Saturday, September 20, 2014
Inquirer Daily News

Andre and 116,500 others in the region are caught in PA's coverage gap

When it comes to health coverage, 116,500 low-income adults in southeastern Pennsylvania, the vast majority of them working, are betwixt and between. Andre Butler, a banquet server, is one such uninsured Philadelphian, caught in Pennsylvania's coverage gap.

Andre and 116,500 others in the region are caught in PA’s coverage gap

When it comes to health coverage, 116,500 low-income adults in southeastern Pennsylvania, the vast majority of them working, are betwixt and between. Andre Butler, a banquet server, is one such uninsured Philadelphian, caught in Pennsylvania’s coverage gap.

Adults like Andre don’t qualify for Pennsylvania’s Medicaid program because they are single, or they are part of families with annual incomes greater than 33 percent of the federal poverty level (about $5,118 a year for a family of two).

What about getting coverage through the Health Insurance Marketplace? There’s no help for Andre here either. To get help paying for your health insurance, you have to earn at least $11,490 a year ($23,550 for a family of four).

That’s right, single adults have to earn more than $11,490 a year in order to get financial assistance through the Marketplace. If that doesn’t make sense and you would like to know how this coverage gap happened, please read the explanation below*.

As part of his Healthy PA plan, Governor Corbett has proposed a way to provide affordable coverage for people like Andre, through commercial insurance plans offered on the Health Insurance Marketplace in Pennsylvania. Many details remain to be worked out, and the federal government has to approve the plan, before this coverage can become a reality.

The hospital community urges Governor Corbett to move as quickly as possible to finalize his plan and expand coverage.

Add your voice to this important conversation. Go to CareforPA.org and click Take Action to send an email asking the Governor to act now. Andre and many others are waiting.

*How the Coverage Gap Happened: The federal government expected that, as part of the Affordable Care Act of 2010, states would expand their Medicaid programs so that adults and families earning less than poverty level could get health coverage. (The act also required the feds to pick up nearly all of the costs of these state Medicaid expansions.) As a result, the Health Insurance Marketplace (also part of the Affordable Care Act) did not include subsidies to assist people and families below the poverty level in buying health insurance. Then, in 2012, the U.S. Supreme Court ruled that states could choose whether or not they wanted to expand Medicaid. Instead of expanding Medicaid, Governor Corbett has put forth a plan (part of his Healthy PA proposal) to provide affordable commercial insurance, via the Marketplace, for Pennsylvanians with incomes near or below the poverty level. Until the Governor’s plan is put into action, Pennsylvania adults and many families below the poverty level have no way to get health insurance.


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The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
Krystyna Dereszowska A third-year law student concentrating in health at Drexel
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