Saturday, February 15, 2014


Approximately 5.8 mln of the poorest Americans who would have been eligible for Medicaid had their states expanded the program under the Affordable Care Act will either go uninsured or be forced to find other, more expensive means of health coverage, according to a detailed new county-by-county analysis by the Urban Institute.

Sy Mukherjee notes at (2/11) that 25 states and the District of Columbia have committed to accepting generous federal funds to raise Medicaid eligibility to all Americans earning up to 138% of the Federal Poverty Level (FPL). Had every state expanded Medicaid — as the law originally intended — the Urban Institute estimates that 10.3 mln poor and uninsured adults would be newly eligible for the program.

Instead, just 4.4 mln uninsured low-income adults will become eligible in the pro-expansion states, while 5.8 mln will be shut out of Medicaid in the other half of the country — including more than 1 mln in Texas, where a quarter of workers are uninsured. And since the ACA did not expect states to refuse Medicaid expansion, it did not provide insurance subsidies for people earning poverty wages. So 27% of uninsured adults in states refusing Medicaid expansion would have been eligible for coverage had their states accepted it, and nearly 5 mln of these Americans are expected to fall into a coverage gap where they make too little money to qualify for the health law’s private insurance subsidies but too much to qualify for their state’s existing Medicaid program.

Opposition to the Medicaid expansion also disproportionately impacts poor people of color. An analysis by the Kaiser Family Foundation (KFF) found that approximately 60% of uninsured black Americans, 51% of uninsured Hispanics, and 53% of uninsured people of color generally have incomes below the Medicaid expansion threshold. In fact, the White House sent out a fact sheet to reporters (2/11) claiming that more than 95% of eligible uninsured Latinos would qualify for “Obamacare” subsidies or Medicaid coverage if every state agreed to expand Medicaid.

Consequently, existing health disparities among these groups in these states — which already struggle with public health issues such as obesity and diabetes — are expected to get even worse.

States that have expanded Medicaid have seen robust enrollment to date. For instance, West Virginia has already cut its uninsured population by a third thanks to the expansion. A recent study by Avalere Health concluded that between 1.1 and 1.8 mln of Americans who enrolled in Medicaid between October and December of last year became newly eligible under expansion. If the Urban Institute’s and Avalere’s figures are correct, than somewhere between 25% and 41% of the newly eligible working poor have already enrolled in government health plans.

But Medicaid expansion is still on precarious footing in red states. Arkansas Republicans, who struck a historic agreement with Democratic Gov. Mike Beebe and the Obama administration to implement an alternative, private plan version of the Medicaid expansion, have reversed course and are now considering nixing the hugely popular program. More than 80,000 low-income Arkansans would be kicked off their health plans if the GOP successfully repeals the so-called “private option.”

One of those residents would be 40-year-old Anita Geiger, a receptionist who works 15 hours a week at a school for disabled children. Geiger had a physical for the first time in five years after enrolling in a private option plan — particularly fortuitous because she found out she suffers from hypertension, which puts her at risk for a stroke, and can now afford medication for her condition. When the New York Times asked her how she feels about the prospect of being kicked off her plan by conservative lawmakers, she tearfully replied, “Have them walk in my shoes. I’m working, I’m going to school, I’m trying to better myself, and this is a help.”

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