How the decision will affect poor people who need healthcare is the next Medicaid story the media should consider. The New York Times’s good second day piece laid out the problem: “Under the law, subsidies are available to people with incomes from the poverty level up to four times that amount, but not to people with incomes below the poverty level ($23,050 for a family of four).” What happens to them?
Speculation about what this governor or that governor will do—or what the consultants and pressure groups, such as hospitals that need patients who can pay, will tell them to do—is fine. But it is not the essential Medicaid story that needs to be told.
That story is about people: What will really happen to low-income people who would have been captured in the expansion of the safety net had the court ruled another way, or now if they lived in a bluer state. How will they pay for their health care? How do they do so currently, if they do? Will they be eligible for subsidies the law makes available for the uninsured? If so, will such subsidies be large enough to buy decent insurance?
What will substitute programs like the one Mitch Daniels talks about for Indiana actually provide? This is the nitty gritty of local reporting, and political speculation does not substitute for it.
Then there’s the larger question that Darshak Sanghavi, writing for Slate.com, zoomed in on: “State reluctance to expand Medicaid gets at the core problem in health care today—it’s just too damn expensive and the ACA does very little about that.”
Serious exploration of the law’s weak cost control measures might be in order too.