The Affordable Care Act, or Obamacare, is, again, a controversial political topic. Those who oppose the ACA say the law imposes too many costs on business and many describe it as a job killer. After doing some research, it seems to me that opposing the ACA is at the very least a person killer — an expense the state should not have to afford.
The ACA was enacted in 2010 with the goal of extending health insurance coverage to the estimated 15 percent of the U.S. population who was lacking it and reducing U.S. spending on health care, which is the largest in the world. The theoretical foundation of major requirements imposed by the ACA are well in line to meet these objectives. However, deductibles and premiums seem to have risen in the last few years.
The truth is that we will never know what would have happened had the ACA not been enacted. It may very well be the case that the recent increase in insurance costs is due to reasons other than the ACA. It may even be possible that they would have risen even more without the ACA. It is impossible to tell whether the law is not working simply because it was bad policy or because it was not aggressive enough.
The ACA requires everyone living in a state that has adopted the extension to purchase health insurance but it also offers a range of subsidies to make coverage affordable for those with incomes between 100 and 400 percent of the Federal Poverty Line. By reducing the cost of insurance for people in this group, the act meant to bring younger, healthier people into the medical coverage system. As a result, the average cost of medical bills per person would decrease and the number of people sharing the total costs would increase, therefore allowing insurance companies to offer lower premiums.
Another main provision of the law is that it bans insurance companies from denying health coverage to people with pre-existing health conditions. This provision allows every covered individual to seek and receive preventive care and services for major health conditions. Therefore, with insurance coverage, people with pre-existing conditions would be less likely to seek care before their illness had become unmanageable and expensive to treat.
In 2012, North Carolina, among 18 other states, declined to adopt the ACA’s Medicaid expansion*, therefore refusing to expand its social safety net for the poor and the elderly as proposed by the act of Congress. Today, the state may be facing a social crisis over the health of its poorest constituents.
Julie Hobbs just got her degree from NC State in Spanish this past December and is now working with the Open Door Clinic providing health care to uninsured residents of Wake County, the majority of which fall in the so-called “Medicaid Gap.”
The Medicaid Gap consists of people living in states that did not adopt the ACA who are not eligible for Medicaid, Medicare or federal subsidies. According to Louise Norris, a journalist specializing in health care reform, in some states, the gap consists of virtually all able-bodied childless adults with incomes below 100 percent of the Federal Poverty Line, as well as a large number of parents with incomes below 100 percent of FPL.
When asked about her ability to use her language skills in her current work setting, Hobbs said, “As someone who is bilingual, I am able to communicate with more people and that means I am able to advocate for more people. I have a responsibility, no matter the languages spoken by our clients, our providers and volunteers sincerely care for these individuals in the gap between Medicaid and the Affordable Care Act.”
When North Carolina decided not to expand Medicaid in 2012, as many as 400,000 North Carolinians fell into this health care purgatory, 100,000 of whom are children.
According to a study by the Kaiser Family foundation, North Carolina has the fourth-largest uninsured population in the country. In Wake County, it is estimated that between 90,000 and 95,000 residents fall in this coverage gap.
People in the gap have limited options for health care. One of them is going to organizations like the Open Door Clinic where Hobbs works.
“We serve people with no insurance coverage. Many of our clients don’t qualify for Medicaid because of their income, because they are non-disabled, because they do not have children and because they are immigrants,” Hobbs said.
Hobbs talks to the desperately poor and desperately sick and helps them file their eligibility application to use the resources available. Hobbs said that Latino and African-American populations dominate the numbers and that the majority are overweight or obese and many of the incoming applicants have mental health conditions. On many occasions, she said she is more of a therapist than a social worker.
Hobbs finds her work rewarding and inspiring. “When a client is listened to and subsequently connected with a service or specialist they need for their health care, we are making progress,” Hobbs said.
The good news is that students at NC State do not need to work for a care provider to contribute and find motivation through service. Nonprofit organizations like Hobbs’ current employer take contributions in the form of volunteer work and donations.
Moreover, within our own university there are organization like the Center for Student Leadership, Ethics and Public Service (CSLEPS) providing opportunities for students to volunteer and get involved in social work. Through CSLEPS you can even travel abroad during spring break for service learning experiences and attend leadership training seminars and conferences.
Outside of NC State there are many institutions that need volunteers to help provide health care and services to the uninsured, low-income residents of Wake County. Urban Ministries of Wake County for example, offers multiple and varied volunteer opportunities. UNC REX Healthcare also has unique opportunities where college students can get hands-on experience of working in the health care environment.
Now you know of a few alternatives available for us to contribute to the local community and advocate for those in need. Whether you are a conscious warrior with a taste for political activism or a member of a student organization and considering a social cause for the fundraiser you are putting together, you are invited, and perhaps should feel it a responsibility, to think about the Medicaid gap and do something about it.
*Editor’s Note: This column has been updated to correctly state that North Carolina, among 18 other states, declined to adopt and implement the Affordable Care Act’s Medicaid expansion.
