Editor’s note: This is the second in a series regarding the Affordable Care Act. Saturday’s paper will address small businesses.
While healthcare services for most will be improved under the new healthcare legislation, it’s Kansas’ poor who have the most to worry about, said Sheldon Weisgrau, a healthcare expert.
“It’s another ‘doughnut hole,’” he said, referring to the gap in coverage for prescription drugs which many seniors have experienced.
For Kansans, the problem begins with the Gov. Brownback’s refusal to expand the state’s Medicaid roles. Kansas has one of the most restrictive Medicaid programs in the nation, including the fact that adults without children cannot qualify for its services no matter how poor they are. Parents can qualify if they have incomes below 32 percent of poverty guidelines. For a family of three, that would be less than $550 a month, or $6,600 a year.
“A single parent with two children and working a minimum wage part-time job is too rich by Kansas standards to receive help,” Weisgrau said.
Under Obamacare, the idea was that states would expand their Medicaid programs to include all adults with incomes up to 138 percent of federal poverty guidelines, or about $15,900 for an individual and $32,000 for a family of four. In Kansas, an individual can make no than $3,677 to qualify for Medicaid services.
So those individuals in jeopardy will be those who earn between that $3,677 and 100 percent of the federal poverty level, $11,490, an estimated 58,000 Kansans.
“They’ll be too rich to qualify for Medicaid, but too poor to qualify for tax credits,” Weisgrau said.
For those who make 100 percent to 400 percent above the federal poverty law, tax credits will be made available in the form of rebates to help with the cost of health insurance premiums.
For those who make less than the lower limit — and should be on Medicaid — “they’ll be left out in the cold,” Weisgrau said.
He estimated 130,000 Kansans currently are without health insurance. Of those, 88,000 are expected to fall into the Medicaid coverage gap.
BESIDES the obvious, having fewer people qualify for Medicaid presents another problem. Before the Affordable Care Act was enacted, hospitals received a stipend from the federal government to help pay for the indigent who used hospital services but could not pay for them. When the U.S. Supreme Court deemed Obamacare constitutional in 2012, those funds for charity cases were scheduled to be taken away from hospitals with the understanding that the money would come from states expanding Medicaid participation and receiving the additional federal reimbursements. Under the ACA, the federal government has guaranteed to reimburse the additional costs of an expanded Medicaid program by 100 percent for three years, 2014-2016, and then a 90/10 federal-state split from then on.
A frequent argument by those who oppose expanding the Medicaid rolls is their distrust the federal government will keep to its promise of paying its share of the Medicaid expansion.
Weisgrau scoffs at the accusation.
“It would take a change in law for the government not to live up to its commitment,” he said, noting the government’s consistent record of paying its share of Medicaid payments since the program’s inception in 1965.
