Five million left in Medicaid gap by Obamacare, state actions

Posted Tuesday, Dec. 31, 2013  comments  Print Reprints

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Starting today, about 5 million people will be without healthcare coverage that they could have had if they lived somewhere else in America.

They represent a coverage gap in President Barack Obama’s signature healthcare law created by the domino effects of last year’s Supreme Court ruling and subsequent policy decisions in many states including Texas.

The court effectively left it up to states to decide whether to expand Medicaid, the federal-state program for the poor and disabled, to more people, primarily poor working adults without children.

Twenty-five states declined, leaving 4.8 million people in those states without the healthcare coverage that their peers elsewhere are getting through the expansion of Medicaid, according to a Kaiser Family Foundation estimate. More than one-fifth of them live in Texas alone, Kaiser’s analysis found. And ironically, they make too little to qualify for federal health insurance subsidies under the federal Affordable Care Act, which requires that they have insurance.

Texas Gov. Rick Perry isn’t about to change his position on the matter, spokeswoman Lucy Nashed said this week.

“It would be reckless and irresponsible to pump more people and billions more taxpayer dollars into a program President Obama himself has said is broken,’’ Nashed said.

What’s more, she said, Medicaid expansion would only reduce Texas’ uninsured rate by 3 percent while sucking more dollars from the state budget.

“The governor would prefer to see more flexibility from the federal government to implement meaningful reforms to the program, Nashed said.

A few economic studies have touted the benefits of expanding Medicaid in Texas, however.

If Texas were to participate, the Fort Worth-Arlington area would receive a $22 billion boost in business activity over the next 10 years, according to a February 2013 study by The Perryman Group in Waco.

The move would also free up private funds and reduce uncompensated care of local safety-net hospitals, Perryman said.

The economists also said that it would be good news for worker productivity.

“When individuals lack health insurance and their access to care is constrained, empirical evidence indicates they have worse healthcare outcomes and, hence, reduced labor force participation, higher absenteeism and lower productivity,” Perryman said.

It’s estimated that at least 1 million Texas residents will fall into the Medicaid gap, according to Stacey Pogue, senior policy analyst at the Center for Public Policy Priorities, an Austin-based organization that supports expanded public medical coverage.

Others, however, including Kathleen Sebelius, secretary of the Health and Human Services Department, has put the number of Texans who might be affected even higher, at 1.5 million to 2 million.

Across the U.S., among those affected is Cheryl Jones, a 61-year-old part-time home-care worker from Erie, Pa., who makes do without health insurance by splitting her blood-pressure pills, which she gets from a friend, in half. She has put off a visit to the dentist to fix her broken partial dentures, and is waiting to get a new pair of glasses, too.

“There are a lot of us who need medical help now,” she said. “I need new glasses, I need to go to a dentist, I need my medicine. … Think about us working poor. We pay our taxes.”

The Medicaid expansion was supposed to work hand-in-hand with tax credits subsidizing private insurance for people with slightly higher incomes, two keys to the law’s broader aim of extending health insurance to 30 million more people. As an enticement for states to expand Medicaid, the federal government promises to pay nearly all of the cost.

But in states that didn’t expand Medicaid, the law is unable to help people who are below the income threshold where tax credits start kicking in, about $11,500 for working adults.

Today, 24 states and Washington, D.C., will extend Medicaid to more than 4 million adults who would otherwise fall into the same gap as Jones. Access to the care they'll get is similar to what people get with private insurance, said Joan Alker, executive director of Georgetown University’s Center for Children and Families.

A 25th state, Michigan, plans to expand in April. Wisconsin effectively eliminated its own gap without using the more generous federal contribution.

Staff writer Yamil Berard contributed to this report, which includes material from the Star-Telegram archives.

Yamil Berard, 817-390-7705 Twitter: @yberard

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