Without Medicaid Expansion, Alaska’s Poorest Get Nothing From Health Law

For low income Alaskans who want to buy health insurance on the federal marketplace, there’s a magic number to keep in mind: $14,350. That’s the amount of yearly income they have to earn to qualify for a subsidy to purchase coverage. With the subsidy, they have to pay very little for health insurance. But below that mark, it’s full price.

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Musokay Lukwago has been uninsured for a decade. And when she went to the Anchorage Neighborhood Health Center recently to meet with an Affordable Care Act outreach worker, she expected that was about to change.

Instead, she walked out of the office with nothing.

“I couldn’t understand it. It’s not like I don’t work, I do! But I don’t make enough money to take care of me. I need insurance because anybody can get sick.”

Musokay is 59. She works a part time service job and earns less than 100% of the federal poverty level in Alaska, or $14,350 dollars. Under the Affordable Care Act, she was supposed to qualify for Medicaid. But a Supreme Court decision allowed states to opt out. Last month, Governor Parnell decided against expanding the program, even though the federal government would pay most of the bill. That means the poorest Alaskans are left without any benefit from the new health law. Musokay says Parnell’s decision is difficult to accept:

“He’s not elected to be in that office just to- I don’t know they’re just showing off in those offices. They can go and show off in their homes. They should not be in those offices if they’re not capable of delivering.”

Without a subsidy, a mid-range health insurance plan on HealthCare.gov would cost Musokay nearly $800 a month, far out of her reach. She can apply for a hardship exemption so she won’t have to pay the tax penalty for remaining uninsured.

Keith Ferrari was worried he was going to be in the same situation as Musokay.

“I really was.”

The Anchorage resident is 61 and works seasonally for his brother’s landscaping business. His yearly income puts him right near the federal poverty line. He decided to sit down with his employer in hopes of earning enough in 2014 to qualify for a subsidy:

“I really spent time with my brother to see if the $14 to $15 thousand dollars was workable.”

It was. And Ferrari’s projected income qualified him for a generous subsidy. He purchased a mid level plan that will cost him just $38 a month.

“It was such a burden off of my shoulders.”

Ferrari is thrilled with his new insurance plan. But he’s frustrated Parnell’s decision has left others in similar situations with no reasonable insurance options:

“I’m happy for myself, but I can’t really fully understand the reasoning that Republican governors have in not accepting Medicaid expansion, just looking at the thousands of people within this state that you have a program and they’re not going to be able to utilize it.”

Governor Parnell understands his Medicaid decision leaves more than 10 thousand low income Alaskans with no access to insurance subsidies.

“They’re real people, their health matters.”

In a press conference announcing the decision last month, Parnell said he would work to address the problem. He directed the Health and Social Services Department to write a report on the issue:

“Clearly we need to know more about the people in this category and their health care needs. What current services available to them are being utilized and if different services need to be accessed.”

Musokay says she would love to sit down and tell Governor Parnell her story. She says having insurance would allow her to visit a doctor regularly and address health problems early on, before they require an expensive trip to the emergency room that she can’t afford.  But she says she has no plans to move to a state that is expanding Medicaid:

“We should not be scared, we have to tell these guys that we’re here and… it’s not like we’re begging them. These guys are paid, and you know how they’re paid? I pay taxes. These guys are paid from my money. They work for me.”

Musokay says being able to go to a doctor is a necessity, not a luxury. She hopes Governor Parnell will reconsider his decision.

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Annie Feidt is the Managing Editor for Alaska's Energy Desk, a collaboration between Alaska Public Media in Anchorage, KTOO Public Media in Juneau and KUCB in Unalaska. Her reporting has taken her searching for polar bears on the Chukchi Sea ice, out to remote checkpoints on the Iditarod Trail, and up on the Eklutna Glacier with scientists studying its retreat. Her stories have been heard nationally on NPR and Marketplace. Annie’s career in radio journalism began in 1998 at Minnesota Public Radio, where she produced the regional edition of All Things Considered. She moved to Anchorage in 2004 with her husband, intending to stay in the 49th state just a few years. She has no plans to leave anytime soon. afeidt (at) alaskapublic (dot) org  |  907.550.8443 | About Annie