Although the Affordable Care Act is intended to provide healthcare coverage to a large portion of the 50 million Americans currently uninsured, a large proportion of poor African-Americans, single mothers and those with low-wage jobs will not have any options, the New York Times reported.
Altogether, about eight million Americans living at or below the poverty level will be unable to obtain free or subsidized coverage.
The combination of states refusing to expand their Medicaid programs and the absence of premium subsidies for those who would have been eligible for Medicaid coverage in those states means about two-thirds of poor African-Americans and single mothers and half of low-wage employees will be unable to obtain coverage, according to the NYT.
This poses a problem for hospitals, as these groups tend to have costly health problems. In South Carolina, one state that has refused expansion, providers are banding together to try and make sure the uninsured have better access to preventative care.
"They are simply out of luck in those states," Stephen Zuckerman, a health economist with the Urban Institute, told Al Jazeera America. Zuckerman added that the law should have been written in a way to cover the gulf between the poor and those who qualify for subsidies.
In some states, such as Mississippi, which has large numbers of poor, Medicaid eligibility is based on incomes of $3,000 or less a year for adults without children. Overall, the median income eligibility for states that have chosen not to expand Medicaid is $6,500 a year--nearly half of the income eligibility for states that are expanding the program.
"The irony is that these states that are rejecting Medicaid expansion--many of them Southern--are the very places where the concentration of poverty and lack of health insurance are the most acute," H. Jack Geiger, M.D., a founder of the community health center model, told the NYT. "It is their populations that have the highest burden of illness and costs to the entire health care system."
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