Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states.
This article is an example of the “single payer pivot” pieces we’ve started to see pop up here and there. A Medicaid expansion and a single payer system aren’t, of course, remotely the same thing, but they are both part of the same philosophy of health care reform, and the first would be a step in the direction of the second. At this stage, any effort by the NYT or other outlets to point out the flaws of Obamacare-in-practice will serve one purpose: arguing that the law we ended up with doesn’t go far enough, and we have to do more.It’s possible the ACA could become so unpopular that the GOP could eventually replace it wholesale with an alternative, but it seems more likely at this point that we’ll end up with a tweaked version of Obamacare: either tweaked slightly by the left or more dramatically by the right. If that happens and a modified Obamacare becomes settled law, we’ll see this kind of single payer pivot piece more and more often.