The Oct. 1 opening of online state and federal health-insurance marketplaces means that many low- and middle-income Mississippians will be able to purchase insurance to cover their basic medical needs. But, because the state declined to expand Medicaid coverage under the Affordable Care Act, thousands of uninsured will not benefit.
Basically, under the law, uninsured people qualify for health insurance on state or federal marketplaces if they have incomes at or above the federal poverty level. For those whose income is up to 400 percent of the FPL, they will qualify for subsidies to help pay for the premiums. (It's more complicated than that, of course, but those are the broad strokes.) Medicaid expansion was designed to fill the gaps between what the states provided, (expansion covers people up to 138 percent of the FPL), and those eligible to purchase insurance on the exchanges. In many cases, expansion would also allow otherwise ineligible people (such as single, childless adults) to qualify for Medicaid for the first time.
But Mississippi—the poorest state in union—chose not to expand Medicaid. That leaves thousands in the gap: They make too much money to receive Medicaid under the state's paltry eligibility guidelines (or they don't qualify under any circumstances), but not enough to qualify for subsidized insurance on the exchange.
As one Mississippian told The New York Times, “You got to be almost dead before you can get Medicaid in Mississippi.”
The Times ran a feature this morning on the problem nationwide—which affects about 8 million Americans—and uses Mississippi as a prime example. Of course, the magnolia state isn't the only state that hasn't expanded Medicaid, but with the exception of Arkansas, every state in the Deep South declined. As a result, poor people will continue to use the most expensive and least effective health-care possible—emergency rooms—while hospitals receive less federal funding for their care. Under the ACA, the expectation was that expanded Medicaid rolls would make that kind of "indigent" medical care a thing of the past.
It seems most southern conservative politicians and Tea Party members prefer the past. Instead of being good stewards of those citizens who are least able to care for themselves, they prefer to let the poor stay unhealthy and unproductive—even though it costs every taxpayer far more to provide health care on an emergency basis than it does to provide preventive care to begin with.