Ron Jackson of Oklahoma Watch wrote one of the best stories I’ve seen laying out the policy dimensions and the human face of the decision by some states to forgo Medicaid expansion.
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.
You’ll recall, of course, that when the Supreme Court upheld the Affordable Care Act it made the Medicaid expansion a state option, not a requirement.
That created an anomaly that the law’s authors did not intend: People with incomes at the poverty level and up to four times the poverty level (roughly $92,000 for a family of four) will be able to get subsidized insurance in the state-based health exchanges starting in 2014. But people who are poorer than that – who are below the poverty level and who are not now eligible for Medicaid in their state (which is way more restrictive than most people imagine) won’t get subsidies.
If their state doesn’t expand Medicaid, they get nothing.
Oklahoma is among the states rejecting the coverage expansion – saying it will leave them on the hook for untold millions of dollars, even though the federal government has promised to pick up the full cost for three years and 90 percent over the long haul.
Jackson described what that means to “tens of thousands of low-income parents.”
So far, much attention on Oklahomans who will not gain access to Medicaid in 2014 under the federal health law has been on adults without children. That group makes up most of the roughly 200,000 Oklahomans of working age who would have been covered if Gov. Mary Fallin had agreed to expand Medicaid, the government program that provides health coverage for the poor, the disabled, children and others.
But also excluded from the Patient Protection and Affordable Care Act will be as many as 50,000 Oklahoma parents with dependent children living at home, according to one study by the Urban Institute, a nonpartisan research group.
The writer tells the story of Greg and Keta Rogers of Del City and their three children. The kids are covered in a state program. But the parents make a bit too much money to get covered by Medicaid, known as SoonerCare in Oklahoma. Yet they make too little to get help purchasing insurance in the new exchanges in 2014. They fall into a coverage gap that’s been dubbed “the crater.” As Greg Rogers told the paper, “It just doesn’t make sense.”
Keta, 38, was covered until she lost her job last year. Greg, 40, works for a small insulation company that doesn’t offer health insurance to its seven workers. He tries to avoid doctors – he can’t pay them. And when he ended up in the emergency room, he was charged $1,000 to get a prescription that cost $30.
A spokesman for the governor, Alex Weintz, said the state wants to find other ways of providing “affordable access to care.” He didn’t say what that would entail.
Johnson’s article reviews the basic structure of coverage in the health law – exchanges and Medicaid – and describes changes in federal financing under the health law. Some of the money to treat the uninsured will dry up – because those people are supposed to get insured. It describes the few options in the state – most of which the Rogers can’t tap into, unless they raise their income just enough to qualify for subsidies in the exchange. It’s not clear that they will manage to do so.
Ironically if a lawsuit by Oklahoma is successful (and many legal experts doubt it will be) the Rogers would be out of luck even if they can edge up their income. Oklahoma is not running its own exchange – it’s letting the federal government take on that job. And the lawsuit would stop subsidies from being available – even to people like the Rogers – in any federally run exchange.
