A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.
Follow the link (my addition) for more.
This is not a massive failure of the design of the Affordable Care Act. It’s due to the Supreme Court ruling that the Medicaid expansion was optional. Nobody thought that such a ruling was likely.
However, one could argue that it was possible to have anticipated that potential outcome and, therefore, the ACA’s designers should have sought a more robust design. Medicare for all — or at least for Medicaid eligible individuals — would have been more robust. Allowing the would-be Medicaid eligible access to subsidies for exchange coverage would have been more robust.
But wait. That’s possible! Arkansas has received approval to do just that. So the design is quite robust. Flexible even.
Yes, there are some federally imposed limits to that flexibility. But the expansion is almost entirely federally funded. So, is that reasonable or not? Are the limits so onerous to warrant denying so many poor Americans benefits almost all other, wealthier Americans enjoy?*
* Anyone in any public program (Medicare, the VA, Medicaid) or receiving a tax subsidy for employer-sponsored health insurance or on an exchange is getting more than millions of poor Americans denied Medicaid will get.