The Cruelty of Republican States in One Chart [View all]

[ProSense]

The Cruelty of Republican States in One Chart

Paul Waldman

The states rejecting the expansion of Medicaid are the ones that already make it the hardest for poor people to get insured.

Many people are talking today about this article in today's New York Times, which focuses on the particularly cruel doughnut hole created when the Supreme Court allowed states to opt out of the expansion of Medicaid in the Affordable Care Act. The problem is that if you live in a (mostly Southern) state run by Republicans, you have to be desperately poor to qualify for Medicaid under existing rules. But it isn't until you get to 133 percent of the poverty level ($31,321 in yearly income for a family of four) that you're eligible for subsidies to buy insurance on the exchanges, because when the law was written the idea was that everyone under that income would get Medicaid. When all those Southern states decided to refuse the Medicaid expansion in order to shake their fist at Barack Obama, they screwed over their own poor citizens. So millions of people will be caught in the middle: not poor enough to get Medicaid, but too poor to get subsidies on the exchanges. But when we say "not poor enough," what we're talking about is people who are, in fact, extremely poor. And you'll be shocked to learn that in those states, the poor are disproportionately black. Could that have anything to do with it? Heavens, no!

In any case, I thought it might be worthwhile to lay out in one handy chart how, state by state, this will affect people. Under pre-ACA law, each state sets its own eligibility level for Medicaid. In more liberal states, these levels are fairly high; for instance, Massachusetts gives Medicaid to families up to 133 percent of poverty, New York up to 150 percent, and Minnesota up to 215 percent. But in conservative states, the levels are far stingier; as someone in the Times article says, "You got to be almost dead before you can get Medicaid in Mississippi." In addition, in most states childless adults can't get Medicaid no matter how poor they are, but under the ACA it will no longer matter whether you have children. This is just one more way conservative states that forego the Medicaid expansion (for which the federal government is picking up almost the entire tab, by the way) are harming their own citizens...That means that the states where the Medicaid expansion would have done the most good for the most people are precisely those states where Republican governors and legislatures have told their poor citizens that they're out of luck.



When you look at these income eligibility levels, you see just how cruel the existing system is. For instance, in Alabama, you can't get Medicaid if your income exceeds 23 percent of the poverty level, or $4,500 for a family of three. Just think about that for a second. Do you think you could find a place to live, pay your bills, and feed your family on that income? But the state of Alabama says if you're that rich, you can afford to buy health insurance. In Texas, the state that will be depriving the most people of insurance by rejecting the expansion, only families under 25 percent of the poverty level, or $4,894 for a family of three, will be eligible for Medicaid. I'm guessing that's about what Rick Perry spends on boots every year.

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http://prospect.org/article/cruelty-republican-states-one-chart

Medicaid expansion was to level the playing field in every state for every low-income American. See the charts in the following piece.

Medicaid Eligibility for Adults as of January 1, 2014

As enacted, the Affordable Care Act (ACA) would expand Medicaid to adults with incomes at or below 138% of the federal poverty level (FPL) ($15,856 for an individual as of 2013) starting January 1, 2014, nationwide.1 This expansion would significantly increase eligibility for parents in many states and end the historic exclusion of adults without dependent children, referred to as childless adults, from Medicaid. In addition, starting January 2014, the ACA establishes new streamlined eligibility and enrollment processes for Medicaid, which include determining income eligibility for most groups based on Modified Adjusted Gross Income (MAGI). The move to MAGI will largely align Medicaid income eligibility determinations with the standards used to determine eligibility for federal subsidies to help pay for coverage through the new Marketplaces.

While the Medicaid expansion was intended to occur nationwide, the Supreme Court ruling on the ACA effectively made it a state option. As of September 2013, 25 states, including DC are moving forward with the expansion and 26 states are not currently moving forward. There is no deadline for states to decide to expand. Regardless of state Medicaid expansion decisions, all states must implement the new eligibility and enrollment processes, including the transition to MAGI income determinations. As part of the transition to MAGI, states’ existing Medicaid income limits for children, pregnant women, parents, and childless adults will be converted to MAGI-equivalent limits.2 Tables 1 and 2 show Medicaid income limits for parents and childless adults as of January 2013, and the new income limits that will be in effect as of January 1, 2014.

In states that expand Medicaid, many low-income parents and other adults will become newly eligible for coverage. Overall, the median eligibility limit for parents in the 25 states moving forward with the Medicaid expansion will rise from 106% FPL to 138% FPL for parents and from 0% to 138% FPL for childless adults3 (Figure 1). However, the scope of changes for these groups varies widely across the states. Overall, eligibility levels will increase for parents in 18 states and for childless adults in 23 states. The remaining states in this group had already expanded Medicaid to higher incomes. These states will either maintain higher eligiblity levels or reduce eligibility to 138% FPL. In states reducing Medicaid eligibility, those losing Medicaid coverage would have incomes that would qualify for federal subsidies to help pay for Marketplace coverage.

In states that do not expand Medicaid, significant coverage gaps will remain for many poor adults. In the 26 states not currently moving forward with the Medicaid expansion, adults between the January 2014 Medicaid eligibility limits and 100% FPL will not gain a coverage option. These adults will not be eligible for Medicaid or the federal subsidies to help pay for Marketplace coverage. As of January 2014, 22 states will have Medicaid eligibility levels for parents below 100% FPL (Figure 2). Childless adults in these states will generally remain ineligible for Medicaid coverage regardless of how low their income levels are.4

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http://kaiserfamilyfoundation.files.wordpress.com/2013/10/8497-medicaid-eligibility-for-adults-as-of-jan-1-20144.pdf

List of states and Governors who refused to expand Medicaid (updated)
http://www.democraticunderground.com/10023789546