In TN, Medicaid Will Cover Low-income Immigrants, But Not Citizens

Republican Gov. Bill Haslam’s refusal so far to expand Medicaid under federal health reform could mean that Tennessee’s poorest residents won’t have access to health coverage in 2014 but some lawful immigrants will, according to the Chattanooga TFP.
That’s because legal immigrants with incomes below 100 percent of the poverty level — $11,170 for a single person or $23,050 for a family of four — will be eligible for federal subsidies to buy private coverage through health insurance exchanges.
American citizens with the same income levels, however, can’t participate in the exchange because the law envisioned those with incomes up to 138 percent of the poverty level would be covered through the Medicaid expansion.
The politically ticklish contrast came about as a result of last year’s U.S. Supreme Court ruling on the 2010 Affordable Care Act.
The act aims to provide coverage to millions of lower-income people in two ways. One is to mandate that most people have health insurance and to help those who can’t afford it by subsidizing purchase of private coverage on new state health insurance exchanges. People with incomes up to 400 percent of the federal poverty level could get subsidies.
The other is by expanding state Medicaid programs, which now cover mostly low-income pregnant mothers, children and some disabled people, to everyone whose income is up to 138 percent of the federal poverty level.
The court upheld the law but made Medicaid expansion optional rather than mandatory for states. Georgia, Alabama and many other Republican-led states have ruled out the expansion.
The prospect that legal immigrants, such as workers and refugees, will be insured but not the state’s poorest residents is “quite an irony,” said Ron Pollack, executive director of the Washington-based health advocacy group Families USA.
He said Arizona’s Republican governor, Jan Brewer, cited that fact among others when she recommended her state expand Medicaid.
Matt Salo, executive director of the National Association of Medicaid Directors, said the Supreme Court ruling sets up a political dilemma.
“If you’re a state that doesn’t do the expansion, there will be two groups of people below 100 percent of the poverty level: citizens, who will likely get nothing, [and] legal immigrants, who get fully subsidized coverage in the exchange. … That’s not going to sit well with folks.”

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