Greetings from the Affordable Care Act Dead Zone

The New York Times' Inara Verzemnieks' article, In the Dead Zone,  featured Kansas City, MIssouri front and center in its discussion about those in the Affordable Care Act's coverage gap.  Those too rich for their state's Medicaid eligibility rules or outside of categorical eligibility but also too poor to purchase health insurance inside the exchanges are in a kind of "dead zone" where health care can be catch as catch can.  This is an article about how the ACA has helped many Americans living between 100 percent and 250 percent of the federal poverty level achieve insured status, and how the ACA — after the optionalizing of the Medicaid expansion at the Supreme Court — has also left many outside of health insurance.

There is a lot to like about this article, particularly its fact-based look at just who is in the coverage gap, including the under-discussed one in eight close to to 65 year olds and how the majority are workers. I have noted before that the average American still retires at 62 years of age (when a reduced benefit is first available) yet Medicare eligibility kicks in at age 65, producing a natural constituency in favor of some kind of health care reform that will cover these vulnerable folks before Medicare eligibility.  I often find that these "dead zone oldsters" are everywhere and everyone seems to know at least one.  

The fact that the ACA has been of tremendous benefit to low income, but not impoverished, near seniors is under-discussed and under-appreciated.  This is the group moving, statistically, toward significant health care needs and, as a result, a group tremendously vulnerable to the effects of medical underwriting for pre-existing conditions.  

Yes, I know, that it has been widely announced that pre-existing condition exclusions will be retained upon ACA repeal or revise.  Let's just say I'm  uncertain how this could be done without some kind of mandate or mass incentive to broaden and deepen the pool of insured with the relatively younger and relatively more robust.  In fact, the Paul Ryan proposal to allow age based  premium banding expansion to a 5:1 ratio, tells us that some health insurance for older low income, but not impoverished, seniors could get very spendy indeed.

Perhaps my favorite phrase in the entire article discusses the "highly improvisational" ways that those in the dead zone must seek out health care. That's one way to put it.  I think of improvisation as a way to accomplish something with the tools and materials at hand.  This looks a little more like desperation to me.