Uninsured could be hurt by Medicaid decision

Sep. 30, 2013 @ 09:31 AM

Getting insurance through the Affordable Care Act will be different for North Carolinians because the state chose not to expand Medicaid.

That means many adults below the poverty level will remain uninsured in the refusing states for perhaps two years because they also can not afford health care even with ACA subsidies.
“Some people will not be able to pay for coverage, even with a subsidy,” Guilford County Commissioner Kay Cashion said during a recent briefing of county officials. “These are the most vulnerable people.”
About 20 states rejected Medicaid expansion, including Texas and Florida. States can expand their Medicaid programs to cover families earning up to 133 percent of the poverty level, about $30,657 for a family of four.
“The state could decide in 2015 or 2016 to expand the program,” said Dr. Adam Zolotor, vice president of the N.C. Institute of Medicine. “Many people believe all states will expand Medicaid by 2016.”
But the full federal payment for the expansion is only available through 2016.
Medicaid is expected to account for about half the 25 million uninsured people nationwide who, the Congressional Budget Office estimates, eventually will gain coverage through the law.
There are about 1.5 million uninsured in North Carolina. If state leaders had expanded Medicaid, the program could have covered an additional 500,000 people.
“Most of the uninsured are working people,” Zolotor said.
If not eligible for Medicaid, households with incomes at or below 400 percent of the federal poverty level may be eligible for tax credits to offset insurance premium costs based on a sliding scale related to percentage of income.
Credits will be available every month to help pay premiums to match the second tier, or Silver, coverage level.
“At Bronze, the insurance could be free, or nearly free. Of course, policies with more features cost more,” Zolotor said.
Bronze plans feature the lowest monthly premiums, but cover only 60 percent of average costs. Platinum plans have higher premiums and cover 90 percent of expected costs.

Medicaid Expansion

In the accepting states, the federal government will pay the full cost of the new coverage from 2014 to 2016, then phase down to 90 percent.