Many Americans must work more due to gap in the ACA

For some Americans, the Affordable Care Act doesn’t mean access to healthcare, simply because they fall into an income gap that prevents enrollment. Those people make too little money to receive federal aid for buying private insurance but too much to qualify for Medicaid, and they live in states that have declined to expand Medicaid […]

For some Americans, the Affordable Care Act doesn’t mean access to healthcare, simply because they fall into an income gap that prevents enrollment.

Those people make too little money to receive federal aid for buying private insurance but too much to qualify for Medicaid, and they live in states that have declined to expand Medicaid under the health care law.

Those affected by this gap add up to about four million adults in nearly two dozen states. Texas has the most with nearly one million. The solution, as The New York Times points out in a thoughtful piece, is working more to bump up their income.

Sponsored Post

Physician Targeting Using Real-time Data: How PurpleLab’s Alerts Can Help

By leveraging real-time data that offers unprecedented insights into physician behavior and patient outcomes, companies can gain a competitive advantage with prescribers. PurpleLab®, a healthcare analytics platform with one of the largest medical and pharmaceutical claims databases in the United States, recently announced the launch of Alerts which translates complex information into actionable insights, empowering companies to identify the right physicians to target, determine the most effective marketing strategies and ultimately improve patient care.

Enrollment counselors are actively trying to help encourage those who fall in the gap to find solutions.

“If they are self-employed and clean houses, we calculate how much do you get per house?” said Elizabeth Colvin, who runs an enrollment program through Foundation Communities, a nonprofit group in Austin, Tx. “Could you do one extra house a month?”

The gap is a consequence of the 2012 Supreme Court decision upholding major pieces of the Affordable Care Act. The law was written with the expectation that all states would expand Medicaid to cover nearly all low-income adults, so those who make less than the federal poverty level are not eligible for subsidies. But the court allowed states to opt out of expanding Medicaid, and 22 states, most of them Republican-controlled, have done so.

Without the expansion, Texas has some of the strictest Medicaid eligibility rules in the country, barring most adults from coverage unless their income is 19 percent of the poverty level or below — and, even then, only if they have dependent children. For a single parent with two children, for example, the number would be $3,760 a year.

As the Times piece illustrates with stories from different people in Austin, this can be a major struggle and really a juggling act to try to determine if you’re going to be above the poverty level when income isn’t fixed.

Currently these people who are unable to get insurance because of their income don’t have to pay the penalty if they fill out a form to get a so-called hardship exemption.