Affordable Care Act Update

Many Polk County residents are continuing to rely on free healthcare clinics, despite health insurance subsidies available through the Affordable Care Act (ACA).  As the nation nears its second open enrollment period for health insurance in November, it is business as usual at some area clinics.

“I think there are aspects about the Affordable Care Act that are positive and can be a real benefit,” says Dr. Glen Barden, an orthopedic surgeon who volunteers at Lakeland Volunteers in Medicine and is a Polk County Medical Association member. “I think the Affordable Care Act is not universal health coverage.” Dr. Barden believes it is a step in the right direction.

Under the ACA, individuals making less than $11,490 don’t qualify for a federal subsidy to help pay for health insurance. Nor do families of four who make less than $23,550, according to consumer advocate, Families USA, of Washington, DC. In other states, expanding Medicaid broadened coverage, but in Florida there is a coverage gap.

“A percentage of people I help fall under the income requirement to be eligible for a tax credit,” says Jane Coyle-Hart, an insurance navigator with United Way of Central Florida, who keeps a notebook listing people who fall in the gap. “It’s our effort to make sure they have a medical home.”

Many people struggle just to put food on the table, much less pay for health insurance. U.S. Census data shows 17.5 percent of the population in Polk County lived below the poverty level between 2008 and 2012. The Agape Food Bank in Lakeland, a program of Orlando-based Catholic Charities of Central Florida, distributed nearly some 8.7 million pounds of food during 2013-2014 in Polk, Highlands, and Hardee counties. Twenty-five percent of it was fresh produce. Kim Long, the food bank’s director, calls it a “hunger crisis.”

“A lot of these people look like you or I,” she says. Regarding ACA, she states, “Access to affordable healthcare is absolutely essential to be able to move our nation forward. How that is done— I absolutely will leave that up to the politicians.”

Traffic at Lakeland Volunteers in Medicine, which serves the working uninsured, rose from 7,619 visits in the first seven months of 2013 to 7,823 in the same period in 2014. Robert Yates, the organization’s president and chief executive officer, says people may believe they cannot afford co-payments or medicines when they become ill. Everything at the clinic is free, from medications to procedures.

Traffic declined only slightly at Angel Care, a multi-denominational free clinic in Eloise, serving Polk County’s indigent. Angel Care saw an average of 96 patients for the months of April, May, and June 2014, down from an average of 101 patients during the fiscal year ending June 2013.

Dr. Richard Honer, Angel Care’s medical director, says they hoped the clinic would no longer be needed after ACA implementation. “I don’t see any changes. I don’t see any hope for this changing,” he states. “It has increased our paperwork.”

The country began edging towards a universal healthcare system in 1965, when President Lyndon Johnson signed into law Medicare and Medicaid, assisting the elderly, the disabled, and the indigent. ACA, signed into law in 2010, is another step closer to universal coverage. The law eradicates lifetime limits on benefits, and ensures those with health conditions they can’t be denied insurance coverage or charged higher prices. Some estimate up to 10.3 million nationwide have gained health coverage; 983,775 enrolled for coverage from the federal Marketplace in Florida.

But some still remain uninsured. For those who don’t qualify for an exemption to the individual federal insurance mandate, there may be financial penalties, called individual shared responsibility payments. Exemptions are available because of financial hardship, membership in a healthcare sharing ministry, American Indian heritage, and more.

“People need to know if they are able to apply for an exemption,” Coyle-Hart says. “They need to see a navigator, or someone who understands the ACA. Or call the health insurance marketplace [1-800-318-2596].”

Married couples need to file their tax return together to be eligible for the tax credit for healthcare. Sometimes their combined income will help them qualify for a subsidy. Yet some are finding insurance more affordable by splitting the families’ coverage, she says. Employees may be covered through their company, while spouses and children are covered through the federal health system.

In Polk County, the average cost of the most popular silver insurance plans for a family of four earning $51,000 a year is expected to increase from $451 to $605 monthly in 2015, according to the Florida Office of Insurance Regulation. Federal subsidies are expected to drop from $593 to $481. For an individual making $27,000 a year enrolled in the silver plan, the rate is expected to rise from $214 to $258 in 2015, while federal subsidies drop from $82 to $50 monthly. Premiums still are subject to federal approval.

The next open enrollment period for the federal health system starts November 15. Those with life-changing events are eligible to enroll sooner. In the meantime, debate continues to rage about the law, who will pay for healthcare, and whether it is affordable. “To be brutally honest, we stayed on bent knees for the last seven months,” says Baxter Troutman, founder and chief executive officer of Winter Haven-based Labor Solutions. “I don’t hold much hope, quite candidly, that a stay of execution will happen.”

Labor Solutions currently does not offer health insurance to its approximately 1,800 employees, many of them seasonal workers in a citrus packinghouse or orange juice plant. Drew Estes, the company’s business development director, explains it will cost an “estimated $500,000 just to offer the plan. To get our employees to enroll with us, we’re going to have to subsidize a large amount of the cost,” he explains.

While Labor Solutions intends to comply with the law, it plans to have help from an ACA surcharge. “This cost has to be passed along only because the burden is too great for Labor Solutions to hold by itself,” Estes says.

Businesses who employ more than 50 may be required to pay a responsibility fee if they don’t provide affordable coverage and their employees take advantage of federal subsidies. Some businesses may choose to reduce the number of hours their employees work, making them part-time. Employers don’t have to supply insurance coverage for part-time workers. Unfortunately, that leaves some looking for a second job to meet financial obligations.

In the meantime, free clinics are doing what they can. Some may need to sign up for insurance to pay for surgeries. “We know we have limitations,” Dr. Barden says.

“Community health centers can’t pay the whole bill,” agrees Coyle-Hart. “We all pay for it some way or another.”



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