My Cousin Got Trapped In The Gap

I was sick recently.  It started with losing my dinner rght before work one Friday night, and over the next two nights, I had body aches and fatigue, and a headache that wouldn't go away.  Finally, on Monday morning, I felt so bad that I had Gaby take me to the emergency room.  A couple of days ago, I got the bill:  $8,040.25, of which my insurance covers all but $991 of, and that will probably be covered in its entirety by my HSA.  I am so glad that we both have health insurance.  Without it, I figure I'd be paying this bill off for the next forty months.
      Monday afternoon, I had a chance to visit briefly with a cousin of mine, Steve, and the stream of the conversation led to him talking about his own health care situation.   He works for a large company and makes a decent living, but he works contracted labor, so his employer doesn't provide health insurance.   He's looked into buying it himself, but since he's a diabetic, the cheapest policies he can find would cost over $20,000 per year.   He makes too little money to qualify for the subsdies from the ACA, and since our Governor has decided to put politics above the well being of the people of the state, he makes too much money to qualify for Medicaid.  So, he, a diabetic, has to do without, and hope that nothing serious happens to him in the five years till he can qualify for Medicare.
    Thing is, the Affordable Care Act was written in such a way that Steve should never have had to worry about this.  The plan was that people who make 133% to 400% of the federal poverty level would be provided help in paying for their health insurance, while those making under 133% would be covered under Medicaid, which is a state sponsored program.  The states would not be out any money for the expanded service because the Federal Government would provide 100% of the funding for the first three years, and then scaled down to 90% by 2022.
    But in 2012, the Supreme Court decided that states did not have to expand their Medicaid program if they didn't want to.  As of October 2014, 23 states, including Oklahoma,  have not done so.  This has created a coverage gap that is not provided for in the ACA,  and in most of those states, the maximum income to be eligible for Medicaid is set so low that anyone with any kind of job could not qualify.  Furthermore, childless adults in all but one of those states are not eligible for Medicaid at all.  In Oklahoma, that leaves 104,000 people without any kind of health coverage, 88% of which are childless adults.  Steve is one of them.
    I had started to write on this subject almost a year ago when a friend of mine posted a meme on Facebook about the Georgia legislature making a rather dubious vote to go against Federal law.  Not the first time for that state, of course, but it interested me because my brother had just moved to Georgia, and he, at one time, was telling the family that he would be dependent on the ACA to enable him to buy insurance.
    Then, shortly thereafter, the story came out that rural hospitals in Georgia were closing because, by not expanding Medicaid coverage, the state had also rejected 14.5 billion in Federal funds,  while denying health care coverage to 646,557 people.  This is not a problem unique to Georgia, but the solution to the problem proposed by the Governor was appalling.
    Back in 1986, Ronald Reagan signed into law the Emergency Medical Treatment and Active Labor Act, which said that Emergency Rooms could no longer reject patients based on their ability to pay for services.  Governor Nathan Deal decided that the way to fix the problems of closing rural hospitals in his state is to repeal the 1986 law.  His critics, naturally, describe his position as If we kill off all the poor people, we won't have to pay for taking care of them.
    (Sidenote here:  Back during the 2012 Presidential Election campaigns, Mitt Romney said the ACA was unnecessary because the uninsured could just go to emergency rooms.  Seems Governor Romney and Governor Deal were at cross purposes.)
    Not that people wouldn't be dying in his state anyway as a result of his failure to expand Medicaid.  The peer-reviewed medical journal Health Affairs estimated that between 501 and 1176 people per year in Georgia alone could die a "needless death" simply because of what is essentially partisan politics.
     Here in Oklahoma, of course, we've got exactly the same thing.  Governor Mary Fallin decided not to expand Medicaid coverage, turning away billions in Federal funding, saying it was "unaffordable."  Personally, I don't understand her math, or why she thinks the state would be better off with more people in the state having no access to health care or dying needless deaths.  Seems to me, she's taken the more expensive route.
    When you stand against something, you should also be aware of what you're standing for. 
    Last Thursday, the front page of the Daily Oklahoman had the headline "Shortfall's Dire Consequences,"  in which educational and health care officials explained to state Government officials how budget cuts would affect the state.  Republicans have a super majority in our State Legislature, and Republicans in general are committed to the idea that tax cuts generate growth, and that cuts in spending will cover deficits.  These ideas have never worked before, and they have no potential for working in the future, and furthermore, we have to look no further than our next door neighbor, Kansas, to see just how badly these ideas work when put into practice unfettered.  Yet that will continue to be the policy here for the foreseeable future.  Maybe all the poor people here will die off, too, and then we won't have to worry about it anymore.