Expanding Medicaid is essential to the Affordable Care Act’s two-part strategy for covering the uninsured — but because many states have not expanded Medicaid coverage as President Barack Obama initially planned, nearly two in three uninsured low-income Americans who would qualify for subsidized coverage under the act might just be out of luck.
Data compiled by the Urban Institute show there is a big coverage cap: Of the 15 million potentially eligible adults, 9.7 million live in states that have refused to expand Medicaid or remain undecided even though time is running out before the insurance exchanges open for enrollment October 1. The fact that a majority of people most in need of access to health care will likely remain uninsured is a predicament unforeseen by the president and congressional Democrats who designed the provision. The law’s pledge that all U.S. residents will be able to afford health insurance will not be fulfilled as its writers envisioned.
This coverage gap arose because the Supreme Court last summer ruled that the mandated Medicaid expansion was unconstitutional. That decision gave states the right to opt out of the expansion, which many states with Republican governors or Republican-dominated state legislatures have done.