Earning Too Much for Medicaid But Not Enough for Health Exchange Subsidies

A story on the homepage of the Times this morning is looking at how millions of poor people will be unable to afford insurance in states that have declined to participate in the expansion of Medicaid under the Affordable Care Act:

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.

The demographics of poor people in the Southern states means that blacks will be disproportionately affected — “6 out of 10 blacks live in the states not expanding Medicaid” according to the Times, which, unintentional or not, makes race a part of the issue: “Dr. Aaron Shirley, a physician who has worked for better health care for blacks in Mississippi, said that the history of segregation and violence against blacks still informs the way people see one another, particularly in the South, making some whites reluctant to support programs that they believe benefit blacks.”

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