A statewide Medicaid eligibility expansion may reach thousands more in Clark County, but it comes at cost — and risk — to Washington. On Page One
MIAMI -- Sandra Pico is poor, but not poor enough.
She makes about $15,000 a year, supporting her daughter and unemployed husband. She thought she'd be able to get health insurance after the Supreme Court upheld President Barack Obama's health care law.
Then she heard that her own governor won't agree to the federal plan to extend Medicaid coverage to people like her in two years. So she expects to remain uninsured, struggling to pay for her blood pressure medicine.
"You fall through the cracks and there's nothing you can do about it," said the 52-year-old home health aide. "It makes me feel like garbage, like the American dream, my dream in my homeland is not being accomplished."
Many working parents like Pico are below the federal poverty line but don't qualify for Medicaid, a decades-old state-federal insurance program. That's especially true in states where conservative governors say they'll reject the Medicaid expansion under Obama's health law.
In South Carolina, a yearly income of $16,900 is too much for Medicaid for a family of three. In Florida, $11,000 a year is too much. In Mississippi, $8,200 a year is too much. In Louisiana and Texas, earning more than just $5,000 a year makes you ineligible for Medicaid.
Governors in those five states have said they'll reject the Medicaid expansion underpinning Obama's health law after the Supreme Court's decision gave states that option. They favor small government and say they can't afford the added cost to their states even if it's delayed by several years. Some states estimate the expansion could cost them a billion dollars a year or more.
Many of the people affected by the decision are working parents who are poor -- but not poor enough -- to qualify for Medicaid.
Republican Mitt Romney's new running mate, conservative Wisconsin congressman Paul Ryan, has a budget plan that would turn Medicaid over to the states and sharply limit federal dollars. Romney hasn't specifically said where he stands on Ryan's idea, but has expressed broad support for his vice presidential pick's proposals.
Medicaid now covers an estimated 70 million Americans and would cover an estimated 7 million more in 2014 under the Obama health law's expansion. In contrast, Ryan's plan could mean 14 million to 27 million Americans would ultimately lose coverage, even beyond the effect of a repeal of the health law, according to an analysis by the nonpartisan Kaiser Family Foundation of Ryan's 2011 budget plan.
For now, most states don't cover childless adults, but all states cover some low-income parents. The income cutoff, however, varies widely from state to state.
Most states cover children in low-income families. Manuel and Sandra Pico's 15-year-old daughter is covered by Medicaid. But the suburban Miami couple can't afford private insurance for themselves and they make too much for Florida's Medicaid.
Manuel Pico, a carpenter, used to make more than $20,000 a year, but has struggled to find work in the last three years after the real estate market collapsed. He occasionally picks up day jobs or takes care of the neighbor's yard. Sandra Pico would like to work full time, but can't afford to pay someone to watch her 34-year-old sister, who has Down syndrome.
"No matter how hard I work, I'm not going to get anywhere," Sandra Pico said. "If you're not rich, you just don't have it."