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“The Scourge Of The Wingnut Hole”: Coverage Totals Would Be Far Greater If Not For “Red” States Refusing Medicaid Expansion

We have a reasonably good sense of how many Americans have enrolled in the health care system in recent months, signing up for coverage made available through the Affordable Care Act. For a more ambitious tally, Josh Marshall includes exchanges, Medicaid, young adults staying on their family plans, and those who were able to bypass exchanges to buy ACA-compliant policies directly from insurance carriers, for a grand total of about 10 million.

But every time these numbers are culled, it’s worth remembering that the coverage totals would be far greater were it not for “red” states refusing to accept Medicaid expansion.

The original plan, you’ll recall, was to simply mandate the greater access. The U.S. Supreme Court, however, said states must have a choice as to whether or not to accept the good deal. Most Republican-led states, naturally, rejected the policy, leaving millions behind for no particular reason.

But how many million? The Associated Press published a report this week with a striking figure.

About 5 million people will be without health care next year that they would have gotten simply if they lived somewhere else in America.

They make up a coverage gap in President Barack Obama’s signature health care law created by the domino effects of last year’s Supreme Court ruling and states’ subsequent policy decisions.

This coverage gap clearly needs a name. Ed Kilgore started calling it the “wingnut hole” months ago, and it’s certainly a descriptive phrase. Ryan Cooper added the other day:

It’s worth remembering that the federal government will pay 100 percent of the cost of the Medicaid expansion through 2016 and 90 percent of the cost afterward. It could very well work out that refusenik states will not even save money because of additional spending on the uninsured in emergency rooms and elsewhere.

But regardless of the pitiful sums involved, make no mistake: This action is utterly gratuitous.

Quite right. In fact, as we’ve discussed many times, Republicans at the state level who refuse Medicaid expansion generally struggle to explain their position in any kind of coherent way.

What’s more, let’s not forget the irony of the larger context: congressional Republicans spent most of their waking hours complaining about a sliver of the population receiving “cancellation notices” through the Affordable Care Act because of changes to the individual market. Indeed, GOP officials routinely claim this will leave 5 million Americans behind with nothing (a total that appears to have been exaggerated by a factor of 500).

And yet, if their concern were genuine, wouldn’t Republicans necessarily be outraged by these 5 million Americans who are suffering because some red-state policymakers are acting out of petty partisan spite?


By: Steve Benen, The Maddow Blog, January 3, 2014

January 5, 2014 Posted by | Affordable Care Act, Medicaid Expansion | , , , , , , | Leave a comment

“Republicans Could Care Less”: Millions More Denied Coverage By GOP Refusal To Expand Medicaid Than Obamacare Cancelations

For weeks as foundered, Republicans focused on President Barack Obama’s claim that “if you like your plan, you can keep it,” which was dubbed PolitiFact‘s Lie of the Year. Republicans purposely neglected to differentiate between the number of Americans whose plans were being canceled and those whose entire coverage was lost.

Now it turns out that the millions of notices that were sent out will result in just thousands of Americans losing access to affordable insurance.

A new report, however, from the minority staff of the House Committee on Energy and Commerce shows that only 0.2 percent of the approximately five million cancelations – the number often referenced by the Republican Party – will lose coverage because of Obamacare, and be unable to regain it.

In other words, only 10,000 people will lose complete coverage.

The report assumes that 4.7 million people will receive cancelation letters about their current plans. It then finds that half of that number will have the option to renew their 2013 plans, due to an administrative fix to the health law. Of the remaining 2.35 million Americans, 1.4 million would be eligible for tax credits through the ACA exchanges or Medicaid coverage, and out of the 950,000 individuals left, according to the report, “fewer than 10,000” people would lack access to an “affordable catastrophic plan.”

As the Washington Post notes, “there’s no doubt that for those 10,000 people, the health care law left them worse off than before.” Still, that number is significantly less than the amount of people who did not have access to any coverage prior to Obamacare.

“This new report shows that people will get the health insurance coverage they need, contrary to the dire predictions of Republicans,” says Democratic representative Henry Waxman (CA). “Millions of American families are already benefitting from the law.”

Ironically, as Republicans fret over the approximate 10,000 people who will lose coverage in 2014, they are to blame for the nearly five million Americans who will not have any health insurance this year because of the GOP’s refusal to expand Medicaid in various states across the country.

Though the Affordable Care Act provides complete funding through 2016 for Medicaid expansion in all states – and 90 percent funding in the following years – 25 Republican-controlled states have still refused to expand the program that offers coverage to the poor.

As a result, approximately 4.8 million people will find themselves inside the so-called “coverage gap,” which one report suggests could cost 27,000 Americans their lives in 2014.


By: Elissa Gomez, The National Memo, January 1, 2014

January 2, 2014 Posted by | Affordable Care Act, GOP | , , , , , , , | Leave a comment

“A Closer Look At Those Falling Into The Wingnut Hole”: Nearly 80% Of People In The Health Care Coverage Gap Reside In The South

Yesterday the Kaiser Family Foundation released some badly needed data on the characteristics of Americans who fall into what I’ve dubbed the “wingnut hole,” and that others just call the Coverage Gap. These are the people too poor to qualify for Obamacare subsidies for purchasing insurance in the exchanges, but too “rich” to qualify for the Medicaid benefits the drafters of the ACA assumed they would get but that their state governments blocked once the Supreme Court let them make the choice. Here’s the Kaiser Family Foundation’s take on the problem:

Medicaid eligibility for adults in states not expanding their programs is quite limited—the median income limit for parents in 2014 will be 47% of poverty, or an annual income of about $9,200 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible. Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults will fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits…. Nationwide, nearly five million poor uninsured adults are in this situation.

Who are they? Well, they’re mostly southerners:

The nearly five million poor uninsured adults who will fall into the “coverage gap” are spread across the states not expanding their Medicaid programs but are concentrated in states with the largest uninsured populations…. More than a fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Sixteen percent live in Florida, eight percent in Georgia, seven percent live in North Carolina, and six percent live in Pennsylvania. There are no uninsured adults in the coverage gap in Wisconsin because the state will provide Medicaid eligibility to adults up to the poverty level in 2014.

The geographic distribution of the population in the coverage gap reflects both population distribution and regional variation in state take-up of the ACA Medicaid expansion. As a whole, more people—and in particular more poor uninsured adults— reside in the South than in other regions. Further, the South has higher uninsured rates and more limited Medicaid eligibility than other regions. Southern states also have disproportionately opted not to expand their programs, and 11 of the 25 states not expanding Medicaid are in the South. These factors combined mean nearly 80% of people in the coverage gap reside in the South

They’re also hard to define by race or ethnicity:

The characteristics of the population that falls into the coverage gap largely mirror those of poor uninsured adults. For example, because racial/ethnic minorities are more likely than White non-Hispanics to lack insurance coverage and are more likely to live in families with low incomes, they are disproportionately represented among poor uninsured adults and among people in the coverage gap. Nationally, about half (47%) of uninsured adults in the coverage gap are White non-Hispanics, 21% are Hispanic, and 27% are Black (Figure 3).

And they’re often the people left behind in wave after wave of incremental reforms based on expanding Medicaid and S-CHIP benefits to kids and their parents.

The characteristics of people in the coverage gap also reflect Medicaid program rules in states not expanding their programs. Because non-disabled adults without dependent children are ineligible for Medicaid coverage in most states not expanding Medicaid, regardless of their income, adults without dependent children account for a disproportionate share of people in the coverage gap (76%)…. Still, nearly a quarter (24%) of people in the coverage gap are poor parents whose income places them above Medicaid eligibility levels. The parent status of people in the coverage gap varies by state….due to variation in current state eligibility.

What doesn’t vary state by state is how outrageous it is to exclude the people who by the accident of a court decision fall into the “wingnut gap” of benefits available to people just above them on the income scale. They are for the most part the “working poor,” people with part-time or small-business jobs that don’t come with private health insurance.

They are ineligible for publicly-financed coverage in their state, most do not have access to employer-based coverage through a job, and all have limited income available to purchase coverage on their own.

You can argue that these people are those most in need of the Affordable Care Act, yet most likely to be excluded from its benefits.

These are also people with an unusually large personal stake in the outcome of the 2014 elections–the kind of people conservatives are thinking of when they conclude Obamacare has created a “tipping point” wherein actual or potential beneficiaries of government programs are essentially being bribed into voting Democratic. But if there’s been any growing groundswell of political mobilization of people in the “wingnut hole,” it has been very quiet. So they will likely become objects of anti-redistribution propaganda from the Right without becoming subjects of any major Democratic comeback.

The latest hope for people in the “wingnut hole” has been enthusiasm for securing Medicaid expansion by very broad waivers allowing states to work their will on the Medicaid program as a whole. To be very blunt about it, such “deals” have tended towards broadening the base of people eligible for Medicaid while degrading its benefits, with the federal government paying almost all the cost of implementation and sharing the political risk that it might fail. The situation is a reminder that about a hundred fifty years after the end of the Civil War, southern states are still fighting the “Reconstruction” potential of federal funds to interfere with the region’s grim perpetuation of inequality.


By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 18, 2013

December 19, 2013 Posted by | Affordable Care Act, Health Care | , , , , , , , | Leave a comment


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