Navigators say some can't afford insurance, but don't qualify for subsidies

After the Affordable Care Act jumped substantial hurdles along the rollout of the online health-care marketplace, people now are able to enroll in health insurance plans with more ease, local navigators say.

But some individuals are coming across another problem -- Missouri's Medicaid guidelines prevent many from being able to afford insurance because they don't qualify for federal subsidies.

Gina Harper, a certified application counselor and navigator with the East Missouri Action Agency, on Tuesday said because Missouri chose not to pass a Medicaid expansion, she has had some difficult conversations with individuals about affording health insurance.

Harper estimated she is able to help about 70 percent of her clients all the way through the marketplace registration process. Of the remaining 30 percent, a majority are individuals whose income and household size put them below 100 percent of the federal poverty level, so they do not qualify for any subsidy assistance, she said.

Some of the individuals who need the most federal subsidy assistance are those who do not qualify for any, Harper said, and health insurance plans could end up costing them hundreds of dollars a month -- something they can't afford.

The way the Affordable Care Act is written, if an individual falls below 100 percent of the federal poverty level, it is assumed the state will take care of them with Medicaid, Harper said. Missouri did not expand its Medicaid program to cover those individuals who fall between 0 to 100 percent below the federal poverty level.

"The good news is that I can make sure they complete an exemption form and do not get penalized on their taxes next year for not having insurance coverage," Harper stated in a news release sent to the Southeast Missourian. "The bad news is that they walk away from my office without health insurance."

There are two types of exemptions, Harper explained. One is an exemption for affordability, which is for those individuals who fall below the 100 percent cutoff, and the other is an exemption for hardship, which, for example, covers an individual who can't afford utilities and has had his or her electricity shut off.

Rep. Noel Torpey, R-Independence, filed House Bill 1901 on Tuesday, which would expand Medicaid to adults whose income falls below the poverty level.

Working-age Medicaid recipients would have to have jobs to be eligible, according to Torpey, the St. Louis Post-Dispatch reported.

The bill was read a second time Wednesday.

Enrollment

For the 70 percent of people Harper is able to help all the way through the process, the health-insurance marketplace can produce good results, she said.

Harper spoke of a husband and wife in Stoddard County who never had health insurance because the wife worked part-time and health insurance wasn't offered, and her husband had a pre-existing condition. They could not afford a health-insurance plan that could have cost up to $800 a month.

As a couple, they now pay $35 a month with subsidy for health insurance through use of the marketplace, Harper said.

As of this month, more than 54,000 Missourians had enrolled in a health-insurance plan on the marketplace, and 3.3 million people had signed up for coverage in the United States, the St. Louis Business Journal reported.

Of the millions enrolled, about one in three are younger than 35, according to data released by the U.S. Department of Health and Human Services. The more young adults who sign up for coverage offset the higher cost of insuring older adults, because young adults acquire fewer health costs.

The deadline, which was extended, for enrolling in a health insurance plan without being penalized is March 31. Individuals who are exempt from purchasing health insurance must file their exemption by March 31.

Harper encouraged people to be proactive and register for a health-insurance plan before the March deadline, and if they can't afford a plan, to file an exemption, in order to avoid any penalties.

"Don't not do anything," she said.

Legislation

The Missouri Senate passed legislation last week that would require navigators to take a written examination and undergo a criminal-background check before becoming licensed to help people sign up for health-insurance plans on the marketplace, the Associated Press reported. Another bill would require that navigators purchase a $100,000 bond in case they are sued for unlawfully sharing a consumer's personal or financial information.

Proponents of the law believe current federal guidelines for navigators are too lax and the legislation would help prevent fraud. Opponents say it would make it harder for people to acquire health insurance and the legislation is another attempt to impair the health-care law.

"Anytime you're going to have any greater qualifications for people who provide a service to the public, that's not bad thing," said state Rep. Kathy Swan on Wednesday.

Ruth Dockins, a navigator with Aging Matters in Cape Girardeau, on Tuesday said as navigators, they were required to pass a test and undergo criminal-background checks before they were licensed.

"Most of what they're asking for, we've already got or already done," Dockins said.

Dockins does not have a $100,000 bond, and if navigators were required to personally pay for such a bond, fewer people would be inclined to become navigators, she said.

She questioned where the money for a bond would come from, as navigators likely wouldn't pay for it out of their own pockets and community action agencies such as Aging Matters "operate on a shoestring anyway."

ashedd@semissourian.com

388-3632

SIDEBAR:

Upcoming Affordable Care Act events:

* Aging Matters will host an enrollment event from 2 to 5 p.m. Friday at Three Rivers Community College, 103 E. Kathleen St., in Sikeston, Mo. For more information, call 335-3331

* The Cape Girardeau Area Chamber of Commerce will host a Business Builders Workshop for chamber members at noon Feb. 26. Gina Harper of the East Missouri Action Agency will present information on what is required of small businesses regarding the ACA, what the ACA states for individuals and businesses and also will discuss deadlines, business incentives and penalties. Registration is required and the cost is $15. For more information, call 335-3312.