Refusal To Expand Medicaid Creates Anxiety For The Working Poor

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The Charlotte Observer has a story chronicling the effects of Governor McCrory and the legislature's decision not to expand Medicaid eligibility to hundreds of thousands of North Carolinians. Many workers earning around the poverty level risk losing all of their health care subsidies should their income fall below the poverty line. Those workers should be eligible for Medicaid, but Governor McCrory and the legislature have refused to consider it. From their article,

At 61, Ken Helms of Charlotte would love to have health insurance. Based on what he earned directing traffic this year, he’s eligible for federal help paying premiums and out-of-pocket costs under the Affordable Care Act.

But he worried that his unpredictable income could leave him in the lurch. The subsidies are designed to provide more help to those with smaller paychecks. But in North Carolina, the floor drops out when a wage-earner falls below the poverty level, a distinct possibility for Helms.

His fear: Getting health insurance – and long-delayed care – could leave him worse off if he loses his coverage and has to repay Uncle Sam.

Experts say that won’t happen, but his trepidation is understandable.

People who rely on tips, commissions or jobs with variable hours can have a tough time predicting annual income, which is the basis for ACA subsidies. In a recent Federal Reserve survey, almost one-third of Americans said their income fluctuates from month to month.

In general, lower income means a higher subsidy.

But for those who hover around the poverty line, a slump can put them into the “no help” category in the Carolinas and 21 other states that haven’t expanded Medicaid coverage.

When Congress passed the ACA, the plan was for all states to use federal money to extend Medicaid to the poorest able-bodied adults, with subsidized private insurance covering low- and moderate-income people. But North Carolina and South Carolina joined other Republican-led states in saying “no thanks,” leaving at least 575,000 low-income Carolinians in the coverage gap.

In 2013, Helms was among them. He works for a temp agency, and that year work was sparse. He says he made only about $2,200, so when the time came to sign up for 2014 subsidized policies he qualified for nothing.

This year was much better: He earned about $19,000 directing traffic at UNC Charlotte, where a new dining hall was under construction for most of the year. But that job ended in November.

Forecasting the unknown

“Next year I know my money’s going to fall down,” Helms said. But he has no way of knowing how much. If he goes as low as $11,670, he’ll get almost all of his costs covered by federal aid. If he dips below that he’s in the gap.

Madison Hardee, a lawyer with Legal Services of Southern Piedmont who is trained to help with ACA enrollment, says Helms won’t be asked to repay any subsidies if he “honestly and reasonably estimates that his income will be over 100 percent of the poverty line” but falls short.

The Kaiser Family Foundation, which does extensive research into the ACA, agrees: “If you were determined eligible for subsidies when you signed up, and your income turns out to be lower, you will not have to repay the subsidies you received,” it says in a list of frequently asked questions.



  1. Frank Mitchell's avatar
    Frank Mitchell
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    I know how Bernie Madoff's clients felt when they found out that they had been bilked out of their hard earned money. We have Governor McMadoff working his Ponzi scheme on us.
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