CHATTANOOGA, TN - At 62 years old, Mattie Billings says her arthritis and bronchitis prevent her from finding another job and her age makes it too expensive to buy health insurance.
The former hospital service worker, who lost her job in January and her unemployment benefits this summer, thought she would get some help from the health care reform plan known as Obamacare.
But to her surprise and frustration, Billings learned during a seminar on the Affordable Care Act that many of those living below the poverty level in Tennessee and Georgia won't get any extra help next year even though many higher-income people will.
"It just doesn't make sense and seems like a cruel joke to the poorest people," she said. "Medicaid should be expanded to help people who are really poor, who need it the most. I know the Lord always opens doors for you, but I don't know what I'm going to do at this point."
Those like Billings who don't have dependent children and make less than the poverty income level ($11,490 for a single person) won't qualify for any assistance in states that opt not to expand their Medicaid programs. The same people earning $11,491 or more a year will qualify for help through one of the new health exchanges and can get subsidies to cut his or her monthly premiums to as little as $19 a month.
"It makes steam come out of my head, but unfortunately in Tennessee and many other Southern states we're not going to help the poorest of the poor -- those folks that need this help the most," said Dr. Mary Headrick, a Crossville, Tenn., physician who has championed health care reform for three decades. "It's unfair, it hurts our state, and it just isn't right."
The incongruous scale that provides subsidies to those above the poverty level while denying such help to those in poverty stems from the way the Affordable Care Act was written and how the U.S. Supreme Court ruled in June on the law's constitutionality. The high court upheld the overall health care reform law, but the court gave states the option not to participate in the expanded Medicaid program since that is a joint federal and state program.
The Affordable Care Act provides that the federal government will pick up the entire cost of expanding Medicaid (TennCare in Tennessee) for the first three years and 90 percent of the cost thereafter.
Georgia Gov. Nathan Deal, an opponent of the Affordable Care Act, balked at having Georgia expand its Medicaid eligibility for an estimated 650,000 low-income Georgians who make up to 138 percent of the poverty level (up to $15,856 of annual income for an individual).
"Even though the federal government promises to pay 100 percent for the first three years and 90 percent thereafter, I think it is probably unrealistic to expect that promise to be fulfilled in the long term, simply because of the financial status that the federal government is in," he said.
Tennessee Gov. Bill Haslam, R-Tenn., didn't reject the plan outright. But he has proposed changes in the Medicaid expansion for TennCare that the federal government has yet to approve. Haslam wants participants to pay a bigger share of the health care bill to make them more cost conscious and to include other cost-saving measures he says would help both the state and federal governments. The governor acknowledges that he probably won't secure federal approval for his suggested plan by the start of next year when the Medicaid expansion will begin in a majority of other states.
Currently, 26 states have agreed to participate in the Medicaid expansion, 13 will not participate (including Georgia and Alabama) and the other 11 states either have yet to decide or are still negotiating for changes in the program.
Most Tennessee Republican lawmakers oppose what they see as a massive government intrusion into one of the biggest parts of the private economy and question whether Obamacare will cut costs for many people.
In March, Haslam announced his decision to pursue an amended Medicaid expansion program, which appeared to thread between many of his GOP colleagues who want no part of Obamacare and supporters of the TennCare expansion who still worry about its cost and long-range viability if many more people are put on its rolls.
The new health care reform law mandates that individuals buy health insurance and that health insurers provide an array of health care coverage regardless of a person's pre-existing conditions. The new law will provide subsidies for people to buy a plan through the health exchanges and, in many states, will expand Medicaid benefits to more individuals and families.
But some limited benefit plans, including the government-subsidized CoverTN plan, won't meet the new standards and are being phased out this fall. CoverTN, which was created in 2006 as a lower-cost alternative for many Tennesseans, has a $25,000 annual limit on benefits and does not cover all the services required by the federal law.
U.S. Sen. Lamar Alexander, R-Tenn., the senior Republican on the U.S. Senate Health Committee, wants Obamacare repealed. He said the Affordable Care Act "has destroyed an innovative state health insurance plan that is helping 16,000 Tennesseans afford health care coverage."
"Like all Americans, these Tennesseans (using CoverTN) were promised by President Obama that under his health care law they'd keep their coverage, but they will likely be forced by the law into the Obamacare exchanges, where the affordability of health insurance, security of their personal information and ability of doctors to take new patients are all in question," Alexander said.
But the head of the state's primary physicians group contends that better alternatives to the limited benefit CoverTN plan would be an expanded Medicaid program and subsidies for most of those on the new health exchanges being introduced next month.
"How is it that the lowest-income people get nothing? Well, that's not the way the law was written and not [what] we need in Tennessee," said Dr. Chris Young, a Chattanooga anesthesiologist who is chairman of the Tennessee Medical Society.
Young said his group in April voted to support Haslam in his bid to gain federal approval for what the governor claims would be a more cost-conscious Medicaid program. But Young says the doctors are building a new coalition and, barring an unexpected approval soon by the Obama White House of the recommended Affordable Care Act changes, he anticipates a strong appeal for Tennessee to expand its Medicaid program.
"Just because we haven't got anything yet doesn't mean we won't get anything in the future," Young said. "We intend to work very hard to address this issue next year."[Image from flickr user Rakka]
Contact Dave Flessner at [email protected] or at 757-6340. ___
I'm a twenty-something below the poverty line (teaching and interning) in North Carolina (which also denied Medicaid expansion) and I've been crying all night. I can't afford any of the insurance plans, and I've got student loans as well...I feel so hopeless. I want insurance so badly- for peace of mind if nothing else. It just doesn't seem possible.
If Medicaid is not expanded in TN then I will be a resident of Colorado on Jan. 1st. I cannot risk staying in TN without it. And I won't be coming back if it eventually passes in TN. It will be a one way ticket for me. I fully expect to be leaving TN on Dec. 29th after being a 12 year resident here.