In some states, more poor Americans get health care under expanded Medicaid

Aaron Macholl-Stanley, a 25-year-old culinary arts student from California, is in the process of enrolling in Medi-Cal, that state's insurance program for the poor. Health policy analyst Susan Dentzer joins Judy Woodruff to discuss how the ACA's expansion of Medicaid has made 400,000 additional Americans eligible to enroll.


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JUDY WOODRUFF: For all of the problems with the rollout of the health insurance program, one part of that effort seems to be going better is the expansion of Medicaid, health care for the poor.

Nearly 400,000 additional Americans have learned that they are now eligible to enroll.

And that brings us to our series of personal stories of health reform. Tonight, we hear from a young man in California who is in the process of newly enrolling in Medicaid, a joint federal and state program that's known there as Medi-Cal.

WOMAN: I'm going to scrape that out. Don't you dare put water in there. Oh, you snot.

AARON MACHOLL-STANLEY, college student: My name is Aaron Macholl-Stanley. I'm 25 years old. I currently live at home with my mother. I am just finishing up a second year at San Francisco City College culinary arts program.

Cooking has always just been one of the things that I have enjoyed. I actually started working at the CommonWealth Cafe and Public House in Oakland, where I am dishwashing, prep cook and line cook.

The employer doesn't provide any sort of health insurance, despite being an awesome place to work and a really friendly environment. At my school, we have a health fee that covers limited medical responses. Like, if I have cut myself, they will give me a Band-Aid. I still need insurance so that I can get a prescription if I get sick.

I don't have any preexisting conditions or health issues constantly, other than maybe the occasional cat allergy, but I'm much more likely to burn myself or cut myself, and constantly around fire and sharp objects.

And I believe that having health insurance is definitely a necessity in this industry. As I was growing up, I had insurance through my mom's employer. Once she retired, I moved onto her retiree group health plan through Aetna insurance.

When I got to be 23, we got a notification from Aetna saying that, at 23, I was going to age out. The difference that they seemed to imply about the retiree plan was that, because everybody was retired, there were no active employees, so that they were not bound by certain language of the Affordable Care Act that said that they had to keep me on until I was 26.

I was at that point looking at different options. I could keep the same plan for $256 through COBRA. Another option was the Kaiser plan that I ended up going with, which was a high-deductible, $90 plan. I did try to avoid going to the doctor, so that I wouldn't get the brunt of the bill because of the high deductible.

At the beginning of October, I got a letter from Kaiser saying that, with the Affordable Care Act, the plan that I had was going to be discontinued. The next closest plan was going to be a $221 plan with a $9,500 deductible. And that seems like an exorbitant jump, despite assurances that I would be able to keep the insurance that I had and continue to pay what I had been paying.

WOMAN: There's a couple of options. It's coverage basics and apply for coverage.

AARON MACHOLL-STANLEY: My mom and I went on to the Covered California site together to look at what options were available.

Given my income level, the Covered California site seemed to indicate I should definitely go with Medicaid, Medi-Cal in California. This is the application that I filled out. It's just all of the questions that I had to answer in order to apply.

At this point, I'm not really sure about what sort of coverage Medi-Cal is going to be providing for me. All I know is that option is the best one for me at this point.

I think the Affordable Care Act is a small step in the right direction. I think that the more people we get on health insurance, the better it will be for the entire nation. Most people my age think that they're invincible, and that they don't need health insurance, and it's really not the first priority.

And I would assume that health should be everyone's first priority, because, if you're not healthy, you're not able to work, you're not able to go to school, you're not able to do all of the things that being alive sort of entails.

JUDY WOODRUFF: Just for the record, we checked back with Aaron today. He said Kaiser insurance told him that it is considering how it will respond to the president's move. But, either way, he plans to enroll in the Medi-Cal program.

As always, we try to fill out the broader picture.

Tonight, NewsHour analyst Susan Dentzer joins us.

Susan, welcome back.

So, Medicaid seems to be one of the bright spots in the rollout of this health care law. What is it, 400,000 people, we said, have enrolled? Why has it become so attractive?

SUSAN DENTZER: Well, first of all, Medicaid has expanded under the law, obviously, and so people with higher incomes than were generally the case can now enroll.

For single individuals, that's up to about just under $16,000 a year of income now can enroll, and, very importantly, the eligibility was expanded so that single adults without dependent children, like Aaron, can now sign up for the program. In many states, if you were a single adult, previously, you were not eligible.

So, because of that, there are an estimated 10 million to 20 million people who could eventually come into the Medicaid program, the expanded Medicaid program. Now, of course, that depends on whether the states have gone ahead and expanded Medicaid. And because of the Supreme Court decision a year ago, which threw that into question, there are still about two dozen states that have not decided yet to expand their Medicaid program. So we will have to see how that plays out over time.

JUDY WOODRUFF: Yes. I was going to ask you, how do you see that affecting this? Because, initially, the Medicaid expansion was very much a part of the health care law. But then, when the Supreme Court said states could decide for themselves, how did that affect the -- people's decisions about what to do? What do we see so far?

SUSAN DENTZER: Well, it certainly has blocked the population in some of the states that have not expanded Medicaid, like Texas, for example. Many people who in other states that have expanded Medicaid would have been eligible are not able to get enrolled.

A state like California, which has probably about two million people who will be eligible for the expanded Medicaid program, those folks, like Aaron, are not going to have trouble getting enrolled.

JUDY WOODRUFF: So, how representative would you say he is? Twenty-six years old, obviously, just getting started in his professional life, still going to school, how typical is he of people who are signing on to Medicaid? Do we know?

SUSAN DENTZER: Well, certainly, there are going to be a lot like him. There are also going to be working older adults, single adults without dependent kids who have struggled in low-wage jobs that don't provide health insurance coverage. That will be another important group of people.

Many people who are living just above the poverty level, because we're expanding now Medicaid up to 138 percent of the federal poverty level, so just -- just richer than that, typically, you haven't been able to qualify. So people like Aaron, who potentially are going to be in Medicaid for a while, also have another advantage going for them in states like California, because, in about 10 states, insurers have offered coverage both in Medicaid and in the health insurance exchange, so that if their income fluctuates over time, they can stay in the same plan.

And that may be the case with Aaron. If he rises through the ranks of the restaurant some day and earns more money, he could potentially stay in the same plan and get coverage through the exchange.

JUDY WOODRUFF: Now, as we're saying, a lot of people are signing up for Medicaid. At the same time, there have been these problems with the technical aspect of signing up, the Web site itself, we know, still troubled.

How much of an effect is that having, do we know, on the ability of people to sign up for Medicaid?

SUSAN DENTZER: It has had some effect in about 36 states, where -- depending on people being able to come through healthcare.gov, and fill out an application for Medicaid that would then be detailed over to the state itself.

That hasn't worked yet. However, it is the case that people can still sign up through their state Medicaid program. You can also get referred to that Medicaid program on healthcare.gov. And, in addition, there have been many states that actually said, we're going to go our own route, states like Oregon that decided in advance to send out letters to people who they thought would probably be eligible.

JUDY WOODRUFF: Right.

SUSAN DENTZER: And those folks have filled out paper applications and sent them back. So, in Oregon, for example, 70,000 people have signed up that way.

JUDY WOODRUFF: Susan Dentzer, thank you.

I have to say, I was struck by the young man saying he doesn't know what type of coverage he's going to have, but it's his only option.

SUSAN DENTZER: And he gets all the benefits that are in all the packages in the exchanges.

JUDY WOODRUFF: Susan Dentzer, we thank you.

SUSAN DENTZER: Great to be with you, Judy.