Nearly three weeks into the opening of the Health Insurance Marketplaces, many people trying to understand their options for health insurance have experienced glitches in online access. However, once they do manage to get a peek at options and costs, many are still finding their options to be unaffordable and others are not even bothering to enroll, having already decided that any amount is too much.

As we know, the term “affordable” is relative.  Two people with the same income can still have very different financial situations, so what is affordable to one may not be to the other. As a result, some people may choose to remain uninsured, but if they make that choice, they may have to pay a penalty when they file their taxes.  Penalties for not having insurance in 2014 will be 1% of income.  However, before deciding that insurance is unaffordable, people need to consider the high expenses they can incur for just one unexpected trip to the hospital or from an unexpected diagnosis with a chronic illness.  It may just be worth taking another look at the family budget to see if there is room for health insurance.

Others that are likely to remain uninsured are those with incomes below the poverty level or people who are in a state where Medicaid has not expanded. These individuals are among those that likely need health care the most and yet, they are likely to remain uninsured because they will not be eligible to receive tax credits or subsidies to help offset the insurance premium and out-of-pocket expenses. 

Originally, the law required all 50 states to expand Medicaid to people making 133% below the federal poverty level.  But the Supreme Court last year ruled that this provision is unconstitutional and states were left with the option to expand or not.  While subsidies are available to those at the poverty level so they can purchase private coverage in states that do not expand Medicaid, the law does not provide subsidies to those below the poverty level. This is because at the time the law was passed, it was presumed all states would be required to participate in the expanded Medicaid eligibility. Twenty five states have moved forward with expanding, while others have refused to expand or remain undecided.  As a result, health insurance remains out of reach for people in the states that are not expanding Medicaid.

In an effort to expand access to healthcare services for the uninsured, the law did increase funding for federally qualified community health centers. The President also recently provided additional funds to support these centers and establish grants for new centers.  These centers are located in areas where there is a high need for primary care.  They offer comprehensive primary health care and social support services and often provide free or low cost care to those with the lowest incomes. However, few provide specialty care for those with serious health problems.   

If you are uninsured or do not have coverage through your employer, visit the health insurance marketplace at www.healthcare.gov to find out which health plans are available to you and how much you will have to pay. If you discover you still will not be able to afford health insurance, visit a community health center near you to get important low-cost primary and preventive care.