outside the health care safety net [Virginian – Pilot]
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For two years,
That changed after doctors found a tumor in her kidney in the summer of 2012. She underwent surgery to remove half of the organ, missed two months of work at a church-affiliated school, then lost her job when the school closed.
Behind on her rent, Churchill sent her two children to live with their father in
Now a part-time waitress, Churchill is uninsured. She wonders whether the Affordable Care Act could help.
"All I hear is that I'm eligible, but I don't know whether I am," said Churchill, 24, who lives in
As it stands right now, it won't do her any good.
Churchill is among about 28,400 low-income people in South Hampton Roads - more than a fifth of the region's uninsured - who will fall into a health insurance coverage gap if
These folks either make too much money to qualify under
But people in the gap also make too little to be candidates for government-subsidized coverage or discounts on insurance premiums through tax credits. That assistance is available on plans sold through the new health insurance marketplaces, which were created by the Affordable Care Act.
"They're still stuck in the same place that they've always been stuck in," said
The divide exists because of the
Under the Affordable Care Act, people making between 100 and 400 percent of the federal poverty standard -
Government subsidies weren't made available for those with incomes under the federal poverty level. The idea was that their coverage would come through expanding
However, the high court ruled that states couldn't be forced to enlarge their
That number included
People who qualify: pregnant women and children up to 19 in households with incomes up to 143 percent of the federal poverty level; certain elderly and disabled people with incomes up to 80 percent of the standard; and adults with at least one child under 18 in households with incomes lower than 33 percent of the standard.
Childless adults and adults in families with children who are 19 and over are not eligible for full
Generally, the state pays half the cost, and the federal government picks up the other half. Under the Affordable Care Act, the federal government would pay the full cost of
Expanding
Opponents say
Supporters say expansion is a good deal, pointing out that
More than 400,000 Virginians would qualify as new enrollees under expanded eligibility, with about 248,000 actually signing up in the first year, according to estimates.
In South Hampton Roads, about 47,100 people with incomes under 138 percent of the federal poverty level were uninsured, making them possible new candidates for
Now, some of these folks do without medical care. Some go to hospital emergency departments, where primary care is more expensive than in a doctor's office or clinic.
About 4,300 times a year, an uninsured patient seeks primary care at the emergency room of a
"We're clogging up the real access to care by treating these patients in an inappropriate setting," Ingold said. "Our taxpayers, our insured population, providers, everyone is absorbing this cost because this clearly could be managed in a less-acute setting, with less overhead and less expense."
Free clinics rely on grants and donations: money from the community, as well as time and expertise from medical professionals, Revell said.
"The care that they get at a free clinic - say at
Four clinics run by the
About half of the center's patients - including Churchill - would qualify for
For patients, the coverage could mean more preventive care and routine visits - because they can afford it - and they could end up healthier as a result. But it also could take time for people to stop using emergency departments for all of their care.
Some worry that
In anticipation of greater demand, Bon Secours primary care practices are expanding, said
Willis said her clinics can absorb about 7,000 new patients.
Some free clinic leaders are considering changing their care model to accept
"A lot of our patients have been here a long time," she said. "They realize that we're a nonprofit, and they feel secure that there's no other motive here but to take care of them."
The 60-year-old divorcee has been without insurance for two decades, working in restaurants and delis. Her only income is a monthly
In 2010, after a nine-month wait, she became a patient at the clinic. It's provided her with a wide array of services, ranging from mammograms to the surgical removal of a stomach tumor.
Still, if Clancy could qualify for
"This way, somebody that wouldn't get
About 28,400 low-income people in South Hampton Roads, roughly 22 percent of the region's uninsured, are poised to fall into a health insurance coverage gap.
Who is eligible today?
* Children up to age 19 in households with incomes up to 143 percent of the federal poverty standard.
* Pregnant women in households with incomes up to 143 percent of the standard.
* Elderly and disabled people in households with incomes up to 80 percent of the standard.
* Adults in families with at least one child under 18 in households with incomes up to 33 percent of the standard.
* Childless adults and adults in families with children who are 19 and over are not eligible for full
Who would be eligible under
* Children up to age 19 in households with incomes up to 143 percent of the federal poverty standard.
* Pregnant women in households with incomes up to 143 percent of the standard.
* Elderly and disabled people in households with incomes up to 80 percent of the standard.
* Adults in families and childless adults in households with incomes up to 138 percent of the standard.
NOTE:
Currently, childless adults and adults in families with children who are 19 and over are not eligible for full
Under
what expansion would mean
More than 400,000 Virginians would qualify as new enrollees under expanded eligibility. It would cost
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