Journalism in the Public Interest

For Uninsured Missouri Reporter, Obamacare Is a Real-Life Story

Harum Helmy fell through a crack created by last year’s Supreme Court decision allowing states to avoid expanding Medicaid. Now, she is among millions who earn less than the poverty level but can’t get subsidized private insurance.


(Photo courtesy of Harum Helmy)

For Missouri public radio reporter Harum Helmy, the Affordable Care Act is more than just a story she covers. It is also a story she’s living.

“I know — an uninsured health reporter,” she wrote to me last month. “The joke’s not lost on me.”

Helmy, 23, a part-time reporter/producer for KBIA in Columbia, Mo., recently completed her coursework at the University of Missouri. She’s on her first professional job. At the station, she covers Obamacare, among other things. But she doesn’t make much money, and if the law worked as it was intended, she would be covered by Missouri’s Medicaid program beginning Jan. 1.

That wasn’t meant to be.

As signed by President Obama, the Affordable Care Act (ACA) would have required every state to expand its Medicaid program for the poor to include adults earning less than 138 percent of the federal poverty level. Those earning more than that, up to four times the poverty level, would qualify for subsidies to purchase health insurance in marketplaces.

But the Supreme Court ruled last year that states could opt out of the Medicaid expansion without consequence, and Missouri along with 24 other states have done just that. The problem is that the law didn’t include subsidies for people in those states who earn less than the federal poverty level to buy coverage through the exchanges — they were supposed to be covered under Medicaid.

That’s the gap in which Helmy sits.

She earns less than the poverty level ($10 an hour for 20 hours per week) and qualifies neither for Medicaid nor a subsidy. Helmy was born in Texas and is a U.S. citizen, though her parents live in Indonesia. While she attended classes at the university, her parents paid for her health coverage.

According to the Kaiser Family Foundation, a nonpartisan think tank, “In states that do not expand Medicaid, nearly 5 million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a ‘coverage gap’ of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits.” In Missouri, 193,000 people, including Helmy, fall into the gap, Kaiser estimates.

On paper, the Medicaid expansion seems like a great deal. The federal government has agreed to pick up 100 percent of the cost of the expansion for the first three years, phasing down to 90 percent in 2020. But officials in states that have declined to take part view Medicaid as a broken program. They don’t trust the federal government to keep its funding pledge and do not believe they have adequate state funds to cover their portion.

Missouri Gov. Jay Nixon, a Democrat, wants to expand Medicaid in his state, but the Republican-controlled Legislature won’t go along with it.

Helmy discussed her situation in a podcast in October (around the 12-minute mark). “I would just get a little bit personal here and say I’m one of those people,” she said. “I’m in this weird gap where I need insurance, my employer doesn’t give me insurance, but I don’t make enough to get a subsidy.”

I asked her what it felt like to be affected by the act.

“I’m still working out how I feel about being part of the story,” she told me in an email. “I’ve talked about it to potential sources as a way to explain to them why this story is important to me, but I’ve quickly learned that compared to many other Americans in the gap, I’m very privileged, barring any catastrophe. I’m healthy, I have no dependents and barely any debt. I’m overly educated, applying for full-time jobs and looking for additional part-time work in the meantime.”

Helmy said she could get a second job, but it’s difficult because she is still working to complete her master’s thesis. “I know that I’m privileged in the sense that I don’t need to get a second job because I don’t have any debt,” she said in a later phone interview.

Helmy said she’s looking for a full-time job and would consider getting a second job so she can get insurance.

She said that she cares more about the people she covers than about her own situation. “I can see why some anti-ACA people out there think that someone like me wouldn’t need any help,” she said, “I’m outraged that my sources, people in unimaginably worse shape than me, can’t get help.”

Editor’s Note: This post is adapted from Ornstein’s “Healthy buzz” blog. Has your insurance been canceled? Have you tried signing up for coverage through the new exchanges? Help us cover the Affordable Care Act by sharing your insurance story.

Katherine Reed

Dec. 3, 2013, 12:05 p.m.

Seems worth a mention in the story that under the health care law, she could remain on her parents’ insurance until she’s 26.

But her parents live in Indonesia…

The article mentions her parents live in Indonesia. Therefore, she cannot “remain on her parents’ insurance until she’s 26.”

Fact check: It’s my understanding that Harum has put her studies on hold somewhat but is still a grad student at MU and is now pursuing her Master’s degree while working with us at KBIA.

I suggest she complete her degree, if her masters is a marketable skill.

Quit your job and collect free insurance.  It is the 0bama way.

No Timm Bacher.

That is YOUR WAY.

We don’t know what her finances are exactly. She may be getting some money from her parents, education grant, scholarship etc. Still, most likely if she quits her job she won’t be able to afford housing, food, nor finish her school.
Even if she quits her job, she still probably wouldn’t be able to get medicaid as it is currently for Welfare recipients. Welfare and Medicaid has been around since long before Obama arrived on the scene.

Does anybody NOT see the why here?  GOP in Missouri CHOSE to NOT expand medicaid.  Once again it is NOTHING to do with the Affordable Care Act or president it IS the obstructionist GOP.

Interesting, the ACA was to make sure that no one was uninsured and it would cost us less.  Who is going to be picking up the subsidies for all who qualify.  Sounds like the whole ACA insurance tab will be picked up by the taxpayer.

I’m in a similar situation as the Uninsured Missouri Reporter.
I’m in my late 50’s and had 30 years of uninterrupted employment in the computer technology fields. My latest job (21 yrs) came to an end in 2009 due to overseas outsourcing, the bad economy, and company downsizing. I’m still out of work. Besides the obvious discrimination against hiring older workers, the higher cost of insuring older people and penalties for new employees with pre-existing conditions is a (hushed) factor that employers consider when looking at job candidates. After age 40, pre-existing conditions such as high blood pressure and high cholesterol, even if controlled by medications, drive up the price of health insurance premiums the same way speeding tickets drive up the price of your auto insurance - except health conditions never go off your health record.
Anyway, I didn’t have insurance for over two years. For adequate coverage, it would cost over $1000.00 a month just in premiums plus the deductibles and co-payments. Recently I acquired INADEQUATE coverage at about $200.00 a month. Basically it doesn’t start paying until I’ve incurred $3300.00 out of pocket. However, because of ACA provisions that have already taken effect, it does cover a yearly physical and flu shot. Also, I don’t think this is part of ACA,  but they include two office visits per year, however it only covers the charge for the examination - but doesn’t pay for any procedures or tests that might be needed.
But on to the upcoming phase/roll-out of ACA. Since I am a displaced/unemployed worker, I fall in the income bracket for Medicaid which is available in my state of California. But, quite frankly, I’d rather not go on Medicaid because of the difficulty to find doctors that accept Medicaid. And I’m afraid that the quality of healthcare through Medicaid is substandard.

So my situation and options:
1. Like the Uninsured Missouri Reporter, I’m not allowed to purchase health insurance in the marketplaces and do not qualify for the subsidies.
2. Although in my state I should be able to get Medicaid, it is nearly like not having any coverage at all. What good is having insurance if you can’t get an appointment to see a doctor?
3. Keep my current insurance with the $3300.00 deductible. With this option I’m certainly apt to let minor medical conditions go unattended or untreated or undetected which eventually could turn into major issues and death.

Considering my situation, I’ve decided that the ACA will not fix the healthcare problem in the USA….... FAIL

Barbara Ruether

Dec. 3, 2013, 8:59 p.m.

Would someone please tell me how Republican governors who failed to adopt Medicaid in their states sleep at night? Or are they totally oblivious of human beings in their states?

In this case, you can’t fault Governor Jay Nixon.  He supports expanding Medicaid. It was the Republican controlled legislature that said “NO”.  So, many people like this young woman will have no insurance and if she gets sick or has an accident, she will go to the emergency room where the cost will be astronomical and we ALL pay. I hear many young people say:  “I am young and healthy—I don’t need insurance”. Fine—until you break your leg ($20,000) have an emergency apendectomy ($30,000) and on and on.  We are all healthy until we are not.

Karen Graves: I totally agree with you about the young people that think they don’t need health insurance.  Not only do they take a chance of not getting decent care in case of an emergency, but as you point out it can be very costly. (break your leg ($20,000) have an emergency apendectomy ($30,000). Not only will the taxpayers eventually have to pay for their medical care, it will ruin their credit ratings which could have detrimental affects on their future. Their credit score not only could prohibit them from getting loans for education, cars, and housing, but can also exclude them from getting employment.

Larry: I’m not sure this will be helpful to you, but I want to clarify that though you unfortunately don’t make enough to take advantage of the subsidies, you CAN still buy in the exchange or the open market in your state.

While you likely won’t find a good plan for what you’re paying now ($200), thanks to the ACA you no longer have to worry about higher rates due to pre-existing conditions and all plans are required to provide certain benefits and protections. I’d recommend checking out to see if any of the available plans fit into your budget.

If not, don’t count out Medicaid. I’m not personally familiar with the program, but I do know their have been efforts underway by ACA opponents to demonize the plan as being no better than no insurance at all. It’s possible it’s better than you think.

Just wondering if a person in her situation would also be paying the “fine” the ACA makes people pay who can’t sign up?  She files her taxes for 2013 and pays $ penalty for this disaster

Exactly, Deb.  There’s a huge hole in this story and the comments suggesting that this is related to the ACA in some way other than refusal of the state to comply with it and the Supreme Court’s approval of that stance.

And I’d also like to take a step back and point out that the reason the ACA isn’t going to help (as far as I can tell) is that insurance doesn’t make people healthy.  Insurance takes more money than they pay out; it’s the entire business plan, whether they can drop you for a pre-existing condition or not.

The real problem is that medical care costs an obscene amount, largely because what amounts to the doctors’ union is also the licensing board and setter of rates via Medicare cost guidelines.  If you let a single, unaccountable organization set both the supply of care and the cost of care, what do we think is going to happen?  Larry and Karen show what does…

Health insurance reform is NOT health care reform.  If we truly want to reform health care, we would go with “Medicare for All” or single-payer.  It is always good to take the middleman out of the equation (insurance companies) but their lobby would overwhelm anything Obama could generate. 

I think more transparency vis a vis what the costs for procedures are would help. How much is the actual cost of a knee replacement in St. Joseph Missouri vs.  Kansas City Missouri vs.Columbia, Missouri?  Consumers dont’ care about the overall costs, only what they will be charged.  I know because I was one of those people. I didn’t have a clue what my new knee actually cost.  All I knew is what Medicare paid and what my supplemental insurance paid.  Those days are hopefully over.

I moved to Missouri about a year ago.  After living here a year, I know that stupidity lies deep, deep in the Missouri DNA.  There is no way to eradicate it.  Even Arkansas and Kentucky has made provisions for Medicaid in their state, but not Missouri.

sure sounds like a bunch of people looking for their “free” stuff.

Damn those Republicans for wanting us to take responsibility and stand on our own two feet and pay our own way!

I sure am not giving up my cellphone, car, flat screen TV , music, hot clothes and expensive makeup to pay for my own health insurance…. do you think I am crazy?

Many universities / colleges offer and/or require health insurance for their students. My daughter’s college offers it (for students not on their parents’ plan) for about $800 per month. Every student enrolled at her college is required to have insurance.

Perhaps this may be an option.

Why is she paid $10 an hour as a reporter? I know it’s public radio, but seriously? It may be marginally better than McDonalds, I guess…it is still offensively low.

The net effect of “Obamacare” (since he likes the name, I’m happy to stick him with it in perpetuity) will be to cause more uninsured, rather than fewer.  So far, the subsidized subscribers swamp, by a large margin, the number of people who have lost insurance and have yet to sign up for the junk that’s being offered…with, on average, higher copayment requirements and far-higher deductibles, than what they had.

When a fair-minded liberal like Kirsten Powers loses her insurance coverage, which was perfect for her needs, and has to pay in excess of 100+% more to find something ‘almost comparable’ and is angry that Obama refers to all the cancelled policies as ‘inferior’ and ‘shabby,’ we can assume that others are experiencing the same dismay, sticker-shock and, to be honest, fury at the deception that was fobbed off on us. 

EVERY single elected official who did not read the bill before signing it should be tossed out at the least.  As most of them are attorneys and would never let a client sign a contract unsigned, I’m perturbed, to say the least, that they Democratic ‘leadership’ was so amused that her sheep would sign an unread contract which destroyed so many Americans’ security.  A pox on all of them who didn’t care at all about the consequences of their cavalier dismissal of ‘of the people’ and ‘by the people’ yet alone ‘for the people’ whose tax dollars they treat like toilet tissue.


If you could do a little math-your “adequate” coverage plan cost you $1000 a month-your new “inadequate” plan costs $200 a month.  That is $800 a month savings, so over the course of a year, you save $9600-three times the $3300 deductible you have.  This is what is wrong with the system-ignorant people would rather have a higher fixed monthly cost and not incur any additional expenses thinking they went to the doctor for free, than actually keep more money in their pocket and take care of themselves and have the insurance for a backstop in case something bad happens.

Of course the $200.00 plan makes more sense financially and that is why I currently have it.  Besides, I currently have no income.
But it’s not that simple. The problem is that because I know that a visit to the doctor may cost me $500.00 due at the time of service, I am likely to not go to the doctor.
I face this dilemma right now. Because of my age and skin type and because my sister died from melanoma, I should see a dermatologist yearly. I had good insurance for many years and I know the dermatologist office visit normally cost $500.00.
So, do you understand how even though it makes more sense financially, its absolutely no good if I won’t go to the doctor because of the cost at the time of service.

Of course the real problem here is that the cost of going to the doctor is exorbitant and nobody should have to pay $1000.00 a month for health insurance.

Ralph Nader get it said in a recent short essay “21 Ways the Canadian Health Care System is Better than Obamacare”

I think Larry mentioned a typical decent health insurance policy was outright around $1000.00/month…Larry was being a tad conservative on that price, I checked on BlueCross some years ago…the quote was $1500.00/month and that was the least expensive policy quoted to me. (similar to an ACA copper level policy) 

Is it any wonder that the Walmarts, McDonalds, American Airlines, etc. has happily opted for the ‘part-time, no fringe benefit’ tact, and shall continue to take advantage/delay in the future employee benefit because it truly is about the bottom line from a business perspective under this long standing trickle-down Reaganomics environment. 

I would imagine that Harum Helmy’s radio station employer shall also continue in the Reaganomics reality and refuse to offer the employee anything that resembles a minimal $1500.00/month health insurance policy.

So then what can we say?  Was any of the practical public opinion considered (an actual vote) by lawmakers & law enforcement during the INTENTIONAL 2007- economic crash, of course not…instead we got Barney Franks’ loud mouth and a $700B bailout.  Was any of the practical public opinion considered (an actual vote) when Margaret Thatcher, Ronald Reagan, and supporting lawmakers shoved austere trick-down economic throughout the lands? Of course not! 

Was medicare-for-all taken off the table when Max Baucus & company was determined to stroke every insurance salesman by law in the country?  You know it was!  And once again the practical public had no opportunity to vote about it, rather it was shoved down your throat by lawmakers intent on pulverizing the citizenry.

so tame;)

So people working 70 hour weeks should pay for her insurance?  People who opted not to get a grad degree because they couldn’t afford it and work full-time should pay?  A single-mom working 2 jobs should pay?

>>>Karen you might be new to the USA, so I’ll just explain a long time fact of life around here.  The USA government & the riches gained thru the exploitation of the citizenry, the businesses, the ground, the oceans, & the air only name a few areas, have been well connected for hundreds of years, this fact has not changed. 

Either by looking the other way, or by tax, or treaty, or exemption, or extortion, or swindle, thru politics, or gifts, or military domination, subsidies, or credit, or penalty…by law this government in reality has obtained an overwhelming stream of riches that exceeds even the fictional national debts commonly posted.

And when was any of this national wealth returned to the citizens in the form of a royalty?  Where is my royalty check as a citizen of the USA of which the government deemed to own all the oil & gas resource that has easily produced for over a hundred years.  Or the royalty from the radio/TV/micro waves that the government deemed by law to own, or the royalty deemed by law for airport real estate, or the royalty from the criminal correctional system…that has the largest number of prisoners within it than any other place on earth.  Do you really believe AT&T when they claim all that ‘investment’ in cell towers was their own capital, not hardly, the USA government is the one that paid for all that infrastructure.  So where is that royalty check, or the royalty from ‘internet access’, for certain NOT in the hands of the citizenry.

But hey maybe it really costs $250,000/year/inmate to keep a thug behind bars and feed him toast & gravy…yanno if you believe those sort of things.  Maybe it really costs $1500.00/month for a decent medical insurance policy, and sad but true, not $1.00 of that insurance is taxed, much like New York or Chicago Stock Exchanges…there is no tax on trades, even if the stocks & commodity trades rip thru vast volumes daily, I never saw a royalty check from that sort of national wealth.  All those hydro electric dams, and nuclear power plants, coal mines so vast you cannot see the other side, nope not $1.00 royalty to the citizenry as the valuable resource is consumed by the multi-train loads.

Well what about when the government signed onto the NAFTA international treaty, years ago, & the hyperversion TPP treaty secretly,  soon to become ‘our new law’, the government says the citizenry doesn’t have a right to claim any of that resource value, and the intentional sell out of heavy industrial manufacturing thru these treaties…should have been worth something to someone, nearly anyone, except USA citizenry.

So where did the riches obtained by the government go?  The government certainly doesn’t hand out ‘citizen royalty checks’.  They were subtly stolen, and shall continue to be stolen from the single moms with 2 kids, and every other citizen that lives and works here. 

Welcome to USA, that is the reality, know this…it isn’t your less educated citizens that have somehow, in some twisted train of thought, decided & devised a way THEY can rip you or your government.  The main rip-off comes from the top down, that is Ronald Reagan & Margaret Thatcher 101.  This rip-off reoccurs often stated as such: “So people working 70 hour weeks should pay for her insurance?  People who opted not to get a grad degree because they couldn’t afford it and work full-time should pay?  A single-mom working 2 jobs should pay?”  These are the same loaded questions that were asked during the 1970’s, only at that time the citizenry was blaming Social Security recipients as ‘the terrible ones’ that were somehow hurting the country.  The truth is the government creates their own money, trillions of it every year, very little of this money is accounted from the tax payers to pay for anything.  Do you really think occupying a couple countries like Iraq/Afganistan for 10+ years is paid for by USA tax payers?  Was it worth it to you as a tax payer, the death, the theft, the ruination of two nations at a time, and where is that USA citizen royalty check from that action? 

The reality is the government insists on consuming as much wealth as possible and the management of intentional destruction of known wealth… is what it is, that is why the citizenry won’t be receiving any type of royalty check.

so tame;)

OWE-BAMA’S 315,000,000

Yet one more story about how to help one person’s individual status, hundreds of millions have to follow the theories of an inexperienced Harvard Law graduate.

Idiotic, ridiculous, and stupid.

You push people—they will push back. Hard.

I was married by the time I was 23. Would I have been eligible to “remain” on my parent’s health insurance?  How about my husband?  What if we’d had children? would they have been eligible for my parent’s insurance plan?  What if they could not afford family premiums any more than we could have?

And what about those 20-something “children” who are estranged from their parents?

D, stop criticizing’s obvious, huge, and predictable failures. That’s racist. /sarc

Hey right wingers and republican governess who are keeping the ACA out of your states…I have a letter for your constituents.  You guys have been lying to the American public about the ACA and you are screwing over the citizens of your states.  Now lying is nothing new to the GOP, their politicians and their right wing media complex.  I’m here to tell the world that this republican congress and their right wing propaganda / entertainment complex has been lying to all Americans while hiding behind a facade of false conservatism and pseudo Christianity every time they open their mouths about the ACA..

And what are these republican lies as they apply to the ACA???  Well…just about anything coming out of their corrupt mouths.  Obama care is not and never was a job killer.  Obama care is not and never was a government takeover of healthcare.  Obama care is not socialism or Marxism as it is still the same insurance market based model of coverage.

But one of the biggest right wing lies of all has been the cost impact to those of us who already have employer based insurance.  There is actually 2 right wing lies to expose on this particular point.

1)  Obama care does not cause anyone to lose their existing insurance policy.  The only thing that makes this happen is insurance companies because they always cancel everyone’s policies each year.  This is nothing new and anyone who has employer based insurance knows this all too well at the end of each of each year when their HR department presents everyone with whatever the employer was able to go out and get for them.  This happens every year regardless of President Obama or his policies.  The only thing that causes insurance companies to cancel policies is insurance companies as they always reformulate their offerings every year.

2)  Obama care does not drive up the cost of anyone’s insurance premiums.  This is a really big lie perpetuated by all republicans and tea billys in congress as well as the right wing entertainment complex.  Anyone who believes this lie has not done their homework and has not researched what is really available via the healthcare exchanges.

And now for the big dose of reality that right wingers do not want you to know regarding Obama Care….you can actually get far superior health insurance coverage through the health exchanges with lower premiums and lower deductibles.  For the better part of 30 years my wife and I have had employer based health insurance and we understand this game very well.  This year, we intentionally opted out of our employer based health insurance to see what is out there via the health exchanges.  In our case, we live in Arizona and I am so thrilled that our governor did not decide to screw over the citizen of the state by doing what corrupt governors of other states have done to their citizens by rejecting the ACA in their states.  You people really do not represent your citizens and you are just screwing them over for no good or justifiable reason.

In any case…here is what it all boils down to for me and my family as well as others who choose to go the route of the ACA Health Exchanges.  Far superior insurance coverage than anything we’ve ever had in the last 28 to 30 years with a smaller premium, smaller deductible and smaller co-pays.  This is possible do to the ACA because for the first time, insurance companies can now compete with each other for our business.

Yes….we got a top of the line “platinum” level plan that has far superior coverage to anything we’ve ever had in past years through our employers, with a cost savings of almost $400.00 per month for the premium, a radically smaller deductible and smaller co-pays.

And for the record…this is all happening without any government assistance or government subsidies.  Our household income disqualifies us from receiving government subsidies and we are reaping all these benefits and cost savings.

Now I realize that those who are given over to twisted skewed right wing ideologies that never cross paths with reality will choose not to believe my story and they will carry on in their bubble of non-reality.  You can’t fix stupid and those people will always vote against their own self interest each and every time they step into that voting booth.  They will always exist in an alternate universe and misrepresent reality and the facts on most subjects.

As for me, I’ll take reality on any given day and the reality here is a very good one for me and my family thanks to the ACA.  For those who prefer the truth and reality, you owe it to yourself to research your options via the Healthcare Exchanges.  For us, the enrollment process was not a train wreck as John Bohener lied about.  In retrospect, it was far simpler to enroll all members of my family this way then through all the ridiculous paperwork and forms we’ve had to wade through in past years.

Dear Den:

You lost those with working brains at “liar.”

OweBama’s (D) won the 2013 “Liar of the Year” award. Duh.

You can keep your ..

I don’t see why you people keep blaming governors or congress in Missouri. Over 70 percent of Missourians voted against Obama care in 2010, it was called prop C, every county in this state, except St Louis voted against your beloved obamacare. If you aren’t from this state and don’t vote here and have no idea what you’re talking about, please keep your comments to yourself. You are quick to ignore the facts and start blaming the GOP with rumors and being badly informed. Thus the politicians are acting in our favor. Missouri is currently in the process of repealing Obama care in our state and protecting the rights of the citizens from taxation from the IRS for not wanting health care. It is our rights as Americans to opt out if we so chose from having health care. If we get hurt and then become indebted for the next 20 years paying the hospital that is our right. I don’t have to have a driver license if I don’t want to. If I want to operate a car I need one. I don’t have to have Medicare or Medicaid. It was not shoved down our throats and demanded we have it or we would be fined. It is an option we have. It is our right to choose as we please. Not have unconstitutional laws shoved down our throats and fined for not complying. The only reason they want everyone to have Obama care is so all our money becomes a hand out so the illegals and irresponsible will be given free government assistance and therefore gain votes. They have racked up 14 trillion and counting in debt and can’t manage our budget yet you really think they’re going to be able to manage health care for over 300 million people? Distribution of the wealth by the government. What system of government does that sound like? It’s proven it doesn’t work. You really want every facet of your life determined by the government? Next it will be “for your safety turn in your guns” for your safety don’t be out after 9pm, don’t have more than two children, just follow the chain link fence into your new home, you’ll find the bunks comfy. Look what happened to other other countries who’s government had this much control. It never turns out good for the citizens. Just keep rolling over and having your rights eroded sheeple. Don’t be so naive to think… This is America that could never happen. Government is supposed to have limited control. You’ve traded in your liberty for temporary security. Soon it will all be ripped from you.

This article is part of an ongoing investigation:
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