Last week we looked at how the Affordable Care Act and the Republican replacement plan changed health insurance for those of us who buy insurance either through our employers or on the individual market. This week we’ll look at how the ACA and the new plan change access to health insurance for people with low income.
The ACA expanded Medicaid in two ways. First, it added adults in poverty to the program, not just poor children and their parents. Before the ACA, low-income adults without dependent children were ineligible for Medicaid in 26 states—the cost of doctor visits, hospital stays, prescription drugs—all had to be paid in cash. The ACA also pushed Medicaid eligibility up to 138% of the federal poverty line (FPL) for everyone (although some states, like New York and California, were already there). For context, the FPL for a single adult is $12,060 and, for a family of 3, $20,420.
At least until a group of states took the matter to the Supreme Court, which ruled that Congress could not require the Medicaid expansion, even though most of the cost was shared among all federal taxpayers. Currently, 19 states have chosen not to expand Medicaid eligibility. Read more »
“Who sinned, this man or his parents, that he was born blind?” Asked of Jesus by the religious authorities of the day, this question haunts many conversations about social welfare and health policy. Self-reliance—that people should “get what they earn”—is embedded in America’s cultural mythology. In some subtle way, people in poor health must be responsible for their condition and simply have to pay when illness strikes.
This is the moral question underlying health policy: Who should bear the cost of caring for the sick? That we are neither wholly blameless or nor wholly guilty for the state of our health is the Gordian knot we labor in vain to untie. We know that smoking often causes lung cancer and obesity can trigger diabetes. But not all lung cancer comes from smoking and diabetes has other triggers. We’re not willing to deny care to victims of either disease. We admire self-reliance but also sense the injustice in “blaming the victim” for diseases and conditions that have no known link to personal decisions (and some that do). As the Republican Congress and the Trump Administration seek to unwind Barack Obama’s Affordable Care Act (ACA), this “who pays?” question takes center stage. Read more »