In the last few weeks, other outlets have burrowed in and amplified this irony of Obamacare and the nightmare that Lesley fears. An emerging theme: some of those with the lowest wages may have a devil of a time affording coverage for themselves and their families. Bloomberg reporters Alex Wayne and David Mildenberg examined how low-wage home care workers might fare under the law. The prognosis: probably not very well. They wrote about Rose Ruiz, who makes $8 an hour as a home care worker for Medicaid patients but who has no insurance herself. Her best chance at getting it was through Medicaid expansion. But that won’t happen because she lives in Texas, a state that turned down Medicaid expansion. The reporters noted that this decision put her in a bind, because Ruiz—and 4.4 million others in the states that have chosen not to expand Medicaid—“would need pay raises potentially triple their current wages or more, depending on the size of their families, to reach enough income to qualify for government subsidies for private insurance.” That nightmare thing again!

Bloomberg also zoomed in on another Catch-22, and a big one: workers with low incomes are not eligible for subsidies if their bosses offer insurance that the law deems “affordable.” That means it costs them less than 9.5 percent of their income. Steve Wojcik, a vice president of the National Business Group on Health, noted that employers who offer coverage may end up disqualifying their workers from subsidized insurance through the exchanges. Yet, he added, the employer coverage may be too much to afford.

Emily Maltby in The Wall Street Journal showed how that feature of Obamacare may snare Salvador Martinez, who works for a landscaping firm in Santa Clarita, CA., and who earns $10.50 an hour. He told the Journal that he would love to have coverage but cannot afford the $140 or so for his share of the monthly premium for the policy his employer provides. His employer, Chris Angelo, said that his workers might say they are interested in employer coverage, but he believes “they will opt out. They’d rather have the cash than pay the employee portion of the premium.” The Journal concluded that the landscape company’s experience “suggests that many low-wage workers could remain uninsured next year, despite the law’s subsidies and penalties.”

In a substantial story posted on HealthyCal.org, Lynn Graebner told what’s likely to happen in California, the state emerging as a leader in all things Obamacare. Citing a study last fall by the Center for Labor Research at UC Berkeley, Graebner reported that nearly 40 percent of the uninsured won’t have an affordable coverage option, and about one-third of them—some one million people—will not be able to shop in California’s exchange because they are undocumented immigrants. “But even legal residents may not have sufficient income to pay for the health plans being offered on the exchange,” she writes.

The stories so far bring up the equity issue in healthcare ignored from the very beginning of the reform debate. Way back in 2008 when debate began, CJR urged the press to examine the equity question—the fair distribution of healthcare to those who need it, a leveling of barriers (cost barriers or other kinds) to care. Almost no one did, largely because the framers of the law never talked about it.

Achieving real equity in a private system is nearly impossible, and a private system was what was on the table. But as the press unravels the ironies laced through the health reform law, it’s good to think about giving voice to those who will be left out. Isn’t that one of the things the press is supposed to do?

Follow @USProjectCJR for more posts from Trudy Lieberman and the rest of the United States Project team, including our work on healthcare issues and public health at The Second Opinion. And for Trudy’s resource guide to covering the ins and outs of buying insurance on the state exchanges, see Open Wide, from CJR’s new July/August issue.


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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.