The XX Factor

Millions of Working People Left Out of Obamacare Because of Republicans

After the temper tantrum, many states will quietly start accepting Medicaid expansion funds

Photo by MLADEN ANTONOV/AFP/Getty Images

Americans are rushing to sign up for Obamacare this week, causing the servers to overload and the sites to crash. But for one group of Americans—the working poor in a number of red states—the enrollment process is just another thing for them to be left out of. As reported in the New York Times, in states that have rejected Medicaid expansion, millions of working poor people are finding themselves unable to get either private insurance or Medicaid. The law as originally written covered these citizens, but a Supreme Court decision allowing states to opt out of Medicaid expansion is being exploited by Republicans who want to keep as many people as humanly possible off Obamacare during this last-stand attempt to derail the health care legislation. This is 100 percent the fault of Republicans. After the Supreme Court gave states the right to opt out, it was Republican governors and state legislatures that made the choice to opt out. Not surprisingly, as the New York Times notes, single moms and black Americans are being hit hardest:

The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.
Twenty-one percent of women ages 15-44 are uninsured, and the loss of the Medicaid expansion is expected to hit them particularly hard. Single mothers who take Republican advice to get a job are being left out. Lower income women who take Republican advice to avoid childbearing at this time are also being left out, because in many of these states, getting regular Medicaid if you don’t have kids is nearly impossible. But there is hope. Right now we’re enduring a right-wing temper tantrum regarding federal spending that is resulting in states making largely symbolic rejections of federal funds. Along with Medicaid money, states have also been rejecting food stamps. But there’s every reason to believe that when right-wing media turns its obsession to another topic, these states will quietly start taking federal funds again, including the Medicaid expansion. Saying no to money is notoriously hard for states to do. It’s also wildly unfair to their taxpayers, who pay into the federal pot but, because of Republican posturing, are not seeing the money come back to their states. In fact, some Republican-controlled states are already opting into the Medicaid expansion, having seen the writing on the wall. After all, refusing the Medicaid expansion is so self-defeating for state governments that even the hardline right-wing nuts have to see the writing on the wall. Planned Parenthood has a useful chart to show exactly how much help states are leaving on the table: The American Academy of Actuaries points out that people who pay for private insurance, either individually or through an employer, will also suffer in states that don’t have the Medicaid expansion, because the opt out is expected to shift a lot of the risk away from the government programs and onto private insurers, causing insurance premiums in these state to go up. Yet another reason we can expect that once the heat is off, many to all Republican-controlled states will quietly start accepting the Medicaid expansion. In the meantime, many of the people who need Obamacare most will have to just wait.