In Thompson’s Station, Tennessee, Robert and Emily Sory are trying to open a nonprofit animal sanctuary, but they have forgone health insurance this year due to the unaffordability of marketplace plans under the Affordable Care Act. The Sorys, who lost their jobs in November, cannot afford the $70 monthly premium for a “bronze”-level plan, which is the cheapest option available to them. Without health insurance, they are seeking alternative ways to access medical care, such as visiting a psychiatrist who has agreed to charge them $125 per visit and going to emergency rooms when necessary.
The Sorys’ situation is not unique, as an estimated 4.8 million people will go without health coverage this year due to the expiration of enhanced subsidies under the Affordable Care Act. Congress has passed legislation to extend these subsidies, but negotiations are ongoing in the Senate. In the meantime, people like the Sorys are being forced to find workarounds to maintain their health, including visiting federally qualified health centers (FQHCs) that offer sliding-scale fees and free prescription medications through partnerships with nonprofits like the Dispensary of Hope.
FQHCs, which are partially funded by the federal government, are bracing for an influx of newly uninsured patients and are concerned that people may not be aware of alternative ways to access medical care. The Dispensary of Hope, a Nashville-based nonprofit, has partnered with hospitals and pharmacies to provide free medications to people without insurance who have annual incomes below 300% of the federal poverty limit. However, demand is expected to outstrip supply in the new year, and the organization is working with pharmaceutical companies to increase donations.
The situation is particularly dire in states like Tennessee that have not expanded Medicaid to cover low-income adults, creating a “gap” in coverage that is expected to cause uninsured rates to jump. The Federation of American Hospitals has urged Congress to extend the enhanced subsidies, citing the threat to hospitals’ financial health. As Emily Sory, who has costly health conditions and has already taken on substantial medical debt, notes, “I understand the system. And I get it’s people like me that don’t pay their bill are why it suffers. And I feel bad. But at the same time, I don’t have the money to pay it.”