July 26, 2012
Jack Meyer, PhD
By Jack Meyer and Karoline Mortensen
Twenty million Americans live at or below the federal poverty line and are uninsured. The Supreme Court ruling on the Affordable Care Act (ACA) could leave many without access to affordable health insurance — but only if we let ideological warfare triumph over practical policy solutions.
The court upheld the Medicaid expansion under the ACA as constitutional but stated that the federal government cannot punish states that opt out of this provision by taking away existing Medicaid funding for current enrollees. Some state officials now say that they plan to opt out of the Medicaid expansion. In the ongoing theatrics and shrill debates over health reform, it is hard but necessary to declare a ceasefire and develop a “peace plan.”
Under the ACA, people with incomes between the federal poverty line and four times that amount (about $92,000 for a family of four) can obtain federal premium subsidies and limits on out-of-pocket spending in state-based health insurance exchanges. But Congress wrote the subsidy provision assuming that individuals at the very lowest income levels would be eligible for the Medicaid expansion.