The Affordable Care Act will expand health care coverage to millions of Americans. Among other key provisions, it ends discrimination against those with pre-existing conditions, allows young adults to stay on their parents’ plans until age 26, provides subsidies to make coverage more affordable, and expands Medicaid to low-income people who cannot afford insurance.
In ruling on Obamacare’s constitutionality, however, the Supreme Court created a potential coverage gap affecting low-wage workers and other poor adults, who may be left out of the Affordable Care Act’s promise.
While the Supreme Court declared Obamacare constitutional, one part of the ruling struck down the health care law’s penalty for states that choose not to participate in the law’s Medicaid expansion. In short, while the federal government can offer states the “carrot” of increased Medicaid funding to expand coverage to low-income populations, it cannot use the “stick” of taking away existing Medicaid dollars from states that do not want to comply. States can choose whether or not to extend health coverage to low-income people.
Seven Republican governors have already announced their intention to reject the Medicaid expansion, which, if implemented, would give more than 4 million people in those states access to affordable health coverage. Workers below the poverty line in those states, however, are in a double bind: They can’t access coverage through the Medicaid expansion but are ineligible for Obamacare subsidies to help people above the poverty line afford health coverage. This creates a coverage gap for low-wage workers.
To see how this coverage gap would play out, let’s examine the hypothetical situation of a low-wage worker named Jan and her neighbor John, who live in one of these seven states where Republican governors say they will reject the Medicaid expansion.
Prior to Obamacare, John was uninsured, as annual premiums for someone
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