Today the NYT reported on the millions of impoverished Americans who will suffer because they live in states that refused Obamacare’s Medicaid expansion:
Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states.
Paul Waldman created a chart (above) that shows state-by-state Medicaid eligibly:
The bars in red are the states that have rejected the Medicaid expansion, and as you can see, almost all of them are clustered at the lowest end of the eligibility spectrum. That means that the states where the Medicaid expansion would have done the most good for the most people are precisely those states where Republican governors and legislatures have told their poor citizens that they’re out of luck.
Yglesias blames this state of affairs on Supreme Court Justice John Roberts:
A couple of the states that don’t expand Medicaid in 2013 will, I think, change their minds fairly soon. Perhaps right after the 2014 midterms. And in a place like Texas that’s superconservative but much too large for Democrats to ignore, the expansion issue will give the party a shot in the arm and a good issue to talk about. Expansion won’t win right away, but it should win soon enough. But Mississippi? Alabama? There are going to be pockets of the country where poor people continue to lack insurance for quite a long time, all thanks to Roberts and the stubborn intransigence of conservative politicians.
Drum thinks this unfair to Roberts, noting that the “vote against the Medicaid provision was 7-2”:
The basic holding was simple: given our federalist structure, states can’t be forced to help fund new federal programs like Obamacare’s Medicaid expansion. They have to be given a genuine choice. If rejecting the program merely means losing the benefits even though your state’s income tax dollars are helping to fund it, that’s a tough choice, but still a real one. Conversely, if you’re threatened with losing not just the funds for the expansion, but your entire existing Medicaid program, it’s not a real choice at all. Nobody could even dream of doing that. In practical terms, you’re being forced to accept the expansion and you’re being forced to pay for it with state dollars.
The Dish 