Reporting Tim Kephart
MIAMI (CBSMiami) – Numerous Republican governors, including Rick Scott, have rejected expanding Medicaid as part of the Affordable Care Act. But a quirk in the law could force governors into a tough spot of denying health coverage to U.S. citizens, but giving it to legal immigrants.
The issue first came to light a few weeks ago when Arizona Governor Jan Brewer broke ranks and said her state would be accepting the Medicaid expansion in the law known as Obamacare. Brewer had been a vocal opponent of the law, but her budget analysts caught the glitch.
A spokeswoman for Governor Scott said he is, “concerned about how legal immigrants and U.S. citizens are treated differently under the president’s healthcare law, which we continue to learn more about.”
The expansion of Medicaid in Florida was quickly rejected by Governor Scott after last year’s Supreme Court decision upheld Obamacare, but allowed states to opt out of the Medicaid expansion. However, Scott has since backed away from that position in recent months, but still hasn’t accepted the expansion.
The Medicaid expansion would be fully paid for by the federal government initially and then roughly 90 percent would be covered by the federal government in several years.
The quirk was an unintended consequence of the Supreme Court’s ruling on the law.
Here’s the convoluted background:
Starting Jan. 1, 2014, the health care law will offer health insurance to millions of people now uninsured. Middle-class uninsured people will be able to get taxpayer-subsidized private policies through new markets called exchanges. Low-income uninsured people will be steered to Medicaid, a government program jointly funded by Washington and the states.
Under previous laws, legal immigrants have to wait five years to qualify for Medicaid. Ng’andu said Hispanic advocacy groups wanted to lift that restriction during the 2009 congressional health care debate, but couldn’t get political support. The Medicaid waiting period remained in place, but a compromise was reached that would allow low-income legal immigrants to get subsidized private coverage in the new health insurance exchanges.
The health care law expanded Medicaid to cover millions of low-income adults who are ineligible under current rules. As written, the law assumed that every state would accept the Medicaid expansion, with Washington paying for most of it. So the law stipulated that people below the federal poverty line — $11, 170 for a single person, $23,050 for a family of four— could not get subsidies for private coverage in the exchanges. Medicaid was to be their only option.
Legal immigrants here for less than five years remained an exception.
Along came the Supreme Court. It upheld Obama’s law, but ruled that states were free to accept or reject the Medicaid expansion. The court did not touch the issue of coverage for legal immigrants in the health insurance exchanges. That provision remained in place.
And that’s how the immigration glitch came to be. Poor people in a state that turns down Obama’s Medicaid expansion can only get government subsidized coverage if they are legal immigrants. U.S. citizens are out of luck.
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