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Helping low wage earners keep their health insurance


@patriciaborns  The Affordable Care Act requires most U.S. residents to have health insurance for themselves and their dependents or pay a penalty. There are many ways to satisfy the requirement -- you could be covered by your employer, by Medicare or Medicaid, under your parents' policy if you're under 26, or through a health insurance plan on the new marketplace opening Oct. 1. 

But still, uninsured Americans near the poverty line, for whom the ACA was intended, will face considerable challenges to understand, buy, and above all, keep their health insurance. In the 20 states including Florida that declined federal assistance to expand Medicaid, the poorest adults may remain without medical coverage, but those nudging above the poverty line could qualify for subsidized health insurance. This means they will be paying insurance premiums for the first time in their lives.

Although their subsidies under the ACA will be large, even a $20/month payment can be a big deal on an hourly salary that may fluctuate with the seasons or other employment vagaries. As a result, low wage earners are more likely to cancel their policies, or have them canceled, and wind up having to pay big hospital bills if they get sick or hurt, as many have to do now. 

Wisconsin, which like Florida declined Medicaid expansion and also has large numbers of low income uninsured, has been thinking about how to help newly insured low wage earners maintain continuous healthcare coverage. Several ideas generated by the Public Policy Institute of Milwaukee-based Community Advocates, Inc. could be useful in our state: 

1. For people who don't have access to a bank account or credit card, pre-paid cards could enable them to make premium payments by phone or online.

2. Libraries, post offices and businesses with numerous retail outlets could be tapped as places where people can make premium payments at a physical location.     

3. For people with relatively stable employment, the ability to make premium payments through employee income withholding would allow employees to authorize deductions from their pay to go directly to the appropriate federal or state agency, or insurance company, as appropriate. 

4.Arkansas and Iowa are negotiating with the Obama administration to expand Medicaid to subsidize the purchase of private insurance for approximately 250,000 of their states' residents who earn up to 138 percent of the federal poverty line. The plans are designed to prevent low-income individuals from: bouncing between Medicaid and private insurance as their income changes, and to avoid their having to make (and possibly default on) monthly premium payments. The states' Medicaid agency would handle the payments in full for people earning between 100 percent and 138 percent of the FPL. 




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