Analysis details expected insurance ‘coverage gap’ in NC

Oct. 16, 2013 @ 05:50 PM

A Kaiser Family Foundation analysis released Wednesday found that 318,710 low-income people in North Carolina will likely remain without health insurance, as they fall into what was called an insurance “coverage gap.”
The analysis, “The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid,” focused on the 26 states, including North Carolina, that were not planning to expand their Medicaid programs as of September.
The expansion, a provision of the federal health care overhaul, is optional due to a 2012 U.S. Supreme Court decision.
According to the analysis, 5.2 million people in those states are not expected to qualify for Medicaid, and they also will not meet the qualifications for the federal subsidies available to help people buy plans on the online insurance exchanges.
The U.S. Supreme Court decision made it an option for states to expand Medicaid coverage for all adults with incomes of up to 138 percent of the federal poverty limit. That would be for people who make up to $15,856 for an individual and $26,951 for a family of three, according to the report.
In states that expanded the program, the expansion opened up the program to non-disabled, childless, low-income adults, according to the report.
Philip Harewood, CEO of the Lincoln Community Health Center in Durham, said in an email that in North Carolina, Medicaid coverage is restricted to pregnant women, children and the disabled.
Last year, Lincoln served more than 31,000 patients who lacked health insurance. He said many of them would have qualified for new Medicaid coverage if North Carolina had opted to expand the program.
He also said about 84 percent of them are below 100 percent of the federal poverty level, and so they do not qualify for subsidies in the new health insurance exchanges.
“In other words, (Lincoln’s) patients who would have qualified for expanded Medicaid coverage, but are too poor to qualify for the subsidies/tax credits in the N.C. marketplace are the ones who fall into the ‘coverage gap,’” Harewood said.
Brian Toomey, CEO of Piedmont Health, a Carrboro-based health care provider that serves people in seven counties, said that currently, 76 percent of the provider’s patients are at 100 percent of the federal poverty limit or below.
“I wish ... we could treat the poorest among us with the same opportunities as the people above them have,” he said.