WASHINGTON (AP) — Nearly 2 in 3 uninsured low-income people who would qualify for subsidized coverage under the Patient Protection and Affordable Care Act (PPACA) may be out of luck next year because their states have not expanded Medicaid.
An Associated Press analysis of figures from the Urban Institute finds a big coverage gap developing, with 9.7 million out of 15 million potentially eligible adults living in states that are refusing PPACA Medicaid expansion money or are still undecided.
A year ago, the Supreme Court blocked the Obama administration from cutting existing Medicaid funding streams for states that opted out of the new PPACA Medicaid expansion program.
Meanwhile, many Republican state lawmakers are continuing to resist any state efforts to cooperate with any type of PPACA implementation, including PPACA Medicaid expansion implementation.
Expanding Medicaid is essential to the Obama administration's two-part strategy for covering the uninsured.
Starting next year, middle-class people without job-based coverage will be able to get tax credits to help them buy private insurance. But PPACA calls for low-income people to enroll in Medicaid, expanded to accommodate a largely excluded group: adults with no children at home.
Expanded Medicaid would cover about half the 25 million to 30 million people who could be helped by the law.
Twenty-three states and the District of Columbia have decided to accept the expansion, which is fully financed by Washington for the first three years and phases down gradually to a 90 percent federal share.
Among those are six states led by Republican governors. But the majority of low-income Americans newly eligible for Medicaid under the law live in states such as Texas, Florida and Georgia, where political opposition remains formidable.
"Because of the Supreme Court's decision making Medicaid expansion optional with the states, we're going to see some pretty significant differences in this country from one place to another in terms of access to health care and access to health insurance," said Gary Cohen, the Health and Human Services official overseeing the rollout of the law.
Republican state lawmakers continue to oppose the expansion for several reasons. Many believe Medicaid has too many problems already. Others worry that Washington will renege on financing, and some believe health care is an individual responsibility, not a government obligation.
"It's an ideological principle piece to us on the conservative side," David Gowan, Arizona's Republican House majority leader said recently. "We don't believe in the expansion of Medicaid itself. … We don't believe it's the government's duty to do that." Gov. Jan Brewer, also a Republican, succeeded in getting the Arizona Medicaid expansion through the Legislature but now faces the possibility of a referendum to block the law.
Health policy expert Gail Wilensky says she did not expect so many states to turn down the Medicaid expansion. While critical of some main features of the Affordable Care Act, Wilensky believes it's important for the country to get uninsured people covered.
