As of now, over two dozen states are not opting in to Obamacare’s Medicaid expansion, thanks largely to hostility to the law among GOP governors who are turning down huge sums of federal money that could otherwise go towards expanding coverage to their own constituents. Result: untold numbers risk falling into a “Medicaid gap,” making too much to qualify for traditional Medicaid, yet too little to qualify for subsidies on the exchanges.
We now have a new look at the consequences of this: Millions will likely remain uninsured, and racial and geographic disparities in access to coverage will worsen.
Two new studies released by the Kaiser Family Foundation today illustrate this in new detail. You can read them here and here, and they take a close look at who makes up the population of those who fall into the Medicaid gap. The key findings:
* Some 4.8 million uninsured non-elderly American adults nationwide are likely to fall into the Medicaid gap.
* Some 79 percent of those who fall into the Medicaid gap are from the south (where Republican governors have disproportionately decided not to opt in).
* Those falling into the Medicaid gap are disproportionately non-white. Some 53 percent of them are black, Hispanic or “other.”
* Some 47 percent of those falling into the Medicaid gap — over 2.2 million people — are white. If attacks on beneficiaries of the Medicaid expansion as freeloaders and takers have “racial undertones,” as National Journal argued the other day, this is a reminder that huge numbers of poor whites will also be impacted by the refusal of GOP governors to opt into the expansion.
This last finding is relevant to a broader political discussion. As Paul Krugman has noted, if attacks on the safety net are meant to rally downscale whites against Dems, the problem is that many whites benefit from safety net programs such as food stamps and unemployment insurance.
The new Kaiser studies are a reminder that this also applies to the Medicaid expansion. Failure to opt in could mean over two million white Americans fall into the gap. This comes as Republicans are resisting an extension of unemployment benefits and are pushing for far deeper cuts to food stamps than Dems are willing to accept (though they are certainly culpable here, too).
Beyond this, the big story is that failure to opt in could deepen disparities in health coverage across the board. As Kaiser puts it:
These adults will not gain access to a new affordable coverage option and likely remain uninsured. Given their high uninsured rates and low incomes, people of color will be disproportionately impacted by this coverage gap, particularly poor uninsured Black adults residing in the southern region of the country where most states are not moving forward with the expansion. These continued coverage gaps and their varied impacts across groups will result in millions of poor adults remaining uninsured and likely lead to widening racial and ethnic as well as geographic disparities in coverage and access to care.
* DEMS GO ON OFFENSE ON OBAMACARE: The DCCC today is launching web ads and other paid media in the districts of 44 vulnerable House Republicans, highlighting what repealing Obamacare would do to ordinary people. There is also a new Website, FacesOfRepeal, that, like the ads, features those people describing what returning to the old health care system would mean to them in concrete, real life terms.
Even if more problems could arise during 2014, the best answer for Dems is to frame this as not a referendum on the law, but as a choice between sticking with a flawed effort to solve the health system’s problems and going back to the way things used to be — the Republican position, which remains unpopular.
* OBAMA DISAPPROVAL HITS ALL TIME HIGH: Brutal new numbers for the President in a new Washington Post/ABC News poll, which finds only 43 percent approve of his performance, while 55 percent disapprove. Meanwhile, 62 percent disapprove of his handling of the health law (which is as it should be, since the rollout was botched horribly). And he has also lost his double digit leads over Republicans on who is more trusted on the economy and to handle the country’s problems.
Meanwhile, the Real Clear politics average of Obama approval has it at 42.6-53.3. This will certainly matter to Dems running in 2014, whose chances are partly tied to Obama’s approval, but it remains a myth that presidents can’t rebound in their second terms.
* WIDESPREAD SKEPTICISM ABOUT HEALTH LAW REMAINS: The Post poll also finds that large majorities think health costs are increasing because of the law; that the federal website is not working as it should; that the rollout mess was a sign of broader problems with the law; and that we should delay the mandate.
However, the law has rebounded to pre-rollout levels, with Americans nearly split 46-49 on approval; and Obama still holds a lead over Republicans on who is more trusted to handle implementing it, 42-37. Even after all these problems, it’s still unclear how much they translate into GOP advantage.
* GOP CAUGHT IN AN “OBAMACARE TRAP”: Byron York says what must never be said: The GOP repeal stance could prove increasingly problematic, because it doesn’t allow Republicans the leeway to entertain any fixes to the law and leaves them advocating for a return to the old system. This is key:
In private discussions, House Republicans stress their differences over the details of an Obamacare alternative. For example, there’s no agreement on precisely how to fix the tax inequity for people who don’t receive health coverage at work. There are similar disagreements over all sorts of other points of policy. “Getting unanimity is a tall order for a divided, leaderless party,” says the GOP aide.
That’s the crux of the situation: There simply is no consensus GOP alternative to Obamacare.
* PUBLIC SUPPORTS BUDGET DEAL: One last nugget from the Post poll: It also finds that Americans support the budget deal to partially replace the sequester, 50-35. Even Republicans marginally support the deal, 39-36, suggesting that Republican lawmakers who have come out against it (those with an eye on 2016; those worried about primaries) are representing only a small slice even of their own party.
* TWEET OF THE DAY, GOP DYSFUNCTION EDITION: With the budget deal expected to pass today, after some frantic rounding up of votes among Republicans, John Harwood aptly sums up what it means:
Baby-step budget deal highlights 2 parties’ governance gap. Ds line up w/little drama, Rs require high-anxiety vote scramble.
Incredibly, the Times notes today that one reason Senate Republicans were reluctant to support the deal was “hurt feelings” over the Dems’ recent change to Senate rules.
* AND SENATE GOP DEBATES NEW OBSTRUCTION TACTICS: Speaking of hurt feelings among Republicans, the Hill reports that Senate GOPers will meet today to decide on their strategy for slowing down other Obama nominees, now that Dems have ended the filibuster on nominations. This is a reminder that even despite the rules change, there are still plenty of tools at the minority’s disposal for fomenting dysfunction and delay. Ah, the United States Senate!