The national health care law that went into effect yesterday will leave two-thirds of poor blacks and single mothers uninsured, as well as more than half of low-wage workers who do not have health coverage.
According to an analysis of census data by The New York Times, the law was originally intended to help such individuals, but they will be left out under the new program. More than eight million needy individuals will be left out because they live in Republican-controlled states that have declined to participate in an expansion of Medicaid, the medical insurance program to aid the poor. The federal government will pay for the expansion through 2016 and 90 percent of costs afterwards.
Such individuals are indigent but rendered ineligible for help. Many of those left uninsured are stuck between the proverbial rock and a hard place; individuals with slightly lower incomes than those who quality for federal subsidies with the new health exchange cannot qualify, and those who are poor enough to quality for Medicaid in its current form are left out. In its current form, Medicaid has income ceilings as low as $11 per day in certain states.
Many people who are trying to participate in the health insurance exchanges that went live this week are discovering that they are ineligible.
"How can somebody in poverty not be eligible for subsidies?" an unemployed health care worker in Virginia asked, crying. The woman, named Robin L., is 55 years old and has high blood pressure. She was waiting for the law to go into effect so she could get coverage. Before she lost her job, she was living in Maryland, a state that expanded Medicaid. Now that she lives with her brother in Virginia, she falls through the wide cracks of the new healthcare law, leaving her uncovered.
Twenty-six states have rejected the Medicaid expansion. The 26 states hold half of the country's population, and almost 68 percent of poor, uninsured blacks and single mothers and 60 percent of the uninsured working poor. Those excluded from coverage include 341,000 cooks, 253,000 nurses' aides and 435,000 cashiers.
Every state in the Deep South, except Arkansas, has rejected the expansion.
"The irony is that these states that are rejecting Medicaid expansion - many of them Southern - are the very places where the concentration of poverty and lack of health insurance are the most acute," Dr. H. Jack Geiger, a founder of the community health center model, told the Times. "It is their populations that have the highest burden of illness and costs to the entire health care system."
Blacks are disproportionately affected because many are poor and live in Southern states. Six out of 10 blacks live in states not expanding Medicaid.
Civil rights leaders aver that the disproportionate impact on black Americans perpetuates the exclusion of blacks from having privileges available to others. Opponents of the Medicaid expansions say that they rejected it for purely economic reasons, and that race was not an issue.
In Mississippi, Republican leaders said that a large portion of people are already using Medicaid, and that with the expansion, a third of the state would have been insured, meaning the state would have eventually covered 10 percent of the cost. Leaders said that it would have been too burdensome a cost for a mostly bucolic state with a low tax base.
"Any additional cost in Medicaid is going to be too much," said State Senator Chris McDaniel (R), who opposes expansion.
Under the new law, lower and middle-income earners can receive subside. Expanded Medicaid was also intended to cover the poorest individuals-- about 30 million Americans. However, the Supreme Court ruled last year that states could choose to opt out of expanded Medicaid.
Poor people who are uninsured will not be subject to fines for not having coverage.
Other states opting out include New Hampshire, Ohio, Pennsylvania and Tennessee, which may still decide to expand Medicaid before coverage takes effect this coming January.
Mississippi is hit particularly hard because the state has 13 percent of poor and uninsured people, the largest percentage in the country.
"You got to be almost dead before you can get Medicaid in Mississippi," said Willie Charles Carter, an unemployed 53-year-old who had leg surgery last year.
Carter's income is below Mississippi's $3,000 a year ceiling for Medicaid, but he has no dependent children, so he does not qualify. His low income also makes him ineligible for health insurance subsidies under the new law.
Almost half of underprivileged and uninsured Hispanics live in states expanding Medicaid. Yet Texas, which has a substantial Hispanic population, rejected the expansion. Gladys Arbila, 45, a housekeeper in Houston, makes $17,000 a year and has two children, but she is under the poverty line and therefore ineligible for the new health care subsidies.
"We came to this country, and we are legal and we work really hard," Arbila said. "Why we don't have the same opportunities as the others?"