Melinda Henderson thought she was going to continue to be uninsured even after the Affordable Care Act went into effect Jan. 1.
The Lawrence bookkeeper didn't expect to earn more than the federal poverty level, or $11,490, so she wouldn't have qualified for Medicaid, since Kansas has elected not to expand the program to childless adults. Nor did she think she could get subsidies on the health insurance marketplace, which are for people who make between one and four times federal poverty.
But after a Christmas bonus put the 60-year-old above the poverty level, she made enough — yes, enough — to qualify for government aid at HealthCare.gov. She qualified for a silver plan, which covers 70 percent of expenses, for about $60 a month and a $250 annual deductible.
"This may not be the best process around. I think it definitely could use improvement," said Henderson, referring to the health care system. "Nothing's really changed except tax credits for poor people like me."
Still, Henderson, who has worked in the medical records, is a savvier customer than most. Even so, local health care officials say enrollment in the insurance marketplace has been increasing in recent weeks, particularly in the days leading up to the Christmas Eve deadline to buy insurance that would start Jan. 1. The next big deadline is March 31, when most Americans are required to have insurance or they will face a fine ($95 or 1 percent of your income in the first year).
Kansas doesn't track data on how many people have enrolled in the health insurance marketplace because the state elected not to set up its own insurance exchange. The federal government doesn't release city- or county-specific numbers and hasn't released data on the state since Dec. 11, when it was revealed that 1,855 Kansans had enrolled through Nov. 30.
Heartland Community Health Center has been able to sign up more than 50 people for insurance since Oct. 1, with much of that activity happening in the days leading up to that late December deadline. "The more people we see with insurance, the more people without insurance we can see," said Ali Edwards, development director for Heartland Community Health Center, which provides care to anyone in the community on a sliding scale, from the uninsured to those with either public or private insurance.
The majority of the clinic's patients, however, will continue to go uninsured. That's because Kansas has thus far elected not to expand Medicaid to childless adults making up to 138 percent of the federal poverty level.
Health Care Access, a Lawrence clinic for the uninsured, also has a certified navigator on staff but has not enrolled any patients as many of the clients there don't make enough money to qualify for subsidies on the exchange. "I’ve had to have the 'you are too poor for help' talk more times that I’d like to," said navigator Jill Flessing.
Brian Edie, an independence Lawrence insurance agent certified to sign people up for insurance through the marketplace, said he has enrolled 15 to 20 people in the new plans since Oct. 1. "I did see a pretty big increase in interest in that last quarter, especially in December," he said.
Navigators at the Lawrence-Douglas County Health Department have helped a dozen people purchase insurance through the marketplace, and have provided guidance and assistance to about another 150. Navigator Amanda Kong said most the people she has helped get insurance have been pleasantly surprised with their rates after subsidies and cost sharing, with plans as low as $5 a month with no deductible.
Gene Meyer, CEO of Lawrence Memorial Hospital, said one of the practices the hospital oversees has already started seeing 26 new patients who bought insurance as a result of the Affordable Care Act. Still, hospital officials don't expect to see a big influx of patients unless the state of Kansas elects to expand Medicaid, which would provide insurance to several thousand low-income Douglas County residents. LMH, like other hospitals across the country had its Medicare reimbursement lowered to pay for the law — about $2.5 million a year — in the thought that the extra Medicaid patients would make up the difference.