On falling through ‘the coverage gap’ without Medicaid expansion

The Chattanooga TFP uses Deborah Merriman, a 51-year-old Cleveland woman who is confined to a wheelchair and “going blind,” to illustrate those among 161,000 Tennesseans with little or no income who have fallen into a health care insurance “coverage gap.” Her daughter is in the same situation. Further from the story:

It’s because they live in one of the 25 states, including Tennessee, Georgia and Alabama, where mostly Republican political leaders such as Gov. Bill Haslam opted not to participate in the Medicaid expansion. The expansion is entirely federally funded through 2016.

At the same time, people like the Merrimans don’t qualify for tax credits to help them pay for private insurance offered on the health exchanges created by the law.

But if the Merrimans lived in neighboring states such as Kentucky or Arkansas, they’d have insurance today. Those states and 22 others, as well as the District of Columbia, opted for the expansion.
Gordon Bonnyman, who on Wednesday stepped down as executive director of the Tennessee Justice Center, said Merriman “is very typical of the people left behind” by the state’s failure to expand its Medicaid program, known as TennCare.

“The people who will remain uninsured are the working poor,” added Bonnyman, who remains a staff attorney for the advocacy group. “Most Tennesseans find it hard to believe the reality that, as a result of the state’s refusal to accept the federal dollars, it is the working poor who remain uninsured, while people with higher incomes will be able to get subsidized insurance. That’s not the fault of the Affordable Care Act, but the result of our state leaders’ decision.”

The Tennessee Justice Center estimates the state would receive $6 billion in federal funds between 2014 and 2019 if it expanded Medicaid.

A University of Memphis study estimated the expansion would generate some 18,000 jobs.
In the meantime, Tennessee hospitals say they’ll be left high and dry without expansion because the federal government is dramatically cutting special reimbursements for indigent and charity care provided by hospitals.

…Merriman, who moved to Tennessee to be with her son nearly three years ago, called the situation “just really a vicious cycle.”

“It’s the [federal] government trying to work with the state and the state’s not working – and you’re caught in the middle of this hurricane.”

She said she injured her back 10 years ago while working in a distribution warehouse in Oklahoma.

“That’s when it began,” she said. Since then, Merriman said, she’s developed “major arthritis” in both knees, has problematic calcium deposits on hip joints and is struggling with macular degeneration in her eyes.

“Everything’s blurry,” she said.

She uses a wheelchair she got free from Goodwill. While grateful, she noted it doesn’t have working brakes.

Merriman said HHS officials told her she could get on the exchange but wouldn’t qualify for any credits because she was eligible for the expanded Medicaid program. So, Merriman said, she contacted TennCare officials.

“They get mad at you,” she said