Like one million Arizonans, the Chandler family of Tucson has no health insurance.
After more than one of their applications for Medicaid was denied, they lived with their fingers crossed that no one would get sick.
That gamble backfired last month.
Kayla Chandler, 13, became unexpectedly ill and after numerous tests and doctor appointments was diagnosed with ulcerative colitis, which is a serious and potentially debilitating inflammatory bowel disease.
The family didn’t want to be uninsured. They simply couldn’t afford it.
Danielle Chandler, 45, is an hourly contract employee who works the overnight shift for a delivery service. As a temporary employee she’s not eligible for her company’s employer-sponsored health care plan. Private insurance is simply too expensive, says Chandler, who earns $16 per hour.
The family brings in too much money too high to qualify for Medicaid, which is a government insurance program for low-income Arizonans. The state’s Medicaid program, called the Arizona Health Care Cost Containment System (AHCCCS), in January will increase its eligibility requirements for people making 133 percent of the federal poverty level of less. That works out to $25,975 or less for a family of three, and Danielle’s annual income of $33,280 is still too high.
There was a window this year when Kayla could have qualified for a form of AHCCCS for children that gives Medicaid to kids whose families make too much to qualify for Medicaid. Danielle had to hand in her pay stubs as part of the qualifying process, and in spite of her persistence, Kayla was denied.
The overtime Danielle worked likely put the family over the KidsCare II income limit, which is 200 percent of the federal poverty level or less.
Kayla could enroll in KidsCare II and possibly get coverage for the rest of the year as long as she qualifies, but enrollment will close Oct. 1, AHCCCS spokeswoman Monica Coury said.
That’s because KidsCare II is going away on Dec. 31. The original KidsCare program has frozen enrollment and will not be accepting any more children, Coury said.
“It really is not needed since the Federally Facilitated Marketplace will provide commercial coverage with premium tax credits and cost-sharing reductions, offering these households affordable and complete coverage,” she wrote in an email.
Beginning Oct. 1, the Chandler family will be able to sign up for private insurance through Arizona’s health-care marketplace, which will offer federal subsidies to people in households where the annual income is 400 percent of the federal poverty level or less, which works out to $78,120 for a family of three.
The Chandlers should be well within that income limit, even if Danielle’s husband, Will, gets a job, they say. If the family was relying on Danielle’s current salary only, they’d qualify for a subsidized standard “silver” plan that would cost them just under 5 percent of Danielle’s salary.
All silver plans on the marketplace must have an actuarial value of 70 percent, meaning that for a standard population, the plan will pay at least 70 percent of health expenses and enrollees will pay 30 percent through a combination of deductibles, copays and coinsurance.
If the family has Danielle’s salary only, the Kaiser Family Foundation’s subsidy calculator says the Chandlers would be able to get a standard silver plan covering the three of them at roughly $137 per month.
Under terms of the law, their out-of-pocket costs per year, excluding the premium, can be no more than $4,500.
Depending on their income, some families will also be eligible for cost-sharing reductions related to out-of-pocket costs like co-pays and deductibles through the marketplace.
But it’s all too late to cover Kayla’s medical bills, which are so far more than $13,000. Her treatment has included a blood transfusion, steroids and an immunosuppressant.
“Her body is attacking itself. Her body thinks her colon is a foreign entity and wants it to go away,” Danielle explained.
Danielle doesn’t know much about the Affordable Care Act, she said. She also is concerned that the out-of-pocket cap will have exceptions.
“All I seem to keep getting fed is anti-Obamacare, and that businesses are going to fail,” she said. “I’d be interested if, for someone on my income level, it would help us get by.”
