States ACA Implementation Inconsistencies Lead to Gaps in Healthcare Coverage

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April 26, 2013; Stateline

As an odd consequence of the nation’s state-by-state implementation of the Affordable Care Act, the states (led by Republican governors) that rejected the expansion of Medicaid for people with incomes up to 138 percent of the federal poverty level may have disadvantaged their current citizens against “citizens-in-waiting.”

Because of the silly requirement that requires legal immigrants to wait five years before becoming eligible for Medicaid, legal immigrants were made eligible for subsidies to buy health insurance on the state and federal health exchanges.  However, the ACA intended people with incomes up to 138 percent of the federal poverty level to get their health coverage through Medicaid, not through purchasing insurance on the exchanges. Those states that rejected the expanded Medicaid package have inadvertently denied a number of low-income citizens Medicaid coverage, but left them without access to subsidies for buying private insurance as well.

Arizona’s very conservative governor Jan Brewer, hardly inclined to support much coming from the Obama Administration, recognized this gap in coverage, which got her to switch her position to one in favor of expanded Medicaid coverage. Her compatriot Republican governors, Rick Perry in Texas and Rick Scott in Florida, have not changed their stances. So, immigrants who could and should have been covered by Medicaid will have an opportunity to buy subsidized healthcare coverage on the exchanges, but those current citizens with low incomes who don’t get access to expanded Medicaid will not. As national healthcare coverage rolls toward full implementation, nonprofit advocates are going to have to function as real-time watchdogs, identifying the areas where the implementation of the law reveals areas that need to be patched or fully overhauled.—Rick Cohen