The Wingnut Hole

As noted earlier, we’re having to come to grips with the fact that about half the states appear unlikely to participate fully in the Medicaid expansion provided for in the Affordable Care Act. But the picture is complicated: some states (Arkansas definitely, and Tennessee, Indiana and Ohio potentially) are expanding Medicaid roughly along the lines provided for in the ACA, but with special “flexibility” provisions (most famously Arkansas’ waiver allowing it to move all Medicaid services into private health insurance plans). Others (notably Wisconsin and most recently Iowa) are covering the newly-Medicaid-eligible populations through state funds while using Medicaid dollars elsewhere.

But that leaves quite a few (including most of the South) just flat out refusing to do anything for people with incomes under the federal poverty line. And that creates a very large “coverage gap,” leaving an estimated 5.7 million folk who don’t qualify for Medicaid or for the Obamacare health exchange subsidies.

While this coverage gap is reminiscent (though much larger and more devastating to those affected) of the “doughnut hole” that existed in Medicare Part D before the Affordable Care Act began closing it, we don’t have a name for it just yet.

I’d suggest the “wingnut hole.”

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Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.