by Charles Ornstein, ProPublica.
For many people without insurance, a key question raised by the Supreme Court’s decision today to uphold the Affordable Care Act is whether states will decline to participate in the law’s big Medicaid expansion.
Although the court upheld the law’s individual mandate to buy insurance, it found that the act could not force states to extend Medicaid to millions by threatening to withhold federal funding.
The act, signed by President Obama in March 2010, required “states to extend Medicaid coverage to non-elderly individuals with incomes up to 133 percent of the poverty line, or about $30,700 for a family of four,” according to a March 2012 report by the Center on Budget and Policy Priorities, a liberal think tank. That alone was expected to reach nearly 16 million people by 2019, one of the law’s main ways of reducing the ranks of the uninsured.
The 26 states that challenged the law before the court together account for an estimated 8.5 million people who would benefit from Medicaid’s expansion by 2019, more than half the total number, according to ProPublica’s analysis of an Urban Institute report prepared for the Kaiser Family Foundation.
Medicaid is a joint state-federal program that provides health coverage to the poor and disabled, with states putting up a portion of the money and the federal government funding the rest. Each state’s matching percentage is based on per capita income.
According to a separate Kaiser foundation report, “Medicaid currently provides health coverage for over 60 million individuals, including 1 in 4 children, but low parent eligibility levels and restrictions in eligibility for other adults mean that many low income individuals remain uninsured. The ACA expands coverage by setting a national Medicaid eligibility floor for nearly all groups.”