Florida’s working poor fall into Affordable Care Act ‘coverage gap’

July 30--When Angel Cardenas, a single mother with a modest income, was diagnosed with breast cancer a few years ago, she struggled to pay for her treatment, which ultimately involved a double mastectomy.

Although Cardenas initially qualified for Medicaid, that coverage was withdrawn after her 16-year-old daughter moved out of their Fort Myers home and Cardenas fell into a different eligibility category.

She tried applying for insurance under the Affordable Care Act. That's when Cardenas, who owns a small house cleaning business, learned her income was too low to qualify for financial aid to buy a plan on the exchange -- and $16 too high for her to receive Medicaid.

"I just choked down the tears," said Cardenas, 48, who grew up in Miami. "I have to find doctors who will treat me out of charity."

Cardenas is one of about 800,000 Floridians who are stuck in the so-called "coverage gap," in which they earn too much to qualify for Medicaid but not enough to be eligible for federal tax credits under the ACA. She took part Tuesday in a conference call, part of an effort by healthcare advocates to persuade Florida legislators to expand the state's Medicaid program, which now sets an annual income eligibility ceiling of roughly $6,930 for a family of three and denies any assistance to individuals and families without dependent children, regardless of how low their income may be.

Under the ACA, Medicaid could be expanded to Florida residents with incomes up to 138 percent of the federal poverty level, or $27,310 for a family of three. So far, Florida legislators have declined to act.

Working poor make up a large number of those who fall into the coverage gap.

"Most of the people who would be helped are working in jobs that are the backbone of the Florida economy," said Dee Mahan, Medicaid program director for Families USA, a nonpartisan, not-for-profit organization that aims to secure high-quality, affordable health coverage for consumers.

As part of their advocacy efforts, Mahan and several colleagues released the findings of a study showing that more than half of Florida's uninsured are employed. "Many are in occupations that are essential to important state industries, such as tourism," a summary of the study said. "They work in restaurants and hotels. They are cooks, cashiers, clerks, and hotel housekeeping staff. They work in industries that range from food service and transportation to construction and building maintenance."

About 23 percent of people in the gap are considered unemployed, and another 26 percent are classified as "not in the workforce," including people with disabilities, students, non-working spouses, and people who have left the workforce.

Julio Fuentes, president and chief executive of the Florida State Hispanic Chamber of Commerce, said that many of the 80,000 minority-owned businesses in Florida cannot afford to provide health insurance for their employees. In that context, accepting "billions" of dollars from the federal government is "good for business, it's good for families, and it's good for Florida's economy," he went on.

Fuentes referred to a finding in the study to the effect that if Florida had taken up the Medicaid expansion when it was first available in January 2014, federal funds flowing into the state would have supported more than 71,000 jobs and led to approximately $8.9 billion in new economic activity in 2016.

"Closing the coverage gap is not only the smart thing to do," Fuentes said. "It's the right thing to do."

In 2012, the U.S. Supreme Court ruled that states could opt out of the ACA's expansion of Medicaid coverage. Florida is one of 24 states that has so far chosen not to expand the program, under which the federal government pays almost all costs of expansion until 2016. Its share would then gradually decline to no less than 90 percent.

Political opposition to the ACA -- known as Obamacare -- is generally entrenched in Republican legislative circles, especially in the Florida House of Representatives. Gov. Rick Scott, initially a vehement opponent of the ACA, indicated last year that he was open to a Medicaid expansion after all, although he has apparently made little effort to move the matter forward. Opponents decry the ACA's "big government" accoutrements, and claim among other objections that it has cost too much to implement.

Leah Barber-Heinz, chief executive of Florida CHAIN, a non-partisan, consumer health advocacy organization, said it was "disgraceful" that so many people in the state remain uninsured. "Every Floridian deserves the security of knowing they can see a doctor when they need to, without the fear of facing enormous medical bills," she said. "People who don't have access to coverage are a lot more likely to end up in our emergency rooms without the ability to pay for their treatment. That's not good for anyone."

In Fort Myers, Cardenas, who has been cancer-free for nine months but still faces difficulties with infections, said she was trying to figure out how to pay a $3,000 anesthesiology bill.

"To me, it may as well be $3 million," she said, "because I can barely rub two sticks together."

This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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