Winners and Losers

The RWJ Foundation and the Urban Institute have produced some interesting data idenitfying the uninsured adults who could gain health insurance coverage under the ACA Medicaid Expansion opt-in.  The data on Missouri is particularly compelling: Missouri has a particularly stringent Medicaid eligibility standard so it is not surprising that Medicaid eligibilty would flex substantially under the ACA's Medicaid opt-in.

So, who are these people, these newly  Medicaid eligibles?

Nationwide, the newly Medicaid eligibles would be disproportionately young  — more than half of the newly eligible insureds are estimated to be under the age of 35.  And just over half of the newly eligible insureds would be male.  The most striking characteristic about the national group of newly eligible insureds would be that they are not parents living with dependent children.

This striking profile resonates with all of our deepest beliefs about who is worthy of public assistance.  The able-bodied poor have long endured  programmatic moral stigma attached to their status. And we intuit, even without sophisticated data manipulation, that merging the program for the able-bodied poor with one for the near poor and working class (up to 138% of the FPL) will make it harder to enforce the poor-law model of separating the worthy from the unworthy poor. Only what we're worried about is de-stigmatizing the able-bodied poor, I suspect.

Missouri also has a historic legacy of relatively low Medicaid participation by parents with dependants as well, however. That will be my next topic.

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