About half the states have said they will not do so, The New York Times reported Saturday. They include two of the largest states, Texas and Florida, and some of the poorest, including Alabama, Louisiana and Mississippi.
Under President Obama's health insurance plan, individuals with annual incomes ranging from the federal poverty level, currently $11,490, to four times that amount, $45,960, will be eligible for federal subsidies for insurance through exchanges. But those under the poverty level will not be.
Kansas Insurance Commissioner Sandy Praeger told the Times many of "the poorest of the poor" will be denied help. Kansas, which does not allow able-bodied adults who are either childless or have children but have incomes above one-third of the poverty line, is one of the states that so far is opting out of Medicaid expansion.
Most of the states that so far have said they will not expand Medicare have Republican governments.
Jonathan Chapman, executive director of the Louisiana Primary Care Association, which represents healthcare providers, said the situation is a paradoxical one.
"If the breadwinner in a family of four works full time at a job that pays $14 an hour and the family has no other income, he or she will be eligible for insurance subsidies," he said. "But if they make $10 an hour, they will not be eligible for anything."
Roy S. Mitchell, executive director of the Mississippi Health Advocacy Program, which wants the state to expand Medicare, hopes there will be an "outcry" as poor residents discover they are not eligible for help.
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