MuskogeePhoenix.com, Muskogee, OK

September 12, 2013

Diabetic caught in insurance law fight


Associated Press

— LAWTON (AP) — Chris Gatliff, who has diabetes, says he feels like a victim of politics.

His home state, Oklahoma, opted not to accept the expansion of Medicaid under the Affordable Care Act. The result is that thousands of Oklahomans who would have qualified under the expanded program are left in limbo about their health insurance.

At the same time, a Medicaid-linked program called Insure Oklahoma that provides coverage for Gatliff, 38, was due to expire Dec. 31. That left him facing the prospect of having no insurance at the end of the year, so the part-time pizza shop employee began planning to stockpile his medications.

However, Gov. Mary Fallin announced a temporary reprieve for the 30,000 Oklahomans who receive coverage through Insure Oklahoma, saying the program would remain operating for one more year.

Gatliff said he was grateful for the temporary extension but said he felt like a victim of Oklahoma’s resistance to the Affordable Care Act.

“I’m glad she did it,” said Gatliff, who makes between $7,000 and $9,000 a year.  “It’s a year, which is good, but it’s still only a year. After that, I’ll have to worry about it.”

He said he believed that Fallin should have simply accepted the Medicaid expansion that was offered to states under the federal health care reforms. The federal government pays for the full expansion for the first few years and 90 percent thereafter.

Opting for the Medicaid expansion under the federal law would have provided medical coverage to as many as one-third of Oklahoma’s 636,000 uninsured residents, about 17 percent of the state’s population.

But for Fallin, agreeing to an expansion of Medicaid would be politically dangerous. She voted against the Affordable Care Act when she was in Congress, railed against it during her campaign for governor and consistently opposed it during her first term.

She said she is concerned that the expansion could cost Oklahoma $850 million through 2020.

Although Insure Oklahoma was pushed by former Gov. Brad Henry, a Democrat, and uses federal Medicaid dollars, Republicans prefer it to a Medicaid expansion because thousands of small businesses use it to provide coverage to their employees. Recipients also are required to make modest premium payments and medical co-pays.

“There’s some personal responsibility in the plan,” Fallin said.

Gatliff would have qualified for the Medicaid expansion offered under the Affordable Care Act, which gives eligibility to those making up to 138 percent of the federal poverty level, or $15,400 for an individual and about $31,000 for a family of four. Under Insure Oklahoma, he pays a $27 monthly premium as well as co-pays for doctor visits and his five medications.

“I don’t mind paying it,” Gatliff said from the mobile home he shares with a friend at the Sherwood Village Manufactured Home Community in Lawton. “I’m not looking for a handout. I want to pay something.”

If Insure Oklahoma had not been extended, Gatliff would have been caught in a coverage gap: He would not have qualified for Medicaid, but he also did not earn enough to qualify for tax subsidies to buy insurance on the federal exchange.

The gap exists because the Obama administration did not anticipate a U.S. Supreme Court ruling giving states the option to reject the Medicaid expansion. Individuals with an income of 100 percent to 400 percent of the federal poverty level would be eligible for government subsidies on the exchange, but Gatliff does not qualify because he earns less than 100 percent of the federal poverty level.