Woman caught in Medicaid gap fears health crisis

Joseph Kenny | jkenny@archstl.org

Four years ago, Rene LaFerla of Immaculate Conception Parish in Arnold was a legal secretary making a decent income with benefits that included health insurance.

When the attorney she worked for died suddenly, she was out of work.

The economy was in a downturn and she couldn't find another job, so she signed up for courses at St. Louis Community College at Meramec, then attended Fontbonne University. She's now studying for a master's degree in social work at St. Louis University and still hasn't been able to find a full-time job or affordable health insurance.

"It's scary. Luckily my health is good, but anything could happen," said LaFerla, who as a student has been a volunteer caseworker with victim services of the St. Louis City prosecutor's office.

Despite having no health crises, she's had a couple of issues, including in 2012 when she had breathing difficulties while driving and pulled into the emergency room at St. Anthony's Medical Center in south St. Louis County. She was diagnosed with an anxiety attack and sent home. Her charges came to more than $1,400, and she's been making payments on the bill. She had to raid her small 401k retirement plan.

LaFerla has lingering back and shoulder issues since a car accident when she was young and has carpal-tunnel syndrome symptoms from years of typing. She needs to see a doctor to receive medication and perhaps physical therapy. But she makes do without it and also goes without medicine when a bad cold or flu hits.

"I used to be middle class. I used to donate to others. I never expected this," she told a gathering Feb. 7 in Festus of Jefferson County residents and activists seeking expansion of Medicaid -- the joint federal-state program that provides health coverage to the poor -- in Missouri.

Another speaker, retired union meatcutter John Antonich, talked about his daughter and son-in-law who live in Perryville. They have seven children, three of whom are special-needs children who were adopted, and also have been foster parents. Antonich's daughter is a social worker and a student. She and her husband, who also works, have no health insurance. The children are covered by Medicaid but, Antonich said, "what happens to them if a critical illness hits my daughter or her husband?"

Rev. Mike Rose, pastor of Redeemer Lutheran Church in DeSoto, said clergy members deal daily with people choosing to forego or delay medical care in order to pay other bills. He is vice president of an interfaith food pantry in DeSoto and president of the ministerial alliance there. "Faith-based organizations have a moral obligation to love and care for those less fortunate than ourselves," he said.

Other speakers noted that most of the people falling into the Medicaid coverage gap have jobs. Eligibility for Medicaid is so low that hundreds of thousands of people don't qualify for it and make too little to get help paying for the insurance through the Health Insurance Marketplace. Federal funds have been set aside to help uninsured, mostly working people, get health insurance through Medicaid, but the state has not acted to close the gap.

An analysis by the Missouri Budget Project shows that adding more people to Medicaid will generate savings that will pay for itself.

The Missouri Catholic Conference, the public policy agency of the state's Catholic bishops, has urged legislators to take action to reform and expand Medicaid.

"Each person as a creature of God has a right to basic health care; at the same time, individuals and families are called to care for their own health," the MCC stated last year in a letter to state senators and representatives. "Properly structured, Medicaid reform will place as much responsibility on individuals as is reasonable, but recognize when people need assistance from others."

The federal government is offering to pay 100 percent of the cost of expanding Medicaid to lower-income adults and parents (90 percent after 2016), the Catholic conference noted. At present, Medicaid is limited to parents with annual incomes of no more than 20 percent of the federal poverty level (currently $20,090 for a family of three). A mother with two children with an income over $4,018 a year does not qualify for Medicaid. Individuals such as LaFerla do not qualify if they make more than $2,354 a year.

A mother also does not qualify for premium subsidies through the newly created insurance exchanges if her household income is below 100 percent of the federal poverty level. This "Medicaid Gap" leaves many of the working poor without health coverage.

A report issued last year in part by the Missouri Chamber of Commerce shows that expanding Medicaid would greatly benefit the working poor in Missouri. About 34,000 working in the food industry could gain health coverage, the study shows, while another 24,000 people in sales could be assisted. The Affordable Care Act offers a full federal subsidy to cover people who earn 138 percent or less of the federal poverty guideline -- about $27,000 for a family of three. Beginning Jan. 1, 2017, states would pay 10 percent of the total.

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