Hot Topic #9: The Medicaid Gap

“People in Medicaid ought to have access to the same insurance as the rest of the population. If they are segregated, it will be a poor plan for poor people.” ~John Goodman

This post was inspired by a post on the National Public Radio (NPR) Facebook page.

The story was titled, In Florida, A Former Fast-Food Worker Lands In Medicaid Gap.

Cynthia Lewis is caught between a rock and a hard place. Reading her story made me sick. She dropped her Burger King-sponsored insurance because of the cost, but then she got sick. Needing insurance, she thought she could get Obamacare subsidies.


Then, she thought she could get Medicaid in Florida.

Not so – She makes too much money.

Also, Florida is one of the states that has not expanded Medicaid.

“… The popular description of Medicaid is that it’s health insurance for the poor.

But in fact it’s more complicated.

To qualify you usually have to also have meet another condition: be pregnant, have a dependent child or a disability. And within each of those groups, there’s even more restrictions.

For example, in a family of four, the most the parents can make to qualify for Medicaid in Florida is just under $8,500. A single parent who makes $6,000 a year and has one kid earns too much to qualify for Medicaid. And if someone is single with no dependent kids and isn’t disabled, no matter how little he or she makes, he or she can’t get Medicaid in the state …”

What the hell?

Depending on where you live, Florida contains some of the priciest real estate. These numbers that were quoted are staggering, and sickening. There are so many that live below the poverty line. And those that are the most vulnerable, especially the children, can’t qualify for insurance coverage from the United States government?

If you divide a $8,500 annual salary by 12, before taxes, that worker only makes $708.33 per month. In probably 99 percent of this great country of ours, a monthly salary like that won’t cover rent. And then after paying the rent/mortgage you still have the bills/utilities, get food, gas for your vehicle or public transportation to get to work, things for your kid(s), medicine, and more.

Cynthia’s story inspired me to do some research.

Medicaid was created fifty years ago this year, in 1965. President Johnson helped enact Medicaid for the poor (and Medicare for the elderly), becoming Title 19 of the Social Security Act. Since then, it’s had a lengthy and complicated history.

Although Medicaid was originally designed as a federal partnership, Florida is one of 21 states that has not expanded Medicaid, after the Supreme Court gave states that option.

I live in Virginia. Virginia is also one of those 21 states that has not expanded Medicaid coverage to low-income adults.

As of May 2015, nearly 960,000 people in Virginia were enrolled in Medicaid and The Children’s Health Insurance Program (CHIP). In comparison, throughout the nation, a total of 71.6 million are currently enrolled in Medicaid and CHIP. Since the July-September 2013 reporting period, over 12.8 million people enrolled in Medicaid and CHIP.

To be eligible for Medicaid and CHIP, it is based on an application and review of modified adjusted gross income (MAGI) levels.

Health insurance is so important, for everyone that you know. It makes me livid that there are so many that are stuck in this Medicaid gap. Most of these people are like Cynthia – They’re caught in the middle between expensive work-sponsored insurance plans and not qualifying for Obamacare subsidies and Medicaid.

I understand the reasoning behind the Supreme Court passing this power to expand Medicaid to the individual states, but, at the same time, that doesn’t solve the problem. Listening to the news reports when Virginia was wavering back and forth between expanding and not, I tried to see all viewpoints. It’s tough though, hearing the governor of your state quote that this expansion will cost the Commonwealth millions of dollars, when there are countless people in the Commonwealth that would greatly benefit from getting Medicaid coverage. It’s a terrible power struggle, and it comes down to one of the biggest and oldest motives – Money.

For more information, check out these links:

Until the next headline, Laura Beth 🙂

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