Nueces County indigent program drops 314 people, urges them to buy insurance through Affordable Care Act exchanges (Letter)

Feb. 18--CORPUS CHRISTI -- In an unforeseen consequence of the new federal health reform law, Nueces County's taxpayer-funded indigent care program dropped 314 people and urged them to buy health insurance through the Affordable Care Act exchanges.

Nueces Aid covers health care for the poorest uninsured residents who don't qualify for other government help, such as Medicaid or Medicare.

But under the Affordable Care Act, about 3 percent of people on Nueces Aid qualify for federal help to cover the cost of buying insurance through the exchanges. Those people will be kicked off the indigent care program after March 31, the deadline to enroll in coverage on the exchanges.

warning patients of the change.

Tightening eligibility and reducing the rolls won't save the hospital district money.

Under a 2012 agreement with Christus Spohn, the district no longer directly reimburses Spohn for treating indigent patients. Instead, the Nueces County Hospital District keeps its tax dollars and gets a cut of Spohn's private patient revenue, which the district then uses as leverage for federal dollars aimed at helping hospitals, including Spohn, treat uninsured and other compensated patients.

Although the hospital district's bottom line remains the same, the change keeps the program in line with its charge: Provide coverage for those who can't get it anywhere else, CEO Jonny Hipp said.

Nueces Aid was designed to be the provider of last resort. Because the Affordable Care Act expanded coverage to more people, some indigent care program enrollees have other options they should take advantage of instead, Hipp said.

But some worry those dropped clients won't get coverage on the exchanges and, instead, join the ranks of uninsured in the county, where one in four people doesn't have health insurance.

That's because for many low-income people, health insurance remains expensive, even for those who qualify for help.

For example, a Corpus Christi resident eligible for the most federal subsidies will spend about $230 per year on a mid level silver plan premium and face $2,250 in out-of-pocket costs, a hefty expense for someone on a fixed income.

Leo Barrera, executive director at Mission of Mercy, which provides free health care to the uninsured and the working poor, could not think of one client who had been able to buy a plan.

"If they were able to get a subsidy, the premiums were still way above their budget guidelines," he said. "They couldn't afford it. I'm finding right now a little bit of a disconnect between who the Affordable Care Act should be helping. The reality is, it isn't (helping), especially for those on the low-income scale."

Another potential problem? Nueces Aid calculates income differently than the federal government, meaning some who were dropped from Nueces Aid may actually earn too little to qualify for federal subsidies, said Laly Pacheco, an outreach and enrollment coordinator at Amistad Community Health Center who has been helping enroll people in health insurance.

"And without any help from the county as well, they are left in that one little gap where they are not qualified here or there," she said.

Recognizing this problem, hospital district officials are considering eligibility on a case-by-case basis, Hipp said.

The Affordable Act was designed with the proviso all states would expand Medicaid, so the law doesn't offer financial help to earning less than 100 percent of the federal poverty level, or $23,550 per year for a family of four.

But the U.S. Supreme Court struck down mandatory Medicaid expansion and some states, including Texas, opted out. With some of the most stringent adult Medicaid requirements in the nation, about 1.3 million Texans who would've been covered had the state expanded Medicaid, make too little to qualify for subsidized health insurance.

However, it also means they won't be penalized when the federal government begins fining the uninsured next year.

Beyond the eligibility restrictions deterring some from buying health care, the uninsured face other, more intangible challenges, such as learning for the first time for some how to buy and use health insurance, particularly in a region where there's been a dearth of outreach and advertising about the new law.

Last year, local insurance agent Will Heavin completely transformed his business model to attract more Affordable Care Act exchange clients. He left his Southside office where he had a comfortable practice selling group insurance, and set up shop in a former Whataburger training center on Gollihar Road, announcing his presence with a U-Haul van parked out front strung with a banner that reads "Obamacare Enrollment Center."

Of those seeking Heavin's services so far, about 40 percent never had health insurance before, he said.

"We have to educate them on the basics of health insurance," he said. "What is a copay? What is a deductible? We have to educate them on the importance of having a primary care provider."

His practice is among the places where the Nueces County Hospital District directs dropped clients for help buying insurance.

The hospital district board is expected to approve the stricter eligibility requirements at a meeting Tuesday, but letters announcing the change have already been sent to allow dropped clients adequate time to find new health insurance before the March 31 deadline. Each enrollee has to requalify for Nueces Aid every six months.

Aside from Nueces County, the Affordable Care Act hasn't affected other indigent programs statewide.

Many counties, especially small, rural ones, only cover those earning 21 percent of the federal poverty level, the minimum required by state law.

Harris County covers people who earn up to 300 percent of the federal poverty level but that program has no plans to kick out people eligible for health insurance subsidies.

Twitter: @CallerRhiannon

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