Original ACA rules could leave millions without coverage

Some of the nation's poorest residents may not get any healthcare assistance at all because of the income eligibility and coverage vagaries of the Affordable Care Act--a fact that could wind up impacting hospitals in specific regions of the country.

According to USA Today, when the ACA was written in 2010, it was presumed that Medicaid coverage would extend to all people earning less than $23,550 for a family of four. They were not made eligible for tax subsidies available on the health insurance exchange. The U.S. Supreme Court's decision to allow states to decide on Medicaid expansion turned that presumption upside down.

As a result, about seven million low-income adults in states that have not expanded Medicaid eligibility won't receive government coverage and will not be able to receive subsidized coverage through the health insurance exchanges.

"You get the worst of all worlds," former president Bill Clinton said as part of a presentation to promote the ACA. "I'm sorry, but you're working 40 hours a week, but you're too poor to get help. This is a serious problem."

The financial stakes for hospitals are also high. In Arizona, a politically conservative state whose leadership reluctantly chose to expand Medicaid coverage, its hospitals are expected to reap an additional $108 million in revenues during the first half of 2014, reported Capitol Media Services. That's despite the fact Medicaid expansion will only cover an additional 300,000 residents--a fraction of what more populous states and Florida and Texas would enroll. In Michigan, Medicaid expansion is expected to cut losses on uncompensated care by 10 percent to 15 percent, FierceHealthFinance previously reported.

To learn more:
- read the USA Today article
- here's the Capitol Media Services article