CREDIT: AP Images
In the states refusing to accept Obamacare’s Medicaid expansion, approximately 42 percent of the Americans living below the Federal Poverty Line (FPL) — i.e., people making less than $11,170 per year — won’t be able to take advantage of any of the health law’s new coverage options for the poor, according to a new study by the Commonwealth Fund.
The health law originally had two avenues to ensure that poor Americans can afford health coverage. It required every state to expand Medicaid coverage to all Americans making up to 133 percent FPL, or slightly under $15,000 per year for an individual. And it offered government subsidies to people making up to 399 percent FPL to help them buy insurance in Obamacare’s statewide insurance marketplaces. The law didn’t extend any government subsidies to the poorest Americans living below the poverty level, reasoning that these people would be eligible for an expanded Medicaid pool and therefore wouldn’t need them.
But the Supreme Court ruled the Medicaid expansion optional last summer, leaving it up to the states to decide whether or not to participate in it. That means if poor Americans live in states that refuse to expand Medicaid, they won’t be able to take advantage of the expanded public program or receive subsidies to buy insurance on the Obamacare marketplace.
Most GOP-led states home to lawmakers hostile to health reform have refused to go along with the optional expansion, despite the fact that the federal government will pay for the vast majority of it. Numerous studies have shown that states that don’t expand Medicaid are losing out on billions of dollars in federal funding and denying health benefits to about two-thirds of the poor Americans who were originally expected to gain Medicaid coverage under the law. Nonetheless, 21 states have explicitly refused to expand their programs while five still remain undecided:
CREDIT: The Commonwealth Fund
The expansion map highlights the reality that many of the states forgoing Medicaid expansion have some of the highest rates of uninsurance and poverty in the country. Texas, Louisiana, Florida, South Carolina, Mississippi, and Georgia are all among the top ten most uninsured states in America. In addition, Oklahoma, Wyoming, Idaho, North Carolina, and Alaska have uninsurance rates higher than the U.S. national average of 21 percent. About one in five Americans residing in these states are living in poverty.
While the Commonwealth study authors note that some states are likely to eventually give in and accept the Medicaid expansion, they suggest congressional action to assist those who fall into the unintended coverage gap in the meantime. “Congress could step in and provide a solution by passing legislation that would amend the law to make all adults with incomes below 100 percent of poverty, who are not eligible for Medicaid, eligible for subsidized private plans offered through the marketplaces. This would ensure that all Americans have access to the law’s sweeping new reforms when they take effect in January,” the researchers wrote.