More Than Facts: The Real Consequences of the Coverage Gap

By: Linet Suarez, Legal Intern

As a legal intern at Florida Legal Services I’ve spent significant time reading and analyzing the fiscal arguments in favor of Medicaid expansion and understanding how states like Florida that do not expand Medicaid create a “coverage gap.”  I’ve learned that Florida would greatly benefit economically from Medicaid expansion and that expanding Medicaid would increase access to healthcare for the 764,000 Floridians who fall into the coverage gap. As many have observed, Medicaid expansion is a “fiscal no brainer.”

This session, the Florida House of Representatives rejected a Senate bill that would have accepted federal funding for people in the “gap.”  Members of the House claim that Medicaid expansion would create an expensive and broken health care system. However, research reveals that the Senate’s bill would actually result in savings for the state of Florida and increased access to health care for hundreds of thousands of people.

In addition to researching and analyzing the fiscal and political arguments, a major part of my summer project has been to call back dozens of Florida consumers who fall into the coverage gap and who were referred to FLS during the session.  The law student who worked with FLS last semester interviewed them, explained the gap and how it was created (the Supreme Court decision making Medicaid expansion a choice for individual states), gave them advice about the local safety net, wrote short poignant narratives about their struggles, and shared those stories with the press and other advocates.

My job this summer was to call these folks back, let them know what happened in the Legislature, how their Senator and Representative voted, and offer assistance if they want to write their elected official to express their anger (most House Representatives voted against their health care coverage) or their gratitude (most Senators voted for their coverage). Over the course of these calls I also learned a lot more about the struggles folks are having getting the care they need at our local safety net providers.  The most important lesson I can share with you after making many calls is simple: the 764,000 Floridians who fall into the coverage gap are people.

I am not sure how or when it happened, but Medicaid expansion has become largely a dehumanized conversation centering on politics, data, and budgets. The House of Representatives voted to deny access to health care for what appear to be ideological reasons, but failed to consider that the people who fall into the coverage gap are not just statistics or strangers that you read about in a newspaper article. They are the people who care for our children and elderly parents, work in our local supermarkets, or serve food at our favorite restaurant. They are the faces we see day in and day out.

One of the people I have come to know is PC, a 60-year-old Miami resident. PC worked as a contractor for years until he was in an accident that damaged his lower back. PC now suffers from severe pain and has not been able to find another job. As a result, he has lost his house and depends on the charity of others when he would much rather be working again. PC cannot afford to get the health care he needs and his best chance at getting better is if the Florida legislature would choose to accept funding for his coverage.

Similar to others in the coverage gap, PC faces many challenges when he tries to access health care.  The local public hospital places him on hold when he calls for long periods of time, it takes weeks to see a doctor, and once he does get an appointment, it is difficult to find transportation to even make it there. There are simply too many barriers to access basic health care.

For the 764,000 Floridians who fall into the coverage gap Medicaid is not a hot topic issue based on political ideologies. It is a necessity. It is time that we each figure out the role we can play in Medicaid expansion. To begin with, we can contact our legislators and encourage informed discussions about Medicaid in our communities. These are our family members, friends and neighbors, and all they are asking is that our state Representatives stop rejecting the federal funding that would pay for their coverage simply because they don’t like “Obamacare.”

Matt’s Story – Fighting to Close the Gap

By: Charlotte Joseph Cassel, Equal Justice Works Fellow

Imagine working part time, without the option for health insurance, and thinking that for the first time in 3 years you will finally be able to get coverage through the Affordable Care Act (“ACA). Now imagine going to an enrollment event and walking away with nothing. Not only that, but imagine that you are dealing with serious chronic health issues.  This is the reality that Matt Ross faces. Living with autism and a serious injury to his right arm, Matt relies on medication to make it through the day. But rather than focus on the difficult hand he was dealt, Matt works part-time and is actively engaged in efforts to expand Medicaid in Florida. Just last week, Matt traveled to Tallahassee to participate in a press conference on the need to expand coverage.

Matt, a 23 year old Brevard county resident, is in the coverage gap. This means that when he was later in a serious car accident that destroyed his right arm, he had no insurance and was unable to afford his medical bills or therapy for his arm. His arm is so “messed up” that he can no longer play golf, a sport at which he excelled – and in fact, he won the gold medal for golf in the Special Olympics. Additionally, he was forced to drop out of the school he was attending at the time because golf is a required part of the curriculum. Without his degree and no transportation, not to mention the challenges of having autism and a not fully functioning arm, Matt’s work opportunities are limited. But, he did find a job holding up a street sign for a cheese steak joint a few hundred yards from his house. While he is grateful for the job, it certainly comes with its own set of risks. Namely, he stands on a dangerous intersection, and has almost been hit by reckless drivers multiple times. Matt would like to work inside but admits that his math skills are not good enough to work the register. And, his autism adds another set of challenges in finding work.

There are 764,000 Floridians just like Matt. They are working hard, every day, but not making enough money to get help in the marketplace and not qualifying for Florida’s limited Medicaid program. These people are in the “coverage gap” and currently have no option for affordable coverage. What does this say when we leave 764,000 of our neighbors, friends, and family members, wondering how they will afford treatment for their next illness or accident? Matt says that having insurance would “mean a whole lot.” He would finally get his arm checked out to see if there is any lasting nerve damage from the accident and get necessary physical therapy. His message to our elected officials is simple: “Give us insurance. Other people could use it and I hate to see people suffer.” Thank you, Matt, for sharing your story. And for those of you reading who think Matt, and everyone else in the gap, deserve coverage it is time to contact your elected state officials and demand that they “close the gap.”

The Miami Herald: A Critical Voice in the Health Care Debate

By: Charlotte Joseph Cassel, Equal Justice Works Fellow

While there is no doubt our culture has become accustomed to a 24/7 stream of “breaking news”–often compressed into 140 characters–there can be no denying the impact and import of a trustworthy, local, community paper, that keeps readers focused on the most critical issues facing decision makers. Case in point, the impact the Miami Herald has had on the community’s conversation around Medicaid Expansion—an issue now being debated in Tallahassee.

Herald reporters have educated readers on complicated and important Medicaid funding issues impacting our safety net providers like Jackson, and the relationship of that funding to the uninsured.  And, in the past month alone, the Herald’s editorial board published two logical and persuasive editorials explaining why our Legislature cannot afford to let another year go by without accepting the federal funding for coverage of low income Floridians.  As the editors wrote today, in response to the bill approved by a Senate health committee last week, “[t]he proposal would throw a life preserver to vast numbers of Floridians drowning in medical bills and unable to afford health coverage.”

We’ve already blogged and will continue to blog about the more than 750,000 Floridians who fall into the “coverage gap.”  These are hardworking men and women who take care of our young kids and elderly parents.  They clean our houses, mow our grass, and serve us in restaurants. They aren’t looking for a handout, just an opportunity to have basic health insurance and not live in perpetual fear of being one illness or accident away from a financial catastrophe.  We applaud the Florida Senate for taking an important first step in moving forward. We need the investment of all community stakeholders to succeed and we commend the Miami Herald for continuing to keep its readers informed and engaged.

Orlando TV Reporter Explains “Coverage Gap” and Stakes in Health Care Debate

By: Miriam Harmatz, Senior Health Law Attorney

It’s not easy explaining the “Coverage Gap.”  Whether you are an “Obamacare” enrollment assister, a reporter, or an advocate, the situation is utterly illogical. Folks above the federal poverty level (or $11,670/year for single person and $23,850/year for a family of four) and with incomes all the way up to $46,680 and $95,400 can get subsidies for  health insurance in the marketplace–while those whose income falls even a dollar below the poverty line usually get nothing.  So to be clear, what this means is some people make too little money to get help buying insurance on the marketplace.

But this seemingly inexplicable situation is the reality in Florida.

An Orlando investigative TV reporter, Eryka Washington, took on the daunting challenge of explaining this bizarre situation to her viewers.  She interviewed a local legal aid attorney, Larri Thatcher, who explained that  the ACA established two  paths to affordable coverage for low income uninsured Americans: 1) through help in the marketplace; or 2) through a greatly expanded Medicaid program. But the Supreme Court, while upholding the requirement that individuals have insurance, said the decision on Medicaid expansion would be up to each state. Most states jumped at the chance to cover their low income uninsured residents—with mostly federal dollars.  But Florida is one of a minority of states that, so far, has refused federal funding for extending coverage.  The result is that Floridians with incomes below the poverty level have no path to affordable coverage; they fall into the “gap.”

Ms. Washington also interviewed Charlene Caines, a working mom who does not get insurance through her job.  Charlene, who is also going to college, works 6 hour shifts each day as a waitress, but is still below the poverty level. Thus, when she went online and tried to get coverage in the marketplace, she was denied.

Finally, Ms. Washington interviewed local hospital officials and industry leaders who explained the fiscal issues—hospitals are at risk of losing tens of millions of dollars, and the state is leaving $10 million per day in federal funding on the table.

Thanks to Ms. Washington’s story, Orlando area TV viewers better understand this critical issue—which is being debated now in Tallahassee.  While the issue has been reported widely in the written press and on the radio—few local TV reporters have taken on the challenge. Please watch Eryka’s segment and share it widely, including with your elected officials.