In many states, people living below the poverty line will not be covered by expanded Medicaid, and won’t receive subsidies to buy private coverage, either.
Former president Bill Clinton at a September 24, 2013 Clinton Global Initiative event: “Lower income people who desperately need health insurance will have the cruelest of all situations, and there’s nothing the president can do about it.”
The 2012 Supreme Court decision allowed states to opt out of the Medicaid expansion that is part of the Affordable Care Act. Even though the federal government would provide 100% of the funding through 2016 and phasing down to 90% by 2020, at least 20 states have declined to expand their Medicaid programs. Others are still debating it. Because the original law did not envision this possibility, many adults below the poverty line in states that don’t expand Medicaid will not be eligible either for a subsidy or for Medicaid. (In states that are expanding Medicaid, everyone with incomes up to 138% of poverty will be eligible for Medicaid and those above 138% of poverty will be eligible for subsidies.)
However, the administration has said poor people in non-expansion states will not face a tax penalty, if they choose not to purchase insurance.