Now that the Affordable Care Act website is working, thousands of Hoosiers who are logging on are finding out they are not eligible for any subsidy.
In some cases they're too poor to qualify.
Ava Laracuente is one of them. For more than a decade, she was an elementary school teacher. But in 1999, she finally had to step away from her career because she had so many health problems, including bone degeneration and Post Traumatic Stress Disorder.
"It's like so many times I couldn't move or having trouble getting up and down once I get straight up, I could move for a while but with the bones and the knee, those are things that need attention," she says.
Laracuente's at the Social Security office in Bloomington because her health has gone downhill since she quit her job because she can't afford the medications and treatment she needs. When she quit her job she also lost her insurance. She tried to apply for healthcare through the state's Medicaid program, but was denied.
Now, Laracuente can't get coverage through the Affordable Care Act either.
The irony, if you make above the 100 percent of federal poverty then you can buy insurance on the exchanges and get a subsidy to help pay for your premiums but if you fall below 100 percent of poverty then you're too poor and you don't get any help at all," says Dr. Rob Stone, the founder of Hoosiers for a Commonsense Healthcare Plan.
As many as 400,000 Hoosiers are in the same boat as Laracuente.
How The Healthy Indiana Plan Plays Into Medicaid Expansion
The Affordable Care Act allowed states to expand Medicaid to 138-percent of the poverty level, but Indiana Governor Mike Pence said no. And he wanted to expand the system using the Health Indiana Plan Model.
In August he announced the state had gotten a waiver from the U.S. Health and Human Services Secretary to continue the program through 2014.
But after 2014 it's up in the air.
The program which has been in effect since 2008 requires Hoosiers to- as Pence likes to say – have skin in the game. People have to help pay for their first $1,100 of care. The number of people who can enroll in it is capped.
"A single person with no dependents essentially can't get on so that's a huge issue," Stone says. "But even a family of four in Indiana right now has a hard time getting on the Healthy Indiana plan because they keep capping the enrollment. And for traditional Medicaid, a family of four can only make 24 percent of federal poverty, it works out to $11.39 a day. If a family of four makes $11.40 a day, they make too much money for Medicaid. It's incredible. Those are third world numbers.
He adds that with a Medicaid expansion, which would include people up to 138 percent of poverty level, a family of four can have two people each working 40 hours a week at $7.25 an hour minimum wage, and they would qualify for Medicaid expansion.
"We've made a decision in this state to pretty much cover females with dependents," says health care expert Chris Schrader, the president of Schrader and Associates human resources firm. "So that's really what the HIP plan is. So if you were an adult who was poor with no children, male or female, it didn't matter, there was pretty much no room for you at the inn."
About 38,000 people are currently enrolled in the state's Healthy Indiana Plan. Another 52,000 Hoosiers are on the waiting list.
But that number could change because eligibility requirements for the Healthy Indiana Plan are being reduced from 200 percent of the poverty level to 100 poverty level.
More than 10,000 Hoosiers who had coverage through the Healthy Indiana Plan are losing it at the end of the month.
A spokesperson for the Family and Social Services Administration, which is in charge of the Healthy Indiana Plan, wouldn't agree to an on camera interview but in an e-mail said "by reducing the income standard for the Healthy Indiana Plan, it allows more people to be covered and eliminates the potential for duplication of coverage."
But Schrader says that does not fundamentally change the nature of the uninsured.
"So the penalty Indiana had to pay to get the waiver extended was to actually throw people off the plan and that was unfortunate," he says. "But that doesn't mean that throwing people off the plan didn't create capacity. So perhaps some poorer people who had been in line for many months might not be able to get on. But that's just moving cups and balls, right?"
Here's how it breaks down:
In other words, starting in 2014, if you make up to 24 percent of the poverty level, you could qualify for Medicaid. If you make between 24 percent and 100 percent of the poverty level, you could qualify for the Healthy Indiana Plan. If you make between 100 percent and 400 percent of the poverty level, you should qualify for subsidies under the health exchange.
Weighing The Cost Of Medicaid Expansion
In this past legislative session, lawmakers set aside $250 million for potential costs associated with the Affordable Care Act. Stone says he would like to ask Governor Pence why he says there's money to expand Medicaid when that money is just sitting.
Through 2016 the federal government has agreed to pay 100-percent of the cost to expand Medicaid. It would go down incrementally after that to 90-percent in 2020. Stone says Indiana has the money to pay its share of the cost.
There are estimates of what it would cost to expand Medicaid in Indiana through the ACA and they range from a low of $50 million and a high of $150 million a year," he says.
Laracuente agrees.
"I think we spend plenty of money on a lot of other things that could wait. Let's make our people healthy," Laracuente says."
With few exceptions, everyone is required to have health insurance in a year or face tax penalties.
"That's great but some people won't be able to pay for it at all," Laracuente says. "I know what I've heard among the extremely poor and those of us who've been at the very bottom and even below, it's like, we have our deadline date or you're going to jail and it's like, well, I guess we're going to have to build more jails."
It's unlikely people will actually go jail if they fail to sign up for insurance.
For states that do not expand Medicaid program, people who fall below 100 percent of the federal poverty level will not be penalized for failing to obtain insurance.
For people with incomes above 100 percent of the poverty level, the penalty in 2014 for not having coverage is either 1 percent of a person's income or $95, whichever is greater. Those fees increase every year.
But the IRS says if you can't afford to pay the fine with the tax return, it will take it out of any refund you might owe, and the law prohibits the IRS from seizing your property as a penalty for failing to have health coverage.
