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Floridians Affected By The Health Coverage Gap

Miami Herald
Credit Miami Herald

Thousands of South Floridians too poor to afford health insurance on their own are going without.

These people end up in what is called the "coverage gap" because they earn too little to get help buying health insurance under Obamacare, but they don’t qualify for Medicaid.

About 850,000 Floridians are affected, according to 2015 estimates from the Urban Institute. Roughly 140,000 of those are in Miami-Dade County alone. Broward County has about 80,000 people.

Expanding Medicaid in the state would bridge this gap, but Florida, along with 21 other states, chose not to do that when the Affordable Care Act started. On Thursday, Gov. Rick Scott said the state will file a lawsuit against the Obama administration for attempting to force Florida into Obamacare.

WLRNand the Miami Herald will look at what life is like for people in the coverage gap, and how being uninsured has affected their lives, their health, and their wallets. 

We spoke with Daniel Chang, health reporter for the Miami Herald, who's involved in the series we’re calling “Falling into the Gap.” Read the Miami Herald's report on the coverage gap.

Why are we talking about Medicaid expansion now?

Well, this year is special because on June 30 the federal government has told the state that they’re going to stop providing the special pool of money that funds hospitals that treat lots of uninsured patients and patients on Medicaid. It’s called the low-income pool, or LIP, and that money has been around since about 2006 so it predates the Affordable Care Act and with federal government essentially said this week in a letter to the state’s agency for health care administration is that that’s the old way of covering the uninsured. There’s a new way under the Affordable Care Act where we provide Medicaid coverage to more individuals.

So what does that mean for hospitals and clinics that are relying on this money to help cover the uninsured?

Well, what it means is that these hospitals are going to have to find a way to make up that loss of funding, up to and including closure of certain hospitals because they have large uninsured populations who had received money through this program. Now, that’s a doomsday scenario, and the federal government could decide to create a program where these hospitals submit their expenses once a month, for instance. But they’ve said pretty clearly that they’re not interested in continuing the old way of doing this.

Bill 7044has passed several Senate committees that’s very similar to Medicaid but how does it differ?

It is essentially a Medicaid expansion program, but it has conservative principles of choice, free market and self responsibility. Essentially what Florida has proposed is to create its own version of or a state operated marketplace. So in this marketplace private insurance companies like Humana, Cigna and others will offer plans to individuals who qualify to buy on that marketplace based on their income. These are the folks who would get Medicaid. These folks will get money to help them pay for their premiums for those plans.

Now they’ll also have some co-payments under this proposal and there are also some requirements that they either be working or searching for work, and these are not types of requirements that the federal government has approved in the past.

In the past, the House has refused to take up the issue, effectively killing it. But this year the Senate included money to fund the bill in their version of the budget. So wouldn’t that essentially force a conversation on the issue?

Yes, they’re going to be required to talk about this now as they reconcile their budgets. You know the one thing they have to do during session is to pass a balanced budget. There’s no way to get around that conversation.

Copyright 2020 WLRN 91.3 FM. To see more, visit WLRN 91.3 FM.

Wilson Sayre was born and bred in Raleigh, N.C., home of the only real barbecue in the country (we're talking East here). She graduated from the University of North Carolina-Chapel Hill, where she studied Philosophy.