Part 3: Invisible to You, Real to Us: Chronic Illness in the Income Gap (Government Programs and Resources)

Part 3: Government Programs and Resources

Section 1: Medicaid

Medicaid is a crucial program that extends a lifeline to millions of Americans, including children and adults with limited income and resources. Operating at both federal and state levels, Medicaid acts as a safety net for low-income individuals and families.

However, Medicaid eligibility criteria vary by state, and not all states have expanded Medicaid under the Affordable Care Act (ACA), leaving millions uninsured or underinsured. John is one of those who doesn't qualify for Medicaid in his state, as his income slightly exceeds the eligibility threshold of 138% of the federal poverty level (FPL).

While Medicaid covers most medical services and some non-medical services, such as transportation to medical appointments, it falls short in addressing all of John's non-medical expenses, including food, lodging, utilities, childcare, and home modifications. As a result, John resorts to using his credit cards or savings to cover these costs, adding to his financial strain.

Some key Medicaid statistics and facts include:

• In 2020, Medicaid provided coverage for 77.8 million people in the U.S., including 35.8 million children (KFF, 2020).
• Medicaid spending accounted for 16% of total U.S. healthcare spending in 2020 (KFF, 2020).
• Unfortunately, 12 states had not expanded Medicaid under the ACA in 2020, leaving 2.2 million people in the coverage gap (KFF, 2020).

Section 2: Medicare

Medicare, another vital government program, offers health coverage to individuals who are 65 years or older, disabled, or dealing with specific chronic conditions. While it significantly helps seniors and those like John, who face chronic health challenges, John is not eligible for Medicare due to his age.

In 2020, Medicare provided coverage for 62.6 million people in the U.S., including 8.5 million disabled individuals (CMS, 2020). While it covers a substantial portion of healthcare expenses, it doesn't eliminate all costs, leaving beneficiaries with out-of-pocket expenses.

For individuals like John, who fall into the income gap, the unavailability of Medicare eligibility exacerbates their financial strain. They must find alternative ways to cope with these expenses.

Medicare covers most medical services but not all non-medical services. It also involves deductibles, copayments, coinsurance, and premiums that can be financially challenging for low-income patients. In John's case, he also invested in a Medigap policy (supplemental insurance) to help offset some of the out-of-pocket costs that Medicare doesn't cover.

Here are some key Medicare statistics and facts:

• In 2020, Medicare provided coverage for 62.6 million people in the U.S., including 54.1 million aged 65 or older and 8.5 million disabled (CMS, 2020).
• Medicare spending constituted 21% of total U.S. healthcare spending in 2020 (CMS, 2020).
• The average annual out-of-pocket spending for Medicare beneficiaries in 2020 was $5,801 (KFF, 2020), a significant burden for those with limited incomes.

Section 3: CHIP

The Children’s Health Insurance Program (CHIP) aims to provide healthcare coverage to children in low-income families who don't qualify for Medicaid. However, John's children don't meet the criteria for CHIP, further complicating the family's financial situation.

In 2019, CHIP provided coverage for 9.6 million children in the U.S. (CMS, 2019). Despite its importance, CHIP faces challenges like funding uncertainty and enrollment caps, which sometimes result in children waiting for coverage.

John's family situation serves as a stark reminder of the disparities in access to care even within a single household. While his children aren't eligible for CHIP, John himself doesn't meet Medicaid criteria. This highlights the intricacies of healthcare coverage and the dilemmas faced by those like John caught in the income gap.

Section 4: ACA

The Affordable Care Act (ACA) has made significant strides in expanding access to healthcare coverage. It offers subsidies to make health insurance more affordable for individuals and families who don't qualify for Medicaid but still grapple with financial challenges.

John and his wife were able to purchase health insurance through the Marketplace. However, they didn't receive subsidies to lower their premiums or out-of-pocket costs. They had to pay the full price of their plan, which was expensive and came with high deductibles and copayments. Additionally, they had to cover expenses for services not included in their plan, such as dental and vision care, and essential cancer treatments.

These high out-of-pocket costs placed a significant strain on John and his wife. They often had to choose between paying for their healthcare or other essential expenses like food, rent, and utilities. They were also forced to delay or forgo certain treatments or medications due to financial constraints, negatively affecting their health and quality of life.

Key ACA statistics and facts include:

• In 2020, ACA subsidies were available to approximately 15 million people in the U.S., with 9.2 million receiving premium tax credits and 5.8 million benefiting from cost-sharing reductions (KFF, 2020).
• ACA subsidies reduced the average monthly premium for eligible enrollees by a staggering 86%, dropping it from $612 to $86 (KFF, 2020).
• Sadly, in 2020, around 4 million people in the U.S. found themselves in the coverage gap between Medicaid eligibility and ACA subsidy eligibility (KFF, 2020).

Section 5: SNAP

The Supplemental Nutrition Assistance Program (SNAP) is a federal initiative that provides food assistance to low-income individuals and families. SNAP plays a crucial role in helping people access nutritious food, ultimately contributing to improved health and well-being.

However, John and his family aren't eligible for SNAP due to their income exceeding the eligibility limit. In 2020, SNAP provided benefits to 42.3 million people in the U.S., helping them afford a healthy diet (USDA, 2020). Yet, the program faces its own set of challenges, including concerns about benefit adequacy, work requirements, and the stigma associated with receiving assistance.

John and his family's situation vividly illustrates the impact of food insecurity on individuals with chronic illnesses. While SNAP could potentially help them afford healthier food and improve their health outcomes and quality of life, they are barred from the program due to their income level. This means that a significant portion of their income must be allocated to food expenses, leaving them with less money for other essential needs.

Some notable SNAP statistics and facts include:

• In 2020, SNAP benefits averaged $125 per person per month (USDA, 2020).
• SNAP lifted 2.5 million people out of poverty in 2020 (CBPP, 2020).
• Unfortunately, in 2020, around 6 million people in the U.S. who were eligible for SNAP did not receive benefits (CBPP, 2020).

Conclusion?

Part 3 of our series has provided insight into the government programs and resources available to assist individuals and families grappling with chronic illnesses. While these programs offer essential support, John's story highlights the challenges of navigating the income gap.

The absence of eligibility for these programs exacerbates the financial hardships faced by individuals like John, who struggle to access essential care and nutrition. In the next installment of our series, "Part 4: Alternative Support Options," we will explore additional avenues of assistance, including charities, foundations, nonprofits, churches, and other organizations that offer hope and help to those dealing with chronic illnesses.

Remember, at Patient Voices Matter, your voice matters. Visit our website, Patient Voices Matter, and be sure to subscribe to this PVM: CommuniTea Cafe Newsletter. Patient Voices Matter Podcast will soon relaunch on Spotify, and Apple iTunes where you can find valuable insights and stories.?

"We must bridge the gap, not just in income, but in access to essential healthcare and nutrition. These challenges are real, and they affect the lives of countless individuals like John."?

-Becky Barnes,, Patient Voices Matter

#PatientVoicesMatter #CreditCardsChronicIllness #GovernmentProgramsChronicIllness #PatientAdvocacy

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References

Centers for Medicare & Medicaid Services. (2019). Children’s Health Insurance Program (CHIP). https://www.medicaid.gov/chip/index.html

Centers for Medicare & Medicaid Services. (2020). Medicare Enrollment Dashboard. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html

Centers for Medicare & Medicaid Services. (2020). National Health Expenditure Data. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical

Kaiser Family Foundation. (2020). Key Facts about the Uninsured Population. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/

Kaiser Family Foundation. (2020). Medicaid in the United States. https://www.kff.org/medicaid/issue-brief/medicaid-in-the-united-states/

Kaiser Family Foundation. (2020). Medicare Beneficiaries’ Out-of-Pocket Health Care Spending as a Share of Income Now and Projections for the Future. https://www.kff.org/report-section/medicare-beneficiaries-out-of-pocket-health-care-spending-as-a-share-of-income-now-and-projections-for-the-future-report/

Kaiser Family Foundation. (2020). Premiums and Tax Credits Under the Affordable Care Act vs. the American Health Care Act: Interactive Maps. https://www.kff.org/interactive/tax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map/

U.S. Department of Agriculture. (2020). Supplemental Nutrition Assistance Program (SNAP). https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program