October marks the first anniversary of sorts of the Affordable Care Act, as in this month last year Healthcare.gov started accepting* applications to receive health insurance beginning in January of this year. The second round of open enrollment begins on the 15th next month, but needless to say (at least for me, but maybe not for you) after one year the law is clearly working.
Yet let us also use this occasion to remember that for many people the law never began.
Specifically, let’s take note of the estimated six-plus million Americans who are left without coverage, according to a new analysis from the Urban Institute**, because they live in one of the 23 states that have so far refused to expand their Medicaid programs under the 2010 health care law. Most live on incomes below the federal poverty line ($19,790 for a family of three this year). Conversely, these folks earn too much income annually to qualify for coverage under existing Medicaid eligibility guidelines in their respective state, and yet too much for subsidy assistance on the federal marketplaces established by the ACA.
The absence of an expanded Medicaid program has consequences all the way down the societal food chain, from state and federal budgetary effects, regional mortality rates, to, well, Charlene Dill. She lived in my current state of Florida, which has the dubious honor of housing the second-largest coverage gap at 1,043,000 adults. (PDF):
As the Urban Institute table shows the median annual income for a Floridian in the Medicaid gap is $9,000, and the median monthly income is $750.00. This is so far below the state’s living wage that it’s not even a particularly useful comparison. A better juxtaposition would be to Florida’s pre-ACA Medicaid eligibility levels, which sets the monthly income ceiling at $295.00 for parents and $0.00 for “other adults.” Let that last sentence sink in a bit.
Done? Yeah, I just won’t get over the absurdly inhumane public policy circumstances in Texas, Florida, Georgia, etc for what should be a no-brainer expansion of health care coverage. So let’s remember this as we approach the mid-term elections. At least in Florida — past statements notwithstanding — it’s pretty clear which side is more in favor of doing the right thing by expanding Medicaid. If you only need one excuse to vote in the Sunshine State, I can give you at least one million forty-three reasons to do so.
* Yeah, yeah, I know. Insert enrollment joke here if you want.
** Big hat-tip to the venerable Harold Pollack for pointing out this new analysis and for mentioning Florida in-particular, which got me thinking about the tragic death of Charlene Dill and the stew-on-low news status of the Medicaid coverage gap.