Your Opinion: Medicaid expansion would close gap

Dear Editor:

The Wall Street Journal Feb. 10 page 1 has pointed out a major health care coverage gap affecting millions of people and Missouri is one of six states hardest hit.

The problem is that a single person making more than 25 percent of the federal poverty level ($11,490) is not eligible for Medicaid in Missouri. That is, a single person can't make more than $2,873 and get Medicaid in Missouri.

So what to do? Can such a person go to the healthcare.gov website and get health insurance under the Affordable Care Act? Only if he can pay for it in full because federal subsidies are not available to anyone unless they make more than the federal poverty level.

There is a gap. Make more than $2,873 and you can't get Medicaid in Missouri. Make less than $11,490 and you can't get a subsidy to help buy a plan under Obamacare.

The Wall Street Journal article gave the example of a single man in Alabama who as a hair stylist earned more than the Medicaid ceiling but less than the poverty level. He can't get Medicaid and the lowest cost plan available to him under Obamacare costs $437 per month with a $6,350 annual deductible. This plan would cost the man more than his entire annual income.

But if he earned more than the federal poverty level he would get a subsidy under the Affordable Care Act. The subsidy would leave him owing only $50 per month which he could manage. But because he earns more than the poverty level he doesn't qualify for the subsidy.

The idea under the Affordable Care Act was that all states would extend Medicaid eligibility to more than 100 percent of the federal poverty level so there would be no gap. To encourage this the federal government will pay 100 percent of the additional costs for the first three years and 90 percent thereafter.

Even so, 24 states, Missouri included, have refused to extend Medicaid eligibility. On Feb. 5 the Missouri Senate voted 23-9 to reject the governor's proposed expansion of Medicaid.

Missouri is now one of only six states where more than 25 percent of the health care uninsured fall into this coverage gap. Even though extending Medicaid would bring millions of federal dollars into Missouri, our Republican legislators will not vote to extend this help to our neediest citizens.