A Gap in Health Coverage
The Supreme Court decision upholding the constitutionality of health care reform inadvertently opened a hole in health insurance coverage that could harm some of the nation’s poorest citizens. The problem arises from a mismatch between how the law was framed and how the court’s ruling will affect Medicaid, the joint state-federal health program for the poor.
The reform law sought to provide coverage to tens of millions of uninsured Americans starting in 2014 through two mechanisms. It required states to expand their Medicaid programs to cover virtually everyone earning up to 133 percent of the federal poverty level (about $31,000 for a family of four) or lose all federal financing for Medicaid. And it established new insurance exchanges through which people without affordable coverage at work could buy coverage. The law provides subsidies to help low- and middle-income families pay those costs.
The Supreme Court’s ruling struck down the mandatory expansion of Medicaid as coercive and made expansion optional. Many states, perhaps most, are expected to expand voluntarily because the federal government would pay 100 percent of the increased costs for three years, dropping down to 90 percent by 2020. Even so, some states may resist paying even 10 percent more. Gov. Rick Scott of Florida announced this week that his state would not expand Medicaid.
http://www.nytimes.com/2012/07/05/opinion/a-gap-in-health-coverage.html?nl=todaysheadlines&emc=edit_th_20120705
