By Logan Hendrix
Rockbridge Area Health Center volunteers helped more than 300 residents sign up for health insurance under the Affordable Care Act before the deadline on Monday..
But thousands of low-income residents in the area remain uninsured as the state General Assembly meets in special session to consider expanding Medicaid benefits.
Virginia is one of 26 states that has opted out of an Affordable Care Act provision that would expand Medicaid coverage to more low-income residents. Gov. Terry McAuliffe has made Medicaid expansion a priority but lawmakers failed to make that happen during the regular legislative session. The special session convened on Tuesday.
Nationwide, seven million Americans signed up for health insurance before the Monday deadline, according to the Obama administration.
Timothy Jost, a law professor at Washington and Lee University and a leading authority on health care and health insurance reform, is a supporter of the ACA, which is also known as “Obamacare.”
However, Jost says the Marketplace, a federal exchange to compare and shop for a particular insurance, doesn’t solve all health care problems in Virginia.
“If your income is below 100 percent of the poverty level, then you’re not eligible through premium tax credits through the Marketplace,” Jost said. “If your income is above that level then you may be eligible for the Marketplace.”
The Marketplace is “better than being uninsured because if you have a major health care problem or accident, you’re not going to be driven into bankruptcy,” he said.
But Jost said the Virginia House of Delegates’ refusal to expand Medicaid has left 300,000 people uninsured, given up 30,000 jobs and $3 billion every year in federal aid.
“Let’s talk about reality,” he said. “Let’s talk about who you’re hurting.”
Connie Forren, a resident of Rockbridge County who has health insurance under the federal Medicaid assistance program along with her two children, said her husband is one of the people who is hurting. Claude Forren is not eligible for Medicaid because his income is too high; however, he does not make enough money to buy insurance through the Marketplace either, so he is currently uninsured.
“It’s concerning he can’t get insurance,” Connie Forren said. “What if he gets hurt? And he’s disabled so that makes getting insurance even more difficult.”
The ACA requires everyone in the country to have health insurance in 2014, whether through the Marketplace, or private insurance companies. After Monday’s deadline, if someone does not have health insurance, he or she may have to pay a penalty. This year the penalty will be $95 per adult plus $47.50 per child, up to $285 per family or one percent of a household’s income, whichever is more.
To avoid a fine, individuals must have insurance that covers a minimum of 10 crucial health benefits — such as emergency services, hospitalization, maternity and newborn care, prescription drugs and more — or covers 60 percent of an individual’s medical expenses.
Uninsured individuals who are not required by law to file a federal tax return because their incomes are so low, or who cannot find coverage that costs less than eight percent of their income, will not have to pay a penalty. Indian tribe members, people whose religion bans health insurance, illegal immigrants, Americans living abroad and people in prison are also exempt from paying a penalty.
People covered through their employers or government-paid programs such as Medicare, Medicaid, the Children’s Health Insurance Program or TRICARE also do not face a penalty.
If someone is uninsured for less than three months of the year, there is no penalty. However, a penalty can be applied to each month someone goes without health insurance after those three months.
Forren is concerned about the penalty for her husband not having health insurance.
“I haven’t really heard much about the Marketplace. Most people I know are on Medicaid or have private insurance. I heard this year there was going to be some sort of fee for not having health insurance. If that happens, I’m not sure what we’ll do.”
Jost said navigating the Marketplace is confusing, but it’s been well advertised.
“It’s been in the papers every day; it’s all over the web; it’s being covered by every television and radio channel and so basically people need to pay attention,” he said. “ Part of the problem is there is still a lot of intentional confusion about what is going on.”
“People are confused because if they watch certain television stations, or read certain websites, they have no idea what’s going on. All their information is bad information. What they need to do is go to healthcare.gov. They need to talk to an insurance agent, and they need to do it quickly.”
Rockbridge Area Heath Center Development Director Katy Datz says the act has helped people find affordable health care through the Marketplace exchange, but nearly eight percent of the local population still won’t qualify for that help. However, Datz says the health center will still continue to see people with and without insurance.
“In addition to that, for the people who remain uninsured because they can’t afford the cost of premiums or for whatever reason they don’t attain insurance, we will still see people without insurance and we have a sliding scale,” Datz said. “ So there’s a financial assistance program that anyone can go through insured or uninsured.”