South’s poorest shut out of health care reform

There’s been a lot of talk these past few days about the rollout of the Affordable Care Act.

A theme has emerged across the country, but particularly in the South, as explained by an Oct. 2 New York Times article and interactive map.

There’s a large group of people who aren’t getting subsidized health care, and not because they can’t log on to healthcare.gov; it’s because they’re too poor.

Yes, paradoxically, you can be too poor for a discount on your health insurance, because the Affordable Care Act was designed to work in concert with the expansion of Medicaid.

So folks who live in South Carolina or any of the other 25 states that opted not to expand Medicaid are stuck in limbo. They’re not poor enough to get subsidized care and they can’t get on Medicaid because the governor doesn’t think we need Medicaid expansion.

Southern charm?

A New York Times review of census data published Wednesday (good thing they did that before the government shut down) shows that poor and uninsured folks are overwhelmingly employed in the service sector. They’re also disproportionately Southern and African-American. And their top five occupations should sound familiar to folks who live here: cashiers; cooks; nursing aides, orderlies and home health care workers; retail sales clerks, and servers.

Nationally, 19 percent of cashiers would be classified as poor and uninsured; 10 percent of retail sales clerks would as well. The others are somewhere in between, but they’re all stuck in the middle.

“We don’t practice what we preach in the South for the most part,” state Rep. Wendell Gilliard said. “We patronize people and events, but we don’t like to give them a helping hand.”

The good news, if there is any, is that these uninsured folks will not be subject to the $95 fine next year as long as health insurance cost would represent more than 8 percent of their income.

Of course, it’s unlikely that many of those folks could easily come up with the money to pay the fine, but that’s another story.

Bad to worse

Nobody thinks Medicaid is the answer to everyone’s problems. If it were, we wouldn’t need the Affordable Care Act.

But it’s still perplexing that all those (mostly Republican) states would turn down the federal government’s offer of free money for three years. After 2017, the state would have to pay for no more than 10 percent of the expansion while the fed continued to pay for at least 90 percent. That’s three years for forward-thinking, thrifty state leaders to set money aside to pay our future share.

But that wasn’t a good deal for the Legislature or the governor, apparently.

Gov. Nikki Haley has repeatedly called the Affordable Care Act and the accompanying Medicaid expansion “bad policy” and a “public policy disaster.” She and other state leaders maintain that there are other, better ways to address health care shortfalls than expanding Medicaid or implementing the Affordable Care Act.

Gilliard has a different take. The Charleston Democrat says it’s a caustic mix of stubbornness, prejudice and racism. And he doesn’t expect any big changes when they return to work in January. “For the most part, the leadership in the session doesn’t want to talk about it, they don’t want to entertain it. They don’t care about the poor and the middle class.”

In the meantime, he added, “South Carolina is making a bad situation worse.”

Reach Melanie Balog at 937-5565 or mbalog@postandcourier.com

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