I really appreciated the depth of detail into what programs Oregon did and did not qualify for, how Medicaid expansion was supposed to work, and how opting out

I really appreciated the depth of detail into what programs Oregon did and did not qualify for, how Medicaid expansion was supposed to work, and how opting out of it effects poor Texans. There's just one data point that it would have been good to see... For people who don't qualify for Medicaid, the next step is a heavily subsidized marketplace plan through ACA. Now it isn't an option for people like Oregon after the fact / in this case because getting sick is not a qualifying life event. You would have to do something like move to another state to qualify for special enrollment. But if he had had an ACA plan, the transplant would have been covered, with some very small deductible. I would really liked to have seen the article address how much this would have cost, in monthly premiums and out-of-pocket expenses, because it's a another very "interesting" minefield. Now, in order to qualify for federal subsidies in the marketplace, you need to make 100%-400% of FPL. If you make less than 100% of FPL you do not get any subsidy whatsoever because the Feds expect you to get Medicaid. This is where states that don't cover people who are making less than 100% FPL can truly fuck someone over. In this case Oregon was declaring $10,944 of income, or 93% of FPL. An unsubsidized silver plan would then cost ~$252 per month with significant annual out-of-pocket expenses. However if Oregon reported income of $11,800 ($856 more) then he suddenly would have been eligible for a subsidized silver plan for $20 / month with virtual no out-of-pocket expenses. (numbers are from Kaiser's cost calculator for Dallas, Texas) This income would be so minimal that it would not have disqualiied him for SSDI. You need SGA (Substantial Gainful Activity) of $1,130 per month for that. In other words, he needed to "rent" a room of his house for a few days and report Schedule E income, or have a garage sale and report Schedule D income, or just report $900 of "Other Income" on Line 21 of the 1040 in order to declare the extra income, and thereby qualify for an ACA subsidy. The ACA was written so as not to expose the Fed to states dumping their Medicaid patients into the marketplace. That's why they have the 100% FPL minimum in order to get any subsidies at all. That makes sense from a Federal policy standpoint, but really drives the point of how badly a state is behaving to not cover people who are under 100% on Medicaid. The "answer" in cases where the number is so close is to make up the necessary income on the tax forms as needed to get the ACA subsidy. And really, at least by my moral compass and theory of civility, you can read make up however you like in this case.