Health experts break down who exists in health insurance coverage gap

MONTGOMERY — The House Health Committee on Wednesday learned more about which Alabamians without health insurance fall in a category often called the "coverage gap," earning too little to afford private insurance but also ineligible for Medicaid.

Lawmakers and presenters were careful not to refer to expanding Medicaid as an option, but instead focused on statistics about working adults living without health insurance. While each state has different eligibility standards for Medicaid, the health insurer for the low-income and disabled, the 2010 Affordable Care Act offered financial assistance and incentives for states to expand their Medicaid programs. Alabama is one of 11 states not to expand Medicaid.

The committee meeting was informational and it is not currently considering any related legislation.

Committee Chairman Paul Lee, R-Dothan, called the presentations "helpful" at the meeting's conclusion and said the information could lead to lawmakers to "have a solution at some point."

'Who are they?'

Danne Howard, deputy director for the Alabama Hospital Association, was the first to provide committee members with a breakdown of who exactly is in the coverage gap in Alabama.

Howard shared with the committee her organization's most recent findings, which reveal that close to 300,000 Alabamians would be eligible for Medicaid were the program to be expanded, with more than half of them being employed. Of those nearly 300,000, around 28,000 worked in food service, 23,000 in retail, though those in the coverage gap included Alabamians of all different industries, from maintenance workers to barbers.

To illustrate how vital she viewed having access to affordable health care is, Howard shared a personal anecdote from 32 years ago with committee members.

"I was in that coverage gap," Howard said. "I left one profession and started working in this arena, and I was an independent self-employed person. I did not have access to an employer-sponsored insurance plan; I did have a 9-year-old child and I was a single parent."

Howard explained that during that time, the only health insurance she could afford was a catastrophic plan that covered only the most serious health emergencies, but not preventive and regular care. After four years, Howard said she was able to secure a more comprehensive plan through her employer that, for her, came at exactly the right time.

"Overnight, I went from being OK to being diagnosed with multiple-sclerosis," Howard said.

"It's not a pity party, I'm just trying to give you a real face behind an example of the importance of health care insurance," Howard said. "I have access to the medication that I have to take, (that) without insurance would be $6,000 a month, without which I would not be able to be standing here today."

Diving further into the demographics of those who fall under the coverage gap, Howard broke down the racial makeup of those majority-working Alabamians who remain ineligible for Medicaid but cannot afford private insurance.

"On the Medicaid rolls now, 30 percent are white women," Howard said.

"It's not necessarily who you might think it is; 55 percent (in) the coverage gap are white, 39 percent are black, and 6 percent are Hispanic, Latino or other, (and) 70 percent of those in the coverage gap right now live in a home with at least one working adult, but they make too much money to qualify."

Ted Hosp, the vice president for government relations at Blue Cross and Blue Shield of Alabama, spoke at the meeting as well, and further broke down the demographics of those in the coverage gap.

"About half of the population gets their health insurance through a commercial plan, about 2.5 million people," Hosp said.

"You've got close to a million in Medicaid, close to a million in Medicare, you have some TRICARE folks, and then there's about 400,000 or so people who are uninsured. Now, of that uninsured population, not all of those people are in the coverage gap."

Hosp explained that of those close to roughly 400,000 uninsured Alabamians, roughly 180,000 of them would be ineligible for Medicaid even if state leaders expanded the program.

Hosp also spoke to the disparities of health care access when comparing rural to urban parts of the state.

"The uninsured population does disproportionately fall in rural communities in Alabama," Hosp said. "About 25-30 percent of the people who walk into a rural hospital in Alabama don't have insurance, which is higher than the urban hospitals which typically have somewhere between 10-15 percent."

Rep. Pebblin Warren, D-Tuskegee, told Alabama Daily News that she was "very optimistic" that the Legislature could come up with a plan this session to help those in the coverage gap.

"I think what it demonstrated more than anything was that we have a problem in this state that we need to correct with health care for people who cannot afford it," Pebblin said. "How that's going to come, I'm not sure, (but) I think the information that was presented this morning was very educational for a lot of the members."

Insurance expansion has looked different in some states since 2010. Arkansas reached an agreement with federal rule makers to use the expansion money to purchase private insurance for low-income residents. It developed its hybrid model in 2013 as an alternative to expansion, The Associated Press has previously reported.

The Arkansas model was not discussed Wednesday.