The date for enrollment into the Affordable Care Act Marketplaces is three weeks away.
Administrators of the program want to cover as many people as possible, who previously lacked healthcare coverage, but millions of people would still lack access to affordable healthcare because of a little-known loophole.
When the Affordable Care Act was signed into law in March 2010, supporters claimed it would cover the estimated 50 million people without health insurance. But as the program moves closer to implementation, things have changed and that's not entirely the case anymore.
"Everyone is not going to be insured on Jan. 1," Sheri Wood, CEO of Kansas City Care Clinic, said.
Kansas City Care Clinic is one of the handful of so-called safety net clinics in the metro that provides care to low-income people. She recently changed the name Kansas City Free, as well as the business model, to keep providing the same level of care.
"We've known, especially since the Supreme Court ruling, that there would be people that could not purchase insurance on the exchange, and that would really form a large donut hole," Wood said.
The ruling she refers to is the June 2012 decision that declared Obamacare constitutional. But the Supreme Court also struck down the mandate, forcing states to expand Medicaid to cover the uninsured.
"Once the states had the choice to opt into the expansion of Medicaid, a number of states decided not to do that and both the states of Missouri and Kansas elected not to expand those programs," said Wayne Powell, the vice president of Blue Cross/Blue Shield.
Powell said most of the uninsured goes to the emergency room for treatment and everyone ends up paying for the overtime.
"It usually ends up as a hidden tax that gets passed on to the fully insured population," he said.
In the Kansas City area, the number of those uninsured is between 50,000 and 70,000 people, and they don't qualify for the federal subsidy used to buy insurance from the marketplace that states are now setting up. That has created a gap, or donut hole, that safety net clinics like Kansas City Care are working to close.
"We're their medical home and we want to make sure they have a place to go," Wood said. "We have a lot of work in front of us to make sure these people get the care that they need."
Missouri and Kansas appear unlikely to change their positions on expanding Medicaid. Critics say the donut hole affects the poorest of the poor.
To break it down. If you are a single person, who makes less than $11,490 per year and you are not on Medicaid, you will not be able to get a tax credit for signing up for your healthcare plan. A family of four who makes $23,550 per year who isn't on Medicaid would also fail to qualify for the tax subsidy.
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