States block health insurance for millions of poor


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The New York Times reported that, thanks to the Supreme Court’s Medicaid loophole and the actions of the governments of 26 mostly Southern states, millions of poor people will be excluded from Obamacare.  The article said:

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help.  The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

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.


The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers.  About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.


Barry Ritholtz on The Big Picture provided this map showing the overlap between those who want to block health insurance for poor people and those who want to shut down the government.


Double click to enlarge

Click on Millions of Poor Are Left Uncovered by Health Law for the full New York Times article.

Sabrina Tarvernise and Robert Gebeloff did a fine job of reporting, but, as Barry Ritholtz wrote, the headline on the article should have read: Millions of Poor Are Left Uninsured by their State Legislatures and Governors.  Click on Where the Uninsured Are to read his post on The Big Picture.

I don’t claim to read minds, but I suspect that a lot of the objection to Obamacare is objection to poor people, especially poor black people, receiving medical care paid for by taxes on middle-class and rich people.  I remember reading about the history of the New Deal and how, in order to enact Social Security and the labor laws, it was necessary to write them so that most African-Americans were excluded from their benefits.

Many white Americans think that government policy is tilted in favor of black people, and sometimes it is, but it is more often the case that they get the dirty end of the stick.

Click on A Rising Tide Lifts All Yachts and Obamacare and the Conscience of a Radical for thoughts of Ta-Nehisi Coates of The Atlantic about black people being left behind in Obamacare.

Click on The Uninsured Are Spread Throughout the Red States, Too for more background from Ronald Brownstein for the National Journal.  [added 10/5/13]

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4 Responses to “States block health insurance for millions of poor”

  1. Atticus Says:

    What exactly are politicians in these states doing to “block health insurance”? Is it the combination of “declined to participate in a vast expansion of Medicaid” and opting out of state exchanges for Obamacare? (I’m not sure if I’m right, but that’s what I’ve gathered from reading the two articles)

    If that is the case I wonder how these states can afford to pay for such an expansion, even if they wanted too, especially considering: “The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor”.

    If those states half an unequal proportion of the countries poor they probably have smaller tax base, more expenditure on existing social programs, and thus less money to expand benefits – and those expansions of benefits would cost them more because more people will use them than in other states.

    I don’t know the solution and I do think we should help the poor, but I’m not sure how. It seems like the best way to help the poor is via education and creating jobs – better social programs seems like a short term fix when we need a long term solution.


    • philebersole Says:

      In answer to your question, what I meant by “block health insurance” was the refusal of 26 state governments to accept federal money to expand Medicaid, the health insurance program for poor people. The link to the New York Times article gives the basic facts.

      The whole purpose of the Affordable Care Act was to provide medical care for people who can’t afford to pay for it themselves. But now it appears that many of the people who need it the most won’t be able to get it.

      Medicare and Medicaid are two government programs that work well, and have stood the test of time. If it were up to me, I would expand these two programs and get rid of the rest of the Obamacare program (but I wouldn’t shut down the government to force this to happen).


      • Atticus Says:

        “was the refusal of 26 state governments to accept federal money to expand Medicaid” Got it.

        However the states would be required to pay 10% of the costs.

        From the article:

        “…eventually covering 10 percent of that cost would have been onerous for a predominantly rural state with a modest tax base.”

        That is the point I was making. I would have to see the hard numbers to determine if each state made a good decision or not.


  2. philebersole Says:

    What an individual, organization or government spends money is limited by what they can afford, and is determined, within those limits, by what their priorities are.

    I don’t know the fiscal situation of all the individual states, nor what the trade-offs would be in funding Medicaid expansion. But Arkansas and West Virginia, which are expanding Medicaid, are not rich states, and Wisconsin, which is not, is not a poor state.

    Here is a link to information on where the various states stand as for Sept. 30.

    I think, although I can’t prove, that the differences among the states on Medicaid expansion have more to do with economic philosophy and with partisanship than they do with the individual states’ fiscal situations.

    I also think, although I can’t prove, that many of the state governors and legislators who oppose Medicaid expansion would be opposed to it no matter what their state’s fiscal situation. I think many of them think it is morally wrong to tax middle-class people and rich people to pay for medical care of poor people. That’s not how I see things, but I know people who think that way.

    Another point: Obamacare is deeply flawed to begin with. Even if all the states accepted federal help to expand their Medicaid programs, there still would be an estimated 30 million uninsured.


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