Here's how it goes in Missouri:
To qualify for Medicaid you have to be under a certain income level, AND you have to be Over 65, or blind, or disabled, or be under age 19, or have dependent children under 18 living in the household with you.
To qualify for ACA you cannot be eligible for health insurance through an employer plan, if said plan meets minimum coverage guidelines set up for the government.
To qualify for income tax credits to offset the cost of health insurance through the marketplace, you must make a minimum of about $13,000. If you don't make that much (an in our rural area, lots here don't), the cheapest plan for you is about $500 or so with like a $10,000 deductible.
To put this in perspective, before ACA, I went to an agent and got health insurance for my son through Blue Cross Blue Shield for my son for less than $100 a month.
As the ACA was written, it called for Medicaid expansion in every state for residents with incomes up to 133 percent of poverty. But in 2012, the Supreme Court ruled that states could not be penalized for opting out of expansion, and Missouri is one of 19 states that has not yet taken steps to expand coverage.
Because subsidies are only available in the exchange for people whose household incomes are at least 100 percent of poverty (since Medicaid was supposed to be available for those below that level), there are 147,000 people in Missouri who are in the coverage gap and have no realistic access to health insurance. They aren’t eligible for Medicaid or for subsidies to offset the cost of private insurance.
And then we have these wonderful people like the woman I just talked to. She qualifies for Medicaid, all she had to do was bring in a copy of her social security card so Medicaid could verify it. I called her every day for 2 weeks, twice a day, each day, she was going to be bringing it in, she was on the way to bring it in. She never did. She owes this facility over $200,000 in medical bills and it's insane! Emergency Rooms have to treat everyone, so we've got people coming in, rcving treatment and then walking out the door, and if you ask about paying, they literally laugh in your face.
Sorry, it's been a rough day.