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And the first open enrollment period comes to an end

Lots of people signed up in the last few days of enrollment. Some tried but came away empty.

It's constitutional - deal with it

It’s constitutional – deal with it

Some of the hundreds of Houstonians who sought last-minute help enrolling for the Affordable Care Act on Sunday left thrilled to have health insurance for the first time in their lives, while others walked away frustrated by high prices, long waits and computer glitches.

“The lowest price plan for me was $387 per month and included a $6,000 deductible. Is this what they think people can afford who are unemployed? This is outrageous,” said Lupe Escalante, 63, a recently laid-off office administrator who attended an enrollment event Sunday at Community of Faith church in north Houston, one of a bevy of events held to help people meet the Monday deadline.

Under the law, uninsured people will be subject to fines of $95 per adult and $47.50 per child – a $285 family maximum – on next year’s income taxes. However, individuals who earn less than $10,150 and married couples earning less than $20,300 will be exempt from the penalty.

Extensions can also be granted for people who started, but did not finish enrollment, by the deadline.

For reasons unclear, the story fails to explain why Ms. Escalante did not get a quote for a policy she could afford. The simple answer is that she almost certainly falls into the coverage gap, earning too much money to qualify for Medicaid but not enough to receive a subsidy. The reason for the existence of the gap is that Texas was one of many states to not expand Medicaid, for which Ms. Escalante would surely now qualify if Rick Perry and the Legislature had done so. Alec MacGillis spells it out.

In Texas, parents can only qualify for Medicaid if they earn less than 19 percent of the poverty level—that is, below $4,531. In Alabama, it’s even lower—16 percent of the poverty level. It’s barely higher than that in Louisiana, Georgia, Missouri, and Mississippi and Florida, all of which have their eligibbility threshold set below 40 percent of the poverty level—that is, below $9,540 for a family of four. In other words, one must be subsistence-level indigent in these states to even think about qualifying. And that’s only if one has kids—if one is a non-disabled adult without dependent children, forget it: no matter how poor you are, you don’t qualify for Medicaid.

So: right now, we have passed a law meant to expand coverage to all Americans, and yet it does not reach the poorest of our fellow citizens in nearly half the states in the country. That, on its face, is a major policy failure. No one really wanted to say this during the law’s drafting, but its underlying goal was to get coverage to people in red states where there was no local political will to address the problem. It’s generally preferable to let states address their own needs, but in this realm, only Massachusetts and a few others had even attempted to bring about near-universal coverage. The only way people in Birmingham or Brownsville were going to get covered was if the federal government saw to it that they did.

We know how that worked out. Despite all the obstacles here and in other states, many people tried to enroll over the weekend and on Monday, pushing the total signup number up towards 7 million, the number that had been originally floated around before the healthcare.gov site took the month of October off. Even more people than that now have insurance because of Obamacare, and there may be many more that are not being counted by current metrics. We’ll know what the final Texas number is soon, but we won’t really know what the national numbers are for months. Whatever they wind up being, the reality is that they could and should have been a lot more. All we needed was state leaders who cared about solving a problem more than they cared about making fools of themselves on Facebook. You wouldn’t think that would be so hard to do. Wonkblog and Jonathan Bernstein have more.

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One Comment

  1. Robert Nagle says:

    Here’s what’s going to happen. Texas under the poverty threshhold have reported their income as being over the poverty threshhold. Then next year when they file their taxes, the feds will flag the tax returns of people who claimed subsidies for Obamacare in Texas when they fell below the poverty level. Then they will turn them over to Texas and say you should pay this. And Texas will refuse.

    No person in poverty expects to make poverty wages in the following year. It’s just what happens. So I don’t think you can ask poor individuals in Texas to pay back their subsidy because their wages last year were too low. The Perry Administration knows this — and that’s how they can get away with freeloading from Obamacare without having to increase Medicaid costs. By refusing to pay, Perry knows that that the feds will end up paying at the end.

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