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Quirk In Health Law Creates 'Coverage Canyon'

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At 60-years old, Wendy Rogers considers herself lucky. She’s healthy, her kids are grown. There’s just one thing that gets her down: health insurance.

“I really don’t let myself think about it, because it overwhelms me.”

Rogers lives in Franklin, in a tidy apartment decorated with framed photos of friends and family. She lost her insurance three years ago, after getting laid off from a local school district  where she was a kindergarten aide. Now she works part time at a child-care center.

Rogers says she relies on family for medical expenses.

“Like when I needed glasses, my daughters paid for my glasses. When I had a tooth removed, I called my daughter from the dentist’s office barely able to talk, to have her help pay for the tooth removal.”

Rogers classifies herself as the working poor. She earns less than $11,000 a year, enough to qualify for fuel assistance and food stamps…but in New Hampshire, not Medicaid.

“In fact you have to be poor, plus something else. Something that we call your category,” says Lisabritt Solsky, Deputy Medicaid Director for the state.

The categories she’s referring to are ‘poor and a child’ ‘poor and disabled’ ‘poor and pregnant’ or ‘poor and elderly.’

The architects of the Affordable Care Act said states must loosen Medicaid eligibility to extend coverage to all poor people.

Ruling Throws Wrench In Plans

But then, says, Deb Fournier, the Supreme Court threw that plan into flux.

“No one imagined that the Medicaid provisions would be modified by the Supreme Court decision and the statute certainly doesn’t imagine that.”

Fournier is with the New Hampshire Fiscal Policy Institute, which supports expansion. She says the Supreme Court ruling that states must be given a choice on the matter, combined with other provisions of the law, created what she calls the coverage canyon.

“And it works like this: imagine a canyon. You have a cliff on one side, and a cliff on the other side.”

"They're sort of stuck in this no man's land."

Atop one cliff are people with traditional Medicaid, who fit the current categories. On the other cliff are all the people that will get tax subsidies under Obamacare to help them buy insurance.

But only people earning between 100% and 400% of the Federal poverty line will get those subsidies.

The thinking was, people earning less than 100% would qualify for the new expanded Medicaid.

So Fournier says in states that don’t expand, there’s a gap. She estimates 40,000 residents in New Hampshire could fall into this category.

“They’re sort of stuck in this no man’s land,” says Fournier.

And states are stuck with this problem unless they fix it themselves.

Any changes to Obamacare would require Congress to act, something not likely on such a polarizing issue. A local fix may also prove elusive.

Cindy Rosenwald, a Democrat who sits on the House Finance Committee, says few colleagues even know about this problem.

“I don’t think there is a good understanding of the fact that the very neediest people will still be left out in the cold.”

But Not Left Out Entirely

People without insurance do get care in medical emergencies, and can often get seen at clinics with sliding scales.

Greg Moore with the conservative group Americans For Prosperity says with state government already picking up a share of those bills, New Hampshire shouldn’t rush to expand Medicaid.

“Do we want to shift that safety net to a totally different safety net? Well I think the senate says, lets slow down and take a look at this deliberately.”

Senate Republicans pushed for a commission to study Medicaid before the state moves to change its program, something House Democrats agreed to to avoid impasse.

The commission must report back by October 15th.

One thing it will look into is how, or if, the state should address the coverage canyon issue.

For her part, child-care worker Wendy Rogers hopes New Hampshire can figure out a way to extend her some support.

“I must be very much like the children I work with. I don’t understand why people can’t help people, if they need it.”

Todd started as a news correspondent with NHPR in 2009. He spent nearly a decade in the non-profit world, working with international development agencies and anti-poverty groups. He holds a master’s degree in public administration from Columbia University.
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