Laval Miller Wilson
Laval Miller-Wilson and Antoinette Kraus
The tens of thousands of Pennsylvanians who recently received cancellation notices from their health insurers are understandably worried. Few know that feeling better than 41,000 Pennsylvanians who saw their adultBasic coverage cancelled two years ago. The key difference: most of those who lost adultBasic weren’t able to find other coverage as insurers could still deny coverage to people with pre-existing conditions, charge high rates for skimpy coverage, and restrict care by placing lifetime and annual limits on coverage.
Those who lost adultBasic didn’t have access to tax credits to reduce their monthly premiums, or cost-sharing help to cut their out-of-pocket costs, as most of those receiving cancellation notices will, by getting a plan in the Health Insurance Marketplace under the Affordable Care Act (ACA).
The two situations are not directly comparable, but there are some important lessons learned from this experience:
Laval Miller Wilson, executive director, and Kyle Fisher, staff attorney, Pennsylvania Health Law Project
Wondering if you will qualify for help to afford coverage through the health insurance marketplace, the signature achievement of the Affordable Care Act? You may be too poor to qualify for premium tax credits!
You read that right. If your income next year is under the poverty line—$11,490 annually for a single person—you are too poor to qualify for marketplace subsidies. There is no provision in the law to provide health insurance subsidies for anyone below the poverty line. Medicaid was supposed to be your fallback option.
Adults without children and without disabilities don’t qualify for Medicaid at any income. Because they don’t fit into a coverage category, it doesn’t matter how poor they are. President Obama and Congress, with the Affordable Care Act of 2010, intended Medicaid to be the health coverage available to people below the poverty line.