ADVERTISEMENT

ATLANTA – Karen LaBar, a mother of four, is 41 and has never had a mammogram. She has high blood pressure but no doctor to attend to it. She works hard providing home health care to others but has no health care of her own.

And here’s the kicker: As President Obama exults in the 7.1 million signups for his health plan, there will be no signup for LaBar. She’s too poor.

Statewide, about 409,350 of Georgia’s poorest, most vulnerable citizens have been left behind by the health care law that was supposed to benefit them the most. Georgia chose not to expand Medicaid, as envisioned by the Affordable Care Act, creating a gap into which these hundreds of thousands fall. Those in the gap make too much money to qualify for Medicaid but too little to get federal tax credits to help buy coverage on the Health Insurance Marketplace.

They are uninsured and likely to stay that way.

LaBar, a mother of five, lost her insurance four years ago when she and her husband divorced. She makes $10 an hour as a home health aide but doesn’t get insurance through work. Her paychecks cover the electric bill, rent, food and other necessities. They don’t come close to covering the $300 or more a month that health insurance would cost her.

“I know people that get Medicaid and they don’t work,” LaBar said. “They sit at home and collect a check and that irritates me. I’m contributing to society. I pay taxes. It just doesn’t seem quite fair.”

It wasn’t supposed to be this way. The Affordable Care Act’s creators envisioned that the nation’s poorest people wouldn’t need tax credits because they would be covered by the expansion of Medicaid. But the U.S. Supreme Court ruled in 2012 that the federal government couldn’t force states to expand.

Georgia Gov. Nathan Deal, a Republican and staunch Obamacare opponent, is among 19 governors who have declined to grow Medicaid under the terms of Obamacare; he estimates that expansion would cost Georgia taxpayers $2.5 billion over 10 years. (Advocates of expansion claim the cost would be far less.)

Medicaid in Georgia already covers about 1.7 million low-income children, pregnant women, the elderly and disabled. Expanding it would extend coverage to an estimated 650,000 people, most of them adults without children. Those who earn between 100 and 138 percent of the federal poverty line qualify for tax credits on the federal insurance marketplace. The vast majority (nearly 410,000), however, don’t qualify for tax credits or Medicaid or anything else.

The law envisioned that those under the poverty line would be eligible for Medicaid. And in many states, they are.

Not in Georgia; indeed, not in most of the South. Kentucky and Arkansas both chose to expand.

Nationwide, 4.8 million uninsured Americans below poverty fall into this coverage gap. Eighty percent of them live in the South, with Georgia having the third-highest number of people behind Texas (1,046,430 people) and Florida (763,890).Fourteen percent of those in the coverage gap are 55 to 64 – nearing retirement but not yet Medicare-eligible. Many suffer from chronic illnesses such as diabetes, high blood pressure and heart disease.

Adults under 65 with no dependents make up the vast majority of the gap population (about 78 percent in Georgia.)

Nearly two-thirds of those in the gap are people of color, according to the Kaiser Family Foundation. More than half are part of a family where at least one person works.

Needless to say, the outlook is grim for Georgians stuck in the coverage gap. However, politicians on both sides of the aisle – many facing re-election this year – aren’t champing at the bit to come up with alternatives to Medicaid expansion.

Jen Rafanan, for one, isn’t happy to be caught in the political tug-of-war over the Affordable Care Act.

As a freelance graphic designer, Rafanan makes less than $10,000 a year and gets paid sporadically, making monthly insurance premium payments untenable. She hasn’t seen a doctor in a couple of years. Instead, at 38, she turns to the Internet and home remedies and hopes her symptoms go away on their own.

Several years ago, severe chest pains landed Rafanan in the ER. It turned out to be a panic attack, not a heart attack as she feared. She left the hospital relieved but with a $3,000 bill that took years to pay off.

Rafanan is upset that she and people who are in even worse situations are stuck.

Obamacare isn’t perfect, but at least it was a step in the right direction, Rafanan said. These are Georgians who work hard and pay taxes but don’t have as many opportunities as others, she said.

“It’s frustrating,” she said. “You’re pretty much screwed no matter which way you turn.”