http://www.washingtonpost.com/blogs...rprise-medicaid-ruling-could-reduce-coverage/
Buried in the Supreme Court’s 193-page decision on the health reform law was one big surprise:
States can opt out of the law’s sweeping expansion of Medicaid, significantly reducing the number of Americans who gain insurance.
That ruling, experts say, could leave some of the poorest Americans in a “no-man’s land:” Not covered by the federal entitlement program but not eligible for the subsidized health insurance.
What the Supreme Court said today was: States do not have to participate in that part of the law. If they want to leave their Medicaid program as is, there will not be a penalty.
What was once a guaranteed insurance expansion is now left to the discretion of the states.
“Prior to the court’s decision today, failure to implement this expansion meant you lost all your Medicaid funding,” says Matt Salo, executive director of the National Association of Medicaid Directors. “Now, you have a political and financial decision to make: Do you do this?”
The Affordable Care Act provides financial incentives to entice states into the expansion. The federal government will, for the first three years, cover the entire cost of all these new patients. Usually states have to chip in for some of the cost.
The federal law was written with the assumption that all people living below the poverty line would become eligible for Medicaid. Federal subsidies, therefore, would be unavailable to anyone making less than that — even if the state opts out of the Medicaid expansion.
That could mean that some of the poorest Americans would be the ones who do not gain coverage through the Affordable Care Act. ”It creates a no-man’s land,” Salo said.
It’s hard to know how many people would fall into that area, largely because — as Salo puts it — “this was a total surprise. We weren’t studying it because it didn’t matter prior to today.” Going forward, however, this part of the Supreme Court decision could have a big impact on the Affordable Care Act’s future.
