John Roberts Cost Millions of People Their Health Insurance

A blog about business and economics.
Oct. 3 2013 8:00 AM

The Millions Left Out of Health Reform by John Roberts

John Roberts struck down a key Medicaid provision that would have penalized states that didn't expand their coverage.

Photo by Chip Somodevilla/Getty Images

This is not news to people who've been following the Affordable Care Act closely, but Sabrina Tavernise and Robert Gebeloff have a timely reminder in the New York Times that the implementation of Obamacare "will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance."

But something that's worth noting here more prominently than they do is that this is not an oversight of the law or of the Obama administration. It's due to the actions of Chief Justice John Roberts and then to a number of Republican Party state and local elected officials led by Texas Gov. Rick Perry. What happened is that the Affordable Care Act relies on an expansion of Medicaid to provide health insurance to many poor families. Yet Medicaid is a joint state/federal program and states have substantial leeway in deciding how many people get Medicaid coverage and on what terms. So the authors of the law decided to make state governments an offer they couldn't refuse—on the one hand, expansion would be nearly 100 percent paid for by the federal government while on the other hand failure to expand would come with significant financial penalties.


Then came Roberts. In his landmark ruling upholding the constitutionality of the individual mandate, he burnished his conservative cred by striking down the penalties portion of the Medicaid expansion.

That's where the problem comes from. Still, it should have been no big deal. Medicaid expansion on these terms is a no-brainer, which is why a range of Republican governors from Michigan to Arizona have embraced it. But most GOP legislators in those states still reject the idea, and Republican officeholders in the south are especially resistant. This becomes a huge problem because the very conservative states whose politicians are most hostile to the idea of poor people getting health insurance coverage are precisely the places that have the largest number of uninsured people. So the nonparticipation of Texas in the expansion just on its own takes a huge bite out of its effectiveness.

A couple of the states that don't expand Medicaid in 2013 will, I think, change their minds fairly soon. Perhaps right after the 2014 midterms. And in a place like Texas that's superconservative but much too large for Democrats to ignore, the expansion issue will give the party a shot in the arm and a good issue to talk about. Expansion won't win right away, but it should win soon enough. But Mississippi? Alabama? There are going to be pockets of the country where poor people continue to lack insurance for quite a long time, all thanks to Roberts and the stubborn intransigence of conservative politicians.

Matthew Yglesias is the executive editor of Vox and author of The Rent Is Too Damn High.



Talking White

Black people’s disdain for “proper English” and academic achievement is a myth.

Hong Kong’s Protesters Are Ridiculously Polite. That’s What Scares Beijing So Much.

The One Fact About Ebola That Should Calm You: It Spreads Slowly

Operation Backbone

How White Boy Rick, a legendary Detroit cocaine dealer, helped the FBI uncover brazen police corruption.

A Jaw-Dropping Political Ad Aimed at Young Women, Apparently

The XX Factor
Oct. 1 2014 4:05 PM Today in GOP Outreach to Women: You Broads Like Wedding Dresses, Right?

How Even an Old Hipster Can Age Gracefully

On their new albums, Leonard Cohen, Robert Plant, and Loudon Wainwright III show three ways.

How Tattoo Parlors Became the Barber Shops of Hipster Neighborhoods

This Gargantuan Wind Farm in Wyoming Would Be the Hoover Dam of the 21st Century

Oct. 1 2014 8:34 AM This Gargantuan Wind Farm in Wyoming Would Be the Hoover Dam of the 21st Century To undertake a massively ambitious energy project, you don’t need the government anymore.
  News & Politics
Oct. 1 2014 7:26 PM Talking White Black people’s disdain for “proper English” and academic achievement is a myth.
Buy a Small Business
Oct. 1 2014 11:48 PM Inking the Deal Why tattoo parlors are a great small-business bet.
Oct. 1 2014 6:02 PM Facebook Relaxes Its “Real Name” Policy; Drag Queens Celebrate
  Double X
The XX Factor
Oct. 1 2014 5:11 PM Celebrity Feminist Identification Has Reached Peak Meaninglessness
  Slate Plus
Behind the Scenes
Oct. 1 2014 3:24 PM Revelry (and Business) at Mohonk Photos and highlights from Slate’s annual retreat.
Brow Beat
Oct. 1 2014 9:39 PM Tom Cruise Dies Over and Over Again in This Edge of Tomorrow Supercut
Future Tense
Oct. 1 2014 6:59 PM EU’s Next Digital Commissioner Thinks Keeping Nude Celeb Photos in the Cloud Is “Stupid”
  Health & Science
Oct. 1 2014 4:03 PM Does the Earth Really Have a “Hum”? Yes, but probably not the one you’re thinking.
Sports Nut
Oct. 1 2014 5:19 PM Bunt-a-Palooza! How bad was the Kansas City Royals’ bunt-all-the-time strategy in the American League wild-card game?