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Medicaid Gap: A Reporter Who Covers Obamacare But Doesn’t Qualify For It

| December 4, 2013

Not if you can't afford it. (Don Harder)

Not if you can’t afford it. (Don Harder)

For Missouri public radio reporter Harum Helmy, the Affordable Care Act is more than just a story she covers. It is also a story she’s living.

“I know — an uninsured health reporter,” she wrote to me last month. “The joke’s not lost on me.”

Helmy, 23, a part-time reporter/producer for KBIA in Columbia, Mo., recently completed her coursework at the University of Missouri. She’s on her first professional job. At the station, she covers Obamacare, among other things. But she doesn’t make much money, and if the law worked as it was intended, she would be covered by Missouri’s Medicaid program beginning Jan. 1.

That wasn’t meant to be.

As signed by President Obama, the Affordable Care Act (ACA) would have required every state to expand its Medicaid program for the poor to include adults earning less than 138 percent of the federal poverty level. Those earning more than that, up to four times the poverty level, would qualify for subsidies to purchase health insurance in marketplaces.

But the Supreme Court ruled last year that states could opt out of the Medicaid expansion without consequence, and Missouri along with 24 other states (including Florida) have done just that. The problem is that the law didn’t include subsidies for people in those states who earn less than the federal poverty level to buy coverage through the exchanges — they were supposed to be covered under Medicaid.

That’s the gap in which Helmy sits.

She earns less than the poverty level ($10 an hour for 20 hours per week) and qualifies neither for Medicaid nor a subsidy. Helmy was born in Texas and is a U.S. citizen, though her parents live in Indonesia. While she attended classes at the university, her parents paid for her health coverage.

According to the Kaiser Family Foundation, a nonpartisan think tank, “In states that do not expand Medicaid, nearly 5 million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a ‘coverage gap’ of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits.” In Missouri, 193,000 people, including Helmy, fall into the gap, Kaiser estimates.

On paper, the Medicaid expansion seems like a great deal. The federal government has agreed to pick up 100 percent of the cost of the expansion for the first three years, phasing down to 90 percent in 2020. But officials in states that have declined to take part view Medicaid as a broken program. They don’t trust the federal government to keep its funding pledge and do not believe they have adequate state funds to cover their portion.

Missouri Gov. Jay Nixon, a Democrat, wants to expand Medicaid in his state, but the Republican-controlled Legislature won’t go along with it.

Helmy discussed her situation in a podcast in October (around the 12-minute mark). “I would just get a little bit personal here and say I’m one of those people,” she said. “I’m in this weird gap where I need insurance, my employer doesn’t give me insurance, but I don’t make enough to get a subsidy.”

I asked her what it felt like to be affected by the act.

“I’m still working out how I feel about being part of the story,” she told me in an email. “I’ve talked about it to potential sources as a way to explain to them why this story is important to me, but I’ve quickly learned that compared to many other Americans in the gap, I’m very privileged, barring any catastrophe. I’m healthy, I have no dependents and barely any debt. I’m overly educated, applying for full-time jobs and looking for additional part-time work in the meantime.”

Helmy said she could get a second job, but it’s difficult because she is still working to complete her master’s thesis. “I know that I’m privileged in the sense that I don’t need to get a second job because I don’t have any debt,” she said in a later phone interview.

Helmy said she’s looking for a full-time job and would consider getting a second job so she can get insurance.

She said that she cares more about the people she covers than about her own situation. “I can see why some anti-ACA people out there think that someone like me wouldn’t need any help,” she said, “I’m outraged that my sources, people in unimaginably worse shape than me, can’t get help.”

–Charles Ornstein, ProPublica

This post is adapted from Ornstein’s “Healthy buzz” blog. Has your insurance been canceled? Have you tried signing up for coverage through the new exchanges? Help us cover the Affordable Care Act by sharing your insurance story.

7 Responses for “Medicaid Gap: A Reporter Who Covers Obamacare But Doesn’t Qualify For It”

  1. fruitcake says:

    With or without Obama care she didn’t qualify for medicaid…
    she can: move to another state that does offer medicaid
    get another job…get a full time job that offers healthcare
    ask parents to continue to pay premiums now under the ACA

  2. Ben Dover says:

    I hope when we get Crist back in office, he get the medicaid extension in Florida , As for Scott ,he can rot in hell for all I care ,would love to see his ugly oblong melon explode like one of the walkers on Walking Dead, he has no more feeling for his fellow man then one if them monsters, he feeds on the poor and tries to suck the life out of the middle class, turns down all aide for the people his ilk put in peril , has them living in cars and woods , taking away school lunches to kids that only get that one meal a day , meals on wheels , now the elderly are eating cat food again, no insurance for the sick poor people even though it would cost the state nothing for 3 yrs and only 10% for ever afterward, he refused the money for the rail system that would have created thousands of jobs, then saved commuters 400 a month in gas , 4 hrs in traffic ,stole that time parents could be spending with their children, maybe giving them the love and attention they need to stop all the bullying and school shootings, they hide behind religion and family , says its their life , when in reality money is all they care about, they steal it all somewhere down the line to keep it from people who built this country with blood and sweat , died in wars , while him and his kind went sailing , or played golf, or sat in boardrooms thinking up new ways to screw the people and the country, we need to weed all these pieces of excrement out of government , before all hell breaks loose.

  3. Sally says:

    Another reason why a single-payer national health care program is needed! Why should people be held hostage by an employer or need to “get a job with benefits”? That’s why so many people are at jobs they hate but they stay for “the benefits”. Why can’t patients and doctors decide what care is needed rather than employers and “benefits managers” (who, BTW, are on the take from the insurance companies they are negotiating with)? It’s an insane non-system!

    • barbie says:

      Because it is a system that benefits the corporate insurers, that’s why. They don’t care if it benefits anyone else or not. And Rick Scott is part and parcel of the denial to Floridians. Anyone who votes for him for Governor again is signing the death warrant of this state.

      For the life of me, when the media stenographers started parroting the line about “Death Panels in Obamacare”, why wasn’t it pointed out that we have Death Panels right now? They’re called Insurance Companies, and they’ve been coming between me and my doctor for a good twenty years.

      Oh, sorry, I’m sure it WAS pointed out by many, but the media stenographers weren’t allowed to report it. Carry on…

  4. Christopher V. says:

    This is what happens when the great unwashed elect a community organizer who never had a real job. Lies, nothing but lies.

    • A.S.F. says:

      @Christopher V. says–So, you would call the majority of Americans “the great unwashed?” If you and your Republican friends are so superior, how come you lost the last two elections and can’t seem to come up with one viable candidate that a majority of the country can stomach? Republicans DO seem adept at halting the workings of government each and every time they don’t get their way. I do not see that as a responsible way to lead…and I think many people agree with me.

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