Georgians stuck without Medicaid increase

Around the clinic room at Medical Associates Plus at Belle Terrace, the small cluster of patients tell the same story – with different themes.

They are uninsured and have spent hours online and making numerous phone calls trying to sign up through the Health Insurance Marketplace. They are in their 50s and early 60s and are being quoted monthly premiums around $500 or more, which they can’t afford. They are seeking care in the Emergency Room, where they feel unwanted.

If Georgia expanded Medicaid, all of them would be covered, but Gov. Nathan Deal said he will not do that.

“Deal is not dealing,” said Michael I. Everett, 57. “Deal is not giving us our due.”

A Deal spokesman said Friday that the governor did not create the problem and it is up to the federal government to solve it.

People who would have qualified for Medicaid if expanded are also not eligible for subsidies under the Affordable Care Act, which leaves them stuck paying the whole monthly premium or going without insurance. In Georgia, that is 409,000 people, or 22 percent of the uninsured, according to an analysis from the Kaiser Family Foundation. Deal spokesman Brian Robinson said they had estimated 620,000 would have been added under Medicaid expansion.

For many uninsured, buying health care coverage themselves is unrealistic. With a fixed monthly income of $1,300, Suzanna Mitchell said the premium quoted to her is $500 a month.

“How do they expect me to live?” she asked.

“Or get medications?” added Wallace England, 53.

Without Medicaid expansion, it is nearly impossible for an adult in Georgia who is not disabled to qualify for the program. Eligibility is limited to parents with incomes below 38 percent of the poverty level, or less than $9,000 a year for a family of four, according to the Kaiser Family Foundation report. Even allowing adults to qualify at the federal poverty level, $11,490 a year for an individual or $23,550 for a family of four, would cover 35 percent of the patients seen at Medical Associates Plus, CEO Janice Sherman said.

While patients pay a co-pay on a sliding scale to be seen at the clinic, it doesn’t begin to cover the actual costs of their care, she said.

“Not by a long shot,” Sherman said.

As a Federally Qualified Health Center, Medical Associates Plus gets a federal grant to help subsidize those costs, but that still means the costs are borne “by us,” she said. If Georgia expanded Medicaid, instead of getting a $25 co-pay, patients would bring about $117 from Medicaid. With that applying to more than a third of its patients, “it would be substantial,” Sherman said.

Everett is on unemployment but “once that unemployment runs out, I’m in a Catch-22,” he said. Unless he raises his income, he still won’t qualify for subsidies to buy insurance.

“To pay that $500 right off the bat ... ,” Everett said.

“Oh, that’s a lot,” said Janice Bailey, 63. She is facing the same thing and has gone through both the paper and online application process and the least she would pay is just under $500.

“They made it sound so easy,” Bailey said. “It gets you really confused.”

It is an issue that President Obama and Congress need to solve, Robinson said.

“There are numerous avenues the administration could take,” he said by e-mail. “It could allow the expansion population to buy private insurance on the exchange or it could block grant Georgia the federal share of the expanded Medicaid money.”

The U.S Supreme Court “said that states cannot be coerced into expanding Medicaid, yet that is exactly what federal policy is attempting to do,” Robinson said. “Gov. Deal simply cannot put Georgia taxpayers on the hook for the billions in new state spending that the expansion would require.”

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WHY IS THERE A COVERAGE GAP FOR THE POOR IN GEORGIA?

When the Affordable Care Act was passed in 2010, a large amount of increased coverage for the uninsured was going to come from states expanding their Medicaid coverage. In many states, such as Georgia, childless adults without a disability have a hard time qualifying for Medicaid even if they are very poor. The Affordable Care Act would have encouraged states to expand Medicaid up to 138 percent of the poverty level (around $32,500 a year for a family of four), by paying 100 percent of the costs for the first three years and never less than 90 percent after that. The Secretary of Health and Human Services could also withhold Medicaid funding if a state did not expand. To presumably keep states from pushing Medicaid patients into the Health Insurance Marketplaces, the law also forbid anyone who qualifies for Medicaid from receiving subsidies in the marketplaces.

The U.S. Supreme Court ruling in 2012 that upheld the law also took away the ability of Health and Human Services to withhold Medicaid funding, which made expansion voluntary. Georgia, South Carolina and many other states chose not to expand Medicaid. Georgia Gov. Nathan Deal said it is not affordable, and instead wants the federal government to put the Medicaid funding into a block grant to allow the state greater flexibility with the program.

Source: Kaiser Family Foundation

TOPIC PAGE: Health Care Reform

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