsured people without coverage. Every state
has its own rules, but typically you have to be pregnant, disabled,
a child or a parent or caregiver --
and poor-- to qualify for Medicaid.
Katherine Mather of Portsmouth, Va., got dropped from Medicaid
in 2012 after her son turned 18. The news sent her into a panic
because Mather, who is 49, is coping with multiple medical
conditions, including a fractured back.
Now uninsured and unable to work, she has applied for disability
insurance but has yet to be approved. In the meantime, she is
receiving charity care from doctors and hospitals affiliated with a
local nonprofit, Catholic health system.
"You know, it's really humbling, the whole process," said Mather, who worked in sales for many years while raising three children on her own, "and now I'm asking for help every day."
The Affordable Care Act, sometimes called "Obamacare," aims to
plug some of the gaps in Medicaid, so people like Mather won't lose
or go without coverage. Adults who no longer have dependent
children or who are not disabled are among those who will benefit
the most from the Medicaid expansion.
The law also helps uninsured Americans who make too much money
to qualify for Medicaid but not enough to buy their own insurance.
They can get tax subsidies to buy their own coverage through the
new insurance marketplaces.
Consumers can begin enrolling in Medicaid or shopping for a
private health plan through their state's health insurance exchange
beginning Oct. 1. You don't need to know which type of coverage you
qualify for. There's a single application and, based on your
household size and income, you'll be advised of your options.
How Obamacare's Medicaid expansion affects the uninsured
The Medicaid expansion is based on income, not whether you have
dependents or a disability. If you're under age 65 and you earn up
to 138 percent of the federal poverty level -- as much as $15,856
for an individual and $37,384 for a family of four -- you may be
eligible for coverage. Even those who have been turned down by
Medicaid in the past could qualify this time around, depending on
the state they live in.
But for many, there's a catch.
In its 2012 decision upholding the constitutionality of the
Affordable Care Act, the U.S. Supreme Court also ruled that states
can opt out of expanding Medicaid. So far, just 24 states and the
District of Columbia are moving forward on the 2014 Medicaid
If you live in one of those places, you may already be in luck.
Five states -- California, Connecticut, Minnesota, New Jersey and
Washington -- as well as the District of Columbia decided to expand
their Medicaid programs early.
"We have close to 600,000 Californians who now have Medicaid-like coverage prior to Jan. 1, 2014, and who will be automatically shifted into full Medi-Cal (California's Medicaid program) on Jan. 1," said Anthony Wright, executive director of the consumer advocacy coalition Health Access California.
If you live in a state that isn't expanding Medicaid, you won't
be penalized for not having coverage. It's possible, though, that
you may be eligible for federal subsidies to buy private coverage
through your state insurance exchange. The exchanges are available
to people who otherwise would have been eligible for Medicaid with
incomes between 100 and 138 percent of the federal poverty level.
That's $11,490 to $15,856 for a single person and $23,550 to
$32,499 for a family of four.
But in states that are not expanding Medicaid, there's no relief
for the poorest of the poor, whose income falls below the federal
poverty level. They won't be eligible for coverage through the
Georgia is one of the 27 states that won't expand Medicaid in
"There will be a lot of people who will be left out," said Cindy Zeldin, executive director of Georgians for a Healthy Future, an Atlanta-based consumer advocacy group that supports extending Medicaid to the state's 650,000 low-income uninsured.
But it's still worth applying for coverage, Zeldin said. "We
would encourage people to go and see if they're eligible for
exchange coverage," she said.
Why bother with health insurance, anyway?
The Affordable Care Act requires most people to have health
insurance or pay a fine. That mandate is meant to keep health
insurance rates reasonable by coaxing everyone, including healthy
people, to buy coverage.
There are exceptions, though. People who earn too little to file
taxes are automatically exempt from the mandate. Plus, anyone who
is homeless, facing eviction, or experiencing another type of
hardship can seek an exemption.
Still, having insurance is much better than going without. The
uninsured often delay or forgo needed medical care, and get sicker
and die earlier than people who have health insurance. When they do
receive care, they pay more out-of-pocket. Sometimes consumers
amass perilous amounts of medical debt because they lack insurance
or their coverage is inadequate.
In a one-of-a-kind study, researchers at the Harvard School of
Public Health and Massachusetts Institute of Technology examined
Oregon's 2008 Medicaid expansion and found striking differences
between low-income adults who made it into the program and those
who didn't. Having Medicaid improved people's access to care and
use of health services. It nearly eliminated catastrophic medical
expenses and boosted their mental well-being.
But will having Medicaid ensure access to care? In California,
fewer doctors take Medicaid due to low reimbursement rates, Wright
conceded. But, he added, "It's also very clear that getting on
Medicaid is much more preferred than being uninsured."
Community Catalyst and Georgetown University Health Policy
Institute's "Health Insurance 101" website can tell you more about
key provisions of the
Affordable Care Act.
To read part one of the series, how to navigate the new health
To read a part-one story on the potential impact on young
To read part two of the series, how the Affordable Care Act will
affect those who get their insurance through their employers,
To read part three of the series, how the Affordable Care Act
will affect workers who don't have insurance through their jobs,
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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