Politics Leaves Millions Uninsured & Ineligible for Affordable Care Act Benefits

By Chris Hoenig

States and the Medicaid Expansion

Insurance exchanges set up by the Affordable Care Act are open, and Blacks and Latinos are expected to make up the majority of new enrollees in the healthcare marketplace. But governors in nearly half the states in the country have been able to exclude their residents from parts of the law, leaving millions—mainly low-income Blacks and single mothers—with no way to find health coverage.

And as if that wasn’t hard enough, many of them will face fines because of the healthcare law.

As part of the Affordable Care Act, all Americans are required to have health insurance or face fines. To do that, subsidies are made available for middle- and low-income individuals and families. For those with the lowest incomes, an expansion of Medicaid provides coverage. The federal government covers the full cost of the expansion through 2016 and no less than 90 percent of the cost after that. The program is designed to insure about 14 million Americans who are eligible, uninsured and living in poverty.

But as part of the Supreme Court decision that upheld the law, states were given the ability to opt out of the Medicaid expansion. In all, 26 states—nearly every one with a Republican governor—have opted not to take part in the expansion. While home to only about half of the country’s population, these 26 states, largely located in the South and Midwest, are home to 60 percent of the country’s working poor and about 68 percent of the low-income, uninsured Blacks and single mothers that the Medicaid expansion was meant to help cover.

That leaves about 8 million Americans who make too little to qualify for subsidies to offset the cost of private insurance, but make too much to qualify for Medicaid under the current guidelines.

In Mississippi, 56 percent of all poor and uninsured adults are Black, even though Blacks make up only 38 percent of the state’s total population. Home to the largest percentage of poor and uninsured people in the country, Mississippi residents can have a maximum income of about $3,000 per year to qualify for Medicaid without the expansion.

“You got to be almost dead before you can get Medicaid in Mississippi,” Willie Charles Carter told The New York Times. Unable to qualify for insurance because Mississippi is one of the states that rejected the Medicaid expansion, Carter is also faced with the closing of his local clinic next month due to lack of funding. “I’m scared all the time,” he said. “I just walk around here with faith in God to take care of me.”

Carter’s income is below the Medicaid threshold, but because he has no children, he doesn’t qualify without an expansion of the program. “If you look at the history of Mississippi, politicians have used race to oppose minimum wage, Head Start, all these social programs,” Dr. Aaron Shirley, a physician in Mississippi, said. “It’s a tactic that appeals to people who would rather suffer themselves than see a Black person benefit.”

And to make the suffering worse for these still-uninsured Americans, they will be subject to fines under the Affordable Care Act for not having insurance.

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