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Left Out: FL’s Poorest Uninsured (AUDIO)

At 7 a.m. on a Monday morning, poor people who don’t qualify for government health programs such as Medicaid are lined up outside a health department building on a busy street in St. Petersburg. 

Some lean against the wall; others sit on the ground, too sick to stand. 

At 7:30, the doors will open and those who are waiting will rush – or limp – inside to take a number. Lucky ones will get to see a doctor. First-come, first-served.

These are some of the people who will not gain health insurance when the federal health law kicks into high gear on Jan. 1. They’ll be left out because they are in Florida, one of the states that turned down federal funds to cover adults below the poverty level – people with incomes under about $11,500.

That decision by House Republicans “was a horrible failure of leadership,” says Ken Welch, chair of the Pinellas County Commission. The county has to tax property owners more to pay for the care of these  low-income adults, he said.

This year that will cost local taxpayers $23 million, according to County Finance Director Clark Scott. That’s $15 million for outpatient care through the health department clinics and $8 million toward hospital care.

The cost is even higher in some counties that have special taxing districts or a sales tax, such as Hillsborough County.

Florida’s Medicaid program covers few adults other than the disabled. Some Republicans who opposed Medicaid expansion during the legislative debate said they don’t believe in extending health coverage to people who are “able-bodied,” even if they are working at a job that doesn’t offer it or earn too little to pay for it. Or even if they are looking for work.

Florida Medicaid covers parents of children on Medicaid only if their incomes are 20 percent of the poverty level  or below – under $4,000 for a family of three.  Childless adults are not covered at all.

None of these  adults who have an income below the poverty level will qualify for the Affordable Care Act’s online marketplace (formerly called the “exchange”), where  insurance will be subsidized on a sliding scale.

They will not qualify because of inaction by the Florida Legislature at this year’s session, where a Senate move to accept federal funds to cover low-income people was blocked in the House.
National studies of uninsured adults below the poverty level suggest that about half are between 18 and 34, mostly healthy.   The other half – those between 35 and 64 – will cost more to cover, studies show. A  lot more.

All of the adults standing in line at the Health Department the day Health News Florida visited, May 13th, were in the 35 to 64 age range. They offered only blank looks when asked how they felt about coming so close to gaining coverage but missing it because of the House vote the week before.

(Transcript of audio):

HNF/Gentry: Not long ago I decided to go find some of the people who got left out when the Florida Legislature voted against expanding Medicaid. They’re uninsured people below the poverty level. I found some in  front of the Pinellas County Health Department. They were lining up early in the morning so that when the doors opened, they could run in  – or limp in – and sign up for an appointment later in the day. It’s first-come-first-served.

HNF: (sound of traffic) "I’m here with…

Woman in line: “Allison Claycomb. I’m here to get clearance to get  my next back surgery and to get all my medications. “

HNF: “How much would your medications cost if you had to go to the pharmacy?”

Claycomb: “They’d be at least  $500 and that’s about how much my disability check is." (Actually, she said later, it’s something over $600).”

At 52,   Claycomb is typical of the people waiting in line. They're white. Middle-aged. In pain. Most of them worked for many years, and quit only when they got sick or laid off.  In Claycomb's case, it was an injury  4 years ago.

 Claycomb: "I was waiting on a customer and I was ready to ring them up,  and as I was carrying the box to the register, the box started to rip and I tried to keep it from breaking and falling, and I broke – I tore about 4 or 5 discs in my back.”

HNF: “I'm Carol Gentry from WUSF, can I ask your name?”
Woman in line:  “Ava Lasher.”

HNF: “I’m asking people in line about health insurance --

Lasher: -- “I haven't had health insurance since – hold -- since 1986."

HNF: She worked for  IBM, where she had good coverage, for 13 years.  But she went back to college, and when she got out, it was hard to line up a job with good benefits.

Lasher: "Security guard, teacher, none of those places had any insurance. Then I was a caregiver for people with special needs, actually a live-in caregiver. Not one agency gave  any insurance."]

 HNF: Next we meet John Nabors. He's been out of work for 2 1/2 years.

Nabors: "I've done underground utilities for the majority of my life.”

HNF: “Underground utilities is like what?”

Nabors: “Light poles. I did a lot of work overthere  at Tampa Airport, all them new signs you see up there, all them big structures, all the cameras you see on I-275, I put all them up.  I’ve done aerial construction, cable TV,  fiberoptics. Traveled out of state for a while. I’ve hung cable in Indiana, Georgia, Idaho, all over the place.”  

HNF: He's 50 but he looks older. He has bad emphysema and almost no teeth.

Nabors: “This  morning I’m here for back and neck problems. I’ve been coming here for about two years. I’ve got back and neck problems. I’ve been here previously for dental. They were able to pull all my teeth pulled all the bad ones but they can’t give me no new ones yet because of a lack of funding. The government’s not paying for them anymore. So this is what I’ve got.”

HNF: Melany Fulkerson is feeling so bad she had to sit down. She has diverticulitis, a sinus infection and swollen joints.

Fulkerson: “I'm waiting ‘til my entire body falls apart to come down here because it's a long wait.”

HNF: These are just a few of the 700,000 uninsured people in Florida who won't be getting coverage next year because the Florida Legislature chose not to expand Medicaid. For Health News Florida, I'm Carol Gentry.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.