The new federal healthcare marketplace opening Oct. 1 could help families struggling to cover their children finally find an affordable plan. But the marketplace could also become a safety net for families on the verge of earning just enough to kick their children off of the current state and federally subsidized healthcare plans.
Shane Watkins is now starting to look at his options. He's an Austin tattoo artist without insurance. His girlfriend is a hair stylist but is lucky enough to have coverage through work. But the real concern for the couple is how to cover their nine-month-old daughter, Piper. Adding her to his girlfriend’s insurance plan wasn’t an option.
"Once we had Piper, our daughter, her insurance almost doubled just for her. And that’s not even with me on it," he says. "Yeah it freaks me out. And I have a new daughter, and all that stuff. So I'm like, 'Oh my God, what the hell's going to change now?'"
Watkins may not completely understand the new exchanges, but he hopes they’ll help him find something cheaper. But for other families, the healthcare marketplace could provide a softer landing for children kicked off the Children’s Health Insurance Program – or CHIP.
"If you make one dollar too much for CHIP there are no affordable options for you," says Stacey Pogue, a health policy analyst with the Center for Public Policy Priorities.
She says starting on Tuesday, families will be able to consider private coverage, with the boost provided by federal subsidies.
"As soon as a family is over an income limit where a family would no longer qualify for CHIP, they can get tax credits to purchase credits for that child in the exchange, or the new marketplace," says Blake Hutson, a senior associate for health reform campaigns with Consumers Union.
For a family of four, the upper income limit for CHIP is $47,100. Kit Abney Spelce, director of Insure A Kid, says her organization sees dozens of families who earn just $10 above the cap for these programs.
"We have staff inside of Dell’s Children’s Hospital and we see it each and every day," Abney Spelce says. "Those kids that come in and are uninsured and have an unexpected diagnosis and it’s very , very costly. And families are left trying to make ends meet, shifting the budget and trying to pay for the care that they need."
Abney Spelce adds that in January, qualifying families will get automatically directed to the marketplace if they don’t qualify for CHIP. Another change coming in January involves a family’s assets.
"So the state of Texas for both CHIP and Medicaid has had an asset test, which means you can only have so much money in the bank if you own cars that are worth so much, you don’t qualify for these programs," she says. "All that goes away and you now just looking at income eligibility."
Central Texas parents who are unsure what they qualify for can:
- Call 211
- Dial 800-318-2596, the federal number that has help available 24 hours a day in English, Spanish and 150 languages
- Go to healthcare.gov
- Visit a center that has certified application counselors available to answer questions in person