Why Even Some Liberals and Independents Are Refusing to Sign Up For Obamacare

A man looking on a display with the option to sign up for Obamacare

The Obamacare deadline is Monday, and a flurry of reports, headlines and talking heads are weighing in its success or failure. But sometimes politics cannot be understood without a human touch.

One of the most devastating aspects of the Affordable Care Act's (ACA) implementation, flying under the radar, is the unwillingness of Republican-led states to accept the Medicaid expansion provision included in Obama's legislation. This, and not the law, is making health insurance cost prohibitive for many — forcing people to choose the annual fine rather than accept the costs of even the cheapest plans.

One state where this applies is Pennsylvania, where Gov. Tom Corbett has dithered from flat-out rejecting the expansion to taking a re-election-friendly "moderate" pose of attaching requirements that cut benefits and rule out helping the unemployed. I started asking around for stories of people negatively impacted by Corbett's decision and, like most Pennsylvianians, I didn't have to go far. These are the faces of those being impacted by a failure to extend Medicaid under the ACA.

Adam, 29, independent

We can start with my friend Adam, a videography student at Northampton County Community College and part-time waiter at a local sushi restaurant. After being told that his income level was too low for any insurance plan offered on the ACA website, he discovered that he would not be allowed to enroll in Medicaid due to Pennsylvania’s rejection of the ACA's expansion of the program. Adam was left with no option but to pay the "individual mandate" penalty.

"I think it was very irresponsible for Pennsylvania not to include the Medicaid expansion for the Affordable Care Act," Adam said, before adding that he was not a wholehearted supporter of the ACA itself. "It is the exact opposite of what people criticize it as being," he explained. "It is not socialism in any way — it is forced capitalism. You are forced to pay these corporations for a service or else you will be fined.

"By passing the bill, our government is arguing that health care is a right and a necessity in our democratic society, but it is abdicating its responsibility to actually provide that service, instead leaving it to a competitive market that is more interested in turning a profit than providing quality and affordable service."

George, 21, independent

George, a musician who also works at a pizza restaurant, had even less luck than Adam. "Every single affordable health care was labelled as 'catastrophic' and required me to pay between $150 and $300 a month, with between a $5,000 and $10,000 deductible," he explained. Because he can't afford the monthly payments, he realized that it was simply easier to pay out of pocket when he sees his doctor, even with the penalty.

And why wasn't Medicaid an option? When he tried applying, he found that he didn't qualify under Pennsylvania's specific guidelines (such as having a record of using other welfare benefits in advance), all of which would have been rendered moot had the ACA’s expansion criteria been accepted by the state.

"It’s not like I refuse to get health care," he pointed out. "Quite the contrary, I want health care, and I’m trying my hardest to receive it. The government won’t let me, so now they’re penalizing me for something that’s their own fault."

Jennifer, 32, liberal

After being accepted into a local nursing program, Jen was informed that she needed to have health insurance to take classes. Despite making very little at her current job as a doula, she explained, she was denied Medicaid coverage because Pennsylvania still requires "you to be a child, pregnant, or have a chronic illness that requires monthly medication, such as diabetes, in order to qualify” — all of which, again, would not have remained in place under the ACA.

In the end, Jen was the one on this list who still signed up for the cheapest plan possible, in no small part because it was a job requirement.

Ironically, the Medicaid expansion problem can be traced to the very Supreme Court decision that upheld the ACA's constitutionality. Prior to the court's ruling, the ACA required any state participating in Medicaid (which, despite being voluntary, every state does) to expand their coverage to include almost all adults under the age of 65 with an income at or below 133% of the poverty line. In addition to closing coverage gaps that had long disqualified millions of low income Americans from receiving Medicaid benefits, this policy would have guaranteed that individuals unable to afford the insurance premiums of the plans offered through the ACA's new insurance exchanges could still receive health care coverage.

Unfortunately, despite constitutionally validating most of the ACA's provisions, the Supreme Court also ruled that states could not be "coerced" into accepting the Medicaid expansion by linking it to other federal payments. As a result, each state has the right to accept or reject the Medicaid expansion on its own, and, as the map below shows, Republicans in many states have chosen to deny this benefit to their residents.

Bear in mind that this is not being done because it could realistically undo the law. Republicans may have good reason for optimism regarding the upcoming midterm elections, but even if they won every seriously contested Senate race, they still would fall short of the veto-proof majority necessary to repeal the ACA. With killing the bill out of the question, the only remaining motive for state Republicans refusing to expand Medicaid is to (a) please their die-hard right-wing bases and/or (b) cause political headaches for President Obama and the Democrats.

In the end, the readers of this article who live in a state that has rejected the Medicaid expansion fall into one of two categories: those who are either struggling themselves or personally know men, women, and children among the working poor who are struggling as a result of Republican partisanship, and those who aren't. If you do know people who are being denied the benefits of the ACA's Medicaid expansion by their state's Republican leaders (or are among them), keep them in mind when casting your ballot this November.

For once, the well-worn cliche is literally true: Your vote can save lives.

In the words of John F. Kennedy, "If a free society cannot help the many who are poor, it cannot save the few who are rich."