Estimates of People in the Coverage Gap

Nationally, nearly five million poor uninsured adults will fall into the “coverage gap” that results from state decisions not to expand Medicaid (Figure 4 and Table 2), meaning their income is above current Medicaid eligibility but below the lower limit for Marketplace premium tax credits. These individuals would have been newly-eligible for Medicaid had their state chosen to expand coverage. More than a fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility (Figure 4). Sixteen percent live in Florida, nine percent in Georgia, seven percent live in North Carolina, and six percent live in Pennsylvania.

Charlene Dill didn’t have to die.

On March 21, Dill was supposed to bring her three children over to the South Orlando home of her best friend, Kathleen Voss Woolrich. The two had cultivated a close friendship since 2008; they shared all the resources that they had, from debit-card PINs to transportation to baby-sitting and house keys. They helped one another out, forming a safety net where there wasn’t one already. They “hustled,” as Woolrich describes it, picking up short-term work, going out to any event they could get free tickets to, living the high life on the low-down, cleaning houses for friends to afford tampons and shampoo. They were the working poor, and they existed in the shadows of the economic recovery that has yet to reach many average people.

So on March 21, when Dill never showed up with her three kids (who often came over to play with her 9-year-old daughter, Zahra), Woolrich was surprised she didn’t even get a phone call from Dill. She shot her a text message – something along the lines of “Thanks for ditching me, LOL” – not knowing what had actually happened. Dill, who was estranged from her husband and raising three children aged 3, 7 and 9 by herself, had picked up yet another odd job. She was selling vacuums on a commission basis for Rainbow Vacuums. On that day, in order to make enough money to survive, she made two last-minute appointments. At one of those appointments, in Kissimmee, she collapsed and died on a stranger’s floor.

Dill’s death was not unpredictable, nor was it unpreventable. She had a documented heart condition for which she took medication. But she also happened to be one of the people who fall within the gap created by the 2012 U.S. Supreme Court ruling that allowed states to opt out of Medicaid expansion, which was a key part of the Affordable Care Act’s intention to make health care available to everyone. In the ensuing two years, 23 states have refused to expand Medicaid, including Florida, which rejected $51 billion from the federal government over the period of a decade to overhaul its Medicaid program to include people like Dill and Woolrich – people who work, but do not make enough money to qualify for the Affordable Care Act’s subsidies. They, like many, are victims of a political war – one that puts the lives and health of up to 17,000 U.S. residents and 2,000 Floridians annually in jeopardy, all in the name of rebelling against President Barack Obama’s health care plan.

rjmacs wrote:
We simply can't afford to keep the Charlene Dills of this world from dying from easily preventable or treatable illnesses, Ted.