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The Right-Wing Attorneys General Fight Against the Poor

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Before the ink had dried on health reform's Affordable Care Act, and before key consumer protections (like ensuring people with pre-existing conditions are no longer denied health coverage) could take effect, right-wing attorneys general filed suit against the constitutionality of the legislation in federal court.

Led by Florida Attorney General Bill McCollum, 20 states have joined the suit, arguing that the "personal responsibility provision" is unconstitutional. This issue will be argued in a federal court in Florida in mid-December, even though a federal judge in Michigan has already ruled the provision is constitutional.

The individual responsibility provision, which requires people to purchase health coverage if they can afford it (many of whom will be receiving substantial tax-credits so they can afford it), is tied together with the prohibition that prevents insurance companies from denying coverage to people with pre-existing conditions. As a result, the attorneys general, if they prevail, would allow insurance companies to continue denying health coverage for people who need it the most.

The attorneys general in the Florida case are taking their political vitriol about the Affordable Care Act one very unfortunate step further: They are seeking to invalidate an expansion of the Medicaid program that would extend health coverage for approximately 16 million low-income uninsured people.

This part of the lawsuit is of critical significance. That is why -- along with the AARP, the American Academy of Pediatrics, the American Public Health Association, and the National Association of Community Health Centers -- Families USA has signed a friend-of-the-court brief seeking dismissal of the attack on the Medicaid expansion.

Medicaid is a program designed to provide health coverage for low-income children and parents as well as people with disabilities and low-income seniors. It is jointly funded by the federal government and the states, and it is administered by the states. Millions of Americans depend on Medicaid for health coverage. Many millions more, however, who are needy under any reasonable standard, do not currently qualify for the program due to unreasonable and stingy eligibility standards.

Consider the following: For parents of dependent children, in 34 states the eligibility standard is below the federal poverty level ($18,310 for a family of three). In 17 of those states, the eligibility standard is barely $9,000 for a family of three.

For childless adults without dependent children, it's even worse: In 43 states, these adults are ineligible for Medicaid coverage even if they are literally penniless. Clearly this is something that should be fixed -- and, thankfully, the Affordable Care Act takes an important step to achieve that.

Starting in 2014, every American whose income falls below 133 percent of the federal poverty level will be eligible for Medicaid. These are hardly princely lavish incomes. For a family of three, that is approximately $24,350 in annual income. For an individual living alone, that is an income of approximately $14,400.

Incredibly, the right-wing ideologues have labeled this Medicaid expansion as "radical." They intend to invalidate it and deny health care coverage for millions of people who otherwise could not afford it.

Their key argument is that this is an undue burden on the states. But this argument ignores essential facts: In the first there years of this Medicaid expansion (2014 - 2016), none of the costs for newly eligible people will be paid for by the states. Thereafter, the states pick up some portion of the costs, but it never goes above 10 percent.

In the process, however, states and local governments -- which pick up the costs of charitable care in public hospitals and other safety-net institutions -- will save significant costs. Moreover, for people who do have private health coverage, their premium costs will be lowered as they no longer have to pay the cost shifts of uninsured people who received care they couldn't afford.

The suit by the attorneys general is clearly part and parcel of a political attack against the Affordable Care Act. That political attack, however, can do cruel damage to low-income, uninsured people who need health coverage but can't afford it. That suit deserves to be dismissed immediately and there is ample legal precedent for that outcome.

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