For the denizens of red state America, the final launch of the Affordable Care Act is fast becoming a Shakespearean tragedy of epic proportions. Even as the Defund Obamacare crowd continues its tale told by an idiot, Republicans are beginning to realize that Obamacare by any other name smells much sweeter. And now, millions of Americans in the red states are learning they will fall into a "coverage gap," needlessly left without health insurance because of the Republicans' murder most foul.
Last week, McClatchy documented the unnecessary pain being inflicted on red state residents by their elected Republican representatives. The account tells the story of St. Louis museum deputy director Erika Neal, an ovarian cancer survivor forced to endure a substantial pay cut and the loss of her job-based health insurance in 2011:
Neal could rest easier if she lived in one of the 23 states where Medicaid eligibility is being expanded for low-income parents and childless adults next year under the Affordable Care Act. Michigan appears close to expanding Medicaid eligibility.
But Missouri and 20 other Republican-led states aren't participating in Obamacare's Medicaid expansion, fearing the cost would require state budget cuts in other areas. The remaining states are still debating the expansion.
That leaves Neal and 5.5 million others in those 21 states to fend for themselves in the "coverage gap," a bureaucratic twilight zone where people with poverty-level incomes don't qualify for Medicaid and can't get tax credits to help buy coverage on the new insurance marketplaces. Enrollment for them begins in October and they open in January.
Roughly 260 million Americans (roughly 85 percent) already have health insurance provided by their employers, the government or through individual policies they purchased. In places like Oregon, Colorado, New York, California and other, mostly Democratic states, governors and state legislators accepted the expansion of Medicaid to provide free health insurance for those earning up to 138 percent of the federal poverty (FPL). For those earning between 138 and 400 percent of the FPL, the Affordable Care Act's subsidies will help them purchase insurance in the private market. But in the states where Republicans said "no" to the expansion of Medicaid, the picture is much different. As the AP explained the coverage gap:
Nearly 2 in 3 uninsured people who would qualify for health coverage under an expansion of Medicaid live in states which won't broaden the program or have not yet decided on expansion.
The resulting Republican body count is staggering. Thanks to the GOP's rejection of Medicaid expansion, 1.3 million people in Texas, 1 million in Florida, 534,000 in Georgia and 267,000 in Missouri will be ensnared in the coverage gap.