Millions left uninsured in GOP-controlled states that haven’t expanded Medicaid

By Travis Gettys
Thursday, October 3, 2013 10:46 EDT
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A single mom and her son. Photo: Shutterstock, all rights reserved.
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Although they’re unlikely to win the legislative fight to kill the Affordable Care Act, Republicans have already succeeded in keeping millions of Americans from getting health insurance.

A New York Times analysis of census data found that two-thirds of the poor black people and single mothers and more than half the low-wage workers who don’t have insurance coverage have been left out of the vast expansion of Medicaid because they live in states controlled by Republicans.

The federal government is paying for the expansion of the medical insurance program for poor Americans through 2016 and will pay at least 90 percent of the states’ costs in subsequent years.

But 26 states have opted out of the expansion, including every state in the Deep South except Arkansas.

About half the U.S. population lives in those states, but they’re home to nearly 70 percent of poor, uninsured blacks and single mothers, and about 60 percent of the uninsured working poor live in those 26 states.

Those hundreds of thousands of cashiers, cooks and nurses’ aides, among others, are stuck between those Americans with slightly higher incomes who qualify for federal subsidies on the new health exchanges and those who are poor enough to qualify for Medicaid in its present form.

The Affordable Care Act requires all Americans to purchase health care insurance, and federal subsidies were enacted to help those on the lower portion or middle area of the income scale.

The Medicaid expansion was intended to cover the poorest Americans, particularly the working poor.

The Supreme Court upheld the law, which is opposed by Republicans despite its similarity to a plan devised by the conservative Heritage Foundation, but the court’s ruling allowed individual states to opt out of the Medicaid expansion.

After slightly more than half the states declined to extend the program, that left about 8 million uninsured people who make less than $19,530 a year for a family of three without any assistance.

Poor people excluded from Medicaid’s expansion won’t be subject to mandated fines because they lack coverage, but the newspaper found that about 14 million eligible Americans are uninsured and living in poverty.

Some states, such as New Hampshire, Ohio, Pennsylvania and Tennessee, may expand Medicaid before coverage takes effect in January, but that still leaves millions without coverage – many of whom live in the poorest states, including Mississippi.

Those states also tend to have less generous safety nets, the newspaper found, and they tend to be disproportionately black.

In Mississippi, 56 percent of the state’s poor and uninsured adults are black, although they make up just 38 percent of the population.

About half the country’s poor and uninsured Hispanics live in states that are expanding Medicaid.

[A single mom and her son. Photo: Shutterstock, all rights reserved.]

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