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Spencer Bowley, a 24-year-old health-care navigator at the Jackson University Medical Center, meets them almost every day. “They’re the working poor, basically,” he says. “They’re making $7,000 a year, and they’re seeing premiums of $500 a month, with really high deductibles. If they were making less, they’d qualify for Medicaid. If they were making over about $11,500 , the government subsidies would kick in.”
When the ACA was written, the law required all the states to expand Medicaid. Low-income people who weren’t poor enough to get existing Medicaid would be covered. Then the Supreme Court decided that states had the right not to expand Medicaid. Mississippi, led by Republican Gov. Phil Bryant, who has described Obamacare as “an assault on the liberty of American citizens,” was one of two dozen states to exercise this right. That left an estimated 300,000 Mississippians with no prospect of health insurance.
Democrats, moderate Republicans and many doctors and hospitals have called on Bryant to rethink his decision, expand Medicaid and collect the billions of federal dollars that would flow into the state. One study done by the Mississippi Health Advocacy Program found that expanding Medicaid would generate $14 billion in economic activity and create 20,000 new jobs by 2020. For the first three years, the federal government pays all the costs of expanded Medicaid. After that, the government pays 90 percent. But Bryant says he doesn’t trust the federal government to honor its commitment and adds that Mississippi can’t afford the ten percent in any event. The state already has 640,000 people on Medicaid. Another 300,000 would mean close to a million people on Medicaid, nearly a third of the state’s population. Bryant says that expanding Medicaid would remove the incentive for the poor to work their way up to a higher income bracket.
However, pressure is building on the governor to expand Medicaid or work out some public-private solution. That’s what happened in Arkansas, which uses Medicaid funds to pay private insurance plans for low-income residents. The pressure is likely to build further in April, when those 300,000 people face their first $95 penalty for not having insurance. Republican governors in Utah, Arizona and Florida have decided to expand Medicaid in their states, despite their opposition to Obamacare. Jake McGraw, a policy analyst and editor of the Rethink Mississippi website, believes the Magnolia State will one day do the same.
“We’ll probably be the last state in the country to do it, and it will definitely make a huge difference,” he says. “But Mississippi has also exposed a key structural problem in the ACA: The poorest, sickest counties in America are generating the highest premiums, because they’re a bad bet for insurance companies.”
On Oct. 10, a poll showed that only 11 percent of those who tried to sign up for health insurance through the website were successful. Seventy-three percent of Americans who tried to register for health insurance reported experiencing problems.