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Health Care Reform:

Health Insurance & Affordable Care Act

Who Gets Covered Under Health Reform?

As the debate rages over 'Obamacare,' here's a look at what the changes will mean.

Who Pays for What? continued...

''Even with federal help, the state would have to find another $4.5 billion over the next 10 years to pay for the Medicaid expansion.

In Indiana, Gov. Mitch Daniels said in a statement that the expansion would put 1 in 4 Hoosiers on the Medicaid rolls at a cost to the state of $2 billion over the next 10 years.

"I think states will turn it down," says Marc K. Siegel, MD, an infectious disease expert at New York University's Langone Medical Center in New York City, and also the physician coordinator of Doctor Radio.

"In New York, it's a billion dollars or more to administer the Medicaid expansion. So a key problem here is not in terms of Medicaid, which the feds are picking up the cost of for the most part, but the administration of the additional Medicaid patients," Siegel says.

Fate of Medicaid Expansion in States' Hands

Medicaid is a government program that helps the poorest Americans get health care. One in four people insured under Medicaid are children.

"The Medicaid program is financed as a partnership between the federal government and the states," says Andrew Bindman, MD, a professor of medicine, health policy, epidemiology and biostatistics at the University of California, San Francisco. Bindman helped to draft the ACA, and he worked on the Medicaid expansion plan.

According to a report by the Kaiser Family Foundation, the federal government pays an average of 57% of the cost of Medicaid. States pick up the rest of the tab.

As it stands, the income cut-offs for Medicaid are very restrictive. Many people fail to qualify if they earn minimum wage.

The Medicaid expansion increases the income cut-off to 133% of the federal poverty level. The level is adjusted each year. But in 2012, for a family of four, the level is $23,050. The new law would bump that up to $30,657.

Currently, an estimated 50% of people who don't have health insurance would qualify for the Medicaid expansion under the ACA.

But only if the state you live in decides to participate.

"The good news is that we're expanding coverage for the uninsured. Concern remains for some of the most vulnerable, because the Medicaid provisions of the law could be interpreted differently from state to state. It's possible that states may choose to opt out of the program with a negative impact on poor people," says Rachel Garfield, a senior researcher with the nonprofit private foundation Kaiser Family Foundation.

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