Coverage gaps still persist among some populations

The Star Tribune reports on how some American Indians -- even now that the health law is in place -- continue to struggle with costs and other challenges related to securing health insurance. Meanwhile, the St. Louis Post-Dispatch examines how state decisions to expand Medicaid impact residents' options.

Star Tribune: South Dakota American Indians Slip Through Cracks Of Health Overhaul
Leslie Wolfname, a registered nurse who works one day a week at the Urban Indian Health clinic here, regularly sees the problems of uninsured American Indians. She watches her bosses trying to eke by on the $800,000 from Indian Health Service that their clinic shares with a similar one in Pierre. And she sees Indian patients who cannot get the care they need, because their problems are too serious for the small center and they lack the insurance to go elsewhere. These were struggles that some hoped President Obama's health care law would address. But Wolfname remains uninsured. Even after government subsidies, the $300 it would have cost her family of four to secure insurance through the federal exchange felt like too much, given that she and many other Indians are accustomed to free health care on reservations. "I know I've got to have health insurance," said Wolfname (Rao, 10/8).

St. Louis Post-Dispatch: For Those Who Make Too Much -- And Too Little -- For Health Insurance, Options Are Limited
Beverly Jones, a 51-year-old St. Louisan with custody of her three grandchildren, is supposed to get her blood tested every few months to make sure the medicine she takes daily isn't harming her kidneys. But she can only afford to make the trip to the doctor two times a year because she lacks health insurance. "It's hard for me to accept that I put in so much work and so much time and now that I get sick there is no one that can help me," she said. "That doesn't seem fair to me." Jones isn't alone. She is one of nearly 300,000 Missourians who would qualify for government-funded health insurance if they lived across the Mississippi River in Illinois or in 26 other states that have decided to expand their Medicaid programs under the Affordable Care Act. But because Missouri hasn't agreed to expand its program, Jones said she is forced to go without her blood tests and some of her prescriptions. She is also a member of a slightly smaller population, about 180,000, that can't get Medicaid but make too much money to get federal subsidies on the online insurance marketplace. She's in a gap (Shapiro, 10/9).

In other related news, hidden costs can build up even for people who are fully covered, and more on canceled health plans --

Charlotte Observer: Hidden Costs For 'Fully Covered' Care Can Slam Patients' Wallets
In North Carolina and across the country, hidden costs have popped up on "fully covered" services ranging from contraception to cancer screening to annual checkups. The goal of mandating coverage is to make sure people don't skip relatively simple tests, inoculations and procedures that can head off health crises and big medical bills. But the line between covered prevention and costly diagnosis can easily be crossed. Meanwhile, insurers, providers, advocates and officials are still wrangling over the rules, at a time when a growing number of people must cover thousands of dollars out of pocket (Helms, 10/8).

Fox News: More Than A Dozen States Plan To Cancel Health Care Policies Not In Compliance With Obamacare
More than a dozen states plan to cancel health care policies not in compliance with Obamacare in the coming weeks, affecting thousands of people just before the midterm elections. The policies are being canceled because states that initially granted a reprieve at the request of President Obama are no longer willing to do so. In coming weeks, 13 states and the District of Columbia plan to cancel such policies, which generally fall out of compliance with the Affordable Care Act because they don't offer the level of coverage the law requires. Virginia will be hardest hit, with 250,000 policies expected to be canceled (Angle, 10/9).