One of the most important aspects of President Obama’s Affordable Care Act is the Medicaid expansion which helps poor people buy health insurance under state health exchanges. But after the Supreme Court ruled last week that the federal government can’t stop states from opting out of the program, several Republican governors have begun a political revolt.
South Carolina Gov. Nikki Haley has already announced that she has no intention to set up the state’s health insurance exchange, though her administration was operating under the faulty assumption that the individual mandate would be ruled unconstitutional. Now that it was upheld, the Washington Post’s Sarah Kliff reports that hundreds of thousands of poor South Carolinians could be left in limbo by Gov. Haley’s decision to opt out of the Medicaid expansion:
In South Carolina, the expansion was expected to cover 330,932 people … who would no longer have access to the program [if the state opts out].
What exactly happens to these people isn’t exactly clear. The Affordable Care Act allows those who are above the poverty line—earning more than $11,170 —to use subsidies to buy coverage on the health insurance exchange.
Poorer Americans—those who live below the poverty line— could be caught in a sort of “no man’s land.” They’re not eligible for subsides under health overhaul because the law worked with the assumption that they would fall under the Medicaid plan.
In addition to the Palmetto State, Republicans in Florida, Texas, Mississippi and Nebraska have all indicated plans to opt out of the Medicaid expansion. Most of those states have some of the poorest communities in the country, and opting out would prevent nearly 3.8 million people from gaining health insurance — almost a quarter of the 17 million people expected to be covered by the expansion.
Unfortunately, all indications are that a decision by South Carolina and other states to opt out of the expansion is only the beginning of the revolt against the health care law. Sen. Jim DeMint is continuing to call for states to refuse to implement any parts of the Affordable Care Act, a nullification push which will only grow stronger as more GOP-led states resist reforms championed President Obama — and in the process, hurt the most vulnerable of their own citizens.