The Need Continues
Although the Affordable Care Act (ACA/"Obamacare") makes health insurance more affordable to many, it is not and was never intended to be universal health coverage. The ~99 Wisconsin free and charitable clinics (FCCs) continue to be a critical safety net provider to over 150,000 Wisconsinites. The Wisconsin Association of Free and Charitable Clinics (WAFCC) formed in 2014 as a result of several of the state’s FCCs coming together to recognize the need to evolve and redefine whom they serve in the changing healthcare landscape. Many of the individuals they provide medical services to may be exempt from the penalty due to financial or affordability hardships. There remain numerous gaps in the United States health care system, leaving millions of Americans and hundreds of thousands of Wisconsinites uninsured or lacking dental, vision, and behavioral health services. #TheNeedContinues
Statistics on the Uninsured
Figure Source: Kaiser Family Foundation (2017, December 14). The Uninsured: A Primer - Key Facts About Health Insurance and the Uninsured Under the Affordable Care Act. Kaiser Family Foundation. Retrieved from https://www.kff.org/report-section/the-uninsured-a-primer-key-facts-about-health-insurance-and-the-uninsured-under-the-affordable-care-act-who-remains-uninsured-after-the-aca-and-why-do-they-lack-coverage/
Last updated April 2, 2018 MEL
Last updated April 2, 2018 MEL
The Uninsured Post-ACA are Those Who...
1. Find employer family coverage unaffordable
• ACA defines "affordable coverage" as the individual premiums that are 9.56% of an employee's monthly salary
• Affordable is linked ONLY to individual premiums, leaving the family ineligible for subsidies
• There are no waivers from penalties for this situation
• Experience high deductibles and unaffordable co-pays. Some deductibles are upwards of $11,000, which often amounts to more than 50% of their salary!
2. Do not have Medicaid (BadgerCare)
• Wisconsin did not expand Medicaid fully to 138% of the federal poverty level (FPL), as recommended by ACA.
• Residents between 100-138% of FPL are eligible for Hardship Waivers
• Only "qualified" immigrants are eligible for Medicaid and CHIP. Many are NOT eligible for BadgerCare until they have been a resident for 5 years. Victims of Human Trafficking and Other Crimes (T Visa/ U Visa) are exceptions.
3. Exempt from Insurance Mandate & the confusion around the Shared Responsibility Payment
• Hardship Waivers - bankruptcy, utilities cut off, victims of domestic violence
• Incarceration Waivers - Huber dorm & work release programs
• Affordability Waivers
• Religious Waivers
4. File taxes separately from their spouse, rendering them ineligible for subsidies in the Marketplace.
5. Are 65 or older and find Medicare Part B and Advantage premiums unaffordable; but are not eligible for any subsidies
6. Are waiting for their insurance to kick-in
• Many companies have a 90-day wait before benefits start for new hires
• Insurance purchased during an open/special enrollment does not begin immediately
• Those applying for BadgerCare may have to wait up to 45 days to learn if their application is approved
7. Have had a change in life circumstances or situation
• Aged out of their parent's coverage or left school
• Death of spouse or parent
• Employment status (lost or changed jobs, or work less hours)
8. Caught in the differences of income determination between the Marketplace (annual income) and BadgerCare (monthly income).
• The result is: Not eligible for subsidies in the Marketplace, AND Not eligible for BadgerCare
9. Are undocumented residents and can not purchase insurance in the United States (i.e., no Social Security number or legal document number)
10. Experience churning between BadgerCare and the Marketplace as income varies (i.e., seasonal workers). This individual is dropped by either BadgerCare or Marketplace due to income changing, and then has to wait for the new insurance to take effect
11. Unable to quit, or choose to smoke, and are penalized up to 50% higher premiums, thus making insurance unaffordable.
12. Missed Open Enrollment (no waiver for this)
• Are confused or just do not know about the Marketplace, subsidies, and cost-sharing assistance
• Many individuals will not learn about the penalty (shared responsibility payment) for not having insurance until they file their taxes once open enrollment is closed. Not knowing about the penalty and open enrollment will not trigger a special enrollment period (no waivers for this situation)
13. Do not have dental or vision insurance
• Dental or vision services are not requirements of the essential health benefits of health insurance plans
• Individuals may have health insurance, but no dental or vision insurance
• There are no subsidies for dental or vision insurance