Let’s Make Sure the Affordable Care Act Lives Up to Its Name

Low-income workers received a potentially devastating blow when the US Supreme Court decided to strike down the provision in the Affordable Care Act (ACA) penalizing states that do not expand access to Medicaid to families earning up to 133% of the poverty line. Unless states voluntarily expand Medicaid, many low-income workers will be left to shoulder the cost of mandated insurance on their own because few are likely to be covered through their employer.

According to the administrative rules for the ACA, employers (with 50 or more employees) have to pay a “shared responsibility fee” only when they neglect to cover full-time employees. Under this new law, full-time employees are defined as those who average 30 or more hours per week, and employers are granted ample leeway in defining the time period on which eligibility is based. Research I’ve conducted in several industries indicates that work hours in today’s hourly jobs are often scarce, with many workers expressing a preference for additional hours of work for additional pay. Because employers condition access to benefits on job status and hours worked, hourly workers, especially part-time workers, are often excluded from company-sponsored health insurance. The ACA is unlikely to do much to extend employer-sponsored coverage to hourly workers and may even heighten their risk of poverty given the incentive to employers to keep work hours below 30 a week.

Let’s make sure the Affordable Care Act lives up to its name by encouraging Governor Quinn and our legislators to voluntarily expand Medicaid. Because the federal government will pick up over 90% of the tab for the expansion, it makes good fiscal sense for both Illinois taxpayers and Illinois families.

Susan Lambert
Associate Professor
School of Social Service Administration
University of Chicago

(Portions of this letter were published in the Chicago Tribune, July 6 Voice of the People here)