John Oliver explains how this year’s elections could affect Obamacare

John Oliver wants you to know how important state elections are, even if you don’t live in one of the states set to hold gubernatorial and legislature elections this week.

“There are American lives at stake here,” he said on his late-night show on Sunday. “A number of these elections could determine whether hundreds of thousands of people remain in or even fall into what’s known as the Medicaid gap.”

Under Obamacare, the federal government was supposed to subsidize health insurance for people above 138 percent of the poverty level. Anyone below that was supposed to be eligible for Medicaid. If that required states to expand Medicaid, the federal government would pay for it: The first few years, the federal government would cover the entire cost of the expansion. Over time, the federal government’s payments would be phased down to 90 percent of the cost, where it would remain. (To get a sense of how good of a deal that is, the federal government typically paid for about 57 percent of a state’s entire Medicaid program before Obamacare.)

At first, the Medicaid expansion was essentially mandatory under Obamacare. But in 2012, the Supreme Court ruled that the federal government was acting in a coercive manner, and the expansion was made voluntary, so states could decide for themselves if they wanted to expand the program.

Many states — notably Texas and Florida — have so far opted not to. These states don’t pay for Medicaid for individual adults unless that person is below 44 percent of the federal poverty level. That means individual adults in these states living between 44 percent and 100 percent of the federal poverty level can get less of a subsidy on his or her health insurance than someone living above poverty and eligible for subsidies from Obamacare’s insurance marketplaces.

“Twenty states have so far declined to expand Medicaid, leaving over 3 million people in the Medicaid gap — people in the illogical situation of not making enough money to receive government assistance,” Oliver said, referencing a Kaiser Family Foundation report.

This year, two state elections could help decide the fate of the Medicaid program. In Virginia, the state legislature, which is the main hurdle toward expanding Medicaid, is being voted on. And in Kentucky, Republican gubernatorial candidate Matt Bevin earlier vowed to undo the state’s existing expansion if he wins.

These kinds of state decisions are why Tuesday’s election and others like it seriously matter, even if they don’t get as much attention from the media as a whole. “So on Tuesday, even if you don’t live in a state holding an election, spare a thought for the people who do,” Oliver said, “because the results may ultimately affect the health of half a million people.”