Nearly 5 million people who were supposed to be covered by the provisions of Obamacare which expanded Medicaid, are not going to get that coverage. They are the poorest among us and they all live in states with a GOP governor and/or legislature.
When the law was written, it was intended to cover those with the lowest incomes through the expansion of Medicaid. However, the Supreme Court ruled, at the same time that it ruled the law Constitutional, that states could opt-out of that Medicaid expansion if they so chose. Twenty five states chose that option, refusing to accept the expansion plan even though the federal government would pick up the entire cost of that expansion for the first three years and then continue to cover 90% of the increased cost thereafter.
Ohio was the last state to agree to expand Medicaid late last month, and New Hampshire governor Maggie Hassan (D) has called a special session of the legislature to run from the 7th to the 21st of this month in hopes of passing approval for expansion there. It is likely that with Terry McAuliffe winning the governor’s race in Virginia this week that expansion will be reconsidered there as well.
In Pennsylvania, governor Tom Corbett has proposed a modified expansion plan which will require approval from the federal government but would, if approved, cover more of those currently left out in the cold.
If these three states do eventually opt in, it will mean an additional 498,320 people covered by Medicaid which still leaves more than 4.25 million without coverage.
This is a serious problem, the people who will be left out in these states are the poorest of the poor. The law was intended to cover them with the expansion of Medicaid, and without that expansion these people will not qualify for a subsidy to purchase insurance through the exchanges — nor will they be eligible for Medicaid, meaning that they will still have no health insurance.
Many of them are ineligible for Medicaid under the current rules because they are childless adults who many states do not extend Medicaid coverage to. The expansion was designed to cover this gap, but with the Supreme Court ruling, other language in the law eliminates them from eligibility for the subsidies.
As with many of the problems that are being experienced in the roll out of the final phases of the law, this one is caused by the intransigence of the GOP which then comes back to say, ‘I told you so — it would never work.’
h/t: Talking Points Memo
Click on the image below to view a map of the state-by-state Medicaid expansion decisions.