The care of 3.3 million uninsured young seniors is now dangerously threatened by the Supreme Court’s decision to narrow the expansion of Medicaid under the Affordable Care Act (ACA). The decision also raises questions about the future care for 16 million older persons and persons with disabilities.
Medicaid is a shared federal and state program with the federal government paying a large share of the costs. Originally, the ACA required states to expand access to their Medicaid program or lose all federal dollars. The Court decided, however, that states can refuse to expand the program without losing their Medicaid funds.
Because the federal government will pick up most of the tab for covering additional low-income people-100 percent for the first three years and 90 percent thereafter-states should decide to move forward and cover more people.
However, some state governors, such as Florida’s Governor Scott and Texas’ Perry, have already threatened not to expand the program. This means that too many low income seniors and others in Florida, Texas and other states that oppose the expansion will not benefit from the law.
Congress and state legislatures will need to act to ensure the court’s decision does not leave the poorest of the poor without access to health care in states that decline to adopt Medicaid expansion.