Here's one consequence of the Supreme Court's healthcare-reform decision: States with low Medicaid eligibility thresholds that choose not to expand Medicaid would leave poor adults to churn between subsidized commercial insurance and no insurance whatsoever.
Yesterday's decision created a potential gap in coverage for poor adults. Here's how: The Supreme Court said that the federal government cannot enforce an expansion of Medicaid eligibility by threatening to cut off all Medicaid funding to states that fail to expand. That leaves states free to ignore Medicaid expansion under the law.
Poor adults were expected to benefit most from Medicaid expansion, which opens the safety-net insurer to everyone with incomes below 133% of the federal poverty guidelines starting in 2014.
As of January, eligibility for poor, working parents in 33 states is capped below 100% of the federal poverty guideline ($23,050 for a family of four), a survey by the Henry J. Kaiser Family Foundation shows. Adults without children are completely ineligible for Medicaid in all but eight states, but can receive limited health benefits or premium support in 17 states, the Kaiser Family Foundation said.
Meanwhile, subsidies for commercial insurance are available for those with incomes between 100% and 400% of the federal poverty guidelines.