On Tuesday, as the insurance exchanges opened for enrollment, I helped a leading Atlanta TV station, WAGA Fox 5, answer viewers’ questions about the...

Con artists often take advantage of confusion over health care.

On Tuesday, as the insurance exchanges opened for enrollment, I helped a leading Atlanta TV station, WAGA Fox 5, answer viewers’ questions about the health reform law.

Only a couple of the questions (sent via Facebook) were about the glitches that beset the healthcare.gov website Tuesday.

The viewers didn’t ask about the differences between a gold plan and a bronze plan in the exchange, or which insurers were offering coverage, and where.

These were people with real-life problems –- with plenty of bills but not much money.  The most prevalent questions focused on the intersection of income and insurance, as they apply to the Affordable Care Act (ACA), also known as Obamacare.

Some viewers described themselves as having little or no income. Would they have to get insurance?

Others had a different perspective. They were below the poverty line, yet seeking affordable coverage.

Virginia, who cares for a disabled family member, wrote, “I don’t have a paying job. . . . Would I be eligible for Medicaid?’’

Cristy said insurance isn’t offered at her husband’s job. Carlyn said, “I would like to have insurance but there’s just no money left after paying the bills. “

For those worried about paying the penalty for not getting insurance, I kept referring in my answers to the federal poverty level, which is about $11,500 for a single individual. If someone is below the poverty line, the individual mandate does not apply to that person. These folks don’t have to face a fine or any other penalty for not getting coverage.

The same is true for families that are below the poverty line (for a family of two, it’s $15,510; for three, it’s $19,530; and for four people, $23,550).

The other group of questioners were a little harder to answer. Cindy asked, “Is it true they’re gonna allow more people to qualify for Medicaid?”

Well, yes and no.

When the ACA was signed into law in 2010, it envisioned expanding state Medicaid eligibility up to annual household incomes of 138 percent of the federal poverty level. This was supposed to apply nationwide. The law included federal financial incentives for states to expand Medicaid, and also gave the feds leverage over states that refused.

In 2012, the U.S. Supreme Court mostly upheld the ACA, including the Medicaid expansion incentives, but it threw out the federal leverage. The court essentially said expansion is up to the states.

About half the states, including Georgia, have decided not to expand Medicaid.

Texas Gov. Rick Perry last month outlined the arguments against expansion.

“In Texas, we’ve been fighting Obamacare from the beginning, refusing to expand a broken Medicaid system and declining to set up a state health insurance exchange,” Perry said. “We took these steps to minimize the damage Obamacare will cause to our economy and state budget, although we’re all too aware Obamacare will still cause our state immense budgetary challenges in the years ahead, just like it will to families and small businesses across our country.”

The way the situation has unfolded leaves many poor Americans, including Georgians, in an ironic predicament. In the states that don’t do the expansion, uninsured people who are below the poverty level can’t get Medicaid. But because of the original assumption that they would get Medicaid, they also don’t qualify for subsidies in the health insurance exchange, which would make coverage much easier to afford.

If you make more than $11,500, you can get cheap coverage. But not below that level.

Correta on Facebook wondered about qualifying for Medicaid. “How can we get medical insurance?” she asked.

Almost 7 million adults ages 19 to 64 would have qualified for Medicaid in the 25 states that have not voted to expand it, according to an Urban Institute report.

Former President Bill Clinton, in a Sept. 4 speech, called that situation “the worst of all worlds.” He characterized it as: “I’m sorry, but you’re working 40 hours a week, but you’re too poor to get help. This is a serious problem.”

Here’s Lauren on Facebook: “So basically this new Health Care Act does nothing for me?”


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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