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Alabama healthcare gap hurts workers

Irby Ferguson, manager of the Access to Care program at St. Vincent’s Health System, expected a lot to change when subsidies under the Affordable Care Act went into effect earlier this year. Because the Access to Care program assists low-income people who have no health insurance, he thought one-third to one-half of his clients would gain access to coverage through the federal Healthcare Marketplace.

To his surprise, only about 30 of the 380 participants in Access to Care had made the transition to health insurance by the time the enrollment period under the Affordable Care Act ended March 31. “The confusing thing to me is to see someone working full-time and not qualify for coverage under the [federal] exchange,” Ferguson said during a telephone press conference last week.

He said about a quarter of Access to Care clients are employed part- or full-time. All have incomes that are less than 200 percent of the federal poverty level, and many of them would qualify for the federal Medicaid program if Alabama had chosen to expand its Medicaid program under the ACA. Because Gov. Robert Bentley has chosen not to expand Medicaid, hundreds of thousands of Alabamians who would receive care do not qualify.

Basically, people whose income falls in the range that would be covered by Medicaid do not qualify for subsidies under the ACA. In Alabama, those with an income of no more than 18 percent of the federal poverty level, or $3,560 for a family of three, are eligible for Medicaid. If Medicaid had been expanded, it would cover those with an income of up to 138 percent of the poverty level, or $27,310. The catch is that those whose income falls within the federal Medicaid limits do not qualify for subsidies that help pay for healthcare coverage under ACA. That means a mother with two children who earns less than $27,310 a year is eligible for neither Medicaid nor a federal subsidy. Alabama does provide Medicaid for children of low-income families.

A number of advocacy organizations are urging Bentley to change his mind and expand the Medicaid program.

“What often gets lost in these discussions is actual people,” Ferguson said.

Ferguson was one of the speakers at a press conference set up by the Arise Citizens’ Policy Project and Families USA to unveil a new study by Families USA on who would be affected by Medicaid expansion.

The study shows that 54 percent, or nearly 185,000, of the estimated 342,000 people who would qualify for coverage if Medicaid was expanded are working or have worked in the past year, said Dee Mahan, Medicaid program director for Families USA. “Alabama has a chance to expand healthcare coverage…and help working people,” she said.

The study shows that another 24 percent of those who would get coverage are classified as “not in the workforce” and include people with disabilities, students, non-working spouses and others who have left the workforce. The remaining 22 percent are unemployed.

“Hundreds of thousands of Alabamians are caught in the healthcare gap,” said Jim Carnes, ACPP’s policy director. “We like to think of the people in the coverage gap as the people who keep things going. … There are many Alabamians in low-wage essential jobs.”

The study details the industries where the 185,000 workers are employed, including 26,000 in food service and another 26,000 in construction. Other industries include sales, 25,000; cleaning and maintenance, 20,000; production, 17,000; transportation, 15,000; personal care and support, 8,000, and installation and repair, 7,000.

“We wanted to dig a little deeper into the big round numbers that everybody throws around. … It’s easy to sort of forget that within that big round number, it’s made up of individuals,” Carnes said. “We knew from the census data that the majority of folks who would stand to gain are working people. We wanted to show who they are in our communities …Who around us is suffering for our lack of taking advantage of the opportunity?”

He said the workers who would benefit are people who the average person interacts with on a regular basis but may not be aware are uninsured. “I think it is interesting that food service is the largest category of employment in the coverage gap. … We should wake up and realize that we want our food service workers to have affordable coverage,” he said.

Carnes added that 27,000 low-income veterans are included in the 342,000 people who would benefit from Medicaid expansion.

Ferguson said the study debunks a misconception that many have about the uninsured. “Somehow the poor are ‘moochers’. They may be deserving of what they are getting,” he said. “I can tell you that is not true. They are hard workers and they are deserving of help.”

To read the study, go to the Families USA website.

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