I’ve abstained so far from blogging on the rate shock debate, mainly because I’ve nothing to add to what’s been written by more knowledgable folks. This will be the exception to that trend because it illustrates a point I originally made on Twitter: the people getting the rawest deal from the Affordable Care Act aren’t “Bros” (the young, wealthy and healthy, with no history of family illness), but low-income Americans residing in states refusing to expand Medicaid.
According to analysis of Census data by Adrianna McIntyre and Josh Fangmeier over at Project Millennial, the vast majority of childless adults aged 19-25 (and to a lesser, but still significant, extent 26-30) who are already in the individual marketplace make less than 138 percent of the Federal Poverty Line (FPL):
This is important information because 138 percent FPL is the new minimum eligibility for Medicaid under the ACA. These are people who, assuming they don’t qualify for the under-26 provision for staying on a parent’s policy, stand to benefit from a much cheaper deal with Medicaid if they live in a state that will participate in the expansion .
As McIntyre and Fangmeier go on to show, the current number of states that have either explicitly or implicitly rejected expanding Medicaid means that “thirty percent of those under 35 could qualify for Medicaid but won’t, because their states opted out.” Others can weep over the plight of bros (or not), but this is really is a BFD for the 30 percent getting the short-straw — or, really, no straw — because they also won’t be getting subsidies for the individual exchanges.
These are the folks who will most likely experience rate shock in a sense that is morally concerning; enough to risk an “ethics shock” in those states. So forgive me if I find the conservative indignation that a minority of affluent healthy males will have to pay more than teaser-rates on a website unpersuasive, given that little to no words have likewise been spent on the 3.6 million being left behind altogether.