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Medicaid expansion
"When the health care law was passed, it required states to provide Medicaid coverage for adults between ages 18 and 65 with incomes up to 133% of the federal poverty level, regardless of their age, family status, or health.
It also provides tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Marketplace.
Under the law, the federal government will pay states all of the costs for newly eligible people for the first three years. It will pay no less than 90% of the costs in the future.
The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states are not expanding their Medicaid programs as of January 1, 2014.
Many adults in those states with incomes below 100% of the federal poverty level fall into a gap. Their incomes are too high to get Medicaid under their state’s current rules. But their incomes are too low to qualify for help buying coverage in the Marketplace." (emphasis mine)
So for approximately half of the country the lowest income people who are already not covered will not be eligible subsidies on their insurance that people who earn more than they do will qualify for and will therefore pay "rack-rate" or be penalized by the IRS for not being able to afford it. Also many people of lower incomes tend to have more health care needs due to living conditions, education, lack of access to preventative care etc yet they are the ones who will receive little or no help in about half of the country. What is being done by either party to address the issue of a lack of affordable coverage which I always thought was a major focal point of the Affordable Care Act? It's unfair to lay this at the feet of the states because it was being forced on them by the federal government yet state leaders must do what their voters have elected them for and what they believe is for the fiscal good of their state. If the federal government came up with this plan it would seem that the onus would be on them to fix it's shortcomings.
It seems like most of what I've read has simply been about people's premiums changing up (mostly) or down (some) and a lot of cheering about all of the people who were now getting coverage.
Re: Medicaid expansion
Then it's an epic fail of the ACA. It is not doing what it is supposed to do.
As an aside, I have heard the argument about the receiving of the federal monies bit before. However, when I have seen that broken down it includes things such as social security benefits for citizens, pensions, military salaries, veterans benefits, medicare and WIC. These are federally administered programs/services some of which the States service on behalf of the federal government. The bulk of these monies go directly to the recipient and not into the coffers of the state governments. Also, the federal government has established these bases in those states partially due to the cost of operating there (among other factors). Most of these states tend to be southern states where people retire so it stands to reason that a disproportionate share of these benefits go to those states.
These states also tend to be lower cost of living states which results in it being easier to qualify for benefits that are tied to federal poverty guidelines. Example: Someone working at McDonalds in New york might start at $10 per hour vs. in North Carolina where they would start at $7.25 per hour. A husband and a wife working full time in North Carolina would potentially qualify for food stamp benefits/medicaid/wic but in New York they wouldn't although they had the same job. However, the standard of living for the New York couple would likely be decidedly more difficult since the North Carolina couple is likely only paying $700 per month rent on their 2 bedroom apartment but the New York couple is paying something closer to $2000 per month. This doesn't factor in cost of transportation, property taxes, services etc which are way higher in places like New York, Boston, Connecticut, California, etc. So the people in those places live decidedly closer to the edge than the people in the states who "don't take care of their poor".
breakdown:
LCOL state married couple with kids earn $7.25 in fast food working an avg of 32 hrs per week(very few give an actual 40 per week) earn roughly 24K
Pays $700 per month out of their say $1200 take home pay their rent, taxes and utilities and then
Using federal guidelines this couple gets $525 in food stamps, daycare assistance, medicaid (at least for children), WIC, potentially housing assistance etc.
HCOL state married couple earning $10 per hour working an avg of 32 hrs per week earn roughly just $30,500
Pay $2000 in rent out of their $2560 per month but earn too much to qualify for food stamps, WIC, Medicaid, housing assistance, etc. They must make their leftover $560 after rent to cover their utilities, higher taxes AND the things the LCOL person who is earning all of those benefits is getting for free although they do exactly the same job. Their state is doing less to take care of them.
Even if McDonalds pays the same in each place and each qualifies for benefits, the HCOL people are still living poorer because their taxes, rent, and services cost so much more. However, because all jobs including lower end jobs tend to pay less in lower COL areas more people qualify for benefits so those states end up with a disproportionate share of "poor" people who live better than other states "not poor" people.
Really though I'm giving the stink eye (not saying that you are necessarily saying this but it is the message that I've seen sort of implied in several venues) to the idea that it's ok to let people in states that aren't expanding medicaid to suffer for the political leanings of their state whether they espouse them or not provided the people in other places that match up majority-wise with the political agenda of Obamacare get theirs. At that point I start to feel that it becomes more of the promotion of an agenda rather than actually getting people covered and getting them medical care. Once this gap became apparent, the people beating the drum of "it's a right to have health insurance" should have gone about trying to fix the gap rather than pointing fingers because any rational person can see that pointing fingers is not getting people insurance coverage.