“Coverage Gap” leaves some still unable to afford health insurance

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KANSAS CITY, Mo. -- The idea behind the Affordable Care Act's Marketplace is to help make health insurance affordable to everyone. But there are still hundreds of thousands of people in Kansas and Missouri alone who are falling through the cracks. It's called the "coverage gap" and it's basically people who make too much money to be covered by Medicaid but too poor to buy insurance, and they don't even qualify for the federal subsidy that would help them buy health insurance on the marketplace.

When the marketplace opens next week aiming to make insurance more affordable, the reality is lots of people still won't be able to afford it. Tammy Beeghley works at Samuel Rodgers Health Clinic in Kansas City now, but when she wasn't working a few years ago she didn't have insurance.

"It would have been difficult for us to have insurance because we have three children, and with my husband's income we were barely able to make rent, we had to go to a food pantry for food," she said.

Now as a patient care coordinator at the clinic, she sees all kinds of patients who fall into the coverage gap.

"Unfortunately, I think there will still be people who are falling through the cracks," she said.

Jim Torres is the Marketplace Coordinator at the Samuel Rodgers clinic and says the coverage gap is huge: 800,000 people in Missouri currently don't have health insurance, and after the marketplace opens an estimated quarter of those people still won't be able to get it.

"These folks are unfortunately in a gray area until the state of Missouri decides how it can -- and if it can -- expand Medicaid to meet these people's needs," Torres said.

The only option for those people is to continue to visit clinics like Samuel Rodgers, which help uninsured people, or head to the emergency room.

"So it will continue to place tremendous demands on our health care system because so many people are uninsured," Torres said.

Only about half of states have expanded Medicaid to eliminate the coverage gap even though Torres says the Affordable Care Act provides states 100 percent of the funding to do that for the first three years. Kansas and Missouri both rejected plans to expand Medicaid this year.

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