Once Focus of Health Law, Some In Poverty May Be Left Out
States' ability to opt out of Medicaid expansion may sabotage the law's intent.
July 18, 2012— -- Ashley Tagert didn't know her family might gain health coverage from the health law -- or that the Supreme Court decision could wipe that away.
Tagert, 28, and her husband live in Pearl, Miss., just east of Jackson, on the $2,224 a month that her husband earns as a mechanic. It's too little, she says, to buy health insurance.
A lifelong migraine sufferer, Tagert has ended up in hospital emergency rooms several times because she couldn't afford $200 a month for medication that helps ward them off. Just one trip to the emergency room left Tagert $10,000 in debt, helping propel Tagert, her husband and three children into bankruptcy.
Families like Tagert's were among those that Democrats targeted in the 2010 health overhaul. But Tagert may end up without any health coverage even after the law takes full effect in two years. That's because the U.S. Supreme Court ruled that states can decide to forgo without penalty a key plank of the law that expanded the federal-state Medicaid program to include all legal residents living in or near poverty.
Republican leaders in some states, including Mississippi, are warning that opting into the expansion is too expensive since the states eventually will have to pay 10 percent of the cost for the new program participants.
Nationally, 17.8 million Americans without insurance earn at or below the federal poverty level, which this year is $11,170 for an individual and $23,050 for a family of four. In Mississippi, 53 percent of the people lacking health coverage fall into this group, a bigger portion than in any other state, according to data from the Urban Institute, a Washington-based think tank.
Families can be earning below the poverty line even if one spouse is working full-time, says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, another Washington research group. Someone earning the federal minimum wage of $7.25 for 35 hours a week, 50 weeks a year would earn $12,688, which is below the poverty line for any couple with at least one child, he said.
"If you're at federal minimum wage, a single earner, two-parent family but only one's working, you could see how that they could stay under the poverty line," Park adds.
At least four of 10 uninsured people were below the poverty line in 28 states, including Alabama, Indiana, Idaho, Kansas, Louisiana, Michigan, Ohio, South Carolina, South Dakota and Wisconsin -- all states that, like Mississippi, had asked the Supreme Court to overturn the law. Out of the 17.8 million uninsured people at the poverty level or below, Urban estimates 11.5 million would be able to gain insurance through the Medicaid expansion; the others either are already eligible but not enrolled.
"If you don't expand Medicaid, but you have the other changes [in the health law], the people who are really falling through the cracks are the needier, sicker patients who will become very burdensome to the health care system," says Dr. Jasmin Chapman, executive director of Jackson-Hinds Comprehensive Health Center, a community health center in Jackson that treated 18,000 uninsured patients last year.
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