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But people are still expected to fall through the cracks. That’s because the requirements and process for signing up for Medicaid can be confusing. And while the overhaul aims to make the process easier, it won’t smooth out all the wrinkles.
The problem? Many people don’t realize that they qualify for coverage. And that likely will still be the case, albeit to a lesser extent, after Medicaid expands.
Coverage depends on how someone’s income stacks up to federal poverty guidelines, which can be obscure to the average person. Plus, because income can fluctuate, someone could qualify one year but not the next.
"Regardless of how much outreach you do ... you’re never going to get perfect enrollment," Matthew Buettgens, another Urban Institute researcher, says.
Staying enrolled can be another hurdle. Medicaid recipients have to re-enroll, sometimes more than once a year. They can be dropped if they miss deadlines, submit incomplete forms or if paperwork doesn’t catch up with them after they move — something poor families tend to do more frequently than the average American household.
Leeanna Herman learned this when an unexpected $300 doctor bill arrived in the mail. The Bakersfield, Calif., resident was pregnant and unemployed and didn’t know her government-funded health coverage had lapsed.
"I was freaking out," says Herman, 23, who went a month without coverage because she missed the deadline to re-enroll. "How do you expect me to pay that?’"
Experts say online applications and electronic verification of income levels and other things will make this process easier. But deadlines will still matter and some people don’t have easy access to the Internet. And there will still be some people who simply won’t enroll.
"There will always be that segment that says, ‘Aw, the heck with it, I will just wait until I get sick and go to the ER,’" says Stephen Schilling, CEO of Clinica Sierra Vista, a nonprofit that has a network of 27 community health centers in California.
Schilling expects to still see a lot of uninsured patients at the nonprofit group’s health centers even if the law is upheld. The center sits in an agricultural area in California’s San Joaquin Valley, populated with migrant workers and saddled with an unemployment rate of around 15 percent.
It cares for about 60,000 uninsured people annually, thanks in part to grants and a sliding fee scale for patients based on their family size and income. Schilling says he still expects between 20,000 and 40,000 uninsured patients if the overhaul is implemented.
LIVING IN THE GAP • The overhaul calls for tax credits to help middle-class Americans buy coverage. But some people who make too much money to qualify for the tax credits may have a hard time finding an affordable option for private health insurance
The subsidies can pay a large chunk of the insurance bill. For instance, a 40-year-old person who makes $50,000 in 2014 and needs coverage for a family of four might receive a government tax credit of more than $8,000.
That would cover more than 70 percent of the premium, or the cost of coverage, according to a subsidy calculator on the nonprofit Kaiser Family Foundation’s website. Of course, that estimate depends on the type of coverage the person choses, where they live and whether they can get coverage through work.
But the tax credits will go to people with incomes up to 400 percent of the federal poverty level, or $44,680 for an individual this year. People just above that level may have a hard time finding affordable health insurance.
Angela Agnew Laws worries that she might remain uninsured like she has been for the past eight years even if the health care law is upheld.
Laws, who lives in Leesburg, Va., runs a small business that cleans and maintains commercial buildings. She hopes her income will climb to about $60,000 by 2014, which would be too high for tax credit help.
A plan that offers more than just basic protection against big medical expenses could cost as much as $10,000 annually for Laws. She could find less extensive coverage for a lower premium, but that may only save about $1,000.
Laws, 58, figures that she’ll remain uninsured if she can’t find an affordable coverage option that fits a monthly budget already crammed with payments of $1,203 for rent $530 toward her car.
"It’s a scary prospect for me," she says.
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