Collins (Keith Srakocic / AP)
Harrisburg, Pa.— About 5 million people will be without health care next year that they would have gotten simply if they lived somewhere else in America.
They make up a coverage gap in President Barack Obama’s signature health care law created by the domino effects of last year’s Supreme Court ruling and states’ subsequent policy decisions.
The court effectively left it up to states to decide whether to open Medicaid, the federal-state program for the poor and disabled, to more people, primarily poor working adults without children.
Twenty-five states declined. That leaves 4.8 million people in those states without the health care coverage that their peers elsewhere are getting through the expansion of Medicaid, according to a Kaiser Family Foundation estimate. More than one-fifth of them live in Texas alone, Kaiser’s analysis found.
The uninsured who fall into this new Medicaid gap are selective about seeking care.
Shelagh Collins of Pittsburgh can get primary care at a federally funded community health center nearby, but she can’t afford more specialized treatment for her joint aches and pains that limit her ability to do certain jobs, she said. After she fell and hurt her hip in the spring, she couldn’t pay for an MRI, she said.
Collins, 56, used to be a high-level administrative assistant at the Chicago Botanic Garden. Now she gets by on occasional secretarial temporary work and unemployment compensation checks and is trying to protect a 401(k) retirement account of $21,000 that she said makes her ineligible for Pennsylvania’s current Medicaid program.
But the job market is brutal, temp work is scarce and her unemployment compensation checks are at an end, she said. “I have never gone through anything like this in my life,” Collins said.
The Medicaid expansion was supposed to work hand-in-hand with tax credits subsidizing private insurance for people with slightly higher incomes, two keys to the law’s broader aim of extending health insurance to 30 million more people. As an enticement for states to expand Medicaid, the federal government promises to pay nearly all of the cost.
On Wednesday, 24 states and Washington, D.C., will extend Medicaid to more than 4 million adults who would otherwise fall into the same gap as Jones. A 25th state, Michigan, plans to expand in April.