States That Need Medicaid Expansion the Most Are Turning It Down

Last week, we referenced an article in the Los Angeles Times detailing how states’ decisions on Medicaid expansion will impact the nations’ health gap.  Over the weekend, The New York Times published a front-page story on the same issue, paying particular attention to the Obama administration’s plans to educate people about the new Medicaid.

As reporter Robert Pear points out, many of the poorest people will not be eligible for the new insurance options.

But those options will be unavailable to some of the neediest people in states like Texas, Florida, Kansas, Alabama, Louisiana, Mississippi and Georgia, which are refusing to expand Medicaid.

More than half of all people without health insurance live in states that are not planning to expand Medicaid.

People in those states who have incomes from the poverty level up to four times that amount ($11,490 to $45,960 a year for an individual) can get federal tax credits to subsidize the purchase of private health insurance. But many people below the poverty line will be unable to get tax credits, Medicaid or other help with health insurance.

Many of the states that have opted out of the expansion are led by Republican governors, although there are a handful of GOP chief executives who have fought to accept the program. Some won the fight, some lost and at least one is still waging a battle against her own party. Arizona Gov. Jan Brewer has vowed not to sign a budget bill unless it includes the Medicaid expansion.

But back to the Times article.  Pear runs through a number of examples in Louisiana, Mississippi, Georgia and Texas where low-income families will not qualify for insurance or subsidies to buy insurance. Because many of those with lower incomes are also among the less educated, there is going to be confusion about what programs are available. To solve that piece of the problem, the administration is urging anyone who does not have health insurance to register at, which will sort through state and federal options for each person.

Come Jan. 1, everyone is to have health insurance. But that seems less and less likely to happen, and we will likely see another shift in advocacy efforts. First we saw the fight over the Affordable Care Act, followed by debates over implementation and Medicaid expansion. Next will be efforts to help those who still need more assistance.