Saturday, November 23, 2013

Huberfeld on the Medicaid Expansion

Andrew Koppelman

There has been considerable press coverage of the refusal of many states, dominated by Republicans, to accept the Obamacare expansion of Medicaid.  The consequence is a major thwarting of the law’s goals: the New York Times reports that two thirds of poor blacks and single mothers, and half of low-wage workers will be left without insurance.

As originally designed, the Affordable Care Act expanded Medicaid to cover childless adults up to 138% of the federal poverty level – with the federal government picking up every penny for the first couple of years and at least 90% thereafter.  Those who got health insurance through exchanges would get a subsidy if they earned between 100% and 400% of the FPL.  But the Supreme Court unexpectedly declared that the states could reject the expansion – and where Republicans are in charge, many have.  The old Medicaid, which continues to operate, can be remarkably stingy.  In Alabama in 2009, it covered adults with children who have incomes below 11.5% of the federal poverty line, which was $2,425.50 a year for a family of four.  So the refusal to expand Medicaid is a pretty severe way to score political points against Obama.

Important new research by Kentucky Law Prof. Nicole Huberfeld shows that this story has been misreported.  Many of the states that have been counted as refusing the Medicaid money are in fact moving toward accepting it.  There are a few stubborn holdouts, including Texas, which has a huge uninsured population.  But the overall pattern is different from what you’re likely to read in the newspapers.

Huberfeld’s paper is here.

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