If ACA Politics Leave People Without Coverage, Maybe It’s Time To Forget The Politics.

About 8 million people have signed up for Year 1 of Obamacare, but millions of others are still falling into the law’s “coverage gap.” They earn too much money to qualify for Medicaid, but they don’t make enough to get federal subsidies to buy private insurance on an Affordable Care Act exchange.

The human toll of the coverage gap can be found all too easily in Hidalgo County, Texas, where less than half of non-senior adults had health insurance in 2012.

“If Obama did this market so we can get affordable insurance, why are we still having a lot of problems? What’s going on?” asked Anna Covacevich, a 57-year-old home care provider and Hidalgo County resident who made $8,000 last year.

People like Covacevich were supposed to be helped by Obamacare.

The Affordable Care Act expanded Medicaid to cover everyone with incomes up to 138% of the poverty line. But the Supreme Court ruled that states could opt out of the expanded federal program — and 24 states have done just that.

Texas is one of them.

Governor Rick Perry has said Medicaid needs to be reformed to emphasize personal responsibility and that the expanded program will be too expensive.

“Those people are caught in between. They’re just going to stay the same. Nothing they can do,” said Raquel Vargas, a Healthcare.gov application counselor at Nuestra Clinica Del Valle, a nonprofit medical clinic in the county.

Nationwide, about 5 million people are in the “coverage gap,” according to the Kaiser Family Foundation. In Texas alone, the number is 1 million.

Raquel Calderon, 55, her arm in a sling after a recent injury, doesn’t have insurance and falls just under the poverty line. She’s paying for her treatment out of pocket. “I consider myself healthy, except for the fall.”
Jose Canchola, a 50-year-old laborer who works in the onion fields, says he can’t afford insurance. “I know that I need to see a doctor,” he said.

Meanwhile, the uninsured continue to visit nonprofit medical clinics for their health care.

“I hope that one day everybody can receive the care that they need, and that’s why we’re here,” said Rebecca Stocker, who runs the Hope Family Health Center, treating only uninsured individuals. “But it’s scary, and it’s sad to be on the front lines.”

Danny Ordaz, who has 8-year-old twin boys, has never had health insurance. When his children get sick, he takes them to Reynosa, Mexico. “It’s cheaper,” he said.

Talk about a place that proves a demand for direct care. If you have people leaving the country to pay cash for health care, then it should be obvious that we are not doing health care right.

Oh, and whose idea was this? The government’s, and the insurance companies’ lobbying for these laws.

Of course, they’re both cozy. The government can collect the fines for people who are uninsured. And the insurance companies just got more customers pushed their way thanks for Obamacare subsidies. Oh, and how convenient, because the government tampered with the free market, the price of private plans has steadily risen, meaning people with income are going to be paying more money for the same “coverage”.

It seems like the real winners here are large corporations and Uncle Same.

Meanwhile, uninsured people aren’t getting the care they need.

Will a Direct Care doctor step up to the plate?

Maybe a new model would be needed in a county like this — $30/mo for adults 18-44, with the same services provided at Atlas MD. A doctor would need to see more patients, but maybe he/she limits their quota to 15 patients per day, and promises no more than two-day wait for an appointement (unless it’s urgent).

See, in the free market, there is creativity.

Doctors are here to help patients. That’s why they dedicated their life to primary care. We know it wasn’t for the glory. In the free-for-service world, we’re one of the lowest paid specialties. Meaning, we’re doing this for the opportunity to build trusting relationships, and change people’s lives.

Hospitals just south of the U.S.-Mexico border advertise medical treatments on their websites. A “basic check-up” at one hospital includes blood work, a urine analysis and chest X-rays for $160.

Do we have it in us? Could a Direct Care doc step up and take care of 80% of these patients’ needs for ~$360 per year?

Covacevich, the home care provider, said she would be happy to pay something for insurance. “What I could afford would be from $70 to $100 a month. That would help me a lot,” she said.

What if she didn’t pay for insurance, but put that towards a doctor instead?

In Covacevich’s case, comprehensive coverage is not an option, or for millions more across the country. The most affordable plan on the exchange that Covacevich found would cost her $227 a month because she does not qualify for the federal subsidy.

And remember, that might only help in the case of an emergency, and if she has $6,500 to put towards a deductible.