Vol 23, 2014 Annals of Health Law 38
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
coverage. 72 In states that refuse to expand Medicaid eligibility this painful
dynamic will likely continue.
Despite its substantial benefits for PLWHA and others who rely
disproportionately on Medicaid, many states have pointed to the
expansion’s alleged financial costs as a justification for refusing to
implement it. 73 Politicians from these states argue that expanding the
program, which they often describe as broken and inefficient, is simply too
expensive. 74 However, states do not have to pay for the expansion at all
until 2016, at which point the federal government will continue to pay for
ninety percent of the program’s costs. 75 Moreover, even if that ten percent
was too financially burdensome, a state could easily participate in the
program until 2016 and then withdraw. 76 These states are having a
devastating impact on the poor and uninsured by refusing to implement the
expansion. 77 Their decisions will result in approximately eight million
more uninsured people, all of whom the expansion would have covered. 78
In Mississippi, where the Medicaid ceiling will be only $5,669 a year
beginning in January 2014, 79 thirteen percent of the population is poor and
uninsured. 80 These people will not be eligible for Medicaid because the
State refuses to implement the expansion. 81
72. See Jessica Camille Aguirre, Cost of Treatment Still a Challenge For HIV Patients
in the U.S., NPR (July 27, 2012), http://www.npr.org/blogs/health/2012/07/27/157499134/
cost-of-treatment-still-a-challenge-for-hiv-patients-in-u-s (telling the story of Ruben
Bermudez, who has been forced to watch his income closely in order to ensure that it does
not climb above Medicaid eligibility levels).
73. Sabrina Tavernise & Robert Gebeloff, Millions of Poor are Left Uncovered by
Health Law, N.Y. TIMES, Oct. 3 2013, at A1 (quoting State Senator Chris McDaniel, a
Republican who opposes the expansion, as stating “[a]ny additional cost in Medicaid is
going to be too much”).
74. Id.
75. 42 U.S. C. A. § 1396d (West, WestlawNext through P.L. 112-283).
76. See Nat’l Fed’n of Indep. Bus. v. Sebelius, 132 S. Ct. 2566, 2608 (2012) (concluding
that the federal government does not have the authority to threaten states with the rescission
of all Medicaid funding if they do not implement PPACA’s Medicaid expansion).
77. See, e.g., Tavernise & Gebeloff, supra note 73 (describing both the vast number of
the uninsured who will not qualify for Medicaid because of many states’ refusal to expand
eligibility and telling the stories of specific people adversely effected).
78. Id.
79. Kaiser Family Found., Medicaid Eligibility for Adults as of January 1, 2014 3 (Oct.
1, 2013), http://kff.org/medicaid/fact-sheet/medicaid-eligibility-for-adults-as-of-january-1-
2014/
80. Tavernise & Gebeloff, supra note 73. In the words of Willie Charles Carter, an
unemployed, fifty-three-year-old resident of Mississippi, “[y]ou got to be almost dead before
you can get Medicaid in Mississippi.” Id.
81. Id.
