The Affordable Care Act mandated that people earnings over 133% of the poverty level ($23,550 for a family of four) must sign up for health insurance and provided financial subsidies in order to make that insurance more affordable. To require families earning below that level to purchase insurance would probably have required the cost of insurance to be completely subsidized. In order to provide free health insurance to those too poor to afford private insurance, the Affordable Care Act proposed increasing Medicaid’s income cut to from the Federal poverty line to 138% thereof.
However, in June 2012, the Supreme Court ruled that the Federal Government could not require states to expand Medicaid eligibility. The Affordable Care Act requires the Federal Government to cover all of the cost of Medicaid expansion through 2017. Starting then the Federal Government covers 95% of the cost and the states cover 5% until 2020, when the states are asked to cover 10% of the cost. In the meantime, there is no cost to the states, yet many states with Republican governors and/or legislatures have refused to expand medicaid.
This leaves eight million Americans in Health insurance limbo. They are “too poor” to qualify for health insurance market place subsidies, and they are “too rich” to qualify for Medicaid. This leaves them without any affordable options for health insurance.
Even worse, a new study found that in states with no expanded medicaid, those who earn 138% of the poverty line or less suffer more often with high blood pressure, heart problems, cancer, stroke and emphysema.
Since this costs the states nothing to provide this coverage over the next 3 years, the only possible reason to refuse this grant is political. The Red States are worried that people will appreciate the benefits of this coverage, reward the Democrats that provided it, and demand that the coverage be continued past 2017 when the states will be asked to make a small contribution to the cost.
This is a very cynical view of politics. Politicians should be looking out for the interest of the country, not of themselves nor their party. Instead these “leaders” who rejected medicaid expansion are putting the lives of their citizens at risk to score political points.
A group of researchers from the Harvard Medical School published a peer-reviewed study in Health Affairs concluding:
Nationwide, 47,950,687 people were uninsured in 2012; the number of uninsured is expected to decrease by about 16 million after implementation of the ACA, leaving 32,202,633 uninsured. Nearly 8 million of these remaining uninsured would have gotten coverage had their state opted in. States opting in to Medicaid expansion will experience a decrease of 48.9 percent in their uninsured population versus an 18.1 percent decrease in opt-out states…
We estimate the number of deaths attributable to the lack of Medicaid expansion in opt-out states at between 7,115 and 17,104. Medicaid expansion in opt-out states would have resulted in 712,037 fewer persons screening positive for depression and 240,700 fewer individuals suffering catastrophic medical expenditures. Medicaid expansion in these states would have resulted in 422,553 more diabetics receiving medication for their illness, 195,492 more mammograms among women age 50-64 years and 443,677 more pap smears among women age 21-64. Expansion would have resulted in an additional 658,888 women in need of mammograms gaining insurance, as well as 3.1 million women who should receive regular pap smears.
Do not despair though, not all Republicans value obstructionism over life. Ohio Governor John Kasich (R) explained why he expanded Medicaid to include 300,000 Ohioans:
When you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small, but he’s going to ask you what you did for the poor. You’d better have a good answer.
Cartoon courtesy of Mike Stanfill.