Falling into the health insurance gap

Falling into the health insurance gap

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by Karen Zatkulak

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KTVB.COM

Posted on September 24, 2013 at 10:58 AM

Updated Tuesday, Sep 24 at 4:41 PM

BOISE -- Big changes are coming to health care, with enrollment in the Health Insurance Marketplace beginning on Tuesday, October 1st.

In Idaho, the marketplace will go by the name "Your Health Idaho."

There will be over 160 different plans from eight different insurance providers.

Along with the options available through the exchange, some people will also qualify for Medicaid.

But, Idaho did not pass Medicaid expansion -- so there is now a group of people who fall into a gap.

They will not be eligible for financial help through the exchange, and they cannot get help through Medicaid.

One of those people is Kathy Rogers-Roy.

She is 62 years old and has been getting her medical care at a free clinic in Canyon County for years.

Rogers-Roy is one of an estimated 77,000 Idahoans without insurance, who is making less than the federal poverty line.

She has also lived through three heart attacks in the last four years.

"It gets really scary when they come in and you've only been in there a few days and they start to tell you the bill so far," said Rogers-Roy.

Rogers-Roy tells us she never thought she'd be in this position.

Years ago, she was married with two sons and had health insurance, and admits it's emotional to live with the fear of medical bills and without coverage.

Rogers-Roy is looking for work, but is currently unemployed.

She has fallen into a gap in the new health care system.

Since Medicaid expansion didn't pass in Idaho, she's not eligible.

Right now, adults over 65, or those with a disability, and also some of those with children can receive Medicaid coverage.

But, Rogers-Roy's kids are grown, so she isn't eligible.

Also, she makes too little to get health-related financial help from the government in the form of premium assistance.

Rogers-Roy makes less than 100 percent of the poverty line, or $11,490 a year, so she's doesn't make enough money to qualify for federal subsidies on the exchange.

She's one of many caught without help, and was disappointed when we told her.

"Um, it would be hard for me to try to explain it let alone fathom that, I don't know really," she said.

Michael Coleman also falls in the gap.

He works odd jobs when he can, but also can't afford insurance.

"It's overwhelming to the point where you need family to back you and help you through to keep you above water," said Coleman.

Coleman is 55 years old and suffers from heart problems.

He says it's difficult to deal with the fact that the exchange won't offer him more affordable coverage since he's also not eligible for federal subsidies.

"The government needs to stick up and take care of us, there are people who don't have the capacity, the physical ability to work and obtain insurance," said Coleman.

The Idaho Department of Health and Welfare says the gap is a result of a change in the Affordable Care Act.

Originally, Medicaid was slated to expand in each state, covering those up to 138 percent of the federal poverty line.

But, when the Supreme Court decided each state could decide whether to pass expansion, those who make less than the poverty line fell into a hole, an estimated 77,000 in Idaho.

That includes people like Michael and Kathy who will continue using free community clinics for their medical needs, hoping for another change that will finally get them coverage.

"I'm not exactly sure how it's going to affect those of us who have fallen through the gaps, I think it's kind of a wait and see situation," said Rogers-Roy.

We do want to point out, you don't have to buy insurance from the exchange if you're already insured, or if you want to buy from somewhere else.

We will have much more on the health care changes coming to Idaho in a special program.

"Your Health Idaho" will air at 6:30 p.m. on Saturday, September 28, on Idaho's News Channel 7.

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