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Medicaid growth creates gap of 5M without health coverage
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Shelagh Collins walks from her car to a job search appointment Monday in Forest Hills, Pa. Collins gets by on temp work and unemployment benefits, but she can’t afford specialized treatment for her health problems. Pennsylvania is among states that will not expand Medicaid this month, leaving her in a coverage gap. (AP)

Tuesday, December 31, 2013

HARRISBURG, Pa. (AP) — About 5 million people will be without health care next year that they would have gotten simply if they lived somewhere else in America.

They make up a coverage gap in President Barack Obama’s signature health care law created by the domino effects of last year’s Supreme Court ruling and states’ subsequent policy decisions.

The court effectively left it up to states to decide whether to open Medicaid, the federal-state program for the poor and disabled, to more people, primarily poor working adults without children.

Twenty-five states declined, including Virginia. That leaves 4.8 million people in those states without the health care coverage that their peers elsewhere are getting through the expansion of Medicaid, according to a Kaiser Family Foundation estimate. More than one-fifth of them live in Texas alone, Kaiser’s analysis found.

Gov.-elect Terry McAuliffe has said he will work to expand Medicaid in Virginia, but he cannot do so without the backing of a bipartisan legislative commission, according to published reports.

Among those in the gap is Shelagh Collins of Pittsburgh. She can get primary care at a federally funded community health center nearby, but she can’t afford more specialized treatment for her joint aches and pains that limit her ability to do certain jobs, she said. After she fell and hurt her hip in the spring, she couldn’t pay for an MRI, she said.

A friend’s loan of $200 covered a month of physical therapy, but it didn’t make the pain disappear.

Collins, 56, used to be a high-level administrative assistant at the Chicago Botanic Garden. Now she gets by on occasional secretarial temporary work and unemployment compensation checks and is trying to protect a 401(k) retirement account of $21,000 that she said makes her ineligible for Pennsylvania’s current Medicaid program.

But the job market is brutal, temp work is scarce and her unemployment compensation checks are at an end, she said.

“I have never gone through anything like this in my life,” Collins said.

The Medicaid expansion was supposed to work hand-in-hand with tax credits subsidizing private insurance for people with slightly higher incomes, two keys to the law’s broader aim of extending health insurance to 30 million more people. As an enticement for states to expand Medicaid, the federal government promises to pay nearly all of the cost.

Without the expansion, the law is unable to help people who are below the income threshold where tax credits start kicking in, about $11,500 for working adults.

On Wednesday, 24 states and Washington, D.C., will extend Medicaid to more than 4 million adults who would otherwise fall into the same gap as Jones. Access to the care they’ll get is similar to what people get with private insurance, said Joan Alker, executive director of Georgetown University’s Center for Children and Families.

A 25th state, Michigan, plans to expand in April. Wisconsin effectively eliminated its own gap without using the more generous federal contribution.

Politics is apparent in states’ expansion decisions. Of those that joined it, all but five supported Obama in last year’s election. Of those that declined, most are more conservative states in the South, Midwest and northern Rocky Mountains that voted against Obama.

One outlier is Pennsylvania, a moderate state that supported Obama twice.

Gov. Tom Corbett, a Republican who sued unsuccessfully as attorney general to overturn the health care law, instead plans to ask the federal government to approve an alternative to a Medicaid expansion. He wants to use the law’s generous Medicaid dollars to cover the same population through private insurance companies while stripping down existing benefits under Medicaid, a target of conservatives’ criticism.

 

 
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