The coverage gap in ‘ObamaCare’ is due to red state sabotage

Posted by AzBlueMeanie:

The red states continue to vote against their own economic best interests because of "freedom!" to be ignorant and poor.

Non Sequitur

The New York Times breaks down the coverage gap in "ObamaCare" due to red state governors and legislatures sabotaging coverage for their poor citizens (with an assist from the Roberts Supreme Court on making participation in expanded Medicaid optional). Millions of Poor Are Left Uncovered by Health Law:

A sweeping national effort to extend health coverage to millions of
Americans will leave out two-thirds of the poor blacks and single
mothers and more than half of the low-wage workers who do not have
insurance, the very kinds of people that the program was intended to
help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have
declined to participate in a vast expansion of Medicaid, the medical
insurance program for the poor, they are among the eight million
Americans who are impoverished, uninsured and ineligible for help.
The
federal government will pay for the expansion through 2016 and no less
than 90 percent of costs in later years.

Those excluded will be stranded without insurance, stuck between people
with slightly higher incomes who will qualify for federal subsidies on
the new health exchanges that went live this week, and those who are
poor enough to qualify for Medicaid in its current form, which has
income ceilings as low as $11 a day in some states.

Demographics-map

Interactive map Where Poor and Uninsured Americans Live

The 26 states that have rejected the Medicaid expansion are
home to about half of the country’s population, but about 68 percent of
poor, uninsured blacks and single mothers. About 60 percent of the
country’s uninsured working poor are in those states. Among those
excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’
aides.

The irony is that these states that are rejecting Medicaid expansion —
many of them Southern — are the very places where the concentration of
poverty and lack of health insurance are the most acute
,” said Dr. H.
Jack Geiger, a founder of the community health center model. “It is
their populations that have the highest burden of illness and costs to
the entire health care system
.”

The disproportionate impact on poor blacks introduces the prickly issue
of race into the already politically charged atmosphere around the
health care law. Race was rarely, if ever, mentioned in the state-level
debates about the Medicaid expansion. But the issue courses just below
the surface, civil rights leaders say, pointing to the pattern of
exclusion.

Every state in the Deep South, with the exception of Arkansas, has rejected the expansion.
Opponents of the expansion say they are against it on exclusively
economic grounds, and that the demographics of the South — with its
large share of poor blacks — make it easy to say race is an issue when
it is not.

In Mississippi, Republican leaders note that a large share of people in
the state are on Medicaid already, and that, with an expansion, about a
third of the state would have been insured through the program. Even
supporters of the health law say that eventually covering 10 percent of
that cost would have been onerous for a predominantly rural state with a
modest tax base.

“Any additional cost in Medicaid is going to be too much,” said State
Senator Chris McDaniel, a Republican, who opposes expansion.

* * *

[T]he Supreme Court’s ruling on the health care law last year, while
upholding it, allowed states to choose whether to expand Medicaid. Those
that opted not to leave about eight million uninsured people who live
in poverty ($19,530 for a family of three) without any assistance at
all.

Poor people excluded from the Medicaid expansion will not be subject to
fines for lacking coverage. In all, about 14 million eligible Americans
are uninsured and living in poverty, the Times analysis found.

The federal government provided the tally
of how many states were not expanding Medicaid for the first time on
Tuesday. It included states like New Hampshire, Ohio, Pennsylvania and
Tennessee that might still decide to expand Medicaid before coverage
takes effect in January. If those states go forward, the number would
change, but the trends that emerged in the analysis would be similar.

* * *

The states that did not expand Medicaid have less generous safety nets:
For adults with children, the median income limit for Medicaid is just
under half of the federal poverty level — or about $5,600 a year for an
individual — while in states that are expanding, it is above the poverty
line, or about $12,200, according to the Kaiser Family Foundation. There is little or no coverage of childless adults in the states not expanding, Kaiser said.

The New York Times analysis excluded immigrants in the country illegally
and those foreign-born residents who would not be eligible for benefits
under Medicaid expansion. It included people who are uninsured even
though they qualify for Medicaid in its current form.

* * *

About half of poor and uninsured Hispanics live in states that are
expanding Medicaid. But Texas, which has a large Hispanic population,
rejected the expansion.

The New York Times followed up wsith an editorial opinion today, A Population Betrayed:

It is outrageous that millions of the poorest people in the country will
be denied health insurance because of decisions made mostly by
Republican governors and legislators
. These people will neither qualify
for their state’s Medicaid program for the poor nor for subsidized
coverage on new insurance exchanges that are being established in every
state by the health care reform law.

Their plight is a result of the Supreme Court’s decision last year that
struck down the reform law’s mandatory expansion of Medicaid and made
expansion optional
. Every state in the Deep South except Arkansas has
rejected expansion, as have Republican-led states elsewhere. These 26
states would rather turn down incredibly generous federal funds that
would finance 100 percent of the expansion costs for three years and at
least 90 percent thereafter than offer a helping hand to their most
vulnerable residents.

* * *

The reform law originally sought to help poor
and middle-income people through two parallel mechanisms. One was a
mandatory expansion of Medicaid (which in most states cover primarily
children and their parents with incomes well below the poverty level) to
cover childless adults and to help people with income levels above the
poverty line. Those with slightly higher incomes would be eligible for
federal subsidies to buy private policies on the new insurance
exchanges.

That approach fell apart when 26 states decided not to expand Medicaid,
at least for now. There is no provision in the law to provide health
insurance subsidies for anyone below the poverty line because those
people are supposed to be covered by Medicaid.

The Times report, based on an analysis of census data, found that eight
million Americans who are impoverished and uninsured will be ineligible
for help of either kind. To add to the insanity, people whose incomes
initially qualify them for subsidies on the exchanges could — if their
income fell because they lost a job — end up with no coverage at all.

There are no easy solutions to the difficulties wrought by the Supreme
Court decision and the callousness of state officials who seized on that
opening to victimize the poor.

States like New Hampshire, Ohio, Pennsylvania and Tennessee that are
still flirting with the idea of expansion should do the right thing and
expand. States that have adamantly refused to expand should relent and
take the generous federal funds. And if Congressional Republicans ever
give up on their obsession to destroy the health reform law, Congress
could surely find ways to make certain that the people most in need of
help get it.

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