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SCOTUS Decision Leaves Poor in the Gap

The New York Times Editorial Board has raised another problem with declaring the Medicaid exception unconstitutional: Many people who live below the poverty line are likely to be left without healthcare coverage all together. This is especially true in the seven states that have already committed to rejecting the additional federal funds. But the Times doesn't do a terribly good job of explaining why.

The little known wrinkle in Medicaid is that poverty alone does not make you eligible for the Washington sponsored health care program. The federal government sets up basic minimum guidelines for different "categorical groups" like children, pregnant women, and family caregivers. But then it's up to the states. The largest group often rendered ineligible based on state guidelines are the non-elderly or non-disabled poor, according to In other words, any adult under the age of 65 who has exercised the good judgment not to have children but has failed to find sufficient opportunity in our dumbbell economy (heavy on low skilled and high skilled jobs) is left out.

The Affordable Care Act simplified Medicaid coverage by making all persons under 133 percent of the poverty line eligible. And the effects are going to be dramatic. Look at the Center for American Progress' Interactive Map on the subject. In New York and California alone, two states that have committed to the expansion, over 5 million people are going to have access to fundamental health services.

Compare that boon to what will occur in the states that are rejecting the expansion and the thrust of the Times editorial becomes clear. In Florida, not only does rejecting the expansion mean that 2 million eligible people will be left without coverage (Florida has about 4 million uninsured), it also means that 1.5 million citizens fall into the no-man's land between Medicaid and the tax credits afforded to citizens between 100 and 400 percent of the poverty line to purchase health insurance. Add the other 6 states together and you're looking at another approximately 1,184,000 people who will be left in the chasm created by SCOTUS.

Republican governors, led by Rick Scott of Florida and Nikki Haley of South Carolina, claim that the costs of covering the uninsured would be too great: “Florida will opt out of spending approximately $1.9 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program.” Too bad that big scary number doesn't really paint a fair picture for voters trying to determine a sane fiscal path for their state government.

According to the Kaiser Family Foundation, in 2004, $125 billion was spent covering the 60 million uninsured, about 40 percent of which was uncompensated. Assuming for a moment that those costs were equally shared (though it's probably the case the Florida bore more of them), we're talking $2 billion annually to cover the medical costs of uninsured Floridians. The federal government is willing to accept 100 percent of those costs for the first 3 years and then 90 percent going forward. Still, somehow this doesn't make good financial sense?

Rick Scott and the rest are playing politics with people's lives. If they had a real alternative, then maybe there'd be a debate to be had. But right now, they're risking the health of millions with the hopes of winning back the White House. No small wonder Americans hate politics.