Without those tax credits, most people living below the poverty line can't afford coverage. In Florida, generally only children, pregnant women, the disabled and single parents or caretakers of underage children are eligible for Medicaid, the government's free health plan for the poor.
"It's the hardest thing to explain to a consumer that they're falling in this gap," said Juanita Mainster, a Miami counselor who helps consumers sign up for health insurance.
She and other counselors estimate only 30 percent of applicants at their Miami office end up signing up for a health plan because they can't afford it.
Christina Coello, a 27-year-old full-time law student with a pre-existing medical condition, hasn't had insurance for seven years.
"So when I heard about Obamacare, I thought this is a really good thing for people that have pre-existing conditions."
But when Coella tried to enroll, she learned she was about $2,500 shy of qualifying for a tax credit, making the premiums impossible to afford on her part-time paralegal salary. Yet, her meager salary is still a bit too much to qualify for Medicaid.
"It's very frustrating because (the Florida House) doesn't want to cover people who are supposedly lazy. It's not only lazy people who need insurance. A lot of students fall into that category," said Coello, who has a 7-year-old son.
Health advocates are doing what they can so consumers don't leave appointments feeling hopeless. Florida CHAIN and navigator groups like the Epilepsy Foundation of Florida, which received a federal grant to sign people up for health coverage, are referring consumers to local health departments and community health centers that treat patients on a sliding scale and offer discounted drug programs.
"They'll keep saying, 'I'm poor. I should qualify for something.' And they're right they should but the fact is this is a state that chose not to expand Medicaid," said counselor Adrian Madriz.
CHAIN and Florida Legal Services are handing out educational material at community centers, colleges and libraries so consumers can share their frustrations with lawmakers. The League of Women Voters of Florida has also launched a campaign to educate business leaders, and cultivate allies among local Chambers of Commerce, trying to convince them that Medicaid expansion is an economic stimulus opportunity for the state.
Vice President Joe Biden made a push for Medicaid expansion in South Florida this month on his way to a fundraiser. He stopped at S&S Diner in Coral Gables where he met with a group of local women who have benefited from the Affordable Care Act. He noted that Florida has led the way with enrollment in the federal exchange with nearly 300,000 signing up, but added those figures could have been higher if Gov. Rick Scott had accepted the Medicaid dollars.
"He can join us if he wants," Biden said.
Medicaid expansion may be a dead deal before the legislative session even begins in a few months. Scott said he supported the expansion, but never made it a priority and nothing has signaled that's changed. Republican House Speaker Will Weatherford has been adamant about turning down any proposal that relies on federal dollars. In a recent editorial, Weatherford showed no sign of changing, calling the decision not to expand a flawed Medicaid program "a common-sense, quality solution to address our health care challenges."
Lucy Driver, 57, doesn't have a computer so she recently went to her church to get in-person help signing up for health insurance. But Driver, who was laid off from her job as a day care worker, learned that she also falls into the gap. Her premium would cost more than $380 a month because she falls below the poverty line, meaning she doesn't qualify for a tax credit.
"I thought that's what (the Affordable Care Act) is for — the poor people. But we can't even afford that," said Driver, a diabetic, who needs nearly $100 a month in insulin, needles and other medication. Sometimes she has to skip her insulin shots or borrow medication from a friend because she can't afford them. Driver, whose four adopted teenagers are all on Medicaid, gets a roughly $1,000 monthly adoption stipend — a bit too much to qualify for Medicaid.
Florida lawmakers will need to act fast if they hope to take advantage of the federal government's offer to pick up the tab. Full funding for the Medicaid expansion population up to 138 percent of the poverty level is available for only three calendar years: 2014, 2015, 2016. That means a state that expanded Medicaid this year will get three years of full federal funding, but a state that expands Medicaid in January of 2015 will get only two years of full federal funding
The federal match starts phasing down to 95 percent in 2017. Health and Human Services Secretary Kathleen Sebelius has said she has no authority to change the statute.
