By Angie McLaughlin, MSW, Executive Director, Community Health Care Clinic
October 2013 began with a very rocky roll-out of online enrollment for health insurance and Medicaid, a very visible part of the Patient Protection and Affordable Care Act (ACA). While website fixes and enrollment numbers improved over the last six months, many Americans remain confused on the main components of the Act and what it means for their community. While it is very easy to bury our heads in the sand, the reality of health care reform is here and, as health care consumers, it is in all our interests to learn how this landmark reform will impact our health care system.
According to the Kaiser Commission on Medicaid and the Uninsured (2013), there were approximately 16,000 uninsured residents in McLean County. In Illinois, health care reform brought two new options for health insurance coverage for individuals: expanded Medicaid and private insurance plans through the federal enrollment website. Previously, federal Medicaid eligibility required an individual’s annual income to fall below 138 percent Federal Poverty Guidelines (FPL) and be blind, disabled, a child under age 18, or a parent/caretaker for a child under age 18. The ACA Medicaid expansion has removed these stipulations so all adults whose annual income fall below 138 percent FPL are eligible for Medicaid in Illinois. According to data estimates from the 2010-11 American Community Survey, McLean County has over 5,800 individuals newly eligible for Medicaid expansion.
In addition to the Medicaid expansion, uninsured individuals also have coverage options through the online insurance marketplace. There are tax premiums and subsidies available to individuals whose income is as high as 400 percent FPL. These premiums and subsidies were designed to help reduce the burdensome cost of insurance for lower income individuals. Illinois Health Matters, a statewide health advocacy organization, estimates that just over 3,900 individuals in McLean County are eligible for some type of subsidy on the marketplace.
How will all of these people get enrolled in coverage? Three organizations received state and/or federal funding to help enroll individuals into the expanded Medicaid option and private health care plans. The McLean County Health Department, Life Center for Independent Living, and Chestnut Health Systems provides in-person assisters to guide people through the online enrollment system. During the open enrollment period (Oct. 1, 2013 to March 31, 2014), approximately 1,100 individuals in McLean County were helped to explore their new insurance coverage options. As of March 31, 64 percent of individuals who found new coverage were enrolled in Illinois’ expanded Medicaid program and 36 percent purchased insurance through the healthcare.gov private marketplace.
With all of these new insurance options out there, it must mean that everyone is going to have affordable health care coverage, right? Wrong. A very large misconception about the Affordable Care Act is that everyone will now have insurance or access to affordable health care. Nothing could be farther from the truth. The ACA is not and was never intended to be a universal health care system and access to affordable, quality care will remain a barrier. Even after full implementation of health care reform and enrollment, almost 7,000 residents of McLean County will remain uninsured.
There are many reasons why so many individuals will remain uninsured even after full implementation of the ACA. One main reason continues to be the cost burden that purchasing insurance has on household budgets. Even with significant tax rebates and cost-sharing, out-of-pocket expenses, deductibles, and co-pays still make insurance out of reach for most low-income, working adults. The April 2014 Kaiser Health Tracking Poll found that nearly 4 in 10 uninsured adults reported affordability as the main reason in continuing to skip insurance coverage.
While Medicaid eligibility has been expanded, it does not mean that all individuals eligible will enroll. Many individuals who face significant life challenges such as homelessness and mental illness will struggle with the bureaucracy of the program. Some individuals simply do not want to participate in government programs and will continue without coverage. Another large population in our community that will remain uninsured is undocumented immigrants, who, regardless of their employment status, are not eligible for Medicaid or private marketplace subsidies.
In the upcoming months and years, doctors, hospitals, states, clinics, and patients will experience the effects of this monumental reform. While there are many unknowns, one thing we do know is that individuals right here in McLean County will still not have access to affordable health care. Our local health care system will continue to identify and address the gaps for the medically underserved and work collaboratively to ensure everyone has access to care, regardless of their insurance status.
If you would like to learn more about health care reform from an easy to understand, interactive, and non-partisan format, please visit the Kaiser Family Foundation website at kff.org/health-reform.
The Community Health Care Clinic is located at 902 Franklin Avenue in Normal. For more information, call 309-888-5531 or visit www.chcchealth.org.
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