Amy Hedges, a working single mother of three who lives in Penhook, earns too little to qualify for a health-insurance subsidy under Obamacare; too much to qualify for state-administered Medicaid; and not enough to afford premiums by herself. She’s one of 400,000 Virginians with the problem.
Before we get into the reason Amy Hedges cannot get health insurance coverage, let’s first consider all the different hats she wears in life.
The 27-year-old divorced mom lives in the Franklin County community of Penhook, near the south end of Smith Mountain Lake.
For the past eight years she’s worked full time at Carl’s Place, an iconic diner along Virginia 40 that’s about 16 miles east of Rocky Mount. In the slow season (winter) she’s there five days per week; in the summer Hedges works six. Her 2014 earnings totaled $16,245.
Hedges has two daughters, Haily, 5, and Kurstin, 9, and a 7-year-old son, Brady. She’s raising them by herself, in a rented 1929 farmhouse that she heats with wood. She coaches their three rec-league basketball teams. She also volunteers one day per month at a nonprofit in Rocky Mount.
When you break down all those different tasks, it looks like this: Hedges cooks, cleans, washes laundry, gets her kids off to school each morning.
She meets them at the school bus each afternoon, then does errands, helps with homework, runs basketball practices, makes dinner, handles her bills, plays games with her kids, then puts them to bed. On Saturdays she coaches basketball games.
Aside from that, she’s at Carl’s Place 35 to 45 hours per week, preparing and serving meals. Somehow she manages to squeeze in volunteer secretarial work at the nonprofit, too.
She qualifies for, and receives, food stamps. The father of her oldest child faithfully pays $250 per month in child support. That’s all the extra help she gets, except for some baby-sitting that family members do when Hedges works on Sundays.
“Amy’s a hard worker,” said her mother, Kathy Tench, who has worked at Carl’s Place for 33 years. “She’s good with people. She’s not going to halfway do anything. But she’s got her hands full.”
Now let’s consider Hedges’ recent experience trying to get health insurance under the Affordable Care Act, aka “Obamacare.” That’s what she called me about last week.
Hedges applied for coverage online through the Health Insurance Marketplace, otherwise known as the federal exchange. She wanted to make sure she didn’t have to pay a penalty for not having insurance, as the law requires.
She believed she was a perfect candidate for an Obamacare subsidy, which is designed to help low-income workers afford health coverage. But she was wrong. For the head of a household in a family of four, the minimum income to qualify for the subsidy is $23,850. Hedges earned $7,605 too little.
A nice man she spoke to at the federal exchange explained it. His name was Johnny Lovely, she said.
“I was not eligible because I didn’t make enough money,” Hedges told me. “He said I should seek coverage through Medicaid.” Her three children already are covered by that.
So Hedges applied through the state of Virginia for Medicaid — that federal program is administered by states. But Hedges didn’t qualify for that, either.
In Virginia, the head of a household of four is ineligible for Medicaid coverage if they earn more than $8,109. Last year, Hedges earned $8,136 too much.
“I thought I had done something wrong,” she told me. “I said, ‘What do you mean, I don’t qualify?’ I of all people should qualify.”
Next, Hedges looked into paying the full cost of health insurance for herself. The cheapest plan she could find would cover 60 percent of her medical bills after a $2,500 annual deductible.
The premium was $179 per month, or $2,148 per year. But Hedges said she can’t afford that on wages of $16,245, especially not with three kids.
The sad thing is, she’s no kind of unusual case. Rather, Hedges is one of hundreds of thousands of working Virginians caught in the Medicaid-expansion coverage gap. It’s the issue that dominated the Virginia General Assembly last year and almost brought it to a standstill. And it’s still lurking behind the scenes this year.
Dr. Jennifer Lee, deputy secretary of the Virginia Department of Health and Human Resources, explained it like this:
When Congress crafted the Affordable Care Act in 2010, it provided subsidies to make mandatory health insurance affordable for millions of the previously uninsured. But those subsidies are available only to people who earn above the federal poverty level. This year, that’s $23,850 for a family of four.
Congress also assumed that states would expand Medicaid eligibility for people like Hedges whose earnings were below the poverty level, Lee said. The ACA requires the federal government pay 100 percent of a state’s expanded Medicaid costs through 2016, and at least 90 percent of the cost thereafter.
Gov. Terry McAuliffe campaigned on the issue of expanding Medicaid and made it his chief legislative priority in 2014. It would have brought an additional $1.3 billion in federal money to Virginia.
But the Republican lawmakers in the Virginia General Assembly (along with legislatures in 21 other states) have refused to expand Medicaid coverage, even though it costs states nothing in the short term and will cost relatively little long term.
That failure has left Amy Hedges and many other low-wage working Virginians caught in the Medicaid-expansion gap.
Hedges “is exactly the kind of person we want to help by closing the coverage gap,” Lee told me. In all, about 400,000 Virginians are caught in that gap. Lee said 71 percent of them are living in low-wage working households.
Who are the rest of them?
“They’re flipping hamburgers at restaurants,” said state Sen. John Edwards, D-Roanoke. “They’re working in retail stores. They’re construction workers. They’re truck drivers. They’re working — sometimes at more than one job.
“We’re treating the working poor as second-class citizens,” Edwards added. “It’s unbelievable.”
Oddly, Hedges’ sister, Christy Treadway, also works at Carl’s Place. Treadway, 33, is a single mother of one. And because she earns above the federal poverty level for a family of two, Treadway qualified for the federal subsidy. She’s now enrolled in Obamacare.
Last week, Hedges called her state senator, Bill Stanley, R-Franklin County, to ask why she doesn’t deserve health coverage through Medicaid expansion. “I talked to his secretary, but he hasn’t called back yet,” she told me. Stanley’s office and I played telephone tag on Wednesday.
I also called Del. Charles Poindexter, R-Franklin County, to ask him why Hedges doesn’t deserve coverage via Medicaid expansion. He didn’t get back to me.
That’s no big surprise; under the circumstances, the General Assembly’s failure to expand Medicaid coverage for people like Amy Hedges seems almost indefensible.
The only good news here is that Hedges won’t have to pay a penalty for not having health coverage when she files her taxes. She may not be eligible for help getting health coverage. But at least she’s eligible for a penalty exemption for people who are caught in the Medicaid-expansion gap.
Nevertheless, “it’s not right,” she said. “It’s not right.”
She can say that again.