In the Nebraska state Legislature, the members of which are officially nonpartisan, the filibustering tactics used to block Medicaid expansion drew comparisons to those in the U.S. Congress, where lawmakers were unable to come to an agreement and prompted a government shutdown on Oct. 1 over objections to the Affordable Care Act, which was signed into law in 2010.
When Nebraska took up Medicaid expansion, “there was quite a lot of support, and bipartisan support,” said James Goddard, health care access program director at Nebraska Appleseed. “But it was stifled by a small group of senators who were opposed.”
At least 54,000 Nebraskans will fall into the coverage gap, Goddard estimates.
In Florida, the number approaches 1 million.
Among them is David Benson, 53, who volunteers with a social services nonprofit in Dade City in exchange for room and board. Through odd jobs, he earns less in one month than a couple might spend on one nice dinner.
But, without dependent children or a disability, Benson gets no coverage under Florida’s existing Medicaid program. He hasn’t been covered in more than 12 years, he estimates.
“It don’t take long before you get to that ‘give-up stage,’ and you’re waiting for the inevitable — the end, the grim reaper,” said Benson, an Alabama native who has lived in Florida since age 6.
“They’re doing something wrong if people like me can exist,” he said. “They really need to put that bill back on the table and renegotiate.”
That remains an option in all 26 states with a coverage gap, since there is no deadline on federal funding for Medicaid expansion.
In the meantime, the 5.8 million without coverage options will not have to pay a penalty on their 2014 tax returns, according to an official at the Centers for Medicaid Services.
For Evans, the Idaho grandmother, that news comes as small comfort.
“I’ve paid taxes since I was probably 15 years old — not as much as other people, but I’ve paid my fair share,” she said.
“I’ve gotten very little in return.”
Health Insurance Marketplace FAQ
On Oct. 1, health insurance marketplaces opened for enrollment in all 50 states. The marketplaces offer new health insurance options for both the uninsured and those who want to shop for lower premiums.
What are the health insurance marketplaces?
Every state now has a marketplace offering private insurance plans with standardized premiums and benefits. By providing your basic information, you can see if you’re eligible for reduced premiums or new benefits through Medicaid.
What is “open enrollment?”
Typically, private health insurers only let new customers sign up during an “open enrollment” period once a year. Otherwise, people might wait until they got sick to buy coverage.
This year, you can buy private insurance on the marketplaces from Oct. 1 until March 31, 2014. For coverage that begins in January, be sure to enroll by Dec. 15.
Will I qualify for reduced monthly premiums?
If you live alone, you’ll probably be able to get reduced premiums if your income is between $11,490 and $45,960 a year. The limits increase depending on family size, but you can enter your information into the online marketplace to see if you qualify.
Am I eligible for Medicaid?
In many states, Medicaid coverage has expanded (see interactive map on Page 1). In states that have expanded Medicaid, single adults earning less than $15,282 are generally eligible. The online marketplaces will guide all who qualify to their state Medicaid portal.
What is the Medicaid coverage gap?
In states that haven’t expanded Medicaid, many adults living below the poverty line will not qualify for reduced premiums or Medicaid.
What if I fall into the coverage gap?
Until your state government acts to expand Medicaid coverage, your options are limited. But you are not alone — an estimated 5.8 million people will fall into the coverage gap unless state leaders act.
What if I have a preexisting condition?
Starting in 2014, you cannot be denied health insurance coverage or charged more if you have a preexisting condition.
What is the penalty for remaining uninsured?
If you can afford health insurance but choose not to buy it, you may have to pay a penalty on your tax returns. In 2014, the penalty will be $95 or one percent of your income (whichever is greater). Those in the coverage gap should be exempt. See the full list of exemptions.
How can I find my state’s online marketplace or get more information?
Visit healthcare.gov or CuidadoDeSalud.gov (for Spanish) for a comprehensive guide to the marketplaces, or call 1-800-318-2596 (TTY: 1-855-889-4325).
Keith Griffith is a freelance journalist based in Chicago. His work has appeared in Grid Magazine, Chicago Reader and other publications. On Twitter, he is @keithgriff. This story has been updated since it was first posted.
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