Middle-Aged, Low Income Fall into 'Gap'

Dec 4, 2014

When the Affordable Care Act’s federal marketplace opened last year, Beth and Doug Warner of St. Petersburg asked a navigator to enroll them. But they discovered their income wasn’t high enough to get a subsidy.

Without one, Doug Warner said, the policy for the couple would cost $700 a month. “Basically the choice was, ‘Keep the roof over your head or buy healthcare.'”

It’s one of the great ironies of the health overhaul. Floridians most in need of health insurance -- adults below the poverty line -- are often blocked from coverage the Affordable Care Act provides.

The law intended to cover those below the poverty line through state Medicaid expansion, using federal funds. But Floridians lost that option when the Legislature declined to implement that part of the law.   

So the Warners and more than 800,000 others in the state fall into a gap:

Doug Warner demonstrates how far an infection rose on his arm.
Credit Carol Gentry, Health News Florida

They don't qualify for Florida Medicaid because they don't have kids at home. But they can't get subsidized coverage on the federal Marketplace either.

Doug Warner, age 58, has been a limousine chauffeur all his adult life.  But he can't do that now because his diabetes is so advanced. Once a diabetic becomes dependent on insulin, Warner said, he no longer qualifies for a commercial driver's license, which is necessary to drive a big truck or limo.

His wife Beth Warner, at age 63, works 40 or more hours a week.  But that's split between two part-time jobs, in a grocery store and restaurant. She's worked for the grocery chain for 16 years. Neither have offered a full-time job with benefits.

"Life is unfair," she said, without bitterness. "We all get old, and the sad thing is, they don't want the old ones out in the world. They want the young cutesy-cutesy people."

I met the Warners at a diabetes class  at the St. Petersburg Free Clinic, a non-profit program for the poor and uninsured. It's a good place to find people in the coverage gap -- like Carlos Seibane of Pinellas Park, 49.

He found out he had diabetes 20 years ago, when he suddenly lost most of his vision. It was restored after intensive treatment with insulin; that hospital bill was never paid.

Seibane has a part-time job taking disabled veterans to medical appointments. His income falls well below the poverty line, so he can't get a  subsidized health plan on HealthCare dot Gov.

But he has to have his injectable insulin, which costs about $400 a month. Without insurance, charity is the only way he can handle his diabetes.

“Thanks to the St. Pete Free Clinic, I got it under control with no damage to my body,” Seibane said. He repays the favor by volunteering at the clinic.

Charities aren't the whole answer for Florida's uninsured, because they don't provide expensive tests like MRI's and they don't cover hospital bills.

Until this week, the leaders of the upcoming 2015 Florida legislative session had given no indication that there was movement on the expansion issue, which would bring an estimated $5 billion a year to the state. But on Wednesday, a proposal that would use the federal money for private coverage – without calling it “Medicaid,” drew support from a key Senator.

As the Times/Herald Bureau reported, Senate Rules Chairman David Simmons, R-Altamonte Springs, threw his support to “A Healthy Florida Works,” a proposal  from a coalition of business groups and hospital associations.

Academics have projected that the state’s businesses – hospitals most of all, but others as well -- stand to lose billions of dollars a year without coverage expansion to low-income childless adults.

And in April 2013, as Health News Florida reported, the Agency for Health Care Administration estimated the state would save $430 million a year if it accepted the federal funds.

So far, resistance to accepting the money has come from the Florida House.  New Speaker Steve Crisafulli has not shown his hand, but powerful House Budget Committee Chairman Richard Corcoran, R-Land O’Lakes, told the Times/Herald Bureau on Wednesday that “it sounds like they are moving in the right direction.”

In the meantime, health insurance agents such as Jeffrey Mercado of St. Petersburg remain busy. Mercado is an Obamacare broker for 11 states, so most of his applicants reach him by phone.

"Arizona, Illinois, New Jersey, Pennsylvania -- states that did expand Medicaid -- those people don't have the income gaps we have here," Mercado said.

So far, he said, he's worked with about a dozen uninsured Floridians he couldn't help because they fell into the income gap.  Mercado remembers in particular a woman who called  him in tears. She has a tumor.

"She's unemployed, her husband got laid off his job after having worked there 30 years," Mercado said. "So they were well below the poverty line."

He says the couple, who live in Charlotte County, are living on the husband's  retirement check of $750 a month. Mercado says the woman has tried to find a doctor, but without coverage she can't.

"Doctors don't want to see her. They don't want to take her without any insurance," he said.

All Mercado can do in such cases, he said, is apologize.

--Health News Florida is part of WUSF Public Media. Contact Special Correspondent Carol Gentry at cgentry@wusf.org. For more health news, visit HealthNewsFlorida.org.