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By Carla Johnson and Kelli Kennedy
August 14, 2012
MIAMI — Sandra Pico is poor, but not poor enough.
She makes about $15,000 a year, supporting her daughter and unemployed husband. She thought she'd be able to get health insurance after the Supreme Court upheld President Barack Obama's health care law.
Then she heard that her own governor won't agree to the federal plan to extend Medicaid coverage to people like her in two years. So she expects to remain uninsured, struggling to pay for her blood pressure medicine.
"You fall through the cracks and there's nothing you can do about it," said the 52-year-old home health aide. "It makes me feel like garbage, like the American dream, my dream in my homeland is not being accomplished."
Many working parents like Pico are below the federal poverty line but don't qualify for Medicaid, a decades-old state-federal insurance program. That's especially true in states where conservative governors say they'll reject the Medicaid expansion under Obama's health law.
In South Carolina, a yearly income of $16,900 is too much for Medicaid for a family of three. In Florida, $11,000 a year is too much. In Mississippi, $8,200 a year is too much. In Louisiana and Texas, earning more than just $5,000 a year makes you ineligible for Medicaid.
Governors in those five states have said they'll reject the Medicaid expansion underpinning Obama's health law after the Supreme Court's decision gave states that option. Many of those hurt by the decision are working parents who are poor – but not poor enough – to qualify for Medicaid.
For now, most states don't cover childless adults, but all states cover some low-income parents. The income cutoff, however, varies widely from state to state.
Most states cover children in low-income families. Manuel and Sandra Pico's 15-year-old daughter is covered by Medicaid. But the suburban Miami couple can't afford private insurance for themselves and they make too much for Florida's Medicaid.
Manuel Pico, a carpenter, used to make more than $20,000 a year, but has struggled to find work in the last three years after the real estate market collapsed. He occasionally picks up day jobs or takes care of the neighbor's yard. Sandra Pico would like to work full time, but can't afford to pay someone to watch her 34-year-old sister, who has Down syndrome.
"No matter how hard I work, I'm not going to get anywhere," Sandra Pico said. "If you're not rich, you just don't have it."
In San Juan, Texas, 22-year-old Matthew Solis makes about $8,700 a year – too much to qualify for Medicaid in that state. Solis, a single father with joint custody of his 4-year-old daughter, said he works about 25 hours per week at a building supply store making minimum wage and is a full-time college student at the University of Texas-Pan American. He aspires to be a school counselor.
He recently sought medical care for food poisoning, visiting a federally funded clinic. But he doesn't see a doctor regularly because he can't afford private insurance. The new health law allows young adults to remain on their parents' insurance until age 26. But that doesn't help Solis, whose father is uninsured and whose mother died of leukemia when he was 8.
Most states base Medicaid eligibility for parents on household income and how it compares to the federal poverty level, which was $18,530 for a family of three in 2011, the year being used for easier state-by-state comparisons.
In Louisiana, the eligibility cutoff for a working parent is 25 percent of federal poverty, or $4,633 for a family of three. In Nevada, it's 87 percent of the federal poverty level, or $16,121 for a family of three.
The national health law's Medicaid expansion would start covering all citizens in 2014 who make up to roughly $15,400 for an individual, $30,650 for a family of four.
The federal government will pay the full cost of the Medicaid expansion through 2016. After that, the states will only pick up 5 percent of the cost through 2019, and 10 percent of the cost thereafter.
