Do Some Conservative States Hate the Poor?

by Madeleine Kando

Last week, I was all excited when the Supreme Court ruled that the Affordable Care Act's Individual Mandate does not violate the U.S. Constitution. But the High Court also found that Congress cannot penalize states that refuse to go along with the law's plan to expand Medicaid to cover adults up to 133 percent of the poverty level.

By that ruling the Supreme Court pulled the rug out from under the most vulnerable part of the population, the poor. Had it been left the way it was intended, they would have benefitted from the Health Care Reform Act the most.

The fact that the Individual Mandate is left intact means that the burden of the cost is shared by everyone, including healthy people, so that sick people don't pay exorbitant premiums. That's good. But we are only talking about that portion of the population that can afford 'private health insurance', whether it be through an employer or the individual himself. If someone's premium in that category exceeds a certain percentage of their income, they get government assistance.

The problem is with the rest of the population, Americans who are too poor to buy health
insurance of any kind. Medicaid is currently available to a portion of this group, i.e. children, pregnant women, the disabled and the elderly, but there are approximately seventeen million Americans who do not qualify for Medicaid because they don't have children and they are not old or disabled. They are just dirt poor. This group doesn't even qualify for Federal assistance for private health insurance because they don't make enough money! It's a bit of an ass-backwards situation. The Feds give assistance to the Middle Class, but the poor get screwed.

The idea of the Medicaid Expansion Program was to remedy that very unjust situation. It would have covered everyone that is too poor to buy health insurance by offering them to participate in Medicaid.

The Medicaid Program is Federally funded but implemented by each state. The expansion would get funded at a 100% for the first 3 years and 90% thereafter. In order to implement this rule, the government wanted to have the option of withdraw existing Medicaid funding to states that would not go along with the Expanded Medicaid Program, a kind of benevolent dictatorship act.

The Supreme Court ruled that it was unconstitutional to take away existing Medicaid funding if the states don't accept the Medicaid Expansion Programs. And many states don't want to, because they say that even the 10% that they will have to pay down the line (3 years from now) is still too much for their (currently) failing budget, a myopic view since you cannot predict what a budget will look like three years down the line. That means that17 million people who were supposed to be covered by the new Medicaid Expansion Act are now at the mercy of each state's whim. Ironically it is the states with the highest poverty rates that refuse to participate (e.g. Mississippi). Their Medicaid Program covers the bare minimum, so they would benefit the most from this new Act. But they don't see it that way. They don't want to be told what to do, even if it means getting lots of cash.

The core of the Affordable Care Act has always been to cover the majority of the population, and the court has just made it optional. Even though many people predict that most states WILL participate, there is no guarantee. Of the 30 million people that the ACA tries to insure, more than half are supposed to be covered by this Medicaid Expansion Program. If some of the States don't go along with this plan, the Government's hands are tied.

Source: Expanding Medicaid under Health Reform: A Look at Adults at or below 133% of Poverty

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