When the Supreme Court gutted the Affordable Care Act last year by making the Medicaid expansion optional for states, advocates immediately feared that this would exclude some of the poorest and most disadvantaged people from access to care, particularly women and people of color. A New York Times analysis has now confirmed this: about half of all states are opting out of the Medicaid expansion, and these are precisely the states in which an expansion is most needed.
These states have extremely limited Medicaid eligibility, exclude childless adults and have high rates of uninsured people. Not coincidentally, these are also the states—including almost the entire South—with the highest levels of poverty, lowest wages, and skeletal public services. In these states, the ACA leaves a gaping hole: a total of 8 million people—not counting undocumented immigrants—will be excluded both from Medicaid and from public subsidies in the exchanges. At the same time, the ACA will reduce support for public and charity hospitals based on a projected decrease in the number of uninsured people. A minimum of 8 million people will thus quite literally have nowhere to go to get the care they need. According to the Times, this includes about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.
This exclusion from health care has a disproportionate impact on African Americans due to the high rate of poverty among black communities as well as the notorious lack of support for public programs that are seen to benefit African Americans—both stemming from our history of oppression and structural racism. This is one of the most disturbing consequences of the fragmented, tiered health care system that the Affordable Care Act leaves in place.
The New York Times reports:
Millions of Poor Are Left Uncovered by Health Law
By Sabrina Tavernise and Robert Gebeloff
October 2, 2013
A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.
Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.
Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states.
Copyright © 2013, New York Times