Shocker: 26 States Refusing to Expand Medicaid Will Leave Nearly Eight Million of America's Poorest Uninsured

The New York Times reported today that even as Obamacare rolls out, nearly eight million poor Americans will be left without health coverage, thanks in large part to the fact that 26 Republican-controlled states have refused to expand Medicaid coverage. Not surprisingly, two thirds of those affected by the political intransigence are poor black Americans and single mothers—the very people that the program was crafted to aide. Says the Times


The law was written to require all Americans to have health coverage. For lower and middle-income earners, there are subsidies on the new health exchanges to help them afford insurance. An expanded Medicaid program was intended to cover the poorest. In all, about 30 million uninsured Americans were to have become eligible for financial help.

But the 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.

According to the Times, the issue stems from a gap that is being created by the state Republicans who refuse to participate in the Medicaid expansion. The gap is made up largely by people whose incomes are slightly too high to qualify for federal subsidies on the new health exchanges that went live earlier this week, despite Republican attempts to block it, and those who don't quite qualify for Medicaid as it exists now, which has "income ceilings as low as $11 a day in some states." So, shockingly, some people are discovering that they are too poor to be eligible for coverage.

The Times reports:

"The 26 states that have rejected the Medicaid expansionare 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 issue of race, and the fact that many of the states declining Medicaid expansion are southern, is an inevitable component of the story. 

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 South of the country, with the exception (most surprisingly) of Arkansas, has entirely rejected the expansion. And many are claiming that in a time of major outrage over a still-struggling economy, as well as a country defined by rapidly changing demographics, the inability for new Medicaid expansion to flourish is preventing the system's genuine overhaul. 

For the full story over at the New York Times, click here.

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