Republican governors refusing generous federal funding to expand Medicaid under Obamacare will leave over five million low-income Americans without basic health benefits, according to a new study by the Kaiser Family Foundation (KFF).
Since the Supreme Court ruled Obamacare’s Medicaid expansion to be optional last summer, just 25 states and the District of Columbia have proceeded to implement expansion. Another 22 states have refused, while a handful still remain undecided. Unfortunately, poor Americans living in states that aren’t expanding Medicaid likely won’t be able to afford health insurance at all.
Current Medicaid eligibility rules vary by state, and most set an extremely high standard for Americans who want to enroll in the program — reserving it for low-income children, their parents, the elderly, and the disabled. Poor working adults who don’t have children don’t qualify for Medicaid in many states, no matter how little money they make. Furthermore, because Obamacare originally intended every state to expand Medicaid, there aren’t any subsidies available for very poor Americans to buy private insurance through statewide marketplaces. That federal assistance is only available to Americans earning between 100 percent and 399 percent of the Federal Poverty Level (FPL).
Therefore, without the expansion, a sizable portion of the working poor will simply be out of luck when it comes to their health coverage. Since they’ll make too much money to qualify for their state’s Medicaid program, but too little to qualify for federal subsidies, they will fall into a coverage gap:
“In states that expand their Medicaid programs, millions of adults will gain Medicaid coverage under the law. However, with many states opting not to implement the Medicaid expansion, millions of adults will remain outside the reach of the ACA and continue to have limited, if any, option for health coverage,” write the study authors. KFF researchers note that this coverage gap will leave many of the poorest without health insurance, since many states refusing Medicaid expansion have high levels of poverty and uninsurance, as well as severe poverty thresholds for Medicaid eligibility.
All told, KFF estimates that 5.2 million Americans will fall into the coverage gap caused by GOP opposition to Medicaid expansion. Over a third of Americans who won’t qualify for Medicaid or get Obamacare subsidies live in Florida and Texas — two high-population states led by governors adamantly opposed to the Affordable Care Act.
Other studies have also highlighted the disparities that poor Americans who live in anti-expansion states will be burdened with. For instance, the Urban Institute and Robert Wood Johnson Foundation (RWJF) found that without Medicaid expansion, just “36 percent of the uninsured in Mississippi would be eligible for assistance,” whereas 80 percent of uninsured Mississippi residents would get assistance under Medicaid expansion.