The U.S. Supreme Court preserved thousands of subsidies in the Augusta area last week for people who purchased health insurance under the Affordable Care Act, but it didn’t help Wallace England, 55, of Grovetown.
England is among at least 300,000 people in the state who don’t qualify for such subsidies and would have been covered by a Medicaid expansion under the act – except the state has declined to do it. He could still spend $750 a month on his own to buy insurance, but “with no income, what do you think?” he said.
Buoyed by the court’s decision, advocates say there should be a renewed focus on getting Georgia to expand Medicaid as the act originally contemplated.
People are falling into the coverage gap in part because of a 2012 Supreme Court ruling concerning the Affordable Care Act. Though the court upheld the constitutionality of the law, it took away the federal government’s ability to force states to expand their Medicaid rolls to cover people with incomes up to 138 percent of the federal poverty level, making it optional.
Georgia and South Carolina are among 21 states that chose not to expand Medicaid. But the Affordable Care Act also forbids subsidies for those who would have been eligible for Medicaid in their states, ostensibly to keep states from dumping their Medicaid populations onto the exchanges. That would deny help to anyone making less than $11,770 a year or $23,850 for a family of four, according to healthcare.gov.
That leaves about 300,000 people in Georgia in the “coverage gap,” according to the Georgia Budget and Policy Institute.
The court’s ruling last week removes the uncertainty over a large part of the law, said Cindy Zeldin, the executive director of Georgians for a Healthy Future.
“From our perspective, it really is time to move on and make sure that it works for all Georgians, and that means people who are currently in the coverage gap,” she said. “It really should be an important pivot point for policy-makers to move away from talking about challenges to the law and whether we are going to keep the law to making sure that it works.”
From a hospital standpoint, allowing people to keep their subsidies and insurance probably wasn’t going to have that big an impact, at least in the short term, said Jim Davis, the CEO of University Hospital. Expanding Medicaid would have a bigger impact, he said.
There is still a high number of uninsured people in Georgia, and “if you go out into the rural areas, sometimes it’s as high as 40 or 50 percent of the market have no health insurance, even though this exchange thing is going on and on,” Davis said. “Because there is no Medicaid expansion, we still have a tremendous amount of uninsured expense while we take all of those cuts from Medicare. We’re getting the bad side of both things here and none of the upside. You’re starting to see rural hospitals fail. I think you are going to see a lot of that quickly.”
Expanding Medicaid would provide about $3 billion in federal funds for coverage for those in the gap, according to the Georgia Budget and Policy Institute. The federal government would bear 100 percent of the cost of the expansion through next year and no less than 90 percent thereafter.
Critics in Georgia have said it would still be too expensive and doubt the federal government could sustain its commitment. The Georgia Legislature voted last year to take any potential decision out of the hands of Gov. Nathan Deal and ensure only that body can approve Medicaid expansion.
Zeldin said the court’s decision last week will renew attention to the act and the coverage gap and perhaps renew the debate on expansion.
“It’s certainly timely and the need remains,” she said. “We’ll see what the Legislature and the governor do with it, but rural hospitals are clearly struggling. Even non-rural hospitals are struggling and Medicaid expansion would clearly help. People are unable to access health insurance and there is money to do it.”
Not acting doesn’t make sense to England because by “not going along with the program where everybody could have gotten health care for little to no cost, that’s just not helping nobody,” he said.