A wrinkle in the healthcare law implementation that seems to not get talked about much around here is the Medicaid gap.
As you can see from the graph, some states have a Medicaid eligibility threshold that is incredibly low. This is one thing the ACA attempted to rectify. The Feds would pick up the tab for increasing the Medicaid threshold to 138% of the FPL in all states for the first three years. After that, state contribution to this expansion phases up to 10% by 2020. The Feds still pick up the other 90%. People at least 100% of the FPL through 400% are eligible for subsidies under the ACA. People under 100% are not. The assumption is that these people would become eligible for Medicaid and be covered that way instead.
Here's where the wrinkle comes into play. The Supreme Court ruled it was unconstitutional to require a state to accept this money. States had to be given the opportunity to opt out. 26 states chose to opt out. All of them with GOP governors or legislatures. In many of these states, the Medicaid threshold is less than 100% of the FPL. This leaves a gap where low-income families are not eligible for Medicaid and are not eligible for subsidies to health insurance premiums.
Your family of three can't get help with healthcare, because your state turned down a ton of money that would have helped you. I'd be upset.
Why hasn't a bill been floated to close this gap? Lower the premium subsidy to 0-400% of the FPL. If you are eligible for Medicaid, you are not eligible for subsidies, so the effect of this would be that the premium subsidies cover down to your state's Medicaid threshold.
Would you approve of such a bill?
I know many of you would prefer a third option of "repeal the ACA." There are a hundred threads to talk about that. This isn't one of them. Assume for the purposes of this poll that the ACA will remain intact at least through 2016 when Obama leaves office.