Affordable Care Act May Not Cover Alaskans Most In Need of Health Insurance
Updated On: Sep 30 2013 10:07:00 PM AKDT
If you’re covered through work or Medicare, you don’t have to buy insurance on the Marketplace, the online shop the federal government set up, so you can buy insurance.
Alaskans in their late 50s and early 60s, who are not covered by their employers and are not eligible for Medicare, will pay the most in premiums—from $800 to $1,000 a month in some cases, according to insurance experts.
Younger, healthier Alaskans in their 20s and 30s will also see rates jump; in some cases, they will double.
But there is a large number of Alaskans who will benefit from the law, experts say.
At least 66,000 Alaskans don’t have health insurance. That number is expected to get higher in coming years when some businesses stop providing coverage for employees.
“These uninsured Alaskans who don't work for companies or don't have an offer of coverage in front of them, they are the winners, in my opinion, under the Affordable Care Act—provided they fall within a certain income range that allows them to avail of immediate tax credits,” said Joshua Weinstein, co-owner of Northrim Benefits.
You can get those tax credits if your income is between 100 and 400 percent of the federal poverty level—between $29,400 and $117,760 for a family of four.
For a single person, that 100 to 400 federal poverty percentage ranges from $14,350 to $57,400.
But the law won’t help everyone.
The Bailey family is among at least 47,000 Alaskans who will not be covered by ACA because they make 100 percent less than the federal poverty level, which is less than $24,410 for a family of three and less than $14,350 for a single person.
A year ago, new parents Callie and Bryon Bailey had a major scare.
“We went to pick him up from his nap, and his whole bed sheet was just covered in blood,” Bryon said. “His whole front of his shirt was just covered in blood.”
Porter was three months old and had just had his milk teeth removed.
“We were soaked,” Callie, Porter’s mother, said. “Our shirts would be covered with his blood and saliva.”
They rushed their baby to the emergency room.
“At first, they thought it was Von Willebrand, which is a different kind of bleeding disorder,” Bryon recalled. “But then when they actually talked to Kyme, our nurse, she was like, ‘Is it a boy or a girl?’ ‘It’s a boy,’ (we responded). ‘No,’ (she said). ‘That's hemophilia.’”
“Which means there is no chance of stopping a bleed without the clotting factor we give him,” Callie said.
In the months since then, the Baileys have become regulars at the Bleeding Disorders Center at Providence.
They visit the center twice a week for infusions.
“But if he bumps his head or has any other kinds of injuries, we have to bring him in,” Callie said. “So it could be an additional two-plus times a week.”
The visits aren’t cheap. Each dose of medicine costs $500. When Porter gets older, treatment will cost at least $4,000 a dose.
Callie quit her job to watch Porter, for whom a simple bump on the head could be a life or death emergency, his parents said.
Bryon works part-time and goes to school full-time for a biology degree so he can eventually become a physical therapist.
Luckily, Porter’s medical bills are covered by Medicaid.
“Every time we come, every visit since he's been born, I just go home, thinking, ‘Oh, thank God for Denali Kid Care,’” Callie said, wiping tears. “’Oh, thank you so, so much for having that program available for us.’ Because there's no way, there's no way we would be able to afford all of this. We would have to do it because he really needs it, but we'd kind of be stuck for the rest of our lives. So we're just so grateful.”
Neither Callie nor Bryon has health insurance.
“We just hope nothing happens to either one of us,” Bryon said.
“Nothing has happened, so we've been really lucky that way,” Callie said.
Health officials say they’re gambling with their luck, though.
“The mother's a carrier, and she could have health issues at any time,” said Kyme Groller, nurse coordinator of Bleeding Disorders Center of Alaska.
Once the Bailey family starts making more money, insurance experts say they will benefit from the Affordable Care Act because insurance companies won’t be able to deny them coverage for a pre-existing condition.
“Hemophilia is the most expensive chronic illness that there is,” said Groller, who has been treating bleeding disorders for 20 years. “It's more expensive than childhood cancer, because that passes. This is life-long.”
Until they’re making more than a hundred percent of the federal poverty level--$24,410—Callie and Bryon have limited options for healthcare coverage. They would be guaranteed coverage had the state expanded Medicaid coverage.
Earlier this year, Gov. Sean Parnell opted out of expanding the program, but he could revisit the issue and opt into it at any time in the next 10 years.
“As I've looked at it right now, the state of Alaska already provides health coverage for about 225,000 people,” Gov. Parnell said. “So over 200,000 Alaskans’ health coverage is being paid for by the state. (That’s) out of 710,000 Alaskans. We do that at significant cost, and I really need to see the benefit for the cost outlay over time that we're going to be making before I agree to expand Medicaid. I haven't seen that proof to date but have reserved an open mind to consider all that in the days and months to come.”
Parnell has until mid-December to decide whether to expand Medicaid coverage.
“A lot of government policies are based on principles,” Groller said. “In healthcare, there aren't principles. These are people.”
Meanwhile, Denali Kid Care will continue to pay for Porter’s medical care, but for his parents, insurance is hope and a prayer they don’t get sick.
Here's a look at how much insurance plans in Alaska will cost on the marketplace:
Contact Grace Jang
(Copyright © 2013, KTUU-TV)