Friday, March 28, 2014

Who took your Medicaid away?

In the long, long runup to full implementation of the Affordable Care Act, Jonathan Bernstein was fond of predicting that many people who gained coverage through the new law would not be aware that the ACA -- or "Obamacare" -- was responsible. Over time, the ACA would "disappear." The state exchanges make no reference to the Affordable Care Act -- and neither, for that matter, does As for the Medicaid expansion, Medicaid is Medicaid.

That forecast will probably come true over time -- though perversely, the exchanges' malfunctioning in the early months probably made more people aware of them in the first signup season.  Meanwhile, the political insight underlying the forecast -- that most people pay very little attention to government initiatives and political battles -- makes me wonder about a shorter-term political question.

The refusal of Republican-led states to expand Medicaid has created a cruel and arbitrary gap in the ACA's insurance expansion. Millions of people earn too little to qualify for subsidies to buy private insurance plans on the exchanges (the threshold is 100% of the Federal Poverty Level, but have been denied the access to Medicaid that the law envisioned. Many of these people are going to ACA signup events and lerning that the law affords them no help.

Whom will these people blame, and hold accountable? The wrong party in many cases, if an anecdote in today's Times is indicative:
Ms. LaFerla, a divorced full-time student in social work at Fontbonne University [in St. Louis], receives $7,000 a year in rent payments from her housemates, she said. As a childless adult, she is not eligible for traditional Medicaid, and her income is too low for her to qualify for a subsidy. She shopped on and was quoted a $450-a-month premium with a $6,300 deductible.

“It’s been a big disappointment,” she said. “A lot of us voted for President Obama because we thought this was going to be a good thing.”
It is of course Republican governors and legislatures that have refused to expand Medicaid despite 100% funding from the federal government in the first two years and 90% funding thereafter. But as with the economy, the president is held responsible for all. The Republican response to the ACA illustrated, so memorably by Tom Toles has been politically effective on many fronts.

1 comment:

  1. Thanks for another good post.............sadly,however, Medicaid recipients plus those denied Medicaid still do not make an effective voting bloc.

    I noticed this about a decade ago when Tennessee expanded its Medicaid program (it was called TennCare.)

    The program delivered new benefits to something like 20% of the state's population.

    But when funding ran out, taxes had to be raised or the program would be cut back.

    And it was cut back, a lot.

    So I said to myself, 20 per cent of the electorate can swing any election. Why don't the recipients of TennCare vote in a liberal government?

    There are a lot of answers, voter suppression being one of them.

    The poor in America do not vote as a bloc, in fact they sometimes do not vote at all.