By Janey Fugate
Connie Forren’s husband hasn’t seen a doctor in 20 years.
“He’s the main breadwinner and he’s the one we can’t afford to get sick,” said Forren, a resident of Rockbridge County.
Forren, disabled and unemployed, qualifies for coverage under the federal Medicaid assistance program, along with her two adult kids. But her husband, Claude Forren, is ineligible. And he probably won’t be able to sign up for individual coverage under the Affordable Care Act – also known as Obamacare — a big part of which went into effect on Tuesday.
“You get emotional on those things because you depend on them so much,” said Forren.
Forren’s husband is just one of the 2,886 uninsured people living at or below 138 percent of the Federal Poverty Level in the Rockbridge area, including Lexington and Buena Vista. While the new act provides federal subsidies to help many uninsured people buy coverage, nearly 8 percent of the local population won’t qualify for that help, says Suzanne Sheridan.
Sheridan is executive director of the Rockbridge Area Health Center. She sees a lot of people like Claude Forren, who make too much money to qualify for Medicaid in Virginia but not enough to get help buying insurance under the new health insurance act.
The act called for many more low-income people to qualify for Medicaid, so it left them out of the new insurance-subsidy program. But Virginia was one of 26 states that decided not to expand Medicaid coverage. So many Virginians near the federal poverty line — $11,490 a year for an individual, $23,550 for a family of four – will get neither Medicaid nor help under Obamacare, Sheridan said.
“[They] will not be eligible for the tax credits and subsidies that are part of the Affordable Care Act,” she said.
Because Obamacare requires almost all uninsured Americans to buy insurance, some of the low-income group will have to pay full price for coverage under the act. If the cost of insurance exceeds 8 percent of their income they could qualify for an exemption.
The act allows each state to set up a health insurance exchange where uninsured people can find insurers competing for clients. There is also a federal health insurance exchange for states, including Virginia, that declined to set up their own exchanges. The government subsidies apply to insurance purchased on the exchanges. But the subsidies don’t apply to the lowest-income uninsured.
Timothy Jost, a law professor at Washington & Lee University and a leading authority on health care and health insurance reform, said that Virginia loses $3.9 billion and 30,000 jobs by not expanding Medicaid to bridge the gap.
“There will be 300,000 to 400,000 people uninsured because they can’t get insurance because they’re too poor,” said Jost, who supports the Affordable Care Act.
More than 50 percent of the Rockbridge Area Health Center’s patients are among those people, Sheridan said.
“So it really leaves our poorest people in our state without any help,” she said.
The Rockbridge Area Health Center serves as a safety net for the people who still fall between the cracks. Rockbridge County is a federally designated medically underserved area. That complicates the process of implementing the new health insurance act because there are not enough healthcare providers to cover the expected increase in insured patients, Sheridan said.
After Jan. 1, under the individual mandate of the act, uninsured people who have not signed up for healthcare insurance will be subject to a fine based on their income.
Physical therapist and Rockbridge resident Elaine Goodall believes that many people will opt to pay the fine, which may be cheaper than buying insurance in the long run.
“I think that people will take their chances,” Goodall said.
Kisha Johns is one such person. Johns turned 19 this year, has chronic asthma, and works about 30 hours a week at a restaurant. She no longer qualifies for Medicaid because she makes too much and does not intend to sign up for insurance in January.
“I don’t know, I guess I won’t get sick,” said Johns. “No more hospital visits for me.”
Jost says the biggest impediment to the success of the Affordable Care Act for uninsured or underinsured people to overcome is the confusion surrounding the law.
“There is so much confusion and misinformation out there, and obstruction at the state level and obstruction at the national level,” Jost said.
Lawrence Goodall, Elaine’s husband and a retiree on Medicare, says being informed might be more than half the battle in health care reform for the uninsured poor. His wife is insured by her employer. They say they are well informed about Obamacare and they expect to see little personal impact from the new law.
“We have more knowledge and less impact,” Lawrence said. “[Low-income people] have less knowledge and more impact.”
| Where Rockbridge area residents can go for assistance with health insurance:1) People can go online to the federal Health Insurance Marketplace at https://www.healthcare.gov/ and shop for a plan.
2) The Rockbridge Area Health Center is a Certified Assistance Counselor Organization and is training employees to offer consultation on health insurance. Go online at http://www.rockbridgeareahealthcenter.org/ or call (540) 464-8700. 3) Bruce Gardner, an agent insurance broker, is registered with the Center for Medicaid Service to offer help with the system, comparisons, and consultation. He can be reached through the Rockingham Group office in Lexington at 540-463-6702. |