Falling Through the Medicaid Expansion Gap

Red States' Refusal Of Medicaid Expansion Coverage Leaves Millions Hanging By A Thread

A Mississippi woman is about to uncover a major flaw in the new Affordable Care Act (ACA) due to red states refusing the Medicaid expansion for the lowest income Americans. On a Sunday afternoon, Laura (not her real name) sits down to try out the new ACA web portal. After some earlier attempts at accessing the website were unsuccessful, she is able to create a profile and fill out her application. Laura is 37, single and has no children. She has a degree but is currently unemployed.

She has not had health insurance coverage since the age she was forced off her parents’ coverage at 21. She is hoping the ACA will finally provide her with the healthcare she has been without for over 16 years.

Reaching the question which asks, “Are you disabled?” she hesitates. Clicking through to find out what the ACA considers disabled, she reads that difficulty walking or inability to climb stairs is one of the criteria. She hesitantly clicks “Yes” in answer to that question, unsure if she is making a mistake or not. She has never been classified as disabled by a physician, but a fall down a flight of steps has left her with back, knee, ankle and feet problems.

Moving through the questionnaire on the ACA website, she is given a link to the results of her application. Because she is unemployed, says the report, she should be able to be covered by her state’s Medicaid expansion. Unfortunately for her, she lives in a red state where Republican governor Phil Bryant has refused to participate in the Medicaid expansion. She learns that unlike people who are employed, she will not receive any assistance to pay for a health care plan, because that assistance comes in the form of a subsidy via tax credit.

Laura is not alone. As of September, 31 states will not enroll the poorest of the poor onto their state Medicaid rolls. Millions of people will fall into this gap meant to be covered by Medicaid under the ACA expansion. The area showing the southern Republican led states refusing the expansion cuts across the map like a swath of blood. The fault lies with the Supreme Court’s decision to allow states to opt out of the Medicaid expansion.

The Federal Government would cover the total costs of the expansion for the first two years of the Act, and then still subsidize the states thereafter. The Republicans claim too much state cost prevents them from expanding. Red state obstructionism is going to continue to leave millions uninsured and afraid.

The only concession Laura will get is an exemption from the tax penalty for not having coverage due to her income. “I had really hoped I would finally be able to get health insurance. The last time I purchased a policy, briefly, they denied all my claims as preexisting conditions.” Fortunately for others, the new ACA prevents denying coverage for preexisting conditions.

“I have some serious conditions that need monthly blood-work,” she says. “I haven’t been treated for my thyroid disease since I was diagnosed by my college’s student health clinic. To see this program fail, the ACA, which was supposed to help people like me, I’m so disappointed.”

She has long been used to the idea of not going to see a doctor. When she gets sick, she says, “I start taking Vitamin C and go to bed.” She recently had trouble with her last employer, because after having pneumonia for weeks, “They didn’t want me to come back to work without a doctor’s excuse covering the whole time I was ill. I had to pay out of pocket to see a doctor only to find out they would not give me the excuse I needed. I feel like I can’t win. I just hoped that I wouldn’t have to face another problem like the doctor’s excuse. They require you to have one, but if you can’t afford to go, you risk losing your job.”

With a condition like thyroid disease, she is at a higher risk for heart disease, diabetes, and stroke. “I don’t know what I will do if something really serious happens to me. I have this thyroid condition and had nodules on my glands. I have a cyst on my ovary the size of a golf ball that could rupture at any time. If I have a stroke or a heart attack, I don’t know what I will do. I guess just die.” She ad libs Alan Grayson: “It’s like that guy from Florida said, ‘The Republican plan is for you to die quickly’ (sic). I know that Phil Bryant and those other Republicans couldn’t care less about me.”

Laura has to wait to see if the combination of her injuries and chronic conditions will be enough to meet the criteria for Mississippi’s Health Benefits, the state’s Medicaid system. Her application was forwarded automatically to them when applying on the healthcare.gov website. In the meantime, she continues to look for jobs, hoping that one or the other will come through for her.

Republicans are committing political suicide. Millions of uninsured voters could mean serious trouble for future Republican campaigns. Uninsured Republicans may sit up and take notice that they too are suffering because of the party’s obstructionism and take their votes elsewhere.

It seems the Supreme Court’s decision to allow states to opt out has the potential for disastrous consequences for those who needed this program the most. Hopefully we might see a challenge to this decision, or Republican led states may see the backlash of their decisions to opt out come back to bite them soon.