Obamacare isn't helping the truly poor in GOP-led, largely rural states that aren't expanding Medicaid

Uninsured African Americans, single mothers and low-wage workers, many of them living in the rural South and other states not expanding Medicaid under federal health reform, are finding out the hard way that they don't qualify for insurance benefits, Sabrina Tavernise and Robert Gebeloff report for The New York Times. "Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, they are among the 8 million Americans who are impoverished, uninsured and ineligible for help." (NYT photo by James Patterson: Claretha Briscoe of Hollandale, Miss., earns $11,000 a year, too much to qualify for Medicaid in her state, but too little to get Obamacare subsidies for private insurance)

The law was written to force states to expand Medicaid, to avoid loss of the federal money that largely supports the program, but the Supreme Court ruled that was unconstitutional. In states expanding Medicaid, the Times notes, "The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years."

Share of eligible adults not helped, highlighting states not
expanding Medicaid; for NYT's interactive version, click here.

The people left out are "stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states," the Times reports, noting that 60 percent of African Americans live in states not expanding Medicaid, and about 50 percent of Hispanics do. "The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides."

In Mississippi, 13 percent of residents are among these truly poor, uninsured people, the highest share in the country. The Times reports that 56 percent of all poor and uninsured adults are black, though they account for just 38 percent of the population. And it won't get any easier for those trying to get insurance, especially for people like Willie Charles Carter, "an unemployed 53-year-old whose most recent job was as a maintenance worker at a public school. His income is below Mississippi’s ceiling for Medicaid—which is about $3,000 a year—but he has no dependent children, so he does not qualify. And his income is too low to make him eligible for subsidies on the federal health exchange." Carter told the Times, "You got to be almost dead before you can get Medicaid in Mississippi."

States that "did not expand Medicaid have less generous safety nets: For adults with children, the median income limit for Medicaid is just under half of the federal poverty level—or about $5,600 a year for an individual—while in states that are expanding, it is above the poverty line, or about $12,200, according to the Kaiser Family Foundation," the Times reports.  "There is little or no coverage of childless adults in the states not expanding, Kaiser said." (Kaiser map)