The Affordable Car Act or Obamacare consisted of two parts to assist people getting affordable health insurance. For those who earned above a certain income level, they provided a subsidy in the form of a tax credit to reduce the effective cost to the consumer of the insurance premiums that they could purchase on the insurance exchanges. Last month’s Supreme Court decision settled the issue as to whether federal–run exchanges were also allowed to provide such subsidies by saying that they were.
But the other part of Obamacare was aimed at those who were too poor to qualify for the tax subsidy but were not poor enough to qualify for Medicaid. Those people were to be covered by expanding the Medicaid eligibility requirement to encompass them. The authors of Obamacare envisaged that as a part of the total package but the Supreme Court ruled two years ago that states could choose to opt out of the Medicare expansion provision.
It seemed bizarre that any state would voluntarily choose to do so because the federal government was paying the entire cost for the first few years and almost the entire cost after that. This influx of federal money would be a huge benefit to states because not only would it enable poorer people to purchase health insurance, it would channel that money to doctors and hospitals and other medical services in the state, thus providing a financial benefit.
But such was the sheer cussedness of Republican politicians and their desire to sabotage Obamacare even if it hurt poor people that many states that had Republican governors and legislatures voted to reject the Medicaid expansion provision. In Ohio, to his credit, Republican governor John Kasich maneuvered to accept it despite the opposition of the heavily Republican legislature and he may pay a price for this in the presidential primaries.
But over time, as the financial hit of such a move sank in, some states that initially rejected it have quietly moved to accept it. Just this past week, Alaska did so and the Kaiser Family Foundation has a considering expanding Medicaid too, so this map might change for the better.
I expect even more states to sign on to the expansion, especially after the 2016 election, as Obamacare becomes more entrenched and ceases to be a hot political issue for Republicans.