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A Population Betrayed
by THE EDITORIAL
BOARD
Oct. 3, 2013
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.
As Sabrina Tavernise and
Robert Gebeloff reported in The Times on Thursday, two-thirds of the country’s
poor, uninsured blacks and single mothers and more than half of the uninsured
low-wage workers live in those states. 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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