Later On

A blog written for those whose interests more or less match mine.

Millions of Poor Are Left Uncovered by Health Law

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Good article in NY Times on how Republican states refused to expand Medicaid (though the Federal government would have funded the expansion fully in the first years, simply so that the poor would not have access to medical care: the GOP in s a nutshell.

I think this attitude stems from the idea that, if you are poor, it is your fault: for children living in poverty, it’s their fault because they did not choose wealthy parents. For the parents, it’s their fault because anyone who wants to and works hard can make plenty of money. Those in the GOP poiont to themselves as exemplars of the virtues of thrift, hard ward, and good luck.

This attitude—that the poor are to blame for being poor—collapsed in the Great Depression: with millions and millions out of work and unable to find any job at all, it began to dawn on people that everyone couldn’t be a moral failure. Perhaps there were larger forces, beyond the control of the individual, and perhaps if we banded together to help one another, things would get better. This brought in the New Deal and a panoply of programs to assist everyone: the social safety net.

The GOP does not like a social safety net, since it mainly helps the poor, and of course they themselves are not poor and never will be, so what’s in it for them? Higher taxes, that’s what. So they oppose it. Sure, the poor will suffer, but the prevailing GOP attitude seems to be, “No skin off my nose.”

Sabrina Tavernise and Robert Gebeloff report in the NY Times:

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.

People shopping for insurance on the health exchanges are already discovering this bitter twist.

“How can somebody in poverty not be eligible for subsidies?” an unemployed health care worker in Virginia asked through tears. The woman, who identified herself only as Robin L. because she does not want potential employers to know she is down on her luck, thought she had run into a computer problem when she went online Tuesday and learned she would not qualify.

At 55, she has high blood pressure, and she had been waiting for the law to take effect so she could get coverage. Before she lost her job and her house and had to move in with her brother in Virginia, she lived in Maryland, a state that is expanding Medicaid. “Would I go back there?” she asked. “It might involve me living in my car. I don’t know. I might consider it.”

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.

“The irony is that these states that are rejecting Medicaid expansion — many of them Southern — are the very places where the concentration of poverty and lack of health insurance are the most acute,” said Dr. H. Jack Geiger, a founder of the community health center model. “It is their populations that have the highest burden of illness and costs to the entire health care system.”

The disproportionate impact on poor blacks introduces the prickly issue of race into the already politically charged atmosphere around the health care law. Race was rarely, if ever, mentioned in the state-level debates about the Medicaid expansion. But the issue courses just below the surface, civil rights leaders say, pointing to the pattern of exclusion.

Every state in the Deep South, with the exception of Arkansas, has rejected the expansion. Opponents of the expansion say they are against it on exclusively economic grounds, and that the demographics of the South — with its large share of poor blacks — make it easy to say race is an issue when it is not.

In Mississippi, Republican leaders note that a large share of people in the state are on Medicaid already, and that, with an expansion, about a third of the state would have been insured through the program. Even supporters of the health law say that eventually covering 10 percent of that cost would have been onerous for a predominantly rural state with a modest tax base.

“Any additional cost in Medicaid is going to be too much,” said State Senator Chris McDaniel, a Republican, who opposes expansion.

The law was written to require all Americans to have health coverage. For lower and middle-income earners, there are subsidies on the new health exchanges to help them afford insurance. An expanded Medicaid program was intended to cover the poorest. In all, about 30 million uninsured Americans were to have become eligible for financial help. . .

Continue reading.

Written by Leisureguy

3 October 2013 at 9:54 am

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