The best part of working as a volunteer helping Kansans enroll for health insurance is when a neighbor gets affordable coverage. Often they come in uncertain if this is something they want any part of, or not. Thrive Allen County offers the assistance of trained and vetted Navigators to help residents of Allen County enroll in the health insurance Marketplace. Call 365-8128 for an appointment or drop in at Thrive, Wednesday evenings 5-8 for assistance.
Some have health problems that they have put off dealing with. Others are trying to do right by their families and community. Some want to just make sure they don’t get hit with a fine or penalty. It turns out to be a good deal for most that come. If you make between $11,490 and $45,960, or between 100 percent and 400 percent of the Federal Poverty Level (FPL) as a single person, more if your family is bigger, it turns out pretty good because you will get some level of tax credit or subsidy to help you pay for coverage. If you are on the lower part of that range, between 100 percent and 250 percent of FPL, it is going to be a very good deal. You will get a larger tax credit and help with deductibles, coinsurance and co-pays. This can make a real and positive difference in lives of people who were uninsured before they came in.
But what about people who make less than 100 percent of FPL? That turns out to be the worst part of the job.
The usual expectation is if we have a program meant to help people get something they can’t otherwise afford, the less a person makes, the more help they get. As we discussed above that is true of the health insurance Marketplace … up to a point. A very precise set of points to be clear: $11,490 for a single person; $15,510 for a family of two; $19,530 for a family of three; $24,550 for a family of four. Below these amounts, we throw the usual ideas of what is fair and decent out the door. These people, who came to us for the same reasons, hopes and fears as their slightly better off neighbors, get nothing. When I help people try to enroll, I have to break this to them and it breaks my heart. This is the worst part of the job.
So how did this come about? In a word, “politics.”
In June 2012 we waited to see if the Supreme Court would strike down the Affordable Care Act. It was mostly about the “individual mandate” that requires nearly everyone to obtain health insurance coverage. No mandate, then no Obamacare. The health care act survived the challenge and the individual mandate was upheld. But there was another side issue in the case. It concerned whether the federal government could require the states to expand Medicaid coverage.
Under the ACA, the federal government would provide Medicaid to all Americans with an income under 138 percent of poverty. This would expand Medicaid coverage to people beyond what states already covered. What states covered varied from state to state, but in Kansas it covered only people with disabilities, elderly, pregnant women and mothers with children all with income much, much lower than FPL. Kansas also has similar coverage for children (one bright spot) of low and moderate income for very modest fees. Between 75,000 and 100,000 Kansans could have gained coverage under Medicaid expansion.
The Supreme Court ruled expanding Medicaid was up to the states, even though the feds had agreed to pay 100 percent of the cost for three years, then gradually drop that amount to 90 percent and pay that amount permanently. Kansas politicians chose to leave this money on the table and let the poorest of the uninsured go without coverage.
Even though the ACA intended those living under 100 percent of the FPL to get coverage under Medicaid, in Kansas get nothing. Never mind the health consequences, including premature deaths from untreated chronic disease, for the still uninsured underclass. Never mind that our hospitals, health centers and private doctors will have to needlessly eat costs for whatever care the uninsured do get.
States can opt in to the Medicaid expansion at any point, although at least one year in which Kansas could have received 100 percent reimbursement has passed and the money wasted. Ironically Kansans are still paying for coverage for low income people’s coverage in California, New York and Massachusetts, http://howmuchhasksleftonthetable.com/among states. We are just not covering our own neighbors. According to the Hutchinson News this will cost the state $5.3 billion in federal money and $2.3 billion that would have been paid to the state’s hospitals for providing unpaid care. If all of this seems unjust and senseless, you can still do something about it. On March 18 the Kansas Medicaid Access Coalition will gather at 9 a.m. at the state capitol and then go on visits to explain to our elected representatives what this means to our community. Visit https://www.facebook.com/KansasMedicaidAccess for more information about this event.
— John Robertson
Kansas’ poor left out of Obamacare
