Poorest of the uninsured fall into coverage gap

Written by Matt Paul, Reporter/Producer | Oct 11, 2013 3:47 AM

Kyle Fisher

(Lancaster) -- Pennsylvanians making between 100 and 400 percent of the federal poverty line are eligible for tax credits or other subsidies on the new federal health insurance exchange. But a gap exists for the poorest of the state's uninsured.

An estimated 400,000 Pennsylvanians earn too little to qualify for federal subsidies on the new insurance marketplace, but make too much to qualify for Medicaid.

Kyle Fisher, a staff attorney for the Pennsylvania Health Law Project, says something is wrong with the way the system is operating.

"We're offering exchange subsidies to families with incomes of $60,000, $90,000, middle class, the upper middle class. But to those parents earning under $15,000 or $19,000 a year we're saying, sorry, we have nothing to offer you."

The coverage gap is the result of last year's Supreme Court decision that made Medicaid expansion optional, and Pennsylvania is one of more than 20 states that have so far declined to take part.

Governor Corbett has proposed using federal Medicaid expansion dollars to help Pennsylvanians below 133 percent of the poverty line to purchase insurance on the exchange, along with several other conditions.

Negotiations between the Corbett administration and the federal government are ongoing. In the meantime, anybody living below the poverty line who doesn't qualify for Medicaid is exempt from the individual insurance mandate.


This chart from the Pennsylvania Health Law Project demonstrates the coverage gap.

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Comments: 1

  • Pamela Parson img 2013-10-14 22:16

    Yep, that would be me! Late Friday evening I was finally able to get on the Marketplace website. Despite what I'd read, I was able to get on without a hitch. Sadly, however this is what I learned:

    "Based on the information you provided,the new federal health care law provides that you could be eligible for free or low cost health care through Medicaid. However, the state of PA has chosen not to offer you this new health care coverage at this time. You are not required to pay a penalty for not having health insurance because of your income and because the state of PA declined to expand Medicaid to cover individuals in your situation."

    I cannot begin to tell you how disappointed I am. My eligibility notice went on to tell me, "You can still choose, but are not required, to buy health coverage through the Insurance Marketplace, but unfortunately you do not qualify for help in paying for health coverage
    through the Marketplace."

    I went on to look at the plans in the Bronze Level. The least expensive plan would cost me about $315/mo. For this I would have a nearly $5,000 deductible, a $60 co-pay ($100 for specialists) and a 40% coinsurance after deductible for drugs. While this is $500/mo cheaper than getting cheaper through my husband's employer - the premiums alone are still a hefty portion of our income, about 15%, with a co-pay on top of that.

    Currently I pay out-of-pocket for medical care and this co-pay doesn't really save me much money. I think, financially, I'll have to take a pass. Once again I make too much money for medicaid, but not enough to buy insurance. I feel like I being punished for being among the working poor.

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