October 7, 2013 10:38:17 AM
Mary is a single parent of two children. She works, earning $9.50 an hour or about $19,300 per year. She receives no child support. She might be eligible for subsidized day care for the children, but her parents keep the kids while she is on the job -- and she much prefers that arrangement.
Mary has no desire to be on the dole; she does what she can to be independent.
The official federal poverty level is $19,530 for a household of three, so Mary is not eligible for Medicaid herself, although her children would be eligible for the federal-state Children's Health Insurance Program (CHIPS). Her employer doesn't offer or participate in a group plan for employees, so Mary has no health insurance.
There are legions of "Marys" in Mississippi.
Now let's look at Obamacare.
When the president signed the Affordable Care Act in March 2010, the only thing everybody knew for certain is that it was a jigsaw puzzle -- with some missing parts. Page after page of interlocking provisions. And, as with everything that comes out of Congress, filled with carve outs and "special" provisions to take care of every group that had invested in good lobbyists.
Let's talk about two key provisions.
Most significant in this conversation is the one that bumped up the amounts people could earn and remain eligible for Medicaid.
The other -- the one talked about so much last week as sign-up began -- created "exchanges" where people -- the Marys of America -- could (and would be required to) select a private insurance plan and start paying premiums.
Now if you will recall, it was the expansion of Medicaid eligibility to 138 percent of the poverty level that sent Gov. Phil Bryant and other stewards of a balanced budget into orbit.
Bryant commissioned three studies. All showed that the cost of adding 150,000 to 300,000 "Marys" to Medicaid would be unsustainable. Taxes couldn't be raised fast enough to provide this much more health care on top of years and years of skyrocketing Medicaid outlays. Mississippi, unlike so many other states, does not pay today's bills with tomorrow's money. (State per capita debt in California is $10,000 per person compared to $5,000 in Mississippi.)
So Mississippi joined 24 other states in opting out of the expansion.
As written, the Affordable Care Act said states that did not expand Medicaid eligibility would lose Medicaid funding, but the Supreme Court said that was illegal. Opt-out states kept Medicaid eligibility as it was, unchanged from the pre-Obamacare days.
Too, many, including Mississippi, do not have approved "exchanges" in place, meaning for Mary to enroll as required, she would have to go to the federal website.
But there's a problem with that, too -- a pretty big one.
And it is this: Insurance plans for sale on the federal site start with the assumption that the lowest-earning people buying policies will be earning at 138 percent of the federal poverty level or more.
In Mississippi, Commissioner of Insurance Mike Chaney wrangled permission to put allow about 65,000 "Marys" -- those making too much for Medicaid but less than 138 percent of the poverty level -- into the state exchange.
Instead of Mary having no coverage and her children being on CHIPS, Mary could buy a policy for about $29 per month that would cover her AND her children -- who would leave the public roles and save the state millions.
But, again, Mississippi, has no exchange.
Call it an "Obamagap" or whatever, but the result is that Mary -- and everyone in her situation -- still doesn't have health insurance.
This is not to say Obamacare is wonderful and Mississippi is backward. It's not to say that Obamacare is a nightmare and that Mississippi is wise, either.
Here's the deal: There's nothing new about spreading the cost of health care or any other risk among a lot of people. That's what insurance does. The big difference is having government and tax funds in the picture -- but that started when Medicare was created in 1965.
Too many wrongly think Obamacare is a handout. There's great concern that giving people access to health insurance is a disincentive, but think about that.
Suppose Mary, who believes in work and struggles to limit dependence, looks around at her neighbors. One, also making $9.50 per hour has four children, so she is Medicaid-eligible. Another is, too, because she doesn't work at all.
Mary could quit her job or another child to join them. Why shouldn't she?
Charlie Mitchell is an assistant dean of journalism at the University of Mississippi. Write to him at Box 1 University, MS, or email@example.com.
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