Mind the gap: Too rich for Medicaid, too poor for Affordable Care Act subsidies

Posted at 7:01 PM, Oct 22, 2013
and last updated 2013-10-23 06:54:54-04

RICHMOND, Va. (WTVR) -- The Affordable Care Act, by design and even by its name, is meant to give Virginians who can't afford health insurance the ability to purchase it.

But Lillie Estes, a Richmond community strategist who made less than $15,000 last year, is finding insurance just as unattainable and unaffordable as ever.


Estes falls in what is known as the "Medicaid Gap" - a group of Virginians who do not qualify for Medicaid but are too poor for the so-called Obamacare tax credits.

"I see a challenge that needs to be addressed," Estes told CBS 6 reporter Joe St. George.

Affordable Care Act tax credits begin when someone makes 138-percent of the poverty level, or about $15,800 a year.

Medicaid in Virginia ends for many families when they make more than $6,000 dollars a year.

Medicaid ended for Estes when her son turned 18.

Why is there this gap? When the Affordable Care Act passed in March of 2010, the federal government expanded Medicaid to reduce the gap. But the Supreme Court ruled that part of the law unconstitutional, allowing states not to expand Medicaid if they so wish.

Therefore 25 states have thus not expanded Medicaid, Virginia being one of them.

"There is not a great deal of trust that the money would be there," Governor Bob McDonnell told CBS 6 reporter Joe St. George.

McDonnell said his thoughts on Medicaid expansion are unchanged.

While McDonnell acknowledged the federal government would cover 100 percent of the expansion for the first three years, the Governor said beyond that it's unclear, fearing a large, unfunded mandate would be dropped on Virginia's budget.

"Medicaid has expanded 1600 percent in Virginia in the last thirty years," McDonnell said.

"The federal government can't even get a budget passed - they can't even get a spending deal for 90 days," McDonnell added.

The issue of medicaid expansion and reducing the "gap" has been a hot topic on the campaign trail.

Democrat Terry McAuliffe says he would pressure lawmakers to expand it. Republican Ken Cuccinelli says he sides with current Governor McDonnell and would not support expansion.