- Photo by Heather Mull
- Shayla Collins is in the coverage gap.
Since the Affordable Care Act went into full swing last fall, those who've been able to acquire health insurance report a common symptom: feeling like a weight has been lifted off their shoulders.
"I'm not panicked about getting injured or sick anymore," says Julie Goodenough of Crafton, who says she previously couldn't obtain insurance because of high cholesterol. "Anytime I got behind the wheel of my car, I thought, ‘What if I get in an accident?' Anytime I got a cold, I thought, ‘What if this turns into something serious?' My life feels a lot more secure now."
Not everyone has been so fortunate. Some Pennsylvanians still can't afford health care, even with new incentives offered by the federal government, and yet aren't quite poor enough to be eligible for Medicaid, a longstanding program that covers health costs for low-income people. The resulting "coverage gap" might trap as many as 500,000 state residents — and advocates say Gov. Tom Corbett is to blame.
Currently, individuals making more than $11,490 a year — or families of four making $23,550 — are ineligible for Medicaid. The ACA included a provision expanding Medicaid to individuals earning $15,900 or less, and families earning $32,400 or less.
That expansion could extend Medicaid to cover 52,322 uninsured individuals in Allegheny County alone, according to U.S. Census data. But Corbett has declined to take advantage of the program, proposing his own alternative instead. That makes Pennsylvania one of 24 states that have opted out.
The federal government has pledged to pay for 100 percent of the expansion for the first three years and 90 percent in the following years. Since January 2014, Pennsylvania has rejected $4.8 million in federal funding per day, says the Pennsylvania Health Access Network. But Republican critics warn that already-strapped states may struggle to pay their 10 percent share of the bill once it comes due.
Corbett's alternative, Healthy Pennsylvania, would use federal Medicaid dollars to give qualifying Pennsylvanians a chance to purchase insurance directly from private companies, instead of a marketplace set up under the Affordable Care Act. This plan requires approval from the U.S. Department of Human Services; there is no deadline for that decision.
"This is a Pennsylvania solution that reforms a broken and financially unsustainable program," Corbett said in a statement. Healthy Pennsylvania, he said, "reduce[s] government bureaucracy by using the private health-care market, and create[s] health-care choices for consumers. I will not accept Washington's ‘one-size-fits-all' approach for Pennsylvania, and I will not expand an entitlement program."
In the meantime, Shayla Collins waits in limbo.
A Pittsburgh native, Collins returned in 2008 to help take care of her mother, who was living with Alzheimer's. Since that time, Collins has been able to find only temporary and part-time work; she's been unable to get health insurance as a result.
For Collins, getting covered would be about more than having a safety net in case of an emergency. She's already dealing with chronic pain and several other health issues that have kept her from getting a job that provides health benefits.