The Other “Coverage Gap”

While the Kaiser Family Foundation study highlighted that nearly 5 million Americans will fall into the “coverage gap” due to dozens of states not expanding Medicaid, there is a similar phenomenon taking place throughout the nation, even in those states that have enacted Medicaid expansion. This “coverage gap” is a direct result of Obamacare, which was supposed to make healthcare more affordable for struggling Americans.

California-resident Valerie knows all to well that this is not the case. Her husband is one of the many millions who lost coverage and was greeted with new, higher premiums that go beyond their family’s means.

“I am self-employed, and my husband has been out of work for the past four years. He was laid off from a company that was downsizing due to the economy. For the past year, he has had a private policy with Aetna Insurance Co. We were notified that they would no longer be offering health insurance (private individual policies) due to Obamacare starting Jan. 1, 2014. We were forced to search for another policy, and our agent said everything would be at least double in cost compared to what we have been paying. This will cause a financial hardship for our family,” explained Valerie.

Looking at plans within and outside of the exchange, Valerie’s fears were confirmed as her husband’s new policy was going to cost them 78% – 119% more than his current coverage. Unfortunately, their low, but not-low-enough income does not allow them to qualify for a subsidy.

“For him to get [a plan] even a remotely close to what he had, it was nearly $700 a month on the exchange. If we do it outside of the exchange, his plan would increase from $319 a month [old policy] to $567 a month,” Valerie shared. “I don’t think we are going to be able to do it [the exchange plan], because we are not going to qualify for the subsidy even though we have very little money.”

Valerie and her husband are not alone in this situation. A USA Today analysis revealed the harsh reality for those looking for affordable coverage on the exchange.

“More than half of the counties in 34 states using the federal health insurance exchange lack even a bronze plan that’s affordable — by the government’s own definition — for 40-year-old couples who make just a little too much for financial assistance, a USA TODAY analysis shows.

Many of these counties are in rural, less populous areas that already had limited choice and pricey plans, but many others are heavily populated, such as Bergen County, N.J., and Philadelphia and Milwaukee counties.

More than a third don’t offer an affordable plan in the four tiers of coverage known as bronze, silver, gold or platinum for people buying individual plans who are 50 or older and ineligible for subsidies.”

Even though California has its own exchange and was not part of this analysis, it is clear – from Valerie’s experience – that state-based exchanges are lacking affordability as well. If the escalating costs of her husband’s new policy weren’t bad enough, Valerie was dealt another devastating financial blow regarding their coverage.

“I’m on Medicare, and my Medicare coverage – a supplemental policy – has increased 100%. That is the other issue. My insurance has doubled,” she stated.

While Valerie and her husband are taking some drastic, undesirable steps to stay financially afloat, some families are foregoing coverage.

There is a “coverage gap” crisis – it is one that families are facing everyday under the Un-Affordable Care Act.