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00000173-d94c-dc06-a17f-ddddb4b10000By Wilson Sayre and Daniel ChangThousands of South Floridians too poor to afford health insurance on their own end up in what is called the "coverage gap." They earn too little to get help buying health insurance under Obamacare, but they don’t qualify for Medicaid.WLRN and the Miami Herald look at what life is like in the coverage gap through the experience of Miami resident Cynthia Louis. Reporters explore how being uninsured affects your life, your health, and your wallet.Need to find low-cost care? The Miami Herald developed a low-cost health care finder. Find help at hrld.us/findcare.

The Barriers People In The Coverage Gap Face To Get Care

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Wilson Sayre
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This is the second part in our series, Falling Into The Gap, in collaboration with the Miami Herald. Read more about the coverage gap and find affordable care on WLRN.org/healthgap.

Before the pain in her arms started, Cynthia Louis would get up each morning, sit on the edge of her bed and fix her shoulder-length hair. In the mirror above her dressing table where her hair products and pins are neatly aligned, she would brush out her curled hair to frame her face.

Today, her hair is arranged in dozens of tight, skinny braids. The perm she loved so much is gone.
For her, it’s a practical choice since she can no longer lift her arms to her head for as long as it would require to maintain her perm.

What Louis thought would be a fairly straightforward process of finding out what’s wrong with her joints has taken more than a year and a half. She’s had to quit the job she loved so much because she can’t stand up for long periods of time.

Because she has no income, though, she does not qualify to get help paying for health plans on HealthCare.gov. She also does not qualify for Medicaid in Florida because she doesn’t have any dependents. She is one of the 850,000 Floridians in the health care “coverage gap.”

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Credit Wilson Sayre / WLRN
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WLRN
The dressing table Cynthia would sit to to fix her hair, which she can no longer do because of pain in her shoulders.

For those people, as a lost resort, there is a program called charity care that is offered at public hospitals. It's essentially a health plan for the uninsured and members pay on a sliding scale.

Louis uses Jackson Health System’s charity care program, which is the largest in the state. Miami-Dade has the most uninsured residents in Florida, so there are a lot of people coming to Jackson’s door: 40,000 of them in 2014. That number includes people in the coverage gap along with undocumented immigrants and others who have no insurance, but Jackson is still serving only a fraction of the roughly 140,000 people in the coverage gap in Miami-Dade.

Through charity care, Cynthia has limited options when it comes to specialist service. Often the only specialists she has access to are at Jackson Memorial Hospital, where her primary care doctor, Katherine Chung-Bridges, referred Cynthia to a rheumatologist almost a year ago. Louis has still not been seen.

“You should be able to get appointment quicker than six months, a year. And it’s not right,” says Louis, who has been in a holding position since her joint pain started.

Chung-Bridges says the system forces doctors to work with one hand tied behind their back. 

“It's being able to access the appropriate labs and the appropriate studies in a timely fashion,” she says. She says waiting for these things delays health care.

Ed Odell from Jackson Health says wait times usually range from two weeks to six months depending on the specialties. Urology, ear nose and throat (E.N.T.) and pulmonary specialists have the longest waits. He says that’s because those operate as teaching and academic clinics that only meet four hours once a week.

The Affordable Care Act was supposed to eliminate these kinds of barriers by insuring more people through Medicaid. This would mean more options for care for patients and greater compensation of hospitals because they would serve fewer uninsured patients.

Florida, though, was one of 22 states that refused to expand its program. At the same time, the federal government is giving less money to states for these charity programs because of the assumption more people would be covered under Medicaid. 

The result is there are still a lot of people who need charity care, but there is less money for it.

In January, Cynthia was finally able to book an appointment with a rheumatologist who might be able to tell her what’s wrong. The appointment is in July.

WLRN is a part of Health News Florida, which receives support from the Corporation for Public Broadcasting.