'It's very frustrating'

Editor’s Note: This continues our series on health and socioeconomic issues affecting Santa Rosa County.

Santa Rosa County currently ranks seventh out of 67 Florida counties for overall health outcomes; however, it ranks 31st when it comes to clinical care, according to the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute’s latest County Health Rankings.

Analyzing those findings, the rate of the population under age 65 without health insurance has decreased in recent years. Currently, 15 percent of Santa Rosa residents are uninsured. The figures were 18 percent in 2011 and 21 percent in 2007.

Florida’s rate of uninsured residents is at 20 percent, with the U.S. average of 14 percent. 

Insurance, or lack thereof, is a hot topic as the country braces for health law changes. 

AFFORDABLE CARE ACT

In the past, gaps in the public insurance system and lack of access to affordable private coverage left millions without health insurance. Starting in 2014, the Affordable Care Act expanded coverage to millions of previously uninsured Americans through the expansion of Medicaid and the establishment of Health Insurance Marketplaces.

The ACA led to significant coverage gains. At the end of 2015, the number of uninsured nonelderly Americans stood at 28.5 million, a decrease of nearly 13 million since 2013, according to the Henry J. Kaiser Family Foundation.

“With [Affordable Health Care] I have gotten health insurance for the first time,” Amanda Davey of Milton said. “However, the last few months Blue Cross and Blue Shield have been playing games with my policy and money, and now until I have time to go talk to a person in Pensacola, I am without coverage again. 

“I work in health care and I am definitely not the only BCBS customer having this issue for the last several weeks. If it helps, I do have a genetic defect of my bones and a few chronic illnesses as well. I fear for what will be lost when the affordable health care policy changes, but I would like to see better options for everyone. It isn't perfect but better than nothing.”

COSTLY COVERAGE

Even under the ACA, many uninsured people cite the high cost of insurance as the main reason they lack coverage.

In 2015, 46 percent of uninsured adults said that they tried to get coverage but did not because it was too expensive, according to the Henry J. Kaiser Family Foundation. Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance for coverage.

Some who are eligible for financial assistance under the ACA may not know they can get help, and others may still find the cost of coverage prohibitive. In addition, undocumented residents are ineligible for Medicaid or Marketplace coverage.

Most uninsured people are from low-income families and have at least one worker in the family. Due to the more limited availability of public coverage in some states, adults are more likely to be uninsured than children. People of color are at higher risk of being uninsured than non-Hispanic Caucasians.

One in five uninsured adults in 2015 went without needed medical care due to cost. Studies repeatedly demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases.

“I now have insurance after not having it for two years. Not sure I am better off,” Kim Fagan of Milton said. “It is very expensive. On top of the monthly premium, pretty much every doctor visit, X-ray, anything at all is also out of my pocket because [I am] nowhere close to meeting the deductible.

“It is very frustrating. I am thankful to have it now in the case of something catastrophic, but it is a financial hardship for sure…Sometimes I think I would come out better paying the penalty and doing without, but [I am] not willing to gamble that I won't have a heart attack or get cancer or something.”

PENALTIES

The uninsured population often faces unaffordable medical bills when they do seek care. In 2015, 53 percent of uninsured people said that they or someone in their household had problems paying medical bills in the past 12 months, according to the Henry J. Kaiser Family Foundation.

If you can afford health insurance but choose not to buy it, you must pay a fee called the individual shared responsibility payment, according to HeathCare.gov. You owe the fee for any month you, your spouse or your tax dependents don’t have qualifying health coverage. You pay the fee when you file your federal tax return for the year in which you lack coverage. 

In some cases, you may qualify for a health coverage exemption from the requirement to have insurance. 

If not, the fee is calculated as a percentage of household income, and per person. You will pay whichever is higher. 

For the percentage fee, you pay two and a half percent of household income. Per person, it is $695 per adult and $347.50 per child under 18 years of age, with a maximum cost of $2,085.

AFFORDABLE HEALTH CARE ACT

On May 4, Congressman Matt Gaetz voted on the passage of the American Health Care Act, a bill replacing the Affordable Care Act, also called Obamacare. 

"I voted in favor of the American Health Care Act — a bill that will make health insurance more accessible and more affordable for people across America," Gaetz said. "For too many Americans, the Affordable Care Act, also known as Obamacare, has been anything but affordable. Premiums have soared, coverage has plummeted, and insurers are leaving the market in droves, making a dire situation even worse.

"States have been robbed of their rights, and the economy has been smothered: small businesses cannot afford to grow, large businesses cannot afford to expand and it continues to expand our out-of-control national debt with alarming speed."

This article originally appeared on Santa Rosa Press Gazette: 'It's very frustrating'