Will Weatherford says about half the people eligible for Medicaid expansion 'can buy a health care plan for $30 a month'

Florida House Speaker Will Weatherford has been a vocal opponent of President Barack Obama’s Affordable Care Act. He’s no fan of the law’s proposed Medicaid expansion, especially.

During an interview with the Tampa Bay Times editorial board on Feb. 27, Weatherford played down the need for Medicaid expansion, which the Legislature rejected last year.

He said many Floridians who might have enrolled under an expanded Medicaid system can now buy affordable private insurance from the federal website HealthCare.gov.

"If you live above the 100 percent of the poverty rate today, which is about 400,000 of the 800,000 who would qualify for Medicaid expansion, half of the people who qualify for Medicaid expansion today can buy a health care plan for $30 a month on the exchange," he said.

Weatherford added that he thought people in that income range "should be able to afford $30 a month and have some skin in the game."

We wondered if half of the people who would have been eligible under a potential Medicaid expansion could get a private insurance plan for $30 a month.

We ran the numbers and found that Weatherford had a point that many people who would have been eligible for Medicaid can buy plans from healthcare.gov for $30 a month. But it’s not half of them, it’s a good bit less. Showing you why is going to involve a deep dive into how the health care law works.

Medicaid math

The federal government offered to pay all the costs initially for states to expand Medicaid, a health insurance program for the poor, and 90 percent in later years. But Florida opted not to expand coverage. Just how many people would have been covered under the potential Florida expansion is hard to gauge. Estimates put it at about 1.3 million.

The government uses the federal poverty level as the measure to determine a person’s eligibility to receive assistance for government programs such as Medicaid and, in the case of the Affordable Care Act, eligibility for insurance subsidies. For 2014, the poverty level is set at $11,670 for a single person and $23,850 for a family of four.

Florida’s Medicaid program has more than 3 million enrollees, but many residents don’t qualify under the program’s guidelines. Some people, like young adults and parents, have to be at 22 percent of the Federal Poverty Level or below to qualify, but most single adults without children don’t qualify for Medicaid at all. The federal law intended to allow all poor adults into the program, but Florida opted not to expand the program.

Who gets tax credits?

The federal health care law intended for the very poor to get Medicaid and for low-wage workers to get tax credits to buy private insurance.

The law splits those groups up by income, using definitions based on the federal poverty level. People who make 138 percent of the poverty level or lower would be eligible for Medicaid. People who make between 138 percent and 400 percent of the poverty level would get subsidies to buy private insurance on sites like HealthCare.gov.

It doesn’t work like that in Florida, though, because the state chose not to expand Medicaid.

In states that don’t expand Medicaid, the law also allows people making between 100 and 138 percent of the poverty level to shop for private insurance with subsidies. (Why that’s the case is another complicated story, which we will address in a separate report.)

Weatherford is right that those people can buy insurance on the exchange. So how much will it cost them?

The president’s health care law keeps premium costs low for households making up to 400 percent of the federal poverty level by providing tax credits to purchase insurance. The size of the tax credit is adjusted based on the cost of the second-least expensive silver option available in the marketplace. (Plans can be bronze, silver, gold or platinum, with the most generous -- and expensive -- plans being platinum.)

Break out your calculators: The second-cheapest silver plan can only cost 2 percent of an individual’s annual income for households making up to 138 percent of the federal poverty level. For a person making $16,104, that’s an annual premium of $322, or $26 a month.

By plugging demographic and salary information into HealthCare.gov, we can see how this rule bears out.

For example, a 35-year-old single man living in Pinellas County and making $16,104 a year (138 percent of the federal poverty level) is "eligible for a premium tax credit" of up to $198 a month, according to HealthCare.gov. That individual could find a Bronze level plan from Humana for $0 a month (yes, zero dollars), albeit with a $6,300 deductible. He could also buy six other plans from various providers for $30 a month or less.

What about a family of four (two adults and two children under 18) living in Miami-Dade County making exactly 100 percent the federal poverty level, or $23,850 a year?

The children may be eligible for Medicaid through the Children’s Health Insurance Program, HealthCare.gov says. The parents would have to buy insurance on the federal marketplace, but they would be eligible for a tax credit of up to $712 a month.

With the tax credit, there are several Bronze options that would cost nothing, but the deductible would be capped at $12,600 a year. There are eight other options for less than $30 a month.

Those individuals would also be eligible for co-payment assistance, which is available to individuals and families making up to 250 percent of the federal poverty level.

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It’s not as good of a deal for those individuals as Medicaid would have been, which basically costs nothing for recipients, but Weatherford is right they could find coverage for pretty cheap.

But what if you’re a family of four making $12,599 a year,  just one dollar less than the federal poverty level?

The parents would no longer be eligible for any financial assistance toward their premiums. The same plans that would cost nothing to the family making $12,600, now cost $555 a month or more.

Rachel Garfield, a senior researcher for the Kaiser Family Foundation, a nonpartisan health care research group, said those individuals making less than 100 percent the federal poverty level would likely be stuck in a situation where they couldn’t afford coverage and would remain uninsured. The law says they cannot be penalized for not having insurance, because affordable coverage is not available to them.

Other estimates

So Weatherford is correct that some people can buy insurance for cheap on the federal marketplace. But is it half of the people who would have been covered by a Medicaid expansion?

Greg Mellowe, director of health research and analysis at the Florida Center for Fiscal and Economic Policy, said it appeared the speaker had gotten confused about his numbers. Mellowe cited a Kaiser Family Foundation study that said there are about 1.3 million uninsured Floridians making 138 percent of the federal poverty level or less.

Of those people, about one-third earn enough to buy cheap coverage on the marketplace.

In another study released in August 2012, the Urban Institute also found almost 1.3 million people would be eligible in an expansion. Of those, 300,000 had income between 100 and 138 percent of the federal poverty level, or about 23 percent, and would be eligible to buy in the marketplace.

Weatherford’s office told us his numbers were based on an estimate from staff analysts projecting that about 937,000 Floridians would be eligible under an expansion. Of those, about 314,000 were between 100 and 138 percent, meaning they now can buy insurance on the federal exchange. That’s about 30 percent, though, not half.

Spokesman Ryan Duffy said projections showed 402,000 Floridians between 100 and 138 percent of the poverty level were expected to enroll over 10 years based on population and economic trends, and that’s the figure to which Weatherford was referring. The speaker said "today," though, not 10 years from now.

Our ruling

Weatherford said that about half of Florida residents who would qualify for a Medicaid expansion "can buy a health care plan for $30 a month on the exchange."

Thanks to an unintended quirk of the law, there are somewhere between 300,000 and 400,000 people who can buy cheap coverage on the federal marketplace without the Medicaid expansion. Using premium tax credits, many could find insurance premiums below $30 a month.

But that’s not half of the individuals who would have qualified for the Medicaid expansion. It’s actually a much lower number, closer to 25 to 33 percent, depending on the study.

We rate the claim Half True.